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Outcomes for Adolescents in Long-Term Residential Mental Health Facilities

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Does Long-Term Residential Treatment Help Teens?

When your teenager has problems in school, at home, and with friends, you know it’s your job to help them work through those problems. When you do that, you know you have to get to the root of the problem. You have to find out what’s causing it. That’s how you help: you identify the source of the issue and work to resolve it. You get your teen back on track and restore balance to their lives and to your family life.

Let’s be more specific here. When we say problems in school, at home, and with friends, here’s what we mean.

Problems at school:

  • Sudden drop in grades
  • Discipline problems, such disruptive behavior, fights, skipping class
  • Problems with teachers, such as conflict over assignments, grades, non-productive communication
  • Abandoning extracurricular activities, such as sports and special interest clubs

Problems at home:

  • Moodiness, including low/depressed mood that keeps them from participating in family life, or high/excitable mood, which disrupts family life
  • Anger/irritability, including outbursts, stomping feet, slamming doors, and in some cases, violent behavior.
  • Withdrawal from all family activities, including family responsibilities, such as keeping their room clean, helping out around the house, and maintaining personal hygiene

Problems with friends:

  • Conflict with long-time friends
  • Withdrawal from long-time friends
  • Inability to resolve issues with friends

The problems we list in these three categories are all warning signs of potential mental health, behavioral, or addiction disorders. They can also all be typical components of adolescent growth and differentiation. To find out what’s typical and what might be a real problem, you take the advice of friends and get your teenager a full psychiatric evaluation and assessment. The result: your teenager has a significant problem that meets the criteria for clinical mental health diagnosis.

The assessing therapist recommends residential treatment.

What do you do?

Residential Mental Health Treatment for Teens

The first thing you do is find out what, exactly, they mean by residential treatment.

We can help with that.

With the exception of emergency inpatient psychiatric hospitalization, there are two basic types of residential treatment for teens:

Standard Residential Treatment:

These programs occur at treatment facilities knowns at adolescent residential treatment centers (RTCs). They’re appropriate for teens who need immersive treatment and full-time professional care. The average length of stay for a teen in a program at an RTC is 30 days, but some teens stay as long as 90 days. A stay of 30-90 days is considered in the typical range for an adolescent RTC. Note: standard is not a term mental health professionals use. We use it here to differentiate it from what we describe next.

Long-Term Residential Treatment:

These programs occur at residential treatment centers, or, in some cases, residential therapeutic boarding schools. The programs last six months or longer. They’re appropriate for teens who need immersive treatment and full-time professional care, but have not been successful in standard residential treatment. Teens referred for long-term treatment may have profound, complex mental health, behavioral, or addiction issues that require long-term stabilization through medication or intensive psychotherapeutic support.

Let’s back up and say your teen’s assessing therapist recommends long-term treatment. That leads you to ask the following questions:

Does long-term residential treatment work?

What factors should I consider when looking for a long-term residential treatment center?

The rest of this article answers both those questions, based on the most reliable research and evidence on outcomes for teens in residential treatment programs at teen mental health facilities.

Long-Term Residential Treatment for Teens: What the Research Says

The two papers that offer definitive, evidence-based answers for these questions are “A Multi-Center Study of Private Residential Treatment Outcomes” published in 2011, and “How Presenting Problems and Individual Characteristics Impact Successful Treatment Outcomes in Residential and Wilderness Treatment Programs.” If you’re the type of person who likes to read the source material, please click through and spend time with these papers – you’ll learn a great deal about long-term residential treatment for adolescents. If not, we’ll summarize the key points for you, which will offer ample information to help you decide whether long-term treatment is the right choice for your teen.

We found these two papers while reading a Ph.D. thesis – which was accepted and approved –  on adolescent residential treatment by Dr. Trevor Earl, who extracted the key elements of these papers in order to answer questions that mirror the two questions we pose above:

  1. Does long-term treatment improve overall functioning in adolescents?
  2. Do these changes vary by the individual?
  3. Do the outcomes vary by facility?
  4. Is full completion of a treatment program a factor in overall treatment success?
  5. Are adolescents more likely to complete their treatment program if they report a high degree of satisfaction with their primary therapist?
  6. Do adolescents who report a high level of satisfaction with their primary therapist experience more overall functional improvement than adolescents who do not?

The answer to the first three questions is the same: yes, yes, and yes. Here’s a summary of the evidence related to question #1:

“The research indicates that individuals enrolled in long-term adolescent residential treatment centers, on average, experience improved psycho-social functioning to degrees that are statistically and clinically significant.”

That’s important to know, and it’s also a direct answer to the first question you, as a parent, are probably most concerned with: long-term residential treatment helps teenagers improve overall functioning. This means that they satisfactorily resolve the types of problems we mention in the beginning of this article. In other words, after long-term residential treatment, teens can return to smooth and typical daily functioning in the three primary domains of their life: school, home, and friends. All that to say that yes, long-term residential treatment does work.

Next, we can see that researchers formulated questions 4-6 in order to get to the bottom of the yes answers in questions 2 and 3. Treatment outcomes vary by individual and by treatment location – but why?

Does completing a treatment program affect the outcome? And if it does affect the outcome, does the quality of your teen’s relationship with their primary therapist have anything to do with completing a program? And finally, does the quality of the therapeutic relationship also affect their treatment success?

We’ll answer those questions now.

Long-Term Residential Treatment: What Factors Predict Treatment Completion and Effectiveness?

We’ll start with an interesting wrinkle in this data that may be confusing at first. The research shows that, in answer to the first question, full completion of a treatment program is a significant factor in treatment success. Remember, we define treatment success by the ability of a teen to return to typical daily functioning in the three primary areas of their life: at school, at home, and with friends. However, the researchers indicate that treatment length was not associated with the success or absence of success of a given treatment program.

How can that be possible?

We’ll explain.

Mental health and addiction treatment do not follow predictable timelines. Therapists and patients don’t define success by time spent in treatment, but rather by the presence or absence of mental health symptoms and their ability to manage those symptoms. Therefore, a teenager – yours, perhaps – can enter a long-term treatment facility with a plan to stay six months, but subsequently meet all their treatment goals within three months.

In that case, their program would be considered complete.

On the other hand, another teenager might enter the same treatment facility with a plan to stay six months. They may stay the full six months and not make sufficient progress to return to daily life at school, at home, and with friends. Because they don’t meet their treatment goals, their program would neither be considered complete nor successful.

That’s complicated, but logical.

Now we’ll look at the additional factors that affect treatment completion and effectiveness, i.e. success.

Long-Term Residential Treatment: The Teen-Therapist Dynamic is Critical

We’ll cut to the chase: relationships are everything.

That may be overstating it. Location matters, types of therapy matter, and individual factors matter, of course. However, what this research shows is that when a teen has a positive relationship with a mental health professional such as a psychiatrist, a therapist, or a counselor, outcomes improve across the board. That’s the answer to questions 4-6 above. We can summarize those answers in the words of the researchers:

“At the conclusion of this study, we found a significant level of association between completion status and the therapeutic alliance, meaning that those who had better overall relationships with their therapist were more likely to complete the program. We also found that those with overall better relationships with their therapists also had greater treatment gains than those with overall therapeutic relationships [that were not considered positive].”

We understand that at this point you may have lost track of which questions we asked, which we answered, and how everything we’ve said relates to your main priority, which is finding the type and length of treatment for your teen.

We’ll transition to that now, meaning we’ll discuss the factors you should consider when seeking long-term treatment for your teenager.

Long-Term Treatment Centers for Teens: What to Look For

1. Quality of Program

First, you need to make sure that any program you choose meets the criteria established by the Substance Abuse and Health Services Administration (SAMHSA) known as The Ten Elements of Top Adolescent Treatment Centers.

2. Program Philosophy

Once you’re sure the treatment center you consider meets the requirements and standard of excellence outlined in the link above, you need to decide whether the overall philosophy of the treatment center aligns with your family values and your teen’s personality. This is huge, especially in light of the outcome data we discuss in this article.

3. Type of Program

Once you review the quality and philosophy of the treatment center, you need to make sure they offer specialized treatment that addresses you teen’s specific diagnosis, e.g. depression, anxiety, substance use disorder, co-occurring disorders, or something else.

4. Clinical Staff

This is important: you need to sit with your teen and review the members of the clinical staff. Are they people your teen may bond with? You can tell by reading bios, qualifications, and any information you can about the clinical team. You can also learn important details by getting on the phone and talking directly to the representatives of any treatment facility you consider.

5. Treatment Environment.

Take a close look at the treatment center location and decide whether it’s a match for your teen. It also needs to be a feasible option for your family on a practical level: is it close to home, or halfway across the country? Both have advantages and disadvantages that are important to think about.

6. Complementary Modalities

Each residential treatment center offers a different array of supporting treatment modalities, like exercise, mindfulness, yoga, music, sports, or outdoor recreation. It’s important to find a center with supporting modalities that resonate with your teen.

Finally, we need to reiterate the fact that treatment progress in not always linear. In fact, the studies we discuss in this article show that the most significant treatment gains are often made early in treatment, then level off towards the end of a treatment program. This means that in many cases, teens who do have success in long term treatment have rapid breakthroughs in the beginning, and use the following time in treatment to consolidate and expand on that initial success.

That doesn’t mean they should stop treatment when they have a breakthrough. It’s important for your teen to take time to work on the practical tools necessary to manage the symptoms of a mental health disorder, and/or create the new life habits and skills required to maintain sustainable recovery from alcohol or drug addiction.

Treatment works, but it takes work – and time. The best time to complete treatment is when your teen, their primary therapist, and the clinical team at the treatment center reach consensus, and decide it’s time to return home: that’s how to define both program completion and treatment success.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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