When choosing a mental health residential rehab center for your teen, there are lots of factors you’d want to take into consideration. Is the program licensed and accredited? Will insurance cover the majority of the cost? Which evidence-based treatments are offered?
But perhaps the most important question you need to ask is:

How will my teen be kept safe?

Caring for adolescents is an enormous responsibility that no program should ever take lightly. You may have hear horror stories abound about teen rehab centers that have neglected this responsibility and put teens in harm’s way. Therefore, when searching for a high-quality residential treatment center (RTC), you need to ask about the program’s safety protocols.

If you have a high-risk adolescent, it is especially important to consider a treatment center’s safety policies. Teens with a history of self-injurious behavior, suicidal ideation, and/or suicidal attempts need a strictly supervised RTC that doesn’t cut corners. Too few staff, a lax attitude towards sharps, missed contraband checks—and the life of your teen may be at stake. It is also particularly necessary to research an RTC’s safety policies if you have a treatment-resistant or unwilling teen. If there are chances that your adolescent might try to elope, or has a history of running away, you must ensure you place your child in a setting that does its utmost to prevent this from happening, has policies on how to handle the situation, and will freely share these with you.

To determine how safe your teen will be at the rehab center, here are some suggested questions:

What is the staff-to-client ratio?

Why it matters: Having a high staff-to-client ratio (meaning, having more staff members than clients present) is essential so that your teen receives the individualized attention he or she needs. Too many clients + too few staff = a recipe for disaster. Many unethical treatment centers cut corners on staffing and monitoring in efforts to keep their costs low, but this translates into poor quality of care. While it varies widely, a good residential treatment center that values patient safety will maintain a high staff-client ratio so they can provide enough supervision. (At Evolve, we pride ourselves on having three staff members for every client.)

How are clients monitored?

Why it matters: If you are choosing a residential treatment center for your troubled teen, you’re doing so because your teen needs 24/7 supervision. Ask about the program’s line of sight and line-of-hearing policies. Are all at-risk teens kept within view and/or earshot at all times? When teens must be out of site—for example, in the bathroom or shower—there should still be modified policies in place to maintain safety.

Does the program use surveillance cameras?

Why it matters: Video cameras are used to make sure that all activities that take place on the property can be reviewed whenever necessary. As such, they are an additional tool to protect the safety of the teens and the staff. The inclusion of surveillance cameras at a residential treatment center usually leads to improved quality of care.

How does the program monitor teens at night?

Why it matters: The frequency and method of these bed-checks, as they’re known, are important. Although your teen’s privacy should be considered and respected, teens must be checked on regularly for their own safety. Research shows that having trouble sleeping at night is associated with an increased risk of suicidal ideation or self-harming behavior. Adolescents who experience sleep issues, insomnia, or nightmares may be more vulnerable at that time to high-risk behavior. This makes it vital for night-shift staff to closely monitor teens at regular intervals during the night as well. The monitoring system should also ensure night-shift staff don’t end up falling asleep when they are supposed to be conducting the check-ins. Because it’s usually quiet at night during these hours, ask how the program verifies that staff are actually monitoring the teens.

What about during off-site excursions?

Why it matters: When leaving the premises of the treatment center, it is even more imperative to have appropriate numbers of staff monitoring the group to ensure teens remain in the line-of-sight at all times. This applies especially when teens go on an outing to a large or outdoor area. Ask how your rehab center monitors teens during off-site excursions. How do they supervise the adolescents in the car? What happens if a stranger approaches the group or starts interacting with one of the teens? At the beach, teens must put on sunscreen, wear life vests if swimming, and drink enough water. When hiking, are there specific safety policies they follow, like making sure teens follow the path and stay hydrated? Every outing’s safety measures should be well thought-out and planned in advance, and communicated effectively to staff.

What happens in case of emergencies?

Why it matters: Your teen’s crises don’t always occur during normal 9-5 business hours. Ask if fully licensed staff are on call 24/7/365. If not, it’s a red flag. Your teen should be getting help right when they need it—and the type of help matters, too. The RTC should have protocols in place depending on the level and type of emergency. If your teen is undergoing a life-threatening emergency, staff should be trained to call 911 immediately. But if your teen is undergoing an emotional meltdown or crisis that’s non-life-threatening, appropriate staff should be helping your teen cope through it safely. A licensed clinician should be on call every day and night to give input on these sorts of emergencies and the type of responses they warrant.

How will you ensure my self-harming/suicidal teen won’t have access to potentially dangerous objects?

Why it matters: Potentially dangerous objects, including sharp toiletries, kitchen knives, keys, scissors, etc. should be kept under lock and key and closely monitored when they need to be taken out. The teen rehab center should be conducting room checks, contraband checks, body checks, and sharps counts regularly. Bathrooms, kitchens (including kitchen storerooms/equipment), offices, and recreation rooms/areas should also be locked at all times when they are not in use.

What are the policies regarding teens’ contact with others outside the facility?

Why it matters: While in residential treatment, teens should be focusing on their recovery. Outside interaction (e.g. visits and phone calls) should be limited to a selected group of appropriate individuals. The therapist and parents should coordinate in advance who should be included in this group. The program should have visitation rules and phone policies in place that they enforce, and be willing to share those with you.

However, clients should be able to speak to their parents on a regular basis; be wary if the treatment program prohibits family contact for weeks on end. Clients should be free to call the licensing or regulatory agency overseeing the program if they feel their rights are being abused. It is a licensing requirement to keep the agency’s contact information prominently displayed at the residential treatment center. If the sign isn’t there, it’s a red flag.

What behavior modification strategies will you use with my child?

Why it matters: This is a big one. Seclusion and restraint are risky endeavors, and as such, are highly regulated. If they are to be used at all, they should only be used in extreme situations by staff trained in the proper techniques and should only be done in programs that have the facilities to do this safely.

Using physical restraint is a dangerous intervention, as it can lead to physical harm for the child (and sometimes the staff member). Some treatment centers are equipped to do this safely; others are not. Other treatment centers instead utilize de-escalation techniques to prevent a teen from getting out-of-control or reaching a crisis in the first place. These treatment centers have a no-contact policy when it comes to their adolescents. Staff should be trained in non-violent crisis intervention and de-escalation techniques.

A note about behavior modification strategies:

Seclusion can turn into a form of abuse. The difference between seclusion and isolation? If a teen is removed from the milieu and instructed to stay in a specific area, alone, prevented from leaving a room of their own free, this is called seclusion. In other words, they are in a locked room. If a teen is isolated, they are just removed from their milieu of peers. They are not locked in the room. They are still able to move about, but they are being monitored closely by the staff. If teens are placed in seclusion or isolation, there should be protocols for constant 1:1 observation. Much like the use of physical restraint, not all programs are equipped to do this safely.

Even if you feel that your teen might need these more extreme types of interventions, it is important to inquire about the training of staff and conditions which would require restraint, seclusion or isolation. What circumstances will lead to staff using physical restraint? For the latter, how will your child be made to leave the group? What forms of monitoring will be conducted while your child is alone? What conditions will they be in? Is it a simple time-out in an effort to deescalate, or is the teen forced to spend a considerable amount of time alone as part of the treatment or as punishment?

If they do not have the facilities or legal ability to restrain a teen, how would they handle an escalating teen who may become a danger to themselves or others? Make sure you are comfortable with all the behavior management interventions that staff have at their disposal.  Ensure you understand to what level and under what circumstances they would be used.

Have background checks been conducted on all staff?

Why it matters: Background checks are conducted to ensure each staff member coming into contact with your child is safe and fully qualified to treat your child. All staff members should pass background checks and should be licensed in each of their specific capacities.

Is the program fully licensed and/or accredited?

Why it matters: Licensing and certification ensure that the treatment center is following certain state rules. These standards maintain the safety of the teens who attend the treatment center. California, particularly, has strict oversight of treatment centers, with many rigorous regulations for licensing.

Accreditation provides an RTC an additional seal of approval. If a program is accredited, it means they have been evaluated even further to meet the accrediting organization’s rigorous standards. CARF and The Joint Commission are the standard accrediting bodies for mental health treatment centers. If a program has other sorts of accreditation, investigate what they are and how they are being monitored. Some accreditations are memberships more than they are oversight.

Safety First

During the admissions process, you will be asking lots of logistical questions to determine whether the residential treatment center is the right fit for you and your teen. You will be wondering about therapies, insurance coverage, length of stay, and how often you can speak to your child. But in the midst of all these technical questions, remember to drill staff about safety as well.

Admissions counselors should be able to quickly put your mind at ease by discussing their safety protocols freely. If there’s any hesitation on their end, or reluctance to discuss policies, or you get a sense that they’re hiding something, it may be a red flag. Even if the program has checked off all the other boxes, and you feel like you’ve found the perfect fit, don’t settle for a program that cuts corners when it comes to the safety of your child. After you’ve done your due diligence, you’ll rest easy, knowing your child is in good hands.