Residential Treatment Facility (RTF) Placement???


New Member
Well...I seem to be quickly becoming a regular poster on the Teens and Substance Abuse forum but wanted to post here as well because I know there are experts all over this board and wanted to reach as many as possible! We are now discussing taking the first steps toward an Residential Treatment Facility (RTF) Placement for my son who is currently in a 28-day MH Crisis unit after his two day stay in a juvenile detention center for simple assault.

Thinking of an Residential Treatment Facility (RTF) makes me very nervous, but there is NO WAY he can come home after this 28-day placement unless he decides to really make some serious progress for the next three weeks of his stay. All that are involved now agree that if he continues the way he is now it would not be safe for him to come home as he would only be a danger to himself and our family.

My question is this...does anyone have, or know of, a positive outcome after being in an Residential Treatment Facility (RTF)? Are there other options I should be asking about? Thanks for your help!


New Member

I am goping to PM you a link to an Residential Treatment Facility (RTF) here in PA that I am sending my son to on Monday. It's an 8 - 10 month intensive, theraputic facility aimed at teaching children how to deal with feelings of anger, aggression, frustration, etc.

I will tell you we are far from Pittsburgh, but it may be worth looking in to.



member since 1999
A ton of variables here. What would be a "positive outcome" in your eyes? What type of Residential Treatment Center (RTC) is being offered, and what is needed in your opinion?

My son has been in Residential Treatment Center (RTC)'s for over 7 years, just recently moved to a transitional living program. He was very unstable for many many years. We could not safely have him living at home. He is not cured but, for the moment, is making much better choices. His medications have been tweaked to be as good as I think they're going to get, after almost a decade. But most importantly, he has finally realized that his quality of life stunk in Residential Treatment Center (RTC) and, after years of trying to get him to understand that placement is based on his own choices, I think he's got it. I think... time will tell. We've have 2 previous discharges that lasted 3 months each before he completely dissolved into dangerous behavior again. I'll feel more comfortable that we've had a "positive outcome" the further past the 3-month mark we get - 10 weeks to go and counting.

I think I'm in the minority here but in my opinion our kids have to learn how to live with- their mental illness, whatever it may be. It eventually falls on their shoulders to use strategies that have been taught over and over and over, so that they can make better choices. My son has had to learn that he cannot, for example, throw furniture or take swings at people just because he was asked to do XYZ, or because he's having a bad day, or because... whatever. Yep, he's bipolar, no question. But if he wants to live in an unlocked facility, he needs to exert some self-control - and he is perfectly *capable* of exerting self-control, just not always willing. If he cannot, then the consequences and quality of life are not going to be what he wants.

If you go to general archives, there's a list of questions to ask potential RTCs. It's a good starting point, and then add your own.

Good luck.


New Member
My granddaughter had a successful placement at a residential facility 4 years ago. She spent almost 18 months at an all girls facility. Even when my funds ran out and she had to come home, there was no guarantee that anything would stick in the real world. However, she has weathered many storms (literally) and life changes since she came home and has done extremely well. I credit the change in her to a therapist that she could relate to, medication, maturity and time. She had many of the characteristics you describe of your son when she was placed at Residential Treatment Center (RTC). And now, she is a typical 18 year old, kind and considerate, happy, and well adjusted. I never thought it could happen as she had severe behavioral problems.

I hope your son gains the same benefits from his placement.


New Member
Wow! You all have been a great resource! I am happy to hear some positive outcomes and I will definitely check out the questions to ask Residential Treatment Facility (RTF)'s.

I guess, right now, the outcomes that I'm looking for would be: 1. He must acknowlege that he is responsible for his own actions and stop blaming everyone else for everything. He doesn't seem to ever say, "I screwed up..."
2. Living by house rules, school rules, and society's rules are non-negotiable. He truly believes that if we would all just do what he wants, his way, everything would be fine (very narcissistic).

3. He must accept there are consequences to his actions.

I think there's more, but I can't think of them right now.

I'm truly not sure if an Residential Treatment Facility (RTF) placement is the right thing to do at this time, but why would I want to wait for everything to get worse and maybe hopeless?? When I read other peoples experiences, ours really doesn't seem that bad. Unless, we're in the middle of a crisis, which over the summer hasn't been too bad but that's because he hasn't had the demands placed on him like he will when school starts again which I'm really nervous about.

We had our first family meeting today at the Respite and they agree that we should pursue an Residential Treatment Facility (RTF) placement (maybe I'm in a little bit of denial regarding how bad our situation is?). It will take a few months to get it together and there's a possiblity, with a lot of hard work, that he may not have to go by the time the placement is finalized. In that case, we'd just say no thanks.

Today I was told that his current/possible diagnosis is: ADHD, ODD (first time I actually heard that out loud referring to my son but I guess I'm not too surprised), and Mood Disorder (not otherwise specified) with rule out Bi-Polar I. This psychiatrist has only seen him once but I believe he's also relying a lot on what the counselors tell him since they observe my son 24 hours a day.

I just don't know what to do now, this may sound silly, but it seems like life with my difficult child is pretty ok until suddenly it's REALLY BAD and then it just all falls apart. It's not a constant that things are bad with him.

When he comes out of this placement while we're pursuing the Residential Treatment Facility (RTF), we're going to continue the wrap-around four hours per week (it's also continuing while he's there) and we're going to add drug and alcohol counseling. Thankfully, the director at the center recognizes that although we caught him fairly soon (three weeks) after he started self-medicating, he does have an addictive personality and without some D&A intervention we will surely find ourselves in more trouble. So far, I'm happy with this director and feel confident that she knows what she's talking about. Time will tell.


I don't want to "burst your bubble" but my son has been at 2 facilities, one residential and 1 group home, had been away from home for a total of about 2 1/2 years(on and off) left one facility, came home, had to go back in again, came home last August. From your list of expectations, my son learned(or chooses not to)none of those things you ask. Actually, he knows rigth from wrong, but refuses to follow my rules. Hates me and wishes I wasn't his mother! The placements were good, but only kept him safe, he must choose to do the right thing on his own. He oculdn't live with me, so had to live somewhere. It is more of a long respite and although the therapists are good, if the child has serious issues that will never go away, I don't think any facility can change him. My son suffers from abandonment from his dad and nothing will change that. He learned anger management,etc. and we had lots of family therapy, he just can't get past his issues. Has ODD and not much else. Can control himself, but hate sme too much. Refuses to follow rules, thinks he is entitled to everything and would be content if he got what he wanted.
I truly hope you have good luck, I was lucky at least I choose good placements for him and he was safe, but he will be 18 next May, I am truly scared of what will happen, he is as bad as he was at age 12.
I like to hear the success stories, gives me hope.
Good luck.


New Member
My daughter is in a 6 month PRTF program right now (2 months into it). The very tricky thing for us is that she always claims that she is "better" and "just fine" and no longer suicidal. BUT, she has been hospitalized 10 times in the past year for suicidal ideation and self-injury and each time she is discharged, she always "wows" the treatment team with her self-reported improvements, newly found self-confidence and assurances that she will confide in others if she starts to crash again BEFORE it reaches crisis stage.. And guess what, she unfortunately can't keep her word.

Tonight she was complaining to me that it is wrong for us as parents as well as her treatment team to be making decisions about how long she needs to stay anywhere as SHE is the only one who knows she is better. If we defer judgement to better qualified mental health professionals, she counters that the last ten times they didn't exactly keep her safe and "cured".

If the issue was poor educational performance or lacking social skills, it wouldn't be such a gamble to decide when she should come home. But with a child who has been seemingly continuously suicidal for nearly a year and has attempted suicide - it is a VERY scary decision to make. Also, she is VERY intelligent and savvy about the therapeutic process - she can tell everyone exactly what they want to hear and change her scores on assessments to show improvement. But is she really better? She has always admitted to being a very successful manipulator...

Her case manager (and we as parents) feel that we need to err on the side of being conservative. Going directly from a secure psychiatric structured environment to home at a new high school (after missing most of 8th grade) seems to be a recipe for sure failure.

Anyone else with experience trying to decide how to "step down" through levels of care safely without driving your child mad because they want to be home NOW???


New Member
Thanks for all of your feedback. There's a lot of good information here. SLSH, I agree with you. They need to be able to live in the real world, getting it "right" while at a placement doesn't count for much if they can't do the same at home. Unfortunately, right now, my difficult child doesn't seem to be getting right even at this respite center. He's not following the rules (keeping his room clean, participating in group, etc).

Peg2, my son sounds very much like yours. My son fluctuates from hating me to hating my husband. My difficult child has never had a normal relationship with his dad and it was very bad when my son was very young...maybe that has affected him forever??? There is talk of him being diagnosed with a cluster b personality disorder. This breaks my heart.

Yesterday he called to find out if he could come home for a visit this weekend. I said that I wasn't sure because I need to talk with his lawyer who is on vacation this week. Then I went on to say that there would be changes here. When he demanded to know what, I explained that the rules that have always been in place will be more vigorously enforced and a few will be added.

He was very unhappy about this, eventually hung up on me, and went into the director's office and told her that he doesn't want to come home because he refuses to follow our rules.

I am sick about this. Obviously, he doesn't get it and I'm feeling right now like he never will. If he can't accept responsibility for his actions and refuses to follow our rules, he cannot come home. I feel we will all be in danger the first time he's not allowed to do something he wants. So....where does he go until an Residential Treatment Facility (RTF) is available for him? Right now it seems like our only option is a shelter.

I don't have any family that can take him and I don't think his dad would be a good option. He (his dad) has porn all of the house, has been in and out of jail himself, and has serious substance abuse problems (I don't know if he still uses or not). He's never been involved in difficult child's life except the occasional weekend to swoop in and make me look like a meanie.

I have about two weeks to decide what to do and I am sick, feel very lonely, and that the weight of the world is on my shoulders.