One of the most heart wrenching experiences that I have had over the years in the field of counseling and psychotherapy involves a parent or family member giving full control to a placement or residential treatment facility (RTF). The experience is difficult for everyone involved, but primarily the family who will lose a certain amount of control to absolute strangers. Many parents struggle with the idea of sending their child or adolescent away from familiar surroundings (school, home, community) and familiar people (family, friends, teachers, etc.). The individual oftenstruggles with losing friends at home or school, parental figures, grandparents, and a certain amount of structure that is familiar. Going away to an RTF for 3 months to 12 months can feel like an eternity for families and can be very traumatic. This article will discuss what an RTF/group home/placement is, what questions to ask, and considerations. This article will also refer onlyto children and adolescents, but some of this information might apply to adults as well.

First, lets define what an RTF/placement is. An RTF is a residential treatment facility or placement where a child or adolescent is placed by a parent or Judge after multiple treatment options have been tried. The facility provides a great deal of structure, therapy, and assistance to the family. A team of individuals works with one specific child. A typical team at an RTF/placement includes:

  1. A psychiatrist/attending physician (who monitors medications and sees the child weekly or monthly)
  2. Master level therapists (individuals who have a masters degree and sometimes is licensed in their state to provide individual, family, and group therapy)
  3. Bachelor level staff (residential workers or individual’s who work with the child throughout the day with daily living skills, going to school, and remaining appropriate with peers and other staff)
  4. Nurses (individuals who can help manage medication and monitor for medical conditions)
  5. Managers and Assistant mangers (individuals who oversee the operations of the bachelor level and masters level staff)

A family whose child or teen has been hospitalized multiple times, has been arrested or has had some run in with the law, and has received multiple community-based services, would quality for an RTF placement. A doctor must recommend this level of treatment in many states and make what is known as a referral. The referral helps other clinicians and psychiatrists determine if the child or adolescent is in need of an RTF or placement level of care. The RTF or placement provides mental health therapy for a longer period of time which could between 3-months to 12-months or longer. RTF and placements often confuse many families because of the terminology and because of the difficulty in seeing any difference between this level of care and other levels of care. But it is always easier to remember that an RTF or placement provides a longer term of care and permits a child or adolescent to receive mental health treatment outside of the home environment. In other words, a child or teen will remain in the care of the mental health agency while receiving therapy. When an RTF or placement is recommended to a family, a family must jump through a ton of hoops, some seen and some unseen. Families also often have many questions that barely get answered.

For this reason, I have created a brieflist of questions that all parents should ask before admission to an RTF or placement:

  1. What should I expect after my child’s doctor makes a referral to an RTF?After a doctor or other mental health professional makes a referral for RTF, you should expect a series of meetings that will occur to discuss your child/teen and your family’s needs. This meeting is often called an ISPT meeting (Inter-agency Service Planning Team), although it may be labeled differently in your area. This meeting provides an opportunity for everyone involved which may include parents, extended family members, therapists, school employees or teachers, etc. to discuss the child and the child’s needs. After the ISPT meeting and if the child/teen is approved to attend an RTF or placement, you will have to attend (and possibly schedule) an admissions or intake meeting. This meeting will happen at the agency your child/teen has been accepted to and involve meeting with the different professionals on your child or teen’s mental health team. For example, you might meet with the psychiatrist, the therapist, the intake worker or case manager, and others. Every RTF is different. Because of this, it is important to ask the right questions to the right people. If you don’t know who you should be speaking with, it is okay to contact your insurance company and ask questions or contact the specific placement or RTF you are interested in. There is always someone in the admissions or intake department that can help you and guide you to the right people. You should also expect to be given a tour of the facility you are interested in. You can ask for a tour of the facility prior to the ISPT meeting or admissions meeting. This will give you some idea of what you are or are not looking for. There are a variety of RTF placements available and finding the right one can be a challenge. However, finding the perfect RTF is impossible. You want to choose what is available, easy to access, and makes you feel safe and comfortable. Choosing an RTF or placement is solely up to you because of what is known as “parent choice.” However, some insurance companies will put pressure on families to choose the placement or RTF that will result in a faster admission. Insurance companies want you to get your child into the RTF as soon as possible which means you may have to choose the RTF or placement you did not ultimately want. This is because beds in RTF or placements go fast. In fact, in my state, there are about 4-5 local RTF’s that are completely full.
  2. Can I reject the referral for RTF made by the doctor? The most difficult decision for a parent whose child or teen is being referred for placement or RTF involves deciding whether you want long-term placement for your child/teen or not. Long-term placement could range from anywhere between 3months to 12months. That’s a very long time for your child/teen to live outside of the home and perhaps even miles away. Many of my client’s not only feel abandoned by their families but also unloved. Many of my young clients often ask me: “how could my mom/dad send me away?” It’s a tough decision for families. That being said, it’s important that you understand that you have the right to reject an RTF referral. You do not have to accept the treatment recommendations of an agency or a doctor. However, there will be consequences and the consequences will be different in each state or area. In the state of Pennsylvania and Ohio, rejecting an RTF referral can make it more difficult for parents to receive another referral in the future if it is needed. Rejection of a doctor’s recommendations will also be listed in your child’s file and could reflect negatively on you and your family. It might also make other providers more leery of serving your family in the future. So it’s a big decision that requires forethought. You are essentially rolling the dice when you reject a doctor’s orders. But it is also important to understand that you have the right to make the decisions that are best for your child.
  3. Can I remove my child from an RTF or placement (after he/she is admitted), even if the therapeutic treatment team disagrees with this? Again, anything that you do against the medical advice of the treatment team may cost you in the future. You want to consider both the pros and cons of “pulling your child” from a program. Who are you benefiting? Who are you hurting in the long-run? Technically, you can remove your child from any program you do not feel comfortable with. Of course, an agency will review all of the consequences with you and may not prescribe medications, provide treatment recommendations, or any support to you for aftercare. You will have to obtain this support on your own. It’s important to consider if you remove your child from an RTF program if you will be able to obtain further services in another agency in the future. Again, sometimes pulling a child from a program prematurely can lead to difficulty obtaining treatment from other agencies, unfortunately.
  4. What is the success rate of RTF treatment?Right now, research is looking at about 50/50% rate of success. Many kids in RTF attend for 3 months, improve, and return home, while another percentage of kids attend for 12-months and continue to struggle long after discharge from the RTF or placement. Every situation is different and requires different things. Next week we will discuss the past and present operations of RTF’s and placements and look more closely at success rate and failure rates.
  5. What does RTF offer that other services such as outpatient therapy and in-home services don’t? You can think of RTF or placement as the highest level of care before a child goes to a juvenile placement or jail. Depending on the behaviors that led to the RTF or placement referral by a clinical team, RTF is often the last resort after multiple other services have been tried. Many families seek RTF or placement level of care after they have tried outpatient therapy, family therapy, trauma therapy, short-term inpatient/respite care, hospitalization, community based mental health treatment, and other types of treatment. Some kids have exhausted all their parent’s resources and finances and no other services are proving to be helpful. In cases such as this, RTf or placement is the only hope.
  6. Will my insurance cover RTF? Some insurance companies will refuse to cover RTF such as private insurance. When this happens, it is helpful to apply for medical assistance. In some very rare cases, a family can cover the cost of an RTF out of pocket but that could go into the thousands. Some RTF’s and placements often equal the amount of money it would cost to send your child to college. You have to consider that an RTF and placement charges for room and board and the use of other services. In some RTF’s, you may have to pay for your child to engage in certain “fancy” activities such as horseback riding, tennis or basketball, and other extracurricular activities. The best thing to do is to do as much research as possible and ask your insurance company what options you have for covering the RTF or placement costs.
  7. Can I choose my own RTF or will the doctor or insurance company choose? You can always choose your own RTF or placement. However, as stated above, “parent choice” is sometimes limited by how many available beds there are in certain RTF’s. For example, if you have two RTF’s or placements that you are interested in and RTF option 1 has 5 beds while RTF option 2 has 0 beds, you will most likely be encouraged (strongly encouraged) to choose RTF option 1. This is not parent choice. But you can also ask if there are other options and how long you can expect to wait. Each state is different so you must learn about and understand your state laws and rights.
  8. How long is RTF and can I request longer care if I don’t think my child/teen is ready to be released? RTF’s and placements are typically 3-months to 12-months. However, there will be meetings conducted along the way that will help the clinical team, doctor, family, and sometimes the child/teen (primarily if the individual is age 14+) determine if returning home or leaving the RTF or placement is a good idea. In some cases, the meeting will occur after 3-months and everyone must agree that continual treatment should occur or treatment should be terminated. It all depends on the child’s specific needs.
  9. What if RTF fails…., then what? There is a good chance that some kids will not receive any therapeutic value from an RTF or placement. In fact, I am not a therapist who encourages the use of RTF’s or placements if psychiatric treatment can occur in the home or community. RTF’s or placements often include other kids and teens who can be a negative influence to your child. The psychiatric needs of other kids in the RTF or placement can also disturb your own child. Even more, there is an ongoing stigma that RTF’s or placements are very similar to holding places or jails where very little to no therapeutic treatment truly occurs.

Sending your child to an RTF or placement can be quite a life changing event. It’s almost as life changing as a wedding or funeral. It disrupts the normal flow of life and requires adjustment. Some parents experience grief and loss while their child feels abandoned or unloved. It might takes months or years before your child understands why RTF or placement was considered by you and your family. Some kids become very angry with their parents and may resent them. It’s a great adjustment.

It is also important to understand that there are multiple reports across the web on children being abused and neglected in certain RTF’s or placements. That’s why it’s important that you do as much research as possible, stay connected to your child while he or she is in RTF, and remain educated about the entire process. Knowledge truly is power.

As always, stay informed.