When Does Your Teen Need A Residential Placement?

Countless times in my 20+ years working with families in crisis, I’ve been asked by parents “how do I know when I should intervene at the level of a therapeutic or intervention placement for my struggling child?”  Often this question is combined with statements such as “is this just typical teenager behavior?”  “will he/she grow out of this?”  “Am I being unreasonable or worrying too much?”  “Are all the other kids doing this too?”  These are important questions and the answers are complicated and personal; while every situation is unique, treatment offers no guarantees and the options are limitless. There is no proven metric that clearly outlines the subtleties and nuances of adolescent behavior and precisely when  intervention is necessary.  

It is my belief that all parents are “the experts” on their kids and need to come to such a crucial decision willingly and with the commitment such a decision requires.  Helping a family member in need affects all members of the family and often requires a significant commitment both emotionally and financially.

In these situations, I ask the following questions to help parents assess their particular situation and to help guide them to their own answers. 

1. Are there safety concerns connected to your child’s behavior?  Have there been or are there medical issues that are of concern such as hospitalizations, threats of violence towards others or to self, injuries due to reckless behavior, “near misses” or other complications that are jeopardizing the child’s safety and physical well-being?
2. Are their legal concerns connected to your child’s behavior?  Have there been brushes with the police or other authorities?  Are there charges pending or active?  Is the child currently on probation or other court-mandated consequence or restriction?
3. Does the child’s behavior suggest or is there evidence that either of the above is looming?  Warning letters or interactions?  Evidence of criminal activity?  Evidence of behavior that may lead to medical or health consequences?  Risky behavior such as running away, substance use and indiscriminate, unprotected or impulsive sexual activity can be important warning signs that “typical adolescent behavior” has progressed to a dangerous level.
4. What professional recommendations have been made?  Are school authorities or medical professionals, educational consultants or mental health professional recommending intervention or residential placement?

These blatant signs can often help a parent assess the obvious or immediate need for intervention.  However for most parents, their situation may not be so obvious.  This indistinctness makes the decision to intervene much more difficult.  In those situations, I typically offer the following questions to help parents assess their own situation.

1. List the behaviors that you are concerned about, in order of priority.  This often includes academic decline, defiance or oppositionality that includes not following the rules of the home such as curfew or completing of household chores, not following through on commitments such as work or activity agreements, withdrawal from family events and activities, changes in appearance or grooming, changes in behavior that are unexplained.
2.  How does your child explain the above?  Does he/she offer an explanation that makes sense?  Does he/she take responsibility for the behaviors in question or does he blame others or just deny that there is any issue?  Is he/she open to improving the situation or finding a solution?
3.  How many times have you tried to talk about the problematic behavior issues?  How many ways have you tried to intervene or change the behavior?  Examples may be family discussions or meetings, meetings with mental health professionals or school officials, consequences such as grounding, restrictions or taking away of privileges and even ignoring the situation with the hope that it was an isolated incident or he/she will “grow out of it”.
4. How much have you solved or attempted to solve on your child’s behalf?  Examples may include money paid for tickets or damage, lawyer or court fees, excusing absences at school, lying or omitting information to the other parent or professionals, making excuses for the child’s behavior, keeping the issue a secret from other family members or friends.  Often times, parents struggle to acknowledge how much their good intentions have allowed the child to avoid consequences or accountability.
5.  Have any of the above attempts brought about positive change or momentum?  Is there evidence that academic performance has improved, adherence to curfew, less family discord or arguments, are some examples to consider.
6.  What is the parent’s level of tolerance for the behavior?  With this question, I often ask parents to write down when they will know for sure they need to intervene at a higher level.  How will they recognize when things have gone too far?  Does someone have to get hurt, expelled or arrested?  This often allows parents to see clearly what they have already tolerated and maybe even become desensitized to.  Sometimes writing this all down gives them a clear way to look at the situation with more objectivity and clarity.
7. Are the parents on the same page regarding the situation?  Oftentimes regardless of whether the parents are married or divorced, there is one parent who sees the situation as more dire than the other.  If this is the case, which pieces do they agree on?  Is there a common ground?  Is one parent unaware of the behavior either due to distance or lack of involvement or due to secrecy and lack of communication?

These are just some of the questions that I use to coach parents through the painful process of deciding what to do.  Using non-judgmental language, objectivity and compassion for the situation can often help parents open up and be candid about the situation allowing for more open discussion. Typically, I like to go through these questions with parents with the goal of creating a plan that makes them feel like they have options, a solution and an action plan.  For instance, if a parent is adamant that they are not ready to intervene, often the list of “how will you know when it’s gone too far” can be eye-opening and offer a clear agreement about when and if to act.  Sharing this with me or other professional can help the parent have some objectivity and accountability if things continue to be problematic or escalate.