We’ve been through so many struggles with our teen son’s substance abuse and violent behavior. He’s turned our entire family upside down, and counseling hasn’t helped. It’s time for more intensive care, but we don’t know how to find a residential treatment center with an effective program. We’re afraid of how much it will cost, and we’re embarrassed for anyone else to know what’s going on.
We wish we were sitting with you over coffee, face-to-face, so you could hear us say clearly, Well done. The high calling of parenting is hard on the best of days. How much more so when a crisis hits and doesn’t quit! But you aren’t giving up, either — on your son or yourselves — and you’ve made the brave choice to reach out for help. It’s our privilege to walk with you.
Finding a good residential treatment center (RTC) has a lot of moving parts, some of which you might already know about. Still, we’re going to cover it all because so many families struggle with children who are troubled, and they need as much information as we can give. It’s a lot to take in, so feel free to jump to certain sections.
- When to get residential treatment for your child
- Face your fears
- Call Focus on the Family’s counselors
- Understand a continuum of care
- How to find a good residential treatment center
- Questions to ask a potential residential treatment facility
- How to parent your child during residential treatment
- How to pay for residential treatment
- Keep things in perspective
Note: This piece is written for families whose child is adopted or biological. Guardianship issues are different for families who foster. If you are fostering a child or teen and believe they need intense professional help, talk to your social services connection.
When to get residential treatment for your child
RTCs address many obvious challenges, including:
- Substance abuse
- Eating disorders
- Mental health issues
- Violent behavior
Look for telltale signs
Sometimes it’s hard to pinpoint how your child is hurting and whether they would benefit from an RTC. When that happens, you can look for the following signs:
- Your child or teen can’t understand that actions have consequences.
- They blame others and never take responsibility for themself.
- Their poor choices escalate to increasingly dangerous behavior.
- They show symptoms of psychiatric issues.
- Your teen has tried to quit alcohol or drugs but relapses every time.
- Your child or teen shows severe mood or behavior changes.
- Ongoing outpatient counseling (regardless of the issue) hasn’t helped.
Two specific situations require the benefits of an RTC:
- The first is when it’s not safe for your child to live at home because they harm other family members — physically, verbally, or mentally. (Keep reading for more on this point.)
- The second is when your child or teen is discharged from a detention facility and needs more than outpatient care to live safely at home (read the continuum of care section for more details).
How to know whether it’s safe for your child to stay in your home
Let’s talk about the difference between hurt and harm.
We all experience occasional hurt in family life: misunderstandings, disagreements, selfishness, busyness — the list is long. But for a healthy family committed to each other, those bummer moments don’t last.
These families build strong communication skills, and they resolve conflict quickly and effectively. They make time for each other, they sacrifice for each other, and they show appreciation. And even when they don’t agree, they let each other be.
What about when your child tests boundaries or your teen is occasionally disrespectful? Yes, those interactions are frustrating, but they’re a normal part of raising children; they’re not harmful.
Harm, on the other hand, causes lasting damage. This is where we see emotional, physical, sexual, or spiritual abuse. Even if your teen thinks they’re only hurting themself, you know better. You have the right and the obligation to safeguard your own well-being and that of your teen and any other children in the home.
Face your fears
Be ready: Choosing to place your child or teen in a residential treatment facility can unleash your deepest insecurities as a parent.
You might be tempted to play the comparison game as you see other families living in peace and joy. You might feel shame because of your child’s actions — especially if you are a follower of Jesus Christ and your child has been raised in the Christian faith.
Bravely face your fears. As you do, here are six important truths to remember:
God loves your child even more than you do
When you feel helpless, take comfort in the truth that God created your child. He won’t stop drawing their heart back to His, and He’ll help you love your child in the best ways possible during this season.
You are not responsible for your child’s behavior
We love our kids, and we want what’s best for them. But most parents, if we’re honest, sometimes have a distorted view of what love should look like — especially when our children make mistakes.
In other words, we might unintentionally enable our child’s poor choices when we don’t let them face consequences or learn accountability. Maybe we bailed our teen out of jail and paid court fees. Maybe we made excuses for our child’s behavior in school or in the community.
As parents, we must be realistic about our part in guiding and nurturing our children to healthy adulthood. At the same time, we need to let go of false guilt when reflecting on the question, Am I responsible for my child’s bad behavior? Dr. Joannie DeBrito points out:
“As parents, we often assume that everything our kids do is somehow related to us. This way of thinking, though, discounts a child’s individuality, the negative influence of peers and our larger culture.”
Author Dave Harvey also notes, “For the one who loves a wayward soul, a shift in gaze is the only link to present sanity and future hope”:
If you love a prodigal, you must learn shame-hating. Christ nailed our shame to the cross. In its place, he imputed to us his record of perfect righteousness. When God looks at us, he doesn’t see our parenting failures. He doesn’t scroll through an unfiltered feed of ugly accusations and regrets. God sees his Son instead of us. We must look to Christ as well. (Lift the Heavy Burden of Shame)
You won’t harm your child by placing them in residential treatment
Some parents feel that sending their child to an RTC is a type of punishment or abandonment. That belief can be further complicated if your child is adopted. You might feel like you’re “giving them away again” and worry about what that will do to them.
But your decision won’t ruin your child. The truth is that residential treatment isn’t a punishment. It won’t worsen any attachment issues. Instead, it gives your child the opportunity to heal. It’s restorative. If your child is willing to do the hard work and face what’s driving their behavior, they will develop skills to successfully handle life’s inevitable difficulties.
Whether your child is biological or adopted, assure them (and yourself!) by saying We want you here. But in your present state, it’s not safe. We want to get you help so you can come home.
Residential treatment can work well because your child will have extended time in a supportive environment under the care of specialists. Letting go of bad habits and building healthy life skills takes time and discipline — even more so when addictions or behavior disorders are present. That’s why we encourage you to let the potential benefits of a good RTC outweigh any hesitations.
Still not convinced? Consider these positive aspects:
- An RTC offers your teen a fresh start, which is valuable if they feel stuck or pressured by unhealthy peers.
- The intensity of an RTC creates an immersive, supportive framework that cuts out distractions and stumbling blocks.
- The RTC can help your entire family through support, resources, and referrals. And once your teen is back home, you’ll always have a place to turn if you have questions or worry that they’ve relapsed.
You won’t harm your other children by getting treatment for your troubled teen
Other children in your home might already feel ignored because of the spotlight on the one who’s troubled (even though that’s not your heart). Or you might know that you’ll have to tighten the family budget to place your teen in residential treatment, but you don’t want the kids to experience that fallout. (You might even be afraid you’ll hurt their chances for financial stability in adulthood if you have to pay for your son’s care by digging into college savings you’d set aside for them.)
It’s easy to let your troubled teen consume all of mom’s and dad’s attention and resources. And it’s easy to assume that your other children will be fine, especially if they’re younger than their struggling sibling and haven’t yet learned how to express their emotions.
You must find a balance.
You cannot ignore the damage your son is causing. You do have to place a lot of your focus on the immediate crisis. At the same time, you can’t just hope your other children will be fine. You can’t overlook the potential for lifelong bitterness that can develop if you don’t find a way to normalize life and family relationships as much as possible.
And one of the best ways you can do that is to get your son the treatment he needs.
So take things one step at a time. Trust God to give you wisdom and energy to care for each of your children. Be a safe space for your other kids to talk about feelings and emotions. And make sure they have trusted adults they can open up to if they’re not ready to share with you. Take time to genuinely engage with each of your children on their level with activities they enjoy. Most importantly, get professional counseling for everyone.
Your child’s education won’t suffer
States require inpatient residential treatment programs to include educational services that will transfer coursework back to your child’s school when he returns home.
To that end, most facilities have a tutor or special education teacher on staff. (Don’t panic; your child isn’t being labeled. Special education teachers work with students who have learning disabilities, yes. But they also work with those who have mental and emotional challenges.)
That said, be flexible and open-minded about how schooling in an RTC is handled. If your child has been failing classes because of substance abuse or behavioral issues, treatment might need to take priority.
You have a say in your child’s healthcare while they’re under 18
In many situations, parents will make the decision to place their child in an RTC without much, if any, pushback from the child.
However, that’s not necessarily the case when a teen battles substance abuse or other dangerous behavior. Under those circumstances, they might defiantly refuse to go to rehab — and threaten to take you down with them.
If you’ve already tried outpatient counseling, mentoring, and steps of tough love (such as restricting your teen’s time away from home and taking away digital devices), sit down with them again.
Talk bluntly about where they’re headed if nothing changes. If possible, give them a choice between two good RTCs so they feel empowered in their recovery. (And mention that if they refuse help now but get arrested for their actions later, they might be ordered to go to rehab.)
At this point, there are two facts to realize:
One, you are your child’s legal guardian. You have the authority and responsibility to do what’s best for them — whether they like it or not. Keep in mind, too, that once your child becomes an adult, getting them into rehab could be even harder (not to mention the further damage they’ll have caused to themselves and others). So don’t wait.
Two, you can’t force your child to own up to their problems and pursue healing. (In fact, some states allow RTC patients to sign themselves out at age 15 without parental consent.) You’ll need to learn to accept that you have no quick fix for your son’s problems — and that despite your love and care for him, he might still choose a destructive path.
Call Focus on the Family’s counselors
We know that looking for a residential treatment center is hard. There are a lot of options, and you have a lot of personal variables to consider. And let’s face it: The whole situation is messy and complicated and just plain ugly — it’s not a journey you would have chosen for your family.
Would you let us share your load? There aren’t any easy answers, but we can help with some of the heaviest lifting. Call us for a free one-time phone consultation at 1-855-771-HELP (4357). You can also fill out our online form to request a callback. Our licensed or pastoral counselors would be glad to talk with you and point you to possible RTCs that best fit your child’s needs.
For ongoing support for you and other family members, check out our Christian Counselors Network. You’ll find a nationwide referral system of qualified and reputable counselors working in your region who can provide in-depth, long-term help.
Understand a continuum of care
A continuum of care ensures that you know what services and next steps are available to help your child. It also offers a map to work backward when your child is released from institutional or residential treatment so that they have appropriate aftercare.
It’s important to note, though, that the level of care someone receives can fluctuate based on symptoms. Don’t get locked into a linear, rigid view of these steps.
1. Family, community, and therapeutic mentoring
For parents just realizing that their child needs more guidance and support than they can give, start with other trusted family members, school counselors, youth group leaders, and regular meetings with a trained mentor.
2. Outpatient care
This is the next step of care, meeting one to three hours each week with a licensed counselor for individual or group therapy.
3. Intensive outpatient care or day treatment
Intensive outpatient care offers therapeutic services three or more days a week for three hours a day. Day treatment increases that amount to five days a week for eight hours each day (and includes school coursework).
4. Residential treatment
Residential treatment happens in an inpatient (live-in) facility.
You might see this described as a residential childcare facility, which includes 24-hour supervision and programming. Or a therapeutic residential childcare facility, which includes 24-hour supervision and programming, mental health, and specialty adjunct services. Or staff-secure residential, which includes 24-hour line-of-sight supervision and programming.
5. Institutional care (legal or medical)
Institutional care is usually a locked-down facility.
In legal situations, that can include short-term detention or incarceration overseen by state Departments of Corrections. In medical situations, the most common scenario is a 72-hour hold in a hospital, but it can include longer care in a state or private hospital system.
How to find a good residential treatment center
Before anything else, we want to gently point out that you’ll never find a perfect residential treatment program.
We don’t say that to discourage you; you’ve already had more than your share of sorrow. Instead, we want to prepare you for the road ahead. When you know the challenges to expect and how to meet them, you’ll be able to confidently say We’ve done what we could, and leave the rest in God’s hands.
Start with prayer
Ask the Lord to give you insight to make this important decision with wisdom and discernment. He knows your situation, and He can lead you to the facility best able to help your child. Ultimately, it’s not the wisdom of man but the work of the Holy Spirit that heals.
Don’t ask What program will fix my child?
The biggest variable to a successful outcome is your child’s willingness to cooperate with treatment.
Second to that is realizing that while most RTCs have good intentions and solid programs, they still have to make ends meet. So sometimes they might have low staff numbers, which can limit the one-on-one care your child gets — or they might not currently have an expert in your child’s issue.
Accept the fact that an ideal program doesn’t exist. Look for good enough. You can be picky and understanding at the same time. Our upcoming section on questions to ask when looking for a residential treatment facility gives some guidelines.
In short, the RTC you choose should meet state licensing requirements or accreditation standards, use evidence-based practices, employ qualified staff, and have a program that specifically meets your child’s needs.
Also, to the extent possible, look for a program with positive outcomes. Just realize that positive outcomes can be subjective since every person’s recovery is different. And an RTC might be limited in what information they’re legally allowed to share.
Be familiar with your basic choices for residential treatment centers
Each RTC uses their own model of treatment. You’ll want to strongly consider the degree to which they incorporate faith-based elements into their programs. However, in crisis situations like you’re experiencing with your son, we believe that therapeutic specialty is more important than a Christian focus. Even so, the facility should at least understand your personal values and agree to support them in the treatment of your teen.
That said, there are three basic choices when considering a residential facility:
- Christian-based programs that specialize in the issues your teen battles.
Even then, loosen your expectations for your child’s faith journey. The point of these programs is to incorporate a Christian worldview into treatment, not be heavy-handed. Take a cue from the RTC: A Christian-based facility may offer chapel services or quiet time, but they’re never forced on patients.
- Christian tracts (like small groups) within a secular organization that specializes in your child’s struggles.
- Secular-only programs that specialize in the issues your child is experiencing.
Again, this choice is better than a Christian-based program that doesn’t have the expertise to help your child.
As you research an effective RTC, focus on three big areas: questions to ask a potential RTC, how to parent your child while they’re in treatment, and how to cover the financial cost.
Questions to ask a potential residential treatment facility
Once you have a lead on a possible RTC for your child, research it thoroughly.
Ask your child’s outpatient counselor if they know the facility and can give any insight. Look at the RTC’s website and online reviews from other parents. And then get in touch with the facility. Ask them the questions below, and listen carefully — vague answers are a red flag and a sign that you need to continue your search.
- What’s the current age range of patients?
You’re not asking what age range the facility is licensed for; you’re asking what the ages look like right now. For example, if the RTC is licensed for ages 5 to 18, but they presently only have 16- to 18-year-olds, your 13-year-old won’t necessarily get the best care.
- Are different age groups housed in the same building or separately?
- Is the program Christian in totality or a Christian tract as part of a secular program?
If the program is a Christian tract within a secular program, ask if the tract is staffed by Christian therapists. (Refer to your basic choices of RTC.)
- How does the program keep parents informed?
Most RTCs require weekly or monthly parental involvement.
- Do you have staff who specialize in the care my child needs?
- How will the program address the specific issues my child has?
Get into the weeds. For example, find out what eating disorders an RTC addresses and how patients are treated.
- Does your program have experiential components?
Many kids don’t do well sitting and talking with a therapist. That’s where hands-on, experiential programs become especially valuable.
Experiential therapy is an umbrella term for several therapies that use activities to encourage a child or teen to identify and address issues and traumas. Experiential therapies include play therapy, equine-assisted therapy, art therapy, and wilderness experience therapy. (For more details, read our article Therapeutic Interventions for an Adopted Child.)
- How is the educational component provided?
Ask about the style of instruction, how the RTC will decide whether treatment needs to take priority, and how to confirm that your child’s school will accept classwork done during treatment.
- How long do you expect my child’s inpatient treatment to last?
Unfortunately, the timeline may depend largely on what your insurance covers. Normally, though, a typical stay in an RTC is three months to one year.
Plan for your child to stay until they have successfully completed the program. Some kids respond well quickly; others fight against change.
- How do you decide when my child has successfully completed the program?
Nobody expects perfection. But the RTC will be sure your teen has reached whatever measurable therapeutic goals were set when treatment started. They’ll evaluate your teen’s sincere efforts to recover and whether they’ve made solid steps toward taking responsibility for themselves.
And if they believe your child no longer needs inpatient care but would continue to improve with ongoing professional care, they’ll create a step-down plan. For example, your child could move from residential care to outpatient care (look back at the continuum of care).
- Will a minor be required to complete a treatment plan if they turn 18 during their stay, or will they immediately be discharged at 18?
- What type of aftercare do you provide?
Recovery from substance abuse or other conditions isn’t always a straight line; setbacks don’t mean failure, but they do happen. A good RTC will make sure you and your child have tools to keep making steady progress in the right direction.
This could include ongoing counseling, pointing you to a Celebrate Recovery group, or checking that your teen and family are connected to a good church, safe friends, and strong mentors.
How to parent your child during residential treatment
Your main role during your teen’s stay in an RTC is to follow the facility’s lead and humbly cooperate as much as you can.
When they set occasional times for calls with your child, stay within those boundaries. When they ask you to minimize other forms of contact so your child has room to focus and heal, respect that. When they ask you to attend family weekends, go. When they recommend family therapy sessions, give it a try. When they make parenting or communication suggestions, hear them out and keep an open mind.
Entrusting your child to the care of someone else is never easy. But don’t lose sight of the bigger picture. You’re agreeing to give up some control for the sake of your child’s future.
How to pay for residential treatment
The cost of healthcare, including mental healthcare, worries almost everyone. But when someone you love is at risk, don’t let fears about financial strain keep you from getting help.
The expense of residential treatment varies among RTCs and depends on several factors, including length of stay, location, amenities, and how much you’ll pay out of pocket once insurance has covered their portion.
The first step is to call your insurance company and ask for information about mental health and addiction treatment coverage. Then, before you make a commitment to an RTC, ask prospective treatment facilities for information about total cost of care and how much your insurance will likely cover.
Once you’ve selected a facility, a good admissions representative should work directly with your insurance company to verify your benefits, get required authorizations, and submit claims to your insurance. Still, you’ll need to stay on top of things, especially if your insurance denies your request and you need to work through an appeal process.
Of course, even with a generous insurance plan, the entire cost of treatment might not be covered. If that turns out to be your case, don’t lose hope. Ask the RTC if they offer financial aid or are willing to work with you on a financing plan. And if circumstances are desperate, get input from your financial advisor or trusted friends about refinancing your house or using savings set aside for college or retirement.
Keep things in perspective
When it comes to family dynamics, one of the wisest choices we can make is to grieve imperfections well.
On this side of heaven, we will feel the pain of broken relationships. But the Lord will sustain us as we trust Him with our present and our eternity. We can admit that our family isn’t what we’d like it to be. We can grieve the loss of the family we want, choose to accept the family we have, and move forward in hope for better days.
Still, we know that doing so can be a complicated and sensitive. Please remember that our offer to come alongside you stands. Call us for a free one-time phone consultation at 1-855-771-HELP (4357), or fill out our online form to request a callback.
In the meantime, the recommended resources listed below could be helpful.