This page will give you a set of criteria to use to determine whether making changes in your approach while your child is at home is best, or whether residential care would be better. You will learn about the continuum of treatment approaches that you and your teen can try, from family self-help through outpatient treatment, day treatment, and finally, residential treatment.

If you decide that professional help is warranted in your teen's case, this page can link you with resources to get you started in your search for a provider.

Defining the Problem

Children's problems come in many shapes and sizes. The three most common types of problems that make parents consider residential treatment are:

• Behavior problems
• School truancy
• Running away
• Stealing
• Abusing others' property
• Hostile, angry attitude toward authority figures
• Destruction of property
• Not respecting curfew
• Not complying with even simple requests
• Substance Abuse
• Using marijuana, LSD, crack
• Using alcohol as a minor
• Arriving home intoxicated
• Possessing illegal drugs
• Legal problems (arrests, probation, mandated treatment)
• Exhibiting behavior problems listed above
• Learning Problems
• Chronic inability to attain passing grades in one or more subject areas 
• One or more grade levels behind peers 
• Inability to work within structure of school rules 
• Suspensions and/or expulsion from school 
• Dissatisfaction with services offered by school system 

Effects on the Family

In addition, having a child out-of-control in the home puts tremendous stress on a marriage, putting even solid relationships on shaky ground. Parents often blame each other for the child's problems. This dynamic is only compounded when the family is "blended," with some children from previous marriages and some from the new union. Then, the step-parent often becomes the target of a lot of anger and frustration over the intolerable situation. 

For the other siblings, the out-of-control adolescent can provoke anger, fear, jealousy, or awe. Some siblings strive to be as different as possible from the acting out teen, while others carefully watch and wait for their turn to try out the negative behaviors. One of parent's worst fears is that their acting out teen will "infect" their younger children, and unfortunately, this can be a realistic worry. More than one youngster has been introduced to drugs by their older siblings.

But even if the younger sibling rejects the negative behaviors, there is still a lot of stress on him or her. Children know everything about each other, so the younger child will have to face the community's opinion of the acting out teen's behavior.

Finally, a family with an out-control adolescent can trigger parent's own emotional wounds to the surface. Depression and substance abuse are commonly found in families with these problems. The parent may become depressed, and may sometimes turn to alcohol or drugs to dull their pain.

If the gloomy picture painted above describes your family situation, then you share in common with many more families than you realize a deep sense of frustration, fear for your child's future, and self-blame. You may have an abiding sense that your family just doesn't work, and a sense of helplessness about how to turn the ship around.

Identifying Solutions

By the time parents consider residential treatment, they have more than likely tried any number of methods to solve their child's problems. The following graph shows the range of treatment available to help families help their teenager. See where your family fits on the graph of solutions.

Unproductive Parental Solutions

• Nagging 

The most common attempted solution that parents try is reminding. In this method, the parents explain calmly why they believe there is a problem, and tell the teen what they want him or her to do about it. If the teen changes his or her behavior, then problem solved. If the teen doesn't comply, however, then the parents remind the teen, usually with more and more anger, about the problem and their desired solution. 

The main problem with nagging is that it doesn't work. If you have to remind your teen more than THREE times before you get the desired response, then for some reason you aren't getting through and continuing to remind will constitute nagging, and will not produce your desired results. What nagging does produce consistently is frustration and anger in parents, as well as teenagers and the other children who have to listen to it. 
 

• Waiting and Hoping 

Parents love their children immensely, and so have ever blooming hope that their children will "wake up" and mend their ways on their own. Some parents tiptoe around their teen's problem, in an attempt to give their child time to work it out on their own. This is a good method when your teen is openly tackling the problem and is getting positive results from his or her efforts. But if you are not hearing or seeing any evidence that your child is aware of a problem and actively working to solve it, then waiting and hoping are useless at best, and potentially deadly at worst. 

• Consulting with Friends and Family 

Chances are you have access to a number of other parents in your extended family or circle of friends. While it can be embarrassing to admit you are struggling with your teen's problems, it can be of tremendous value to ask for the honest opinion of those whom you can trust. It's best to get three or four opinions on what do to, as opposed to taking the advice of the first person you consult. You'd be surprised at how glad people will be to offer solace and advice. 

One caveat: If your child has a grandparent who undermines your authority with your child, then this is not a good source of advice on how to proceed. In this case, you need to find other sources of information, to strengthen your position with both your child and the grandparent. 
 

• Parent Support Groups 

Another source of information and support is available in most communities: parent support groups. These groups are free and open to the public. They are led by parents who have faced difficult problems with their teenagers -- truancy, drug use, legal problems-- and who have found effective coping strategies. Each type of group has its own philosophy; for example, Nar-anon is based on the 12-step philosphy first developed in Alcoholics Anonymous, while ToughLove is based on family contracting (more on contracting later). The yellow pages or your child's school guidance department are excellent places to get information on these groups. Some of the more common groups are: 
 

• Parents Anonymous
• ToughLove
• Nar-anon
• Al-anon and Al-ateen
• Fam-anon
• Church-sponsored parenting clases and support (varies with community).

• Outpatient Individual and/or Group Therapy

Sometimes, a teenager has concerns that can be worked out in individual or group counseling. Perhaps the teen is having problems with peers, a boyfriend or girlfriend, or is confused about authority, career or educational direction, or their emerging sexuality. Alternatively, the teen may have had one or more traumatic experiences (e.g., loss of a loved one through death, divorce, or separation; relocation of family away from teen's support network; violence at school.) In counseling,  the teen can gain perspective and objective feedback on the problem and learn about communication, problem-solving, and effective life management. When ready, the teen can invite the parents into therapy to share progress, set goals, and find strategies for achieving them.
 

• Outpatient Family therapy 

Family therapy can help each family member present his or her own view of the problem and of solutions that might solve it. One advantage of family therapy is that it makes the teen feel less like "the problem" and helps motivate him or her for therapy since it's "all for one and one for all." Family therapy also helps parents and siblings identify how they can help the teen turn the problem around. Siblings who may be affected by the problems can vent their anger or fear a in a constructive manner, and  ask for what they need from parents, who may be preoccupied with helping the teen. 

Family therapy also can help parents become a high-performance parenting team, to form a "circle of wagons" around the teen. This is time and energy intensive, but it does work to help teens decrease the behaviors that are causing them trouble.

Usually, family therapy occurs once a week for 50 minutes.  During times of crisis, a more intensive schedule can be of benefit, for example after a teen has run away, to help the family stabilize the situation. While families can't control the crisis, they can change how they react to the teen, thus stopping any "secondary gains" the teen may be getting from the crisis.  

Change at time of crisis may come easily, but maintaining the change when things are calming down can be dicey. The teen is trying to convinnce the parents that everything's OK so that the interventions will stop, and thent he teen can resume the negative behaviors. 
 

• Day School

Day school is an option for kids who are not behavior problems in any setting except school, and/or who have learning disabilities such as ADHD, ADD, Math or Reading Disorder, or low IQ. The teacher-student ratio is low and the teen is monitored closely to assure that he or she can achieve the goals in the educational plan.  
 

• Day Treatment 

Day treatment is a modality in which the teenager attends school in a setting that also provides intensive counseling, both individually and in groups.  The staff is trained in counseling techniques and uses them both during counseling sessions, and while the teen is in the classroom or in extra-curricular activities.  This type of treatment is particularly effective for teens who need both intensive supervision in the classroom, and intensive, ongoing counseling.
 

• Home-based Services

In home-based services, a counselor comes to your home one or more times per week, usually for a few hours. The counselor may serve many different roles while in your home--help with homework, transportation, helping coordinate the teen's appointments with treatment providers, and supervision of the teen. The counselor's main job is to support the parents or other cargivers so that they are able to deal effectively with the teen.  They may lead family discussions, or provide counseling to all the family's members. Home-based services are usually available when a family is in need of intensive treatment for the teen, but the situation does not call for inpatient or residential treatment (see below).
 

• Inpatient Treatment 

Inpatient treatment occurs within a hospital setting. It may be in psychiatric wing of a general hospital, or in a free-standing psychiatric hospital.  Inpatient treatment is an effective option for children and adolescents who are in danger of harming themselves or others.  The teen may be experiencing suicidal impulses arising out of depression; or have urges to burn, cut, or otherwise harm himself or herself..  If a teen intends to act on a plan to harm another person (e.g., shooting or stabbing, or gang-related plan of revenge), inpatient treatment can provide a safe alternative, so the teen, as well as the intended victim, are safe.  In addition, if the teen is experiencing psychiatric symptoms (hearing voices, feeling "outside" of  his or her body), inpatient treatment is usually indicated.  Inpatient treatment provides the teen with constant support, psychiatric observation, and the full array of medical services, such as medication monitoring and medical testing, should they be needed. 

For teens involved in substance abuse or dependence, inpatient treatment can take the form of detoxification. In detox, the teen is provided with a contained environment that is drug and alcohol free, while being monitored for any medical complications of withdrawal from the substance.  Detox is a difficult process, and being in a locked unit of a hospital provides the safety net when the teen's will to detox fails.  The first stages of substance abuse treatment also may take place during detox treatment, with the teen being introduced to the concepts of  recovery, 12-step groups, sponsorship, relapse prevention, and the emotional and cognitive side effects of substance abuse or dependence.

Inpatient treatment is designed to be a crisis intervention. It is not the best setting for a child or adolescent for an extended period, because it is so different from everyday life. When the crisis subsides, the teen--and the family--will have to learn to maintain stability on the outside. Aftercare--the range of services that will be offered to the teen upon discharge--should be uppermost in the minds of both staff and the family as soon as possible after the teen is admitted. The teen gradually should be oriented toward resuming his or her normal life, with the support of the aftercare plan.

If you've ever been away from home, in a strange and unfamiliar place, you know the value of visits by friends and family. Teens need to know they have not been "dropped off" at the door of the hospital and can be  extremely sensitive to lapses in family visits. Even if the teen is openly hostile to parents when they visit, he or she is still "keping score" on the number of vists parents make. (True! Even though teens will be loathe to admit this until much later in their recovery!)
 

• Residential Treatment

Residential treatment can last from a few weeks to more than a year.  It is reserved for those teens who cannot be treated successfully in a less restrictive environment.  For example, a teen may engage in habitual runaway behavior in settings that are unlocked, or from their homes, despite their parents' efforts to contain them,  when  in outpatient treatment. Another reason residentail treatment may be beneficial is in cases where the teen lacks a supportive, proactive family or caregivers that can help the teen engage in outpatient treatment on a consistent basis.

Optimally, residential treatment should occur in a setting as near to the teen's community as possible.  Proximity to home allows the teen to have some continuity in his or her life-- the teen may be able to continue attending the same religious services, sports events, and family activities. The family--parents and siblings--can be more highly involved in the teen's life since they are nearby.  Finally, if a negative peer group has been a factor, the teen can begin to build more positive, supportive relationsips that will sustain him or her after leaving treatment.

When a teen is in residential treatment, it is important that as soon as possible, there is a "step-down" plan in place. This aspect of the treatment plan defines the changes the teen needs to make in order to be eligible for a less restrictive form of treatment, such as day treatment or outpatient treatment. In addtion, plans for discharge and aftercare, the services that will help the teen maintain the progress made in residential treatent, should be made as quickly as is feasible. 

As with all forms of treatment for minors, family involvement is critical to the success of the treatment.  Parents know their child better than anyone, and will have a lifelong relationship with the child long after treatment is finished. In addition, it is important that the teen realize that the parents are working closely with the staff in the treatment center, so that the teen can't play one against the other in an attempt to avoid necessary consequences or tasks in the process of recovery.
 

• Wraparound Services

A new and highly effective form of treatment for teenagers with serious emotional and behavioral problems is called wraparound services. The many people who have ongoing contact with the teen--parents, teachers, counselors, physicians, probation officers, and others, such as the teen's friends--come together to form a collaborative plan to help the teen overcome his or her problems. A "safety net" is formed so that the teen is supported 24 hours per day and parents have a well-coordinated treatment plan that meets all the teen's needs.  Wraparound services may be available as an attempt to keep a teen out of inpatient or residential treatment, or may be offered as a plan of aftercare.

Hope Is Important

Families with a teen in trouble suffer the worst stress imaginable.  It is important that parents' needs and other areas of life aren't neglected while the teen struggles with his or her problems. Taking time out as a couple, and doing upbeat activities with the other children, are ways to fight stress and take a step back from the problems. With your batteries recharged, you can be a more effective parent to all of your children. I hope the information in these pages has helped you understand some of the options available to you to help you family through this difficult time.