Therapeutic Boarding School Hell
July 29, 2024 9:36 AM Subscribe
Please, please, please...no judgmental comments.
Our 13 year old daughter has histrionic personality disorder, and we want desperately to get her help before it tears our family apart. We have tried EVERYTHING, including meds, counseling, and therapy, but the onset of puberty has made things exponentially worse, and we fear that it's only a matter of time before her behavior causes her irreparable harm.
We've tried in vain to find a reputable residential program where she can get the help she needs, but the horror stories about the "Troubled Teen Industry" are absolutely terrifying. Any advice or suggestions would be greatly appreciated. We're located in Atlanta, but at this point, would be willing to look at out-of-state solutions, as well (except Utah...God, there are so many bad stories about the "schools" there).
FWIW (and just to show you how desperate we are) the most expensive option that we've looked at is Applewood Academy in Ontario, which charges $89,000/year (CAD)...it would be charitable to call that a stretch for us financially, but we could [probably] make that work even though that's probably the top of our price range.
I don’t know anything about Applewood, but Belleville is in the middle of a really bad opioid crisis. I would definitely ask staff (and parent providers if they have those at this facility) how they are making sure the kids don’t get mixed up in it (Belleville is not that big.)
As someone who lives in Scarborough and doesn’t particularly worry (beyond the usual) about either my kids and drugs or the ways neighborhoods and drugs work, Belleville actually worried me the last time I was there (last fall) and made me wish I’d brought my naloxone kit. I’m sorry because I’m sure this is a hard decision and I don’t want to add to your worries but the combination of lack of housing and being a kind of way station between big cities means a lot of open drug use on the street..more than I’d seen in my life. If the school is really good at keeping track of the kids of course that’s less of an issue.
posted by warriorqueen at 10:29 AM on July 29 [4 favorites]
As someone who lives in Scarborough and doesn’t particularly worry (beyond the usual) about either my kids and drugs or the ways neighborhoods and drugs work, Belleville actually worried me the last time I was there (last fall) and made me wish I’d brought my naloxone kit. I’m sorry because I’m sure this is a hard decision and I don’t want to add to your worries but the combination of lack of housing and being a kind of way station between big cities means a lot of open drug use on the street..more than I’d seen in my life. If the school is really good at keeping track of the kids of course that’s less of an issue.
posted by warriorqueen at 10:29 AM on July 29 [4 favorites]
perhaps consider a boarding school not specifically focused on therapy? my understanding of such places is partly based on The Holdovers, yet they generally seem to be well-resourced & would hopefully be able to assist. is your daughter involved in the search process? if not & there are a few options, you could see if she has a preference.
posted by HearHere at 10:57 AM on July 29
posted by HearHere at 10:57 AM on July 29
I unfortunately have some direct experience in this area, if you want to drop me a line through my profile.
posted by chesty_a_arthur at 10:58 AM on July 29 [2 favorites]
posted by chesty_a_arthur at 10:58 AM on July 29 [2 favorites]
Applewood is notoriously abusive. Children's Hospital of Atlanta is good.
posted by PinkMoose at 11:05 AM on July 29 [3 favorites]
posted by PinkMoose at 11:05 AM on July 29 [3 favorites]
Prior recent question on similar topic
(NOT a psychologist at all, but:) I always thought histrionic wasn't usually diagnosed until at least 18. Alarmingly, when I google the diagnosis + "teenager" the front page of results is almost all creepy-looking boarding schools. 13 seems unbelievably young for it; so many of the diagnostic criteria could include conduct not far out of range for teenagers, especially ones who've been traumatized. I am not criticizing you at all--I'm sure whatever the behaviors are are bewildering and disturbing and you're obviously seeking professional help--but how confident are you in the actual diagnosis?
posted by praemunire at 11:13 AM on July 29 [24 favorites]
(NOT a psychologist at all, but:) I always thought histrionic wasn't usually diagnosed until at least 18. Alarmingly, when I google the diagnosis + "teenager" the front page of results is almost all creepy-looking boarding schools. 13 seems unbelievably young for it; so many of the diagnostic criteria could include conduct not far out of range for teenagers, especially ones who've been traumatized. I am not criticizing you at all--I'm sure whatever the behaviors are are bewildering and disturbing and you're obviously seeking professional help--but how confident are you in the actual diagnosis?
posted by praemunire at 11:13 AM on July 29 [24 favorites]
Someone in my family had a good experience at the Menninger Clinic. They were in the young adult program but there is also a lower-age program; I don't know what age the cutoff is.
posted by BlahLaLa at 11:25 AM on July 29 [2 favorites]
posted by BlahLaLa at 11:25 AM on July 29 [2 favorites]
I do feel you should focus on inpatient treatment, not a school.
I want to echo this important comment.
I'm not going to say that a "therapeutic school" is always bad; I will say that such schools often sell themselves as the solution to problems they're not suited for, which at worst results in an abusive and traumatizing experience for the child who was sent there, and at best results in the child failing out, returning home, and being where they started.
You have not said that this was recommended by an expert in treating the kinds of problems that your child has, nor how you got that diagnosis (do you have a second opinion). What you are considering here is drastic, potentially devastating, and it would be absolutely your responsibility to (a) make sure that the professional consensus is that the diagnosis is accurate and that this is a choice that is the most beneficial to your child, not a choice that you're making because you can't deal with her, and (b) that you do intensive research on any school you're considering, keeping in mind that abuse is often covered up, that teens coming out of these schools often don't have avenues to share their stories, and that you might never be 100% sure.
I will say that as someone who briefly went to a boarding school (not therapeutic) because my parents were desperate, and who actually liked the school and had a lot of respect for it, it was still incredibly difficult. And I was pretty well-adjusted apart from some possible add (I went because I had chronic health issues public schools wouldn't/couldn't accommodate). I burned out and had a nervous breakdown when I was supposed to go back for the new semester, because the environment was just so drastically unsuited for me. And that was a school that, again, was not abusive.
Again, is a school what she needs and not an inpatient program.
posted by Kutsuwamushi at 11:31 AM on July 29 [15 favorites]
I want to echo this important comment.
I'm not going to say that a "therapeutic school" is always bad; I will say that such schools often sell themselves as the solution to problems they're not suited for, which at worst results in an abusive and traumatizing experience for the child who was sent there, and at best results in the child failing out, returning home, and being where they started.
You have not said that this was recommended by an expert in treating the kinds of problems that your child has, nor how you got that diagnosis (do you have a second opinion). What you are considering here is drastic, potentially devastating, and it would be absolutely your responsibility to (a) make sure that the professional consensus is that the diagnosis is accurate and that this is a choice that is the most beneficial to your child, not a choice that you're making because you can't deal with her, and (b) that you do intensive research on any school you're considering, keeping in mind that abuse is often covered up, that teens coming out of these schools often don't have avenues to share their stories, and that you might never be 100% sure.
I will say that as someone who briefly went to a boarding school (not therapeutic) because my parents were desperate, and who actually liked the school and had a lot of respect for it, it was still incredibly difficult. And I was pretty well-adjusted apart from some possible add (I went because I had chronic health issues public schools wouldn't/couldn't accommodate). I burned out and had a nervous breakdown when I was supposed to go back for the new semester, because the environment was just so drastically unsuited for me. And that was a school that, again, was not abusive.
Again, is a school what she needs and not an inpatient program.
posted by Kutsuwamushi at 11:31 AM on July 29 [15 favorites]
I live in Ontario. I do not trust the Ontario government to ensure there is appropriate supervision of a remote residential school here.
posted by grouse at 11:38 AM on July 29 [9 favorites]
posted by grouse at 11:38 AM on July 29 [9 favorites]
I agree with thinking more about the diagnosis, but regardless:
- Inpatient care is typically only for individuals who are actively a danger to themself or others, e.g. current active plan and intent to harm; inpatient stays are usually a few days to a few weeks at most and focus on stabilization
- Residential mental health programs involve individuals living on a mental health unit for several months while focusing on intensive treatment
- Partial hospitalization programs (PHP) lets individuals live at home but they attend a full 6-8 hour day of mental health treatment every weekday for weeks to months
- Intensive outpatient programs (IOP) lets individuals live at home and largely continue their normal activities but they attend 2-3 hours of intensive treatment every weekday (usually in the evenings) for weeks to months
- Therapeutic boarding schools focus on academics while providing mental health support but not intensive treatment for the duration of a school year
If your daughter is not an immediate and present risk to herself and others (I suspect not based on "a matter of time" phrasing), then she likely would not qualify for inpatient care. However, residential, PHP, or IOP could be an excellent fit, and I would consider any of those above a therapeutic boarding school. Residential mental health treatment, PHP, and IOP may all be covered by insurance as well, while therapeutic boarding schools typically are not. Residential mental health programs also typically participate in some kind of accreditation or standard of care process with an outside entity (such as Joint Commission) that you can ask about to ensure they are being regularly monitored and providing good patient care.
There are typically not residential/PHP/IOP programs for specific personality disorders; DBT treatment is considered the gold standard for the most common PDs, so most programs specialize in providing that for a range of diagnoses. Searching for "adolescent DBT residential treatment" should get you a number of options.
posted by brook horse at 11:48 AM on July 29 [27 favorites]
- Inpatient care is typically only for individuals who are actively a danger to themself or others, e.g. current active plan and intent to harm; inpatient stays are usually a few days to a few weeks at most and focus on stabilization
- Residential mental health programs involve individuals living on a mental health unit for several months while focusing on intensive treatment
- Partial hospitalization programs (PHP) lets individuals live at home but they attend a full 6-8 hour day of mental health treatment every weekday for weeks to months
- Intensive outpatient programs (IOP) lets individuals live at home and largely continue their normal activities but they attend 2-3 hours of intensive treatment every weekday (usually in the evenings) for weeks to months
- Therapeutic boarding schools focus on academics while providing mental health support but not intensive treatment for the duration of a school year
If your daughter is not an immediate and present risk to herself and others (I suspect not based on "a matter of time" phrasing), then she likely would not qualify for inpatient care. However, residential, PHP, or IOP could be an excellent fit, and I would consider any of those above a therapeutic boarding school. Residential mental health treatment, PHP, and IOP may all be covered by insurance as well, while therapeutic boarding schools typically are not. Residential mental health programs also typically participate in some kind of accreditation or standard of care process with an outside entity (such as Joint Commission) that you can ask about to ensure they are being regularly monitored and providing good patient care.
There are typically not residential/PHP/IOP programs for specific personality disorders; DBT treatment is considered the gold standard for the most common PDs, so most programs specialize in providing that for a range of diagnoses. Searching for "adolescent DBT residential treatment" should get you a number of options.
posted by brook horse at 11:48 AM on July 29 [27 favorites]
See if there is a local chapter of the We Are Brave Together support group. Parents in your area may be a better resource for connecting you with programs and providers their families have experienced directly. They can also give you some support of your own, without a lot of judgement and second-guessing.
posted by corey flood at 12:01 PM on July 29 [4 favorites]
posted by corey flood at 12:01 PM on July 29 [4 favorites]
I live in Ontario. I do not trust the Ontario government to ensure there is appropriate supervision of a remote residential school here.
The Ontario government does not oversee private schools, except to ensure that they meet curriculum requirements and evaluation practices if granting the OSSD (high school diploma.) They do not inspect condition of premises, health and safety practices, or staffing. (Source.)
posted by warriorqueen at 12:52 PM on July 29 [4 favorites]
The Ontario government does not oversee private schools, except to ensure that they meet curriculum requirements and evaluation practices if granting the OSSD (high school diploma.) They do not inspect condition of premises, health and safety practices, or staffing. (Source.)
posted by warriorqueen at 12:52 PM on July 29 [4 favorites]
I have personal experience as a therapist intern at a psychiatric medical institution for children (PMIC), which is what long-term (6mo to 2 years) residential inpatient care for children with mental health diagnoses and co-occurring behavioral challenges is called in the state of Iowa. Please feel free to MeMail me--I am happy to help you do research into this path in your state.
PMICs are licensed, have staff trained in mental health as well as a therapist for each residential unit of 12 children, children meet with a staff psychiatrist at least monthly (more often if needed). There are specific regulations and protocols on restraint and seclusion and records are kept; parents are able to see these records. No matter where you and your child are considering, ASK LOTS OF QUESTIONS about restraint and seclusion--this is the most dangerous aspect of legitimate treatment, and reputable facilities should be able to answer your questions.
posted by epj at 1:30 PM on July 29 [13 favorites]
PMICs are licensed, have staff trained in mental health as well as a therapist for each residential unit of 12 children, children meet with a staff psychiatrist at least monthly (more often if needed). There are specific regulations and protocols on restraint and seclusion and records are kept; parents are able to see these records. No matter where you and your child are considering, ASK LOTS OF QUESTIONS about restraint and seclusion--this is the most dangerous aspect of legitimate treatment, and reputable facilities should be able to answer your questions.
posted by epj at 1:30 PM on July 29 [13 favorites]
I really like the idea of connecting with local parents group if you can find it. Surely some bad and some good advice there but easier to evaluate from people you can dialog with locally. Maybe asking for names of groups/resources from local pediatric clinic or children's hospital social workers though that is very hit and miss.
Wishing you the best - this must be incredibly heartbreaking and challenging. I know how shitty it can feel to get buckets of unsolicited advice and little that is actually helpful and actionable. One day at a time.
posted by latkes at 2:02 PM on July 29
Wishing you the best - this must be incredibly heartbreaking and challenging. I know how shitty it can feel to get buckets of unsolicited advice and little that is actually helpful and actionable. One day at a time.
posted by latkes at 2:02 PM on July 29
Echoing others that residential, partial hospitalization, or intensive outpatient might be more appropriate than those boarding schools. I unfortunately have become familiar with mental health facilities in Atlanta. Hillside has residential and day treatment DBT programs for adolescents that might be appropriate. Summit Ridge and Ridgeview both have residential, PH, and IO programs for adolescents. I can never keep those two straight in my head. It looks like Ignite at the Berman Center starts at age 14, so not appropriate yet.
posted by hydropsyche at 2:07 PM on July 29 [4 favorites]
posted by hydropsyche at 2:07 PM on July 29 [4 favorites]
Longer term care treatment should be only concidered when all other shorter term options have been tried and failed. This includes inpatient hospitalization and php and iop programs. Removing a child from their supports ( parents, friends, school) should really only be a last resort of last resorts.
13 is young and you do need to concider that most of the programs will be housing children 13 to 17 and there is a huge difference between 13 and 17 year olds and it isn't uncommon for children to learn behaviors from eachother. And those children are all going to be very sick kids. Children in these facilities will witness all the things that children with severe behavioral health concerns will do like self harming behaviors ( cutting, head banging and so forth), agression ( yelling, verbal threats, physical threats, physical violence), children breaking down in strong emotions, children having panic attacks. They will talk about unsafe sex, they will talk about drugs, and all kinds of other stuff.
That being said, some children do need longer term structured programs.
Things to concider: is it connected to a reputable medical system?
What are visitation policies? For a location that is not local how well you travel and how often? Is your child safe enough to travel? Seclusion and restraints policies are so very very important. Do they inform you of behavioral incidents?
Any program should be able to articulate after the initial assessment treatment plan goals. What improvement are you looking for? What is the targeted, individualized care? These should be evidenced based interventions. Look at the group content. Who runs the groups? If you don't know, ask one of your current providers if it is evidence based. How often do they see a psychiatrist? How do they involve you? Are they willing to talk to you all about possible parenting changes? Using new strategies to work with your child and their condition? Do they use incentives or restrictions? What do those look like?
A good facility isn't going to make huge promises of magic turnaround. They are going to talk about skills and resources, they are going to talk about accomidations and return to their normal lives as quickly as possible even if it takes a long time. They are going to want family involvement.
Staff retention is a big clue, so something to look into on glassdoor and other employment sites.
During intake there should be talk to assess for an appropriate level of care. There should be no promises that this is the perfect place for your child.
Your current treatment team should be 100% on board with whatever you choose there should be coordination of care. They should be requesting records and releasing records with your permission so that when your child leaves there is a plan in place.
posted by AlexiaSky at 3:59 PM on July 29 [10 favorites]
13 is young and you do need to concider that most of the programs will be housing children 13 to 17 and there is a huge difference between 13 and 17 year olds and it isn't uncommon for children to learn behaviors from eachother. And those children are all going to be very sick kids. Children in these facilities will witness all the things that children with severe behavioral health concerns will do like self harming behaviors ( cutting, head banging and so forth), agression ( yelling, verbal threats, physical threats, physical violence), children breaking down in strong emotions, children having panic attacks. They will talk about unsafe sex, they will talk about drugs, and all kinds of other stuff.
That being said, some children do need longer term structured programs.
Things to concider: is it connected to a reputable medical system?
What are visitation policies? For a location that is not local how well you travel and how often? Is your child safe enough to travel? Seclusion and restraints policies are so very very important. Do they inform you of behavioral incidents?
Any program should be able to articulate after the initial assessment treatment plan goals. What improvement are you looking for? What is the targeted, individualized care? These should be evidenced based interventions. Look at the group content. Who runs the groups? If you don't know, ask one of your current providers if it is evidence based. How often do they see a psychiatrist? How do they involve you? Are they willing to talk to you all about possible parenting changes? Using new strategies to work with your child and their condition? Do they use incentives or restrictions? What do those look like?
A good facility isn't going to make huge promises of magic turnaround. They are going to talk about skills and resources, they are going to talk about accomidations and return to their normal lives as quickly as possible even if it takes a long time. They are going to want family involvement.
Staff retention is a big clue, so something to look into on glassdoor and other employment sites.
During intake there should be talk to assess for an appropriate level of care. There should be no promises that this is the perfect place for your child.
Your current treatment team should be 100% on board with whatever you choose there should be coordination of care. They should be requesting records and releasing records with your permission so that when your child leaves there is a plan in place.
posted by AlexiaSky at 3:59 PM on July 29 [10 favorites]
First of all just wanted to nth everything that brook horse said about residential/partial/IOP treatment being what you should focus on (assuming she is not a danger to herself/others).
In terms of specific programs, I would look at Mclean Hospital, especially their 3East DBT program for adolescents. The quality of care is very high there, and I know someone who had a good experience in that specific program. However, a lot of residentials at Mclean do not take insurance. Residential therapy is going to be VERY expensive without insurance.
posted by litera scripta manet at 6:48 PM on July 29 [2 favorites]
In terms of specific programs, I would look at Mclean Hospital, especially their 3East DBT program for adolescents. The quality of care is very high there, and I know someone who had a good experience in that specific program. However, a lot of residentials at Mclean do not take insurance. Residential therapy is going to be VERY expensive without insurance.
posted by litera scripta manet at 6:48 PM on July 29 [2 favorites]
Just wondering if you have tried a BCBA behaviour consultant, combined with a psychologist or psychiatrist, and in-home supports, such as support workers and tutors, who carry out plans. It would be more connected to your daughter, family and community and you could see if she’s safe. I also wonder if you have ruled out neurodevelopmental disabilities, which are often missed in girls.
posted by shockpoppet at 9:12 PM on July 29 [1 favorite]
posted by shockpoppet at 9:12 PM on July 29 [1 favorite]
I’m a therapist (IANYT) and this is not a comment on the severity of her behaviors or symptoms (kids can have scary-intense behaviors when they’re in a mental health crisis), but: I’m immediately very concerned to see a 13-year-old described as having a personality disorder. Teens are still figuring out how to operationalize their personalities—they don’t fully know who they are, they desperately want to know how to relate to others as adults (but don’t), and they don’t have a complete frontal cortex yet. It’s not that 13 is too young to tell what personality diagnosis is lurking inside the person, it’s that 13 is too young for the person to have the necessary psychological ingredients for a personality disorder. Lots of teens have behaviors and symptoms consistent with personality disorders. It’s developmentally pretty normal, and even if there are big outrageous behaviors, it’s not appropriate to call this work-in-progress personality “disordered.” It’s too soon to tell, and weird to use such a final, stigmatized diagnosis to a kid who needs help with their mental health. Someone who has the symptoms of a personality disorder after they are a grown adult meets criteria for the diagnosis because that’s not developmentally normal. I would really encourage you to at least ask her current therapist (or whichever provider used that diagnosis for her) to explain why they’re using a diagnosis that’s not intended for teens, but ideally look into an inpatient treatment option if she truly can’t be safe at home.
If you haven’t already had her tested for autism I would absolutely start there. Autism in women is often misdiagnosed as a personality disorder, so whoever applied the term histrionic personality disorder to her might have been picking up on some behaviors that were meltdowns rather than tantrums or social difficulties rather than defiance, and just didn’t connect the dots to autism. This is not a diagnosis. I have no idea if she’s autistic. It’s just a pattern I’ve seen play out often enough to suggest having her tested.
posted by theotherdurassister at 12:19 AM on July 30 [43 favorites]
If you haven’t already had her tested for autism I would absolutely start there. Autism in women is often misdiagnosed as a personality disorder, so whoever applied the term histrionic personality disorder to her might have been picking up on some behaviors that were meltdowns rather than tantrums or social difficulties rather than defiance, and just didn’t connect the dots to autism. This is not a diagnosis. I have no idea if she’s autistic. It’s just a pattern I’ve seen play out often enough to suggest having her tested.
posted by theotherdurassister at 12:19 AM on July 30 [43 favorites]
Also a therapist, and I cosign on to the statement above from theotherdurassister
posted by bearette at 4:35 AM on July 30 [10 favorites]
posted by bearette at 4:35 AM on July 30 [10 favorites]
As a former boarding school teacher and autistic woman, third cosign.
Get her evaluated for autism before you send her anywhere. Just to check. A lot of parents have trouble with undiagnosed neurdivergent kids, not know how to deal since they don't know what it is they are dealing with, so they send them to boarding school. Where I taught quite a few of them. It doesn't help the relationship between parent and child, and if it ends up working out for the kid is a total toss up.
posted by wellifyouinsist at 9:49 AM on July 30 [10 favorites]
Get her evaluated for autism before you send her anywhere. Just to check. A lot of parents have trouble with undiagnosed neurdivergent kids, not know how to deal since they don't know what it is they are dealing with, so they send them to boarding school. Where I taught quite a few of them. It doesn't help the relationship between parent and child, and if it ends up working out for the kid is a total toss up.
posted by wellifyouinsist at 9:49 AM on July 30 [10 favorites]
Please MeMail me if you would like to hear about my experiences as a parent with a variety of treatment places in the US. Speaking strictly about my own experiences, I was a single parent, I was super reactive, and I had my own mental health challenges (ADHD and anxiety, primarily). At the time, I was completely unequipped to cope with a child eventually diagnosed with bipolar disorder partly because of my own issues and partly because I had been raised by young, emotionally immature parents. Plus I was poor. My relationship with my kid was fractured for many years after but at the time I saw no other option. I expected one or both of us to end up seriously injured or dead. You are facing a hard, hard thing. Sending you virtual hugs if you want them and my support. All we can do is our best. Sometimes that is not good enough and yet, that is all we have.
posted by Bella Donna at 7:35 AM on July 31 [5 favorites]
posted by Bella Donna at 7:35 AM on July 31 [5 favorites]
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Out of state, CHOP is considered one of the best children's hospitals in the US and are one of the very few that have an inpatient program.
I do feel you should focus on inpatient treatment, not a school. She can miss school (though I assume these programs provide some form of schooling when possible); getting stabilized comes first.
I'm sorry, I know this is incredibly difficult to navigate.
posted by Lyn Never at 9:52 AM on July 29 [16 favorites]