Warnings Signs: Cautions when Considering a Residential Placement for a Child or Adolescent
If you have already explored all local, recommended forms of intervention for your child and family, and these efforts have proven unsuccessful, then you might find yourself considering a residential placement for your child or teen. While some residential programs are high quality, others are high risk.
You may feel pressured to make an immediate decision about sending your child to a residential placement. Above all other recommendations, we suggest that you resist the pressure. The decision to place your child in a residential program far away from home, or in a program that you have not seen, is too important and too risky to do without taking the time for careful consideration.
If there is an immediate danger in the present moment, use resources such as local mental health centers, mobile crisis units, or hospitals in your own community to reestablish a safe environment for your child and family. This will provide you with the time needed to make a careful decision.
We recommend that you beware of residential programs that reflect the following characteristics.
- Programs that are not state-licensed and accredited with regard to all three aspects of the program components: educational, mental/behavioral health, and residential.
- Programs that claim to be able to assess your child and make program recommendations by Internet or by phone, and then urge you to “act now” to prevent serious harm to your child and family.
- Any program that recommends or supports the use of private “escort” or “transport” services to take your child to the program.
- Programs that do not respect the wisdom and expertise of parents and youth.
Beware of programs that:
- Do not allow your family and child to visit the program, see all the facilities and meet all the staff before deciding to admit your child.
- Tell you to expect that your child will lie to you while in the program, and encourage you not to believe reports of abuse because these will be “attempts at manipulation.”
- Do not encourage you as parents to be active participants throughout all stages of the program.
- Do not welcome feedback (praise or criticism) from your child regarding the program.
- Programs that restrict youth and family rights in terms of communication, parental rights and other aspects.
Beware of programs that restrict:
- Contact with family by phone, mail and in person, for example:
– No phone contact or visits for first month;
– Monitored visits with no opportunities for parent/child discussion in private.
- Dress code, for example:
– Requiring youth to wear jumpsuits or flip-flops
- Typical age-appropriate behavior, for example:
– Forbidding eye contact with youth of the opposite sex;
– Forbidding speaking, smiling, or moving without permission.
- Parental rights, for example:
– Not contacting parents immediately in the case of illness, injury, emergency, or a change in treatment or medication.
- Do not provide hotlines for youth and families to call at any time if they feel that their rights are being violated or they are being mistreated.
- Programs that use harsh and excessive discipline practices, including “tough love” seclusion, restraint, corrective “behavior modification,” fear, or humiliation and more.
Avoid programs with harsh and excessive discipline practices such as these:
- Seclusion, restraint, or corporal punishment;
- Punitive “behavioral modification,” fear tactics or humiliation;
- Peer-on-peer discipline, or peer pressure;
- Forced labor;
- Heightened physiological stress, for example:
- Excessive exercise
- Sleep deprivation
- Exposure to the elements
- Forced retention of bodily waste or nutritional deprivation
- Sedation by medication.
- Some residential programs for teens provide sub-standard therapeutic intervention, or therapies that are unsuitable for a child’s specific needs.
Avoid programs that:
- Do not provide an individualized program with a detailed explanation of the therapies, interventions and supports that will address your child’s specific needs;
- Do not provide the kinds of therapies and supports that are recognized as most effective for the problem(s) or symptom(s) your child is experiencing;
- The majority of participating youth are experiencing problems very different from the types of difficulties your child is experiencing—this suggests that the program emphasis will not be optimally focused on the needs of your child;
- Claim to serve youth with specific psychiatric diagnoses (for example, ADHD, Bipolar Disorder, PTSD, Eating Disorders, Depressive Disorders, Anxiety Disorders, or Substance Abuse), but do not have full-time licensed mental health professionals on staff (such as licensed psychologists, psychiatrists, clinical social workers, marriage/ family therapists and psychiatric nurses).
– Provide individual, family or group psychotherapy that is delivered by staff who are not trained and licensed mental health professionals;
– Force youth to self-disclose personal information and/or admit to having problems as proof of “therapeutic progress” or “recovery” or as a prerequisite for “graduating” from the program.
- Programs that provide sub-standard education.
Ask for specific information about how education is provided and by whom, including whether education is:
- Limited to some variety of monitored study halls, videotaped lessons or independent study;
- Delivered by staff who are not licensed/certified teachers with degrees from accredited colleges;
- Provided in an environment with a high student to teacher ratio (i.e., very few teachers for the number of students);
- Not providing credits that will be recognized by your child’s home school district, the State Department of Education where the program is located or by future college admissions departments;
- Unwilling or incapable of recognizing your child’s IEP (Individualized Education Plan).
- Programs that admit youth with psychiatric diagnoses but then do not provide appropriate medical treatment, and programs that do not require a physical/psychological exam for youth before admission, or that disregard opinions from outside medical and psychiatric professionals.
Be very cautious of facilities that:
- Do not require that the child complete an initial physical exam and psychiatric evaluation or review a physical exam/psychiatric evaluation, including drug screening and detoxification, conducted immediately prior to admission. ASTART strongly recommends that parents themselves identify and select qualified, independent physicians/psychiatrists for these exams, and not use providers employed, affiliated or identified by a program. Please also prevent your child from
participating before drug testing results are known and your child has fully completed detoxification before participation, especially in wilderness challenge activities;
- Do not request (prior to or upon admission to the program) your consent to contact psychiatrists, therapists and teachers who are currently working with your child or have worked with your child in the past (parents should confirm that these providers have, in fact, been contacted before admission);
- Do not ensure that child/adolescent psychiatrists are regularly available to prescribe, monitor and adjust medications as needed
- Do not ensure that youth who are prescribed medications are administered medications by trained/qualified staff;
- Over-medicate youth in order to sedate them;
- Explicitly state that the program follows an anti-medication philosophy, particularly if your child is currently taking medication(s) for a diagnosed disorder.
- Require parents to sign contracts with unreasonable terms, such as signing over custody or agreeing not to file suspected child abuse reports.
DO NOT sign contracts with unreasonable terms, such as:
- Parents must agree to relinquish their custody rights;
- Parents must agree to pay for services not rendered if youth leaves program;
- Parents must agree not to hold program responsible for providing services as described in promotional materials or specified in original contract;
- Parents must agree to pay rates and fees that are not clarified up front;
- Parents must agree not to file suspected child abuse reports against program staff or participants;
- Parents must agree not to sue program if their child or family is mistreated.
- Contracts with facilities or staff that have been reported, investigated or cited by at least one source (for example: Dept. of Health, Dept. of Child Welfare, Dept. of Child Protection, Dept. of Education, Police Department, family advocacy group, or newspaper) for:
– Unsanitary or unsafe living conditions;
– Nutritionally compromised diets;
– Exposing youth to extreme environmental conditions or physical over-exertion;
– Lack of supervision by staff (low staff to youth ratio);
– Medical neglect;
– Physical or sexual abuse of youth by program staff or by other program youth;
– Violation of youth/family rights.
Please heed these warning signs and contact local authorities if you suspect a facility of abuse or fraud.
Last updated 5/27/14