If your teen received a recommendation to attend a rehab center for his or her diagnosed substance abuse, mental health, or behavioral issue, you might be a bit overwhelmed at all the available options. Residential treatment centers, inpatient hospitalization, wilderness camps, therapeutic boarding schools, military schools…What’s the difference? Read on as we delve into some of the common options for struggling teens.
Cases of severe emergency require inpatient treatment at a psychiatric hospital or mental-health facility. The following cases qualify a teen for an involuntary (or “emergency”) hold at the hospital:
- Suicide attempt, or severe danger to oneself
- Serious danger to others
- Undergoing an acute phase of their mental illness (such as a psychotic episode)
Of course, one can admit voluntarily for the same, or similar, concerns. If minors check themselves in voluntarily, their caregivers must be notified within 24 hours.
Inpatient psychiatric treatment is a short-term intervention. Patients are hospitalized for about 72 hours to receive immediate treatment and evaluation. The hold can be extended if the doctor determines that continued stabilization is needed for the safety of the patient or the public. Or, the hold can be lifted if the doctor decides that the patient is safe to leave earlier (which is less common). After discharge, teens step down to a lower level of care, such as a residential treatment center. If the patient refuses to accept treatment, the mental-health hospital may hold him/her for long-term involuntary treatment in their facility.
Otherwise known as boot camps or outdoor therapeutic programs, wilderness programs are located in remote, rural areas across the country. While the immersion in nature, rigorous activity, and survival-style programming in wilderness camps may spur some troubled teens to start toeing the line, this kind of rehab may lack the appropriate resources to treat the underlying roots of more complex mental-health, substance abuse, or behavioral disorders.
Additionally, most wilderness programs employ a “tough love” approach and relatively primitive conditions. (Think: tents, heavy backpacks, food rationing, and lack of amenities nearby.) This may not be a good fit for highly sensitive teens, severely depressed teens, teens whose recovery progress may be hampered by deprivation of material comforts, or teens who need more intensive attention. These types of adolescents may reject these outdoor programs’ heavy-handed approach and possibly sink deeper into their internalizing disorder. (An RTC may generally be a better option for this population.) Additionally, since these programs are often located in remote areas, the nearest hospital to receive medical attention in emergency situations can be relatively far.
While these outdoor camps strive to teach teens the value of self-reliance and hard work, they usually offer limited (if any) family involvement, evidence-based therapy, or skill-building training in real-world settings. Additionally, many private wilderness programs may be unlicensed and unaccredited. Often, they are located in states that do not strictly regulate adolescent treatment programs. For this reason, insurance does not cover most wilderness boot camps.
If deciding to choose a wilderness program for your teen, make sure you engage in sufficient research. Confirm that your program is regulated and overseen by a higher supervising body.
Therapeutic Boarding Schools
A therapeutic boarding school (TBS) is usually a diploma-granting academic institution that allows troubled teens to remain active students in a school environment. These boarding schools offer long-term treatment for adolescents’ emotional, behavioral, addiction, or learning issues. However, they may not be equipped to accommodate those with more acute mental-health issues that require a higher level of attention and supervision. Since there can be as many as 60-80 students at a time in these schools, the client-to-staff ratio is much higher than at RTCs. Teens will not receive 24/7 supervision and care. Intensive 1:1 therapy, family therapy, and process groups may not be offered. This can be problematic for teens who exhibit more complex issues or who need more intensive supervision.
A TBS usually requires one/two years of treatment. Adolescents live on campus, earn high school credits and engage in weekly individual and/or family therapy sessions between their classes and extracurricular activities. These tuition-based schools follow the academic calendar. During breaks (like summer vacation), teens return home to their families.
Because these therapeutic boarding schools may be unregulated and do not require licensing or accreditation to exist, insurance does not cover most of them. Most families enroll in a TBS after being unsuccessful at a short-term, less restrictive RTC.
Combine the educational structure at a TBS with the structure and discipline at a wilderness program, and you get a military school. Many programs fall under the “military school” umbrella—everything from genuine training schools that prepare teens for admitting into the U.S. military to regular day schools that employ a disciplined and highly structured approach to education. These programs aim to whip troubled teens back into shape. Most military schools focus on conduct issues. Their “tough love” approach aims to instill in their students the values of self-discipline, respect for authority, and proper work ethic. Like wilderness programs and therapeutic boarding schools, military-style schools are generally allowed to be unlicensed and unregulated. Insurance usually doesn’t cover them.
Residential Treatment Centers
At a residential treatment center (RTC), teens live on-site in a non-hospital setting with 24/7 support and supervision. Licensed therapists and clinicians, psychiatrists, residential counselors, and medical support staff make up the staff at an RTC. Residential treatment centers usually have a low staff-to-client ratio, as teens need to be supervised around the clock. They primarily focus on evidence-based modalities like individual therapy, 1:1 therapy, family therapy, Dialectical Behavior Therapy, Cognitive Behavior Therapy, and other experiential therapeutic activities such as equine-assisted therapy or surf therapy. As such, insurance covers most RTCs. These programs treat teens with substance abuse, mental health, and/or behavioral issues. The clinical environment of an RTC can professionally treat extreme emotional dysregulation or high-risk behavior. Many teens at RTCs struggle with rage-filled outbursts, acting out sexually, self-injurious behavior, and/or suicidal ideation.
RTCs are usually located in fairly comfortable homes. Although most are not diploma-granting institutions, RTCs generally offer academic and educational support so teens can maintain their academic standing in school.
Most teens attend a substance abuse or mental-health rehabilitation center because they are in crisis, have just stepped down from inpatient hospitalization, or have been unsuccessful at lower levels of care.
There are various types of residential treatment centers:
Locked facilities are typical in long-term residential facilities for more severe patients. Patients are physically unable to leave the premises. Staff members are able to physically restrict patients from attempting to leave.
In an unlocked (or “staff-secured”) facility, patients have the physical ability to walk out of the premises. However, it is almost always an infraction of program rules.
The length of stay at a long-term residential mental-health treatment center for teens is usually 90 days to a year. Teens usually attend long-term residential treatment centers when short-term ones were not adequately successful in treating their symptoms. Long-term RTCs typically are more expensive than short-term programs. The longer time commitment may also come at the cost of personal/life commitments such as school.
One benefit of short-term residential therapeutic programs is the flexible time commitment. These RTCs typically last 30-90 days. Such programs are intensive, high-impact therapeutic experiences since they condense the full treatment curriculum into a one- to three-month period. Clinicians typically recommend attending a short-term RTC before a long-term one (if needed at that point), as it is less restrictive.
Also, some RTCs may choose to focus on specific specialties that they treat (such as eating disorders RTCs) or the therapeutic modalities that they offer (such as Dialectical Behavior Therapy RTCs).
It is important to keep in mind that every teen is unique. Every residential program is unique. No one rehab center can claim to be “the best” for “every” teen. For example, a teen with a chronic history of running away, or a teen who has demonstrated significant treatment resistance, may be served well in a licensed, regulated wilderness program. A teen with severe depression and suicidal ideation, on the other hand, may have his needs better addressed in the clinical environment and intensive level of care offered by an RTC.
Much also depends on the comfort level of you, as a parent. Trust your gut. If you aren’t comfortable with the approach of a specific program, reconsider sending your child there.
But whichever program you choose, ensure that it is fully licensed and strictly overseen by a regulatory supervising institution.
Disclaimer: This article cannot diagnose your teen. We’re here to help by offering information that can serve as a launch point or a guide for your decision-making process. To receive a free assessment and consultation for your teen’s mental health, behavioral, and/or substance abuse issue, call us today at 1-800-665-GROW.