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As noted in prior blogs, various groups are working to ensure that parents have as much information as possible before placing a teen in a therapeutic program.  One such organization is the Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START – http://astart.fmhi.usf.edu/).

Per their website:

“A START, the Alliance for the Safe, Therapeutic, and Appropriate Use of Residential Treatment, is an organization of mental health professionals, parents, advocates, and young adults who came together in 2005 amidst growing concern about mistreatment of youth in residential programs.

These concerns were reinforced in hearings held in 2007 and 2008 by the Committee on Education and Labor of the U.S. House of Representatives. During these hearings, Committee Chairman George Miller described the practices in some of these programs in simple and powerful terms as “inhumane.”  The concerns were further documented in reports prepared by the Government Accountability Office, in which the GAO reported that allegations of abuse were widespread, and that “the current federal-state oversight situation is inadequate to protect youth from maltreatment” (more on this in a future blog)…

A START seeks to increase awareness of this problem, promote protections for children and families, and provide information about residential programs and community-based alternatives so that parents and youth can make the best choices. ….”

One of the ways, ASTART is achieving their objectives is by providing a simple fact sheet (see http://astart.fmhi.usf.edu/AStartDocs/factsheet.pdf) which parents can use to help guide them in their decision making process.  Some of the recommendations on the fact sheet are listed below.  Please note that, where applicable, I have added comments after each number based on our experiences.  As before, my goal is to create a single selection criteria questionnaire for parents to use but I feel it is more important to share the individual information and sources first.

Also as you read this, please remember there are good legitimate programs out there, the key is to weed out the other ones.

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We recommend that you beware of programs that

1. Are not state-licensed and accredited with regard to all 3 aspects of the program: the (1) educational, (2) mental/behavioral health and (3) residential components.

Comments for consideration: Ideally, all programs should be state-licensed and accredited with regard to all aspects of their program.  However, depending on the length of the program and the type of program, my thought is that there may be different considerations. As an example, if your son or daughter will be attending a residential treatment center for a short time period, say 3-5 months, whether the school is accredited for educational components may not be as important as whether the residential and mental health components have been accredited.  It may be more important that the credits earned during this time be transferable to the school district that your son or daughter will be attending next and that, if applicable, these units will count towards college credit (see Item 8 below).

As to the type of program, given the short- term nature of a wilderness program, my thought is that these programs should have special accreditation/training for wilderness/field work (e.g. Wilderness First Responder, EMT – Emergency Medical Technician, etc.) and mental/behavioral health.  However, it may not be as important that the wilderness program be accredited for educational and residential components. In all circumstances, programs should have adequate safety training but in the case of a wilderness program, this safety training is even more critical.  Ideally, all residential programs should have some form of residential and mental/behavioral health review/licensing/or accreditation.

Lastly, please keep in mind that not all states require licensing nor do all states have robust review procedures of the facilities that they have accredited/licensed.  For this reason, I must again reiterate the importance of a professional team supporting you in making a placement decision.  In addition, if while your son/daughter is attending a program you feel that there is something that just doesn’t seem right, follow your instinct and notify the appropriate person of your concern (i.e. educational consultant, therapist, etc.) and follow up.  Looking back, I feel that we could have avoided some hardships for our daughter and ourselves had we been more persistent.

2. 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.

Comments for consideration: Unfortunately, many families begin to take action when there is a crisis with their son or daughter.   Families will then quickly research by using search terms online such as troubled teens, teen addiction, etc..  In some cases, parents will call the programs that showed up on their search.

I am far from an expert but I know that it’s possible to attract traffic to your website by the use of key words.  Please note that driving traffic to a website may not be a bad thing as there are legitimate businesses attracting web traffic to their website, the risk comes with those websites/businesses that are not so ethical and/or knowledgeable.  Some of these programs/businesses may want you to act faster than you are comfortable with and/or than what is warranted.  In fact, you may have time to do adequate research through your local doctor, therapist, educational consultant, etc. and/or to contain the current situation.

However, to be clear, there are legitimate emergencies that must be dealt with immediately.  If you have a local support team already in place, contact the appropriate person.  Ideally, you had been working with a local team and had developed an emergency plan (local hospital, mental health crisis clinic, etc.).  If not, and it is a medical emergency/crisis, call 911.  As an example, if you are dealing with a suicide attempt or an overdose, you need an intervention and/or medical attention immediately – everything else can be dealt with later.

3. Recommend or support the use of private “escort” or “transport” services to take your child to the program.

Comments for consideration: The reality is that most of the teens that I met at the programs that my daughter attended went to the program with an escort service.  In our case, in both instances, our educational consultants recommended this option for our daughter.  In the first instance, we opted against using an escort service, and in the second instance, we did use these services but told our daughter that the escort service would be taking her to the new program and at what time the escort service would be arriving.  In fact, we met the escort team with our daughter the evening before they all left for the program.

I know that the choice to use an escort service is not that simple and depends on each individual family’s circumstance.  If all agree that this is necessary, in my opinion an escort service should be screened like any other program you are dealing with (e.g. who is recommending it, why, is there another option, do they have a record, what is their approach, etc.).

4. Do not respect the wisdom and expertise of parents and youth

• 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

Comments for consideration: On the first item, if your child is attending a wilderness program, it may be difficult to get him/her, or possibly yourself, to visit the program prior to admission.  However, if you are using a reliable educational consultant, the educational consultant (or someone from their team) should know the facilities, have a clear understanding of the programs therapist/staff/practices, etc..  Also, speak to parents whose son or daughter have attended the program, find out if your local therapist is familiar with the program, check with the appropriate agencies to determine if any charges (and what type of charges) have been brought up against the program, etc..  Simply stated, you need to feel comfortable.

As to having your son/daughter visit the residential program prior to placement, in our case we visited the programs that had been preselected based on our daughter’s needs, and prescreened through a review of their literature, phone calls to the program, and phone calls to former parents.  Our daughter did not visit the programs based on recommendations received from a couple of members of our team.  However, we did ask our daughter about her preferences and, when possible and appropriate, we tried to meet these.

5. Restrict youth & family rights in terms of:

• Contact with family by phone, mail and in person (for example, no phone contact or visits for first month; censored mail; monitored visits with no opportunities for parent/child discussion in private)
• Dress code (for example: require youth to wear jumpsuits or flip-flops)
• Typical age-appropriate behavior (for example: forbid eye contact with youth of the opposite sex; forbid speaking, smiling, or moving without permission)
• Parental rights (for example: do not contact parents immediately in the case of illness, injury, emergency or treatment/medication changes)
• 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

Comments for consideration: We found that reduced phone communication was typical during the first few weeks of stay at each of the program our daughter attended. In one program, our daughter was also monitored while on the phone.  This made us feel very uncomfortable and had it not been for the level of comfort that we had with the program from various other sources this would have been unacceptable.  Our level of comfort came from the history our educational consultant had with the program, from our pre-enrollment visit to the program, from our pre-enrollment phone calls, from the parents we had spoken with prior to placement, from the conversation our local therapist had with the program therapist, etc..

We also learned that different states have different rules regarding letter writing privacy.  One state we dealt with allowed letters between teen and parent to be read by staff prior to being sent to the parent while another state considered this inappropriate.  As above, our level of comfort with these practices was directly impacted by all our other information on the program.

As to dress codes, we did run into some form of dress code at each program.  I think that there is more to this category as in some instances certain types of dress codes may not be appropriate (e.g. gang related attire, low cut outfits in a coed program, etc.).  The key may be appropriateness to the circumstances.  It may sound silly but I also feel that the standard should be applied uniformly whenever possible.  Otherwise, it may give the appearance of favoritism.

6. Use harsh and excessive discipline practices that include: seclusion, restraint, corporal punishment, punitive “behavioral modification,” fear tactics, humiliation, peer-on-peer discipline /peer pressure, forced labor, heightened physiological stress* or sedation by medication

* for example, excessive exercise, sleep deprivation, exposure to the elements, forced retention of bodily waste or nutritional deprivation

Comments for consideration: In addition to what is listed above, I think discipline has to fit the circumstances of your teen.  As an example, a teen entering a program struggling with depression/low self esteem, may react strongly to group therapy sessions where the struggling teen is singled out.

7. Provide sub-standard therapeutic intervention

• Do not provide an individualized program with a detailed explanation of the therapies, interventions & 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* but do not have full-time licensed mental health professionals** on staff
• 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

Comments for consideration: Unless you’re a therapist, this is one of the areas where you need a team (which includes a therapist) to support your decision making and to help you assess if your son or daughter is getting the right treatment based on their needs.

8. Provide sub-standard education that 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: 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)

Comments for consideration: We found that the difference in the educational portion of programs was broad.  As examples, some programs had a heavy emphasis on arts while other programs tended to be more academically focused, some required a laptop for each teen while others had limited computer access.  I think looking at the bigger picture of who your son or daughter is, what are his /her support needs, what are his/her interest, what grade are they in, etc. will help you make the best choice for your family.

9. Admit youth with psychiatric diagnoses but then do not provide appropriate medical treatment:

• Do not complete an initial physical exam and psychiatric evaluation or review a physical exam/psychiatric evaluation conducted immediately prior to admission
• 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
• 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

Comments for consideration: All of these are valid points.  In addition, there is subtlety in some of these points.  As an example, any program that does not require a physical immediately prior to admission is putting all other attendees and their staff potentially at risk of a communicable disease.

10. Require parents to sign contracts with unreasonable terms:

• 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

Comments for consideration: We saw some of these requests in contracts (i.e. will not sue program).  As with any other contract, please read the contract carefully and ask questions before you sign.

11. Have been reported, investigated or cited by at least one source* 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: youth ratio)
• Medical neglect
• Physical or sexual abuse of youth by program staff or by other program youth
• Violation of youth/family rights

* for example: Dept. of Health, Dept. of Child Welfare, Dept. of Child Protection, Dept. of Education, Police Department, Family Advocacy Group, newspapers

Comments for consideration: In addition, to the agencies listed above, I recommend you also consider contacting some of the government agencies noted in the Resources page.

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I recognize that this is a lot of information to digest but hope that this blog helps you step back and look at the bigger picture.

Simply stated the industry is not unscathed.  Although there are excellent legitimate therapeutic treatment programs there have also been cases of abuse, even, sadly, negligent deaths at some programs.  In addition, there have been cases where the program simply did not deliver the services they said they would.  If you wonder why, these issues are due to a variety of reasons including: unfortunately, and as seen in many industries, there are people who are simply unethical, people who will take advantage of people’s fears and moments of crisis, and simply people who just don’t have the appropriate training and background to provide the services they advertise they offer.  In addition, the reality is that today not all states have licensing requirements for these programs nor do all states require monitoring of these programs as mental health or educational facilities.  Furthermore, the federal government has yet to require regulation of these programs.  The good news is that various groups have mobilized and are working to pass legislation (there is an act in Congress pending approval – more on this in another blog).  In addition, there are other groups  helping educate parents in the interim(I will also follow up more on this in another blog).

So what does a parent do now?  In my opinion, you surround yourself with a strong local team that includes someone who is knowledgeable and has an unbiased relationship with different residential and local programs.  In addition, you do your own independent research, you make phone calls.  Simply stated you educate yourself as much as possible and as quickly as possible (unfortunately, many families are in crisis when they’re looking at programs) to the options that are available.  With this team and information in hand, you make the best decision for your family.  Whether your son or daughter goes to a therapeutic residential program  or not, it is important that you follow up to make sure that everything is going according to plan as adjustments may be needed.

With this background, over the next few blogs I will provide additional sources of information for parents to consider when looking at a residential treatment centers so as to better enable to make the best decision for their family.  The first of these sources is the Federal Trade Commission (FTC ).  In posting the FTC’s questions to ask prospective programs, some results from the Government Accountability Office’s (GAO) Report to Congress (October 2007) will be addressed (more on this report in another blog).

Please note that although it is my goal to consolidate these multiple sources in a summary page, for now, I thought I would share this information independently so parents could at least have an opportunity to peruse this data at their discreition.  I will follow up with other sources shortly.

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Federal Trade Commission

Per their website,

“The Federal Trade Commission (FTC), the nation’s consumer protection agency, cautions that before you enroll a youngster in a private residential treatment program, check it out: ask questions; ask for proof or support for claims about staff credentials, program accreditation, and endorsements; do a site visit; and get all policies and promises in writing.”

The FTC provides the following set of questions to ask prospective programs (from http://www.ftc.gov/bcp/edu/pubs/consumer/products/pro27.shtm).  You will note that some of these questions are almost identical to those provided in the blog Selection Criteria while other questions are more detailed  (e.g. licensing requirements details), etc..  Hopefully the specifics noted here will help explain the reasons for these questions.

Questions for Prospective Programs

1.  Are you licensed by the state? If the answer is yes, find out what aspects of the program the license covers: educational, mental/behavioral health, and/or residential? If the program claims to be licensed, get the name of the state agency that issued the license and contact the agency to verify that the license is current. Often, the licensing will be through a state Department of Health and Human Services or its equivalent. If the program’s representative can’t provide the name of the licensing agency, consider it a red flag.If the program is unlicensed and you still want to consider it, contact the state Attorney General (via the National Association of Attorney Generals – www.naag.org), the Better Business Bureau (www.bbb.org), and the local consumer protection office (www.consumeraction.gov/state.shtml) where the program is located. Regardless of whether a program is licensed, when contacting any of these groups:

• Ask for copies of all publicly available information, including any complaints or actions filed against the program, site visit evaluations, violations, and corrective actions.
• Pay particular attention to any reports of unsanitary or unsafe living conditions, nutritionally compromised diets, exposure to extreme environmental conditions or extreme physical exertion, inadequate staff supervision or a low ratio of staff to residents, medical neglect, physical or sexual abuse of youth by program staff or other residents, and any violation of youth or family rights.

2.  Do you provide an academic curriculum? If so, is it available to all program participants? Do you have teachers who are certified or licensed by your state? Some programs may offer only self-study or distance education. Sometimes, educational options are not made available until a resident has reached an advanced phase of the program. In addition, some programs may claim that academic credits will transfer to the resident’s home school and count toward a high school diploma. Check with the board of education in the state where the program operates – and with your state board if you live out-of-state – to verify that academic credits will transfer.

3.  What about accreditation? Several independent nonprofit organizations, like the Joint Commission (JACHO), the Council on Accreditation (COA), and the Commission on Accreditation of Rehabilitation Facilities (CARF), accredit mental health programs and providers.

• JACHO accredits and certifies more than 15,000 health care organizations and programs in the U.S. (www.jointcommission.org)
• COA is an international child- and family-service and behavioral healthcare organization that accredits 38 different service areas, including substance abuse treatment, and more than 60 types of programs. (www.coanet.org)
• CARF International is an independent accreditor of human services providers in areas including behavioral health, child and youth services, and employment and community services. (www.carf.org)

Ask whether all components of the program are accredited, for example, the base program, the drug and alcohol component, and the wilderness program. Then contact the accrediting organization for confirmation.

The GAO’s Report noted that one program claimed to be accredited by the JACHO, but in fact, only the base program was accredited. Neither the wilderness program nor the drug and alcohol component was accredited.

The organizations above grant accreditation and certification after evaluating the quality of services provided by a treatment program. Parents and guardians should be aware that some other organizations that claim to accredit schools may serve merely as membership organizations, and may not conduct site inspections or otherwise evaluate the quality of the programs they certify. If a treatment program claims to be certified or accredited, parents and guardians should contact the accrediting organization and ask about the standards the organization uses when issuing a certification.

4.  Do you have a clinical director? What are his/her credentials?Typically, a clinical director is responsible for overseeing, supporting, and maintaining the quality of care for the program. A clinical director may have an advanced degree in a related field, like clinical psychology, and may be involved in providing individual therapy, assessment and consultation, staff training and development, and managing or supervising the components of the program.

5.  What are the credentials of the staff, especially the counselors and therapists, who will be working with my child?Do they have appropriate and relevant advanced degrees like a Masters in Social Work, a license to do clinical social work (LCSW), a Ph.D., or an M.D.? Are they certified or licensed within the state? If they are, by what agency or organization?Ask to see copies of relevant documents, and consider contacting the certifying or licensing organization to confirm the staff credentials. The GAO found that some program leaders falsely claimed to have credentials in therapy or medicine, which led some parents to trust them with teens who had serious mental or physical disabilities requiring different levels of treatment.

6.  How experienced is your staff?  Have they worked at other residential treatment programs?  If yes, where and for how long?  Ask to see current certifications in CPR and other emergency medicine. For wilderness programs, also ask for proof of relevant training and expertise.

7.  Do you conduct background checks on your employees?  If the answer is yes, find out who does the background check and how extensive it is. Call the company to confirm that it provides background check services for the treatment program.  If the answer is no or the program does not conduct background checks, consider it a red flag.

8.  What are the criteria for admission ?  Do you conduct pre-admission assessments?  Are they in person, by phone, or over the Internet?  Who conducts them?  If your child has serious addiction problems or psychological issues, take special care to ensure that the program is equipped to deal with them.  Discuss the appropriateness of the program with your child’s psychologist, psychiatrist, or other healthcare provider.

9.  Will you provide an individualized program with a detailed explanation of the therapies, interventions, and supports that will address my child’s needs?  When is this done?  How often will my child be reassessed?  Ask whether your child will have group or individual therapy sessions. If the answer is yes, ask how often the sessions will take place and who will conduct them. Once enrolled, confirm with your child that the promised level of care is being received.

10.  How do you handle medical issues like illness or injury?  Is there a nurse or doctor on staff?  On the premises?   Will you contact me?  Will I be notified or consulted if there’s a change in treatment or medication? Ask for copies of procedures the program follows on dealing with medical emergencies.

11.  How do you define success?  What is your success rate?  How is it measured?  Some programs make specific success claims in their advertising materials.  To date, there is no systematic, independently collected descriptive or outcome data on these programs.

12.  How do you discipline program participants? Ask about policies and procedures for discipline.

13.  Can I contact/speak with my child when I want?  Can my child contact me when he wants?  Some programs prohibit, monitor, or otherwise restrict verbal or written communication between you and your child. Find out what is allowed and prohibited before you enroll your child.

14.  What are the costs?  What do they cover?  What is your refund policy if the program doesn’t work out?  Private residential treatment programs often charge hundreds of dollars per day.  While health insurance sometimes may pay a limited amount, for the most part, the youngster’s family is responsible for paying the fees and bills.

15.  Do you have relationships with companies and individuals that provide educational and referral services?  Some companies may provide services, claiming to match troubled kids with an appropriate treatment program.  Be aware that although some of these services represent themselves as independent, they may not be.  They may actually be operated or paid by one or more of the treatment programs.  Ask the service if it receives commissions from the treatment programs.

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The Federal Trade Commission also provides additional information sources.  These include:

• The Government Accountability Office’s (GAO) Report to Congress: “Residential Treatment Programs: Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth” (October 2007) – www.gao.gov
• The U.S. Department of Health and Human Services, Centers for Disease Control and Prevention’s list of state mental health agencies – www.cdc.gov/mentalhealth/state_orgs.htm
• The U.S. Department of State Fact Sheet: “Behavior Modification Facilities” – www.state.gov
• The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) – http://astart.fmhi.usf.edu. A START is sponsored by the Department of Child and Family Studies of the University of South Florida. The Alliance includes leaders in psychology, psychiatry, nursing, mental health law, policy and family advocacy, as well as individuals with direct program experience as director, evaluator, parent, or participant in such programs.

My hope is to address these sources in individual blogs.

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As always, I hope that this has been of use.

“NEDA is here to support the millions of families whose loved ones are battling eating disorders.  How do we do it? By offering the latest information, resources, action-oriented advocacy and media campaigns to educate the public and policymakers and, most importantly, a sense of community to people often feeling alone and overwhelmed in their struggle to access quality, affordable care.”

And I must say that their website reflects this.   NEDA’s web categories include information & resources, how to get involved, stories of hope, current research, etc..  They have also created an 80 page Parent Toolkit which includes items such as: common myth of eating disorders, treatments available for eating disorders, sample letters to deal with insurance companies, etc..  The link to the Parent Toolkit is http://www.nationaleatingdisorders.org/uploads/file/toolkits/NEDA-Toolkit-Parents_03-10-09.pdf.   There is so much information here that it may serve as a useful reference guide as well as an educational tool.

If you are struggling with eating disorders in your family, my heart is with you.  May the stories of hope in NEDA’s website help support you.

For this first blog I thought I’d share a checklist I compiled to help families looking for a program for their struggling teens.   This checklist comes from my family’s personal experience going through this process.   I know that finding a program for a struggling teen is an incredibly painful place for a family to find themselves in and I am truly sorry that anyone has to consider this option.   Unfortunately, as in our family, some times families feel that they have exhausted all possibilities and that they need additional support.   When we found ourselves at this junction, we chose to explore options with the help of a professional educational consultant and our daughter’s therapist.   After conducting an assessment of our daughter’s needs, the educational consultant made several recommendations of programs she felt would be appropriate for our daughter.  It was then our turn to narrow the number of programs via phone interviews and visits to the program.  The checklist below is a result of  information I found on line on the NATSAP website (National Association of Therapeutic Schools and Programs – Questions to ask before making a Final Placement Selection at http://www.natsap.org/parent_questions.asp), other web sites, and the lessons our family learned along the away.

As a note, I recognize that some parents find programs through the web.  In my opinion, the checklist below is not sufficient to address certain risks that may be present if a family doesn’t use the services of an educational consultant.   Nevertheless, I hope the checklist below is of service to some families.   Any enhancements that you may have would be appreciated.

Respectfully,

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Selection Criteria Guide
Therapeutic Boarding Schools/Residential Treatment Centers

Admissions

-What is the program’s admission criteria (i.e. what type of students are admitted to the program)?   As an example, open and closed campuses have different admissions criteria.   Also, most programs don’t mix teens with different issues.

- Is having attended a wilderness program a pre-admission requirement?

-Who reviews my teen’s application for admission? What are their credentials?

-How many students are there in the program?  Is it coed?  Programs vary in size.  In addition, some teens do better in small same sex environments.

-What are the program costs? What does this cost cover?  Note: Some programs include all cost in one fee while others don’t.  Are there other costs?  What are these additional costs?  Examples include a student fund account and specific clothing/shoes requirements (Some schools allow teens to use regular clothes and others have a dress code).

Really important: Keep receipts of everything. Certain travel expenses and the cost of the school/program may be deducted as a Schedule A Medical Expense (subject to limitations of course) – talk to your tax adviser.

-Are there student loans available (Sallie Mae, etc.)?  How are payments made (billed monthly to credit card, etc.)?

-Will a portion of the therapeutic portion of the program be covered by insurance?   Will the program bill your insurance company on your behalf?  If they are unable to bill the insurance company, can they provide you a bill with all costs split out (i.e therapy, etc.).

-How long will the admissions process take?

-Who will you be meeting during the admissions process?

-Will you be able to say goodbye to your teen after the enrollment process is complete?

-Ask for an estimate of program length.

-What is the state’s age of consent?

Licensing and Accreditation

-Is the program licensed by the State? What type of license is it?  What State office issued the license?

-Is the program accredited by a mental health agency, such as Joint Commission (JCAHO), Council on Accreditation (COA), Commission on Accreditation of Rehabilitation Facilities (CARF)?

-Does the program have a Clinical Director? What are his/her credentials? May you meet him/her?

- What are the credentials of the staff that will be working with your teen? Specifically the credentials of the counselors and/or therapists. Are they certified? Licensed within the State of the program?  If the state in which the program resides does not require licensure, what are the credentials of the staff?  Are these appropriate to the treatment they propose to offer; e.g. if they have individual or group therapy, is it provided by individuals with appropriate advance degrees (MSW, LCSW, Ph.D. MD, etc.)?

-What organizations are they affiliated with?  e.g. NATSAP

Therapeutic Model/Clinical

-Will your teen be receiving clinical therapy? How often?

-What will be expected of the parents during the program?  Note: Some programs strongly advice parents to attend regular therapy at home while their teen is away, some have parent weekends that parents are expected to attend – the goal is to create the strongest family you can.

-Does the program provide family therapy? How often?  If so, who facilitates it?  What if the parents are divorced?

-Does the program provide group therapy? How often? If so, who facilitates it? Are there specific group therapies offered? (i.e. adoption issues, drug/alcohol abuse, etc.)

- How is progress judged? Who participates in determining progress? Most programs have a “level” system or series of steps in the program that determine progress and privileges. Ask for a description of the program’s “levels” or stages of progress.

-If counseling is offered, is it provided by staff that are full time employees of the program or is it provided by adjunct or independent personnel? If the latter, is the cost included in the program’s tuition or is there an additional fee for this service?

-What is program philosophy? Behavior Modification, Positive Peer Culture. Etc.  As them to explain.

Academics

-Does the program provide an academic curriculum? If so, what is the core curriculum?

-Is the academic program accredited by a national or regional accrediting agency? Is this accreditation through a 3rd party? If so, what is their name?

-Does the academic program have in-house teachers?  If so, are they certified or licensed within your State?  Are the teachers qualified by credential or experience to teach the courses the school / program offers?

-How many students are in a class?

-Is your academic curriculum internet/computer based? We found that some schools required a laptop and others didn’t – at the end we chose one with limited use of technology.

-Do you offer junior high/high school credits that can be transferred to other educational institutions?

-Do you award high school diplomas (if applicable)?

-Are the arts a core component of the program?  Note: Some programs have a greater emphasis on the arts.

Medication

-Can my teen be on medication while at your facility?  What about non-prescription medication (e.g. vitamins, fish oil, etc.)?  How is this managed (reordering)?

-Who is responsible for the medication management? What are his/her credentials?

-Where is the medication stored? Who has access to the medication?

-Who administers the medication? What is their training?

Direct Care Staff

Note:  In my experience, the value the direct care staff brings is key as they are in the front line and develop day to day relationships with the teens.

- What type of training is provided to your direct care staff?

- What are their duties and qualifications?

- Do you perform background checks? Who does the background check? How extensive is it?

- Do you provide on-going training for your staff?

Risk Management

- What measures do you have in place to keep my teen safe?

- What are your discipline procedures with resistant students?

- How do you deal with risk-taking behaviors? (i.e. running away, self-harm, etc.) Have they had runaways and how have they dealt with them?

- What is the program’s relationship with the local police department?

- Will my teen be exposed to other students that have more negative behaviors?

- What if my teen becomes ill?  Do you have a nurse on staff? Will you transport my teen to medical facilities?

Note: We found that most programs required a complete physical prior to enrollment or shortly thereafter

Questions for Specific Program Types

Long Term Residential Specific

- Are you a locked facility?

- Is there 24-hour awake staff supervision?

- How often will I see my teen?

- Will I be able to speak with my teen on the telephone?  How often?  Is this the same if parents are divorced?  Will these calls be supervised?  If so, by whom and for how long? 

- Will I be able to write and receive letters?

- Ask about any restrictions on family communication and visitation.

- Ask about restrictions in communicating with other people (peers/family)

- How do they handle emergencies?

- What type of food do you provide?  If applicable, can the program support special dietary needs?  If applicable, does the program support a vegan diet?

Success Rate / Outcomes

- How long has your program been in operation?  Some programs that are relatively new don’t have much historical information, however, the background of some of the key staff (e.g. Clinical Director) can be so compelling that it overrides the lack of historical information for the program.  We found this to be the case for the wilderness program that our daughter attended.

- What is your success rate?  What constitutes success?

- Do you administer an outcome study? If so, what is that data?

- Do you have students return to your program?

- How do they assess student improvement and determine readiness for advancement or graduation?

Transition / Next Step

- How many of your students return home after the program?  If they don’t return home, where do they go?

- Will your program help us assess what is the next best step?

- Will I need an educational consultant to plan a next step?  Do you compensate an educational consultant for any reason?

- Do you provide aftercare?

- What contact do we have after our teen leaves your program?

Other

- Are there any extracurricular activities?  Are there social activities?

- If your teen has braces, how will these be taken care of? Also, contacts/glasses. Other special needs?

- You may want to obtain multiple sources of information about the program / school prior to enrollment. For example, you can ask for references from past clients.  When speaking with the references., keep in mind that the program probably gave you names of people that were satisfied with the program.  This doesn’t mean that there is no value to the recommendation, just that you have to look at this as one of many data points.  Another value of speaking with a former parent is that you learn about the inner workings of the program before you go on a site visit.

- If at all possible, visit a few of the programs to determine if you are comfortable with the environment, culture, methods employed, and general assessment of staff, students and climate of the school.  Can you see your teen growing here?

- When you visit the program, ask to speak to current students without staff present and ask the students what their experience is like. Ask each student what they have gained from the program, what they like the most and what they like the least.