Reputable residential psychiatric treatment for 16-year-old
January 8, 2019 1:27 PM   Subscribe

I am searching for a short-term residential placement for my 16-year-old, who is currently a danger to himself and us. Right now he is on the psych ward of the local hospital, which is more a holding pen than a therapeutic environment. His long-time psychiatrist is adamant that it's too dangerous for him to be at home. His issues are with impulsive aggressive behavior toward other family members and property destruction (including setting fires). He does not use illegal drugs or alcohol.

Internet searching shows dozens of places, most of which are not acceptable to us. We are NOT looking for anything that involves "wilderness", "boot camp", "tough love", or anything punitive. We ARE looking for medical evaluation and treatment in a therapeutic setting and evidence-based psychological treatment. His doctor suggested the Menninger Clinic in Houston, but I'd like to know what other options are. We are in Florida but can go anywhere in the US if necessary. We have decent insurance and could also self-pay if required. If you've had personal experience with this kind of setting, any information you can offer would be helpful.
posted by anonymous to Health & Fitness (18 answers total) 2 users marked this as a favorite
I'm so sorry you're in this place. While I haven't been exactly there, I do have some information or resources I might be able to share. Please feel free to drop me a line.
posted by chesty_a_arthur at 1:35 PM on January 8, 2019

I interned at a PMIC (psychiatric medical institute for children) in Iowa, which is a state-funded, privately run long-term residential treatment facility for children ages 5-17 with psychiatric diagnoses and challenging behaviors. It sounds like this type of program would be a good fit for your child. You may wish to investigate if these facilities exist in Florida, under this or another name. Residential treatment can be very expensive and Medicaid covered all the children residing with us, either immediately upon entry or when their private insurance stopped paying. Feel free to MeMail me if I can be of further help. I’m pulling for your family!
posted by epj at 1:37 PM on January 8, 2019 [1 favorite]

Is the issue that his safety requires a higher level of therapeutic and psychiatric attention than you can provide with weekly appointments etc? Or is it that he needs to be under lock and key, and can't be outside an institution even briefly?

If having him home at night and in a supportive program all day every day is an acceptable outcome, then you can consider intensive outpatient programs and partial hospitalization programs. My experience as a patient is that those are often less holding-pen-like than inpatient programs. They're also more geared towards longer stays. And at least for me, insurance likes them better: I have trouble getting my insurance to cover three days inpatient, but they're happy to cover three weeks of partial hospitalization.

Obviously, if the issue is that he needs to be under lock and key, then disregard this, trust your judgment, and go full inpatient.
posted by nebulawindphone at 1:55 PM on January 8, 2019

McLean Hospital in Massachusetts (near Boston) offers inpatient psychiatric care for adolescents. It has a good reputation generally but I don't have personal experience with its adolescent programs.
posted by praemunire at 1:56 PM on January 8, 2019 [6 favorites]

Friends have had great experiences with this one near me, but I have no idea if it's special/ different enough to warrant the long distance.

I'm sorry that the doctor is not more helpful in generating options, and that you are going through this.
posted by metasarah at 2:27 PM on January 8, 2019 [1 favorite]

Can your child go to short term impatient locally while you figure out long-term?
posted by heathrowga at 2:50 PM on January 8, 2019

I actually clicked through to suggest Menninger if you (and they) have the resources.

They have a good reputation and are the only clinic I know of that provides anything close to a living environment that makes it easier, rather than harder, to successfully approach remission. Although there aren't single rooms, fyi.
posted by Verba Volant at 3:47 PM on January 8, 2019 [1 favorite]

My family also had a good, positive experience with Menninger. It costs a bundle, but was worth it in our case. (And we had the ability to pay for it.)
posted by BlahLaLa at 4:03 PM on January 8, 2019 [1 favorite]

I'm not familiar with The National Association of Therapeutic Schools and Programs (NATSAP), but it may be able to help you find a consultant to help assess your situation and make recommendations, and they have a list of programs and other informational resources on their website. I strongly recommend consulting someone with appropriate credentials and expertise to help you make a decision.
posted by Little Dawn at 4:44 PM on January 8, 2019

My family also has experience with Menninger. My family member was willing to (and continues to) do the hard work, and it saved her life to go there.
posted by Sauter Vaguely at 5:48 PM on January 8, 2019 [1 favorite]

Keep in mind that there is a big difference between an inpatient program (such as Menninger), which is part of a psychiatric hospital, and a residential therapeutic program (such as what Little Dawn linked to, and what it sounds like your googling has turned up). Since you say "short term" and your doctor suggested Menninger, I'm guessing that your son requires an inpatient psychiatric placement . If that's the case, you should focus your search on highly ranked psychiatric hospitals , most of which are affiliated with academic institutions (e.g. Mass General/Harvard, New York Presbyterian/Weill Cornell & Columbia, Johns Hopkins Hospital).
posted by scalar_implicature at 6:29 PM on January 8, 2019 [3 favorites]

McLean Hospital in Massachusetts (near Boston) offers inpatient psychiatric care for adolescents. It has a good reputation generally but I don't have personal experience with its adolescent programs.

I do, it's quite good and really is one of the more innovative without being "woo" places in the New England area. I know you are not in the New England area but it might be worth it. I do not have experience with Menninger. If this is a new issue, I'd also strongly suggest making use of the local NAMI support groups. People there may have other ideas and it's nice to know you are not alone when you are dealing with something like this.
posted by jessamyn at 6:48 PM on January 8, 2019 [2 favorites]

Nthing Menninger and McLean, and adding recommendations for Silver Hill and Lindner.
posted by gollie at 8:09 PM on January 8, 2019

Adding Hillside in Atlanta as well. They do really excellent work.
posted by gollie at 8:14 PM on January 8, 2019

I don't have program recs, but wanted to suggest asking:
-Your health insurance
-Your son's IEP team
-The PTI and/or CPRC that serves your county; there are five in Florida, and you can find the right one at this link.
posted by Snarl Furillo at 2:24 AM on January 9, 2019

As a larger picture thing to look at, consider contacting your state's Department of Human Services and checking there for resources, including getting your son evaluated for state level disability programs and similar. Once in that system, ask for a case manager for him and see what that person can tell you.
posted by bile and syntax at 5:50 AM on January 9, 2019

My heart goes out to you. I've been dealing with a very similar situation for almost a year now. Here's what I've found out in recent research in looking for a place for my 14yo - she's been on an acute unit for the past 5 weeks (this is her fourth hospitalization in 8 months). I've been looking looking for residential programs, as well as school programs.

McLean won't take any kid in their 3East program that is aggressive because they don't have a locked unit. Their feeling is that it's detrimental and traumatic to the other patients and they are not set up for it in terms of security. They require that the kid be willing to attend, and will interview the kid a week prior to having a bed available to confirm their willingness and understanding of the program. They also usually have a wait. The first eight weeks runs about $80k and it's not covered by insurance.

Silver Hill is absolutely beautiful (she was there for a month back in July). They have an acute floor and a DBT house (called K House). K house is about $32k for a month (again, self-pay). Again, not set up for any aggressive behavior and the kid has to be entirely willing. My daughter was deemed not acceptable for the program because she 'didn't successfully complete the program' the last time she went (she refused to go to the DBT house because she didn't agree to the rules).

There is a place called the O School in Chicago that looks pretty promising. It touts itself as taking kids that would normally have to be sent to hospitals, or are high risk. I don't know about cost, as they're next on my list. They do have a page on their site (I think it's on their blog section) that specifically lays out the difference between Therapeutic Schools, Residences, etc. A good and valuable read.

When I spoke to McLean, the admissions LSW suggested that I look into contacting an Education Consultant. These are people that are specifically well-versed in finding facilities appropriate for our kid's needs/situations. I will also point out to you that she specifically brought up the issue of transportation and the likely need of hiring someone to assist in doing this. There are companies that do just this - whether by air or land.

This is such a long and lonely road. I hope you find what your son needs and your are able to get him the right help. Big hugs to you.
posted by dancinglamb at 4:11 AM on January 11, 2019

One other thing that I forgot to mention. Since he is currently on an acute unit, you need to find out what his doctor is asking for. Are they requesting a lateral transfer to another acute unit for stabilization or are they recommending a subacute step-down unit? In order to be transferred to another acute location, it needs to be justifiable (this has been one of our roadblocks).

Also, what is your son's current legal status? Has he been determined to be involuntarily committed by his doctors (and how does that transfer between states - because it's not the same time line for court reviews across all of them). How often is this reviewed? One thing you need to especially need to find out is **what is the timeline for parental discharge** if you find that you don't like wherever you send him. In some states it's less than 24hrs, others it's 72hrs.
posted by dancinglamb at 4:43 AM on January 11, 2019 [1 favorite]

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