My Son Is Out of Control

Dear Dr. Michelle:

Our 14-year-old son is out of control. He is very aggressive toward family members and we fear for our safety. We have tried family therapy and we have had counselors come to our home and work with him. It helps for a little while and then his aggression returns. We are thinking about having him placed in a residential treatment program. Is this the right decision and how do we go about getting him admitted?

Tim

Dear Tim:

I am so sorry that you are going through this with your son. It must be very difficult for you as a parent and scary for your family.

Placing a child in residential treatment is a hard decision for any parent to make; no parent likes the idea of sending their child away from family to live in a facility. Remember though, this decision is not forever (usually only 6-8 months), and it can change your son’s life for the better.

Residential treatment is an appropriate option when a child cannot be kept safe from themselves, or if the safety of others is at risk. Given the fact that your son is continuing to be aggressive even after other treatment services have been offered, and the fact that you are concerned for your family’s ongoing safety, residential treatment is a viable and appropriate option.

Residential treatment will provide 24/7 trained staff supervision for your son as well as  regular and intensive therapy for your family.  The day-to-day programming in residential treatment is generally designed to provide counseling and behavioral intervention by trained staff throughout the day. If necessary, medication monitoring by medical personnel is also an option; and in a residential environment, medication side effects can be observed and closely monitored for further evaluation. In addition, when a family is in fear for their safety, residential treatment will give your son and family immediate safety while allowing you to regain trust as you work with the treatment team to address issues and concerns.

Usually youth are admitted to residential treatment in one of three ways:

1. voluntarily placed by family due to a mental health concern;
2. court ordered by a judge due to a child breaking the law; or
3. placed through a state’s human service or child welfare department because custody has to be taken away from a child’s parent(s).

Your question suggests that you can pursue the first option. Children who are displaying high levels of aggression usually have an underlying mental health condition that qualifies them to receive residential treatment. When children are placed voluntarily in a residential program, services will either be paid for directly by family (a very expensive option), by the family’s medical insurance, or through state or federal welfare dollars (when a family qualifies). Each state is very different in how they manage their funding for mental and behavioral health services, so you will need to conduct the following additional research as you consider your options:

• If your son is not already a Medicaid recipient, call your medical insurance to find out if insurance pays for residential treatment and to learn about co-pays, requirements for admission, deductibles, and length of residential treatment they cover.
• You will also want to research the specific human services department in your state that assists with mental health treatment for children. This will most likely require a few calls to get directed to the right place; tell them that you are looking for help to voluntarily place your child in a residential treatment program for mental or behavioral health. Such a department will assist you in the steps needed to receive non-emergency voluntary help, as well as help you identify payment options.
• Finally, you will want to research different treatment programs to understand the services they offer and their capacity for new patients. Search online for the terms “Psychiatric Residential Treatment Facilities” (PRTF) and “Residential Treatment Facilities or Centers” (RTF or RTC) in your state. Visit each facility’s website and become familiar with what they offer and their different approaches. Look for their admission phone line; call them and talk about what they offer and how to get your son admitted. They can help you navigate payment options and will help you get connected to the right state child welfare/human services department. If you find good options, you can feel confident about beginning the application process.

Although the research and admission process for a residential program is not quick or necessarily easy to navigate, stick with it, be patient, and do not give up.  This is a big step for your family, and residential treatment could be just the help you and your family need.