How to Get Them into an Residential Treatment Center (RTC)?

Discussion in 'General Parenting' started by WSM, Feb 2, 2009.

  1. WSM

    WSM New Member

    Our difficult child needs to be in an Residential Treatment Center (RTC). He needs intensive cognitive therapy, behavior modification, cause and effect consistent consequences, and a thorough, complete evaluation.

    Yet, he doesn't tantrum or destroy the property of anyone outside the house. He's off probation for his legal troubles. The school doesn't have much trouble with him (of course not, they've waived the requirement that he do homework, get an agenda signed each day, and wear the uniform--they say they'll work on those problems later, but we suspect they are buying his sob story that 'someone' at home is out to get him and 'steals' his agenda and clothes and homework).

    He seldom self harms and hasn't spoken of suicide in a couple years (he did once at age 9--and was shocked when he found himself in psychiatric-care, hastily backtracked and said he did it to make people feel sorry for him).

    We can pay for one ourselves, but they cost $5000 plus a month. Health insurance doesn't pay (I checked out all the insurance programs the Fed Gov offers at our last open season, nothing). And the courts won't commit him for no reason.

    I think he could benefit although I don't think the need is crisis-critical, it could wait until summer, I think it's critical to prevent or maybe thwart future problems. There's just something very wrong, almost scary wrong, but if he's on good behavior as he is outside the home, it's impossible to get others to see it.

    Altho maybe he shouldn't be in one and I misunderstand what they can do. I imagine it being just one very long, very intense therapy session that the child cannot escape from. Like being at school, except instead of learning about the world, kids in Residential Treatment Center (RTC) learn about themselves and their problems and how to handle their problems and to be happier and more productive.
  2. Steely

    Steely Active Member

    Well, if you can pay for it, than you just start applying to different RTCs. They would admit him based on his history, needs, your needs, etc.

    Do you have a counselor you are working with that has suggested this route?
    The biggest concern would be that you are getting him into one that is right for him - and that this decision is the right thing for him. That is why it would be wise to have a counselor or social worker helping with this.

    RTCs are not just for a mildly troubled kid. They are intense, demanding, and in my opinion pretty sterile and void of affection. For some kids, this is exactly what they need to get back on track. In my son's situation, I looked high and low for a place that was more of a group setting, that also had 24/7 counseling and medication checks. It is a really comprehensive decision, that takes many months to research in order to find the right fit for your child.

    If you and husband are sure this is what difficult child needs, than the next step is to enlist the help of a counselor, or an educational consultant, and really research to find the best choice for him.
  3. Janna

    Janna New Member

    I sure wish Residential Treatment Center (RTC) was a long, intensive therapy session. Maybe it would have been worth something to us then.

    Residential Treatment Center (RTC), in my humble opinion, is fun. Our experience was that they put D into a residence with 8 or 9 other children (all sorts of diagnosis'es and issues). The staff that work in the residence with the kiddos have no particular experience or degrees in anything. In fact, alot of them were kids coming out of college, or in college working toward whatever. There was a therapist that handled all those 8 or 9 children, plus 8 or 9 children in another residence, and she spent, ooh, about 30 mins per week with D, and an additional 30 minutes with him in her office and I on speaker phone doing "family therapy" (this, to me, was a joke - it's more like "so what are you doing wrong as a parent to have your child here, and let's talk behavior modification - when we didn't need that). Then, of course, we would hope and pray that the therapist with her 18 children would make sure that all the pertinent information regarding D would get to the psychiatrist, who saw my son a whole, whopping 10 minutes, once per month. Much to no surprise of my own, most of the information never got to him, and even if he did - he handled 50 something kids and probably wouldn't have paid too much attention to it anyway.

    They did have art therapy, horticultural therapy, pet and equine therapy. What did they do for the "therapy" part? Nothing LOL! "Be nice to the kitty, D". And, he, what did they work on? Nothing. Art therapy was fun. And, he got to make some stone/gem thing for our garden, which was cute.

    Did he get anything out of it? Yeah - he learned what a stress ball is. I have them, they're underneath the furniture, somewhere.

    Oh - the way he got in, was with a referral from our local MH/MR (Mental Health/Mental Retardation) agency and a referral from the psychiatrist. He is also on child disability through SSI, which gets him state insurance, which paid for everything.
  4. slsh

    slsh member since 1999

    WSM - There's a list of questions to ask RTCs in the General Archives. If you do decide to go that route, it's a good starting point and then just add your own questions.

    This is just my experience: Most RTCs will tell you average stay is between 12-18 months. My son has been in 3 RTCs plus his current placement, and in every single one of them the percentage of kids who are wards of the state has been at least 90%. That in and of itself is not necessarily a bad thing, but it has meant that my son has been exposed to kids who have come from some very different kinds of families and kids who have life histories that *no* child should ever have, kids who get zero visits, etc. It can be hard. I secretly hoped it would make him appreciate what he has but... no such luck. ;) Also, with every placement he's had, I found that I had to "prove" myself to staff - I am an involved parent and I want to know what is going on with my kid. I get the sense that that is not always the case and staff is more used to dealing with parents who are less invested.

    My son has been in 2 truly outstanding RTCs, really the best of the best. There were still various kinds of problems ranging from inappropriate sexual behavior with- peers to less than stellar followup in terms of routine medical issues. Every facility is going to have it's problems. You simply are not going to find one that will "parent" the way you do. Some things you may have to let slide (movies were my biggie when he was 9/10/11 years old - PG was forbidden here at home but okay at Residential Treatment Center (RTC)).

    Again, just my experience, but it is not one long therapy session. Absolutely, in the good ones there's a huge therapeutic component, much more than can be provided at home, but ... it's not what I would define as intensive. It probably depends on the program, but even in the very best placement my difficult child has ever been, there was a *lot* of down time. Of course, it could have had a lot to do with my kid, LOL. Kind of hard to be intensively therapeutic with a kid who's being dangerously violent or rolling around on the ground making animal noises.

    You also need to remember than an Residential Treatment Center (RTC) is an artificial environment. My son honeymooned for 18 months in his first one - they really didn't see the degree of behaviors we had dealt with at home for a very long time. Transferring skills from the Residential Treatment Center (RTC) environment back to home has been our worst challenge - my kid has been discharged to home twice and both times, we ended up back where we started within 3 months. From a clinical standpoint it was interesting because husband and I used almost opposite parenting styles the second time compared to the first - but it still was a disaster.

    There is absolutely no guarantee with an Residential Treatment Center (RTC). 4 years and 7 months in 2 excellent settings (and 1 year 1 month in a facility that was a real snake pit but hid it well), and my kid is .... well, he's still incredibly challenged. He talks the talk but the internalization of coping skills and tools, which in my humble opinion is the ultimate goal of Residential Treatment Center (RTC) in a perfect world, has not happened with him. I don't mean to be discouraging but I would really hate for you to think that an Residential Treatment Center (RTC) will "fix" things definitively. There has to be an iota of willingness on the part of the child to participate in his/her own treatment. If it's not there, I don't think any program will be unable to get them to the other side.

    There's a huge variety of RTCs out there. I'd do your research very carefully, get input from professionals working with your family, and absolutely visit each Residential Treatment Center (RTC) in person (goes without saying in my book). Some RTCs are geared towards specific diagnoses or cognitive levels.

    If you're looking for an evaluation, I'd try to have it done as an outpatient. If you're looking for intensive therapy and can afford it, I'd almost recommend finding a behavior specialist who will work with you in the home, as many days a week as it takes, before taking the Residential Treatment Center (RTC) route. That's just my bias - it may not work but... Residential Treatment Center (RTC) may not either.

    I truly truly don't mean to be discouraging but I think it's important to remember, as one of our old-timers (Rita) told me a long time ago, your child will *still* be a difficult child when he/she comes home from Residential Treatment Center (RTC). Hopefully better equipped and able to use coping skills but at the end of the day, still a difficult child.
  5. WSM

    WSM New Member

    Wow, thank you for your replies; I really appreciate how much time you all put into them.

    Two things jumped out at me that echo the fears I have in my heart: one, that your son 'honeymooned' for 18 months, and it took them a long time to see the problems we see at home.

    Dear heavens that is what is so frustrating NOW for us. Out in the world, difficult child is a timid, wounded puppy dog who has good manners and is victimized by mean people, mostly his family, mainly his parents. Last year it was me 'abusing' him, this year he seems to have switched to my husband being the abuser. The schools all love him and don't understand what our problem with him is. He's in a military school now and they are the same. They've excused him from homework, uniform wearing, and having an agenda every day. To be fair, he's kind of different from the other kids, he's one of the youngest, is skinny and quiet, and his acting out is passive aggressive and very covert. Most of the others are from Miami's impoverished neighborhoods, are belligerent, overtly angry, and big, most are between 15-17 years old. I think the difference works very much to his advantage and he knows it.

    The other fear I have is that some of these places are mere holding tanks for kids no one wants, and they have a veneer of therapy to get the money, but that's that. They are warehouses.

    difficult child is one step away from the juvenile detention center. Several probation officers have told him bluntly he will be raped there, the staff can't watch you all the time, and that he will be teased and beaten. I don't know if it's true or if they were just trying to scare him straight, but I fear it for him.

    My husband during one particularly awful time when difficult child quietly slipped husband's new laptop into the pool when no one was looking, yelled at him that he had a nice home and people who love him and why can't he appreciate it? He said, if you go to the dentention center, maybe then you'll appreciate what you have here. But you said that wasn't the case with your son. I suspect it wouldn't be the case with ours either.

    difficult child also knows how to 'talk the talk'. He's had so much therapy, he knows how to play many therapists (not all). He knows the jargon and the catch words: "I just want positive attention", "I'm just want positive reinforcement." "I just want to be alone with my dad" (but when he gets it, he punishes dad). What he really wants is rewards for 'not doing' things. He wants to be rewarded for not throwing away his shoes. For not tearing up his homework, for not pouring syrup on his bed, for not taking weapons to school. And he desperately wants to the right to misbehave without consequences. People feel so sorry for him (or are so unsettled by him maybe), a lot of times they DO let him get away with it.

    His goals in life are different from everyone else's.

    I am also afraid that we'd end up with the same problems when he got out as when he went in. After all that money and aggravation and hope. My husband says, 'at least we'd get a break'.

    >>RTCs are not just for a mildly troubled kid. They are intense, demanding, and in my opinion pretty sterile and void of affection. For some kids, this is exactly what they need to get back on track. In my son's situation, I looked high and low for a place that was more of a group setting, that also had 24/7 counseling and medication checks. It is a really comprehensive decision, that takes many months to research in order to find the right fit for your child.<<

    difficult child is not mildly troubled. He's profoundly troubled, possibly hearing voices (altho probably not), and has a severe thinking disorder. He's also deeply angry, probably a better word is severely enraged, cold rage--and he NEVER expresses it verbally, ever. Not in therapy, not at home, ever. It comes out in 'games' like throwing electronics in the pool, abuse allegations, and one of his newest games, needing to be ordered to do basic things like go to the bathroom or eat. If you don't order him to, he won't; he will pee his bed and then cry. He will refuse to eat.

    difficult child might need an intense demanding place. We found a well regarded Residential Treatment Center (RTC) 7 miles away run by a church. It had trained married couples as house parents, two individual therapy sessions a day and one group therapy session, and a psychiatrist twice a week. They came home on weekends. It only cost $300 a month, and $150 if parents participated etc... It was clean, new, comfortable, they went to the local public school which was good. They refused to take him; difficult child's problems were too severe no matter how well behaved he was. My husband just about cried as we left.

    We can't afford anything. We would need the school system to pay for it or the state. Last year the school ordered a full psychological/psychiatric assessment. I forget what it was called. But it resulted in a scale that had recommendations of what therapy the student needs. difficult child was three points away from recommendation to a residential facility. And the assessors didn't know about his self harming/suicide threat or about the violent picture, the stabbing of his mattress or the knifing a bean bag chair. I wasn't there and husband forgot to mention these things.

    I'm hoping to get a new assessment (have to wait until summer) and that he will be 3 points lower (there's new behaviors since the last assessment, plus this time there will be no forgetting important information). If the school psychiatric assessment, the one demanded by the IEP recommends residential therapeutic education, doesn't that require the school district to accommodate him and pay for his education?

    Or is that just wishful thinking on my part?

    We can't give him what he needs. We don't know how to help him and part of the problem is the struggle between difficult child and husband. And I'm tired and exasperated and disengaging. We are starting to do what everyone else does, just give up and let him get away with it, letting most of his behaviors go because it's exhausting and time consuming to enforce consequences on them. But that just causes him to escalate (he used to throw water on his bed--then we said, fine sleep on a cold wet mattress; and then he started throwing syrup on his mattress. He can't be allowed to sleep in a puddle of syrup. He used to throw his shoes away, so we ignored it and got permission from the military school to send him in flipflops, it was no fun doing PT in flipflops, so he started throwing his clothes away--sigh).

    He's 12, they always say early intervention is key, but no one will help us.

    We are just simply desperate.

    But it sounds like an Residential Treatment Center (RTC) is not right for him.

    Thank you for your caring.