Residential Treatment: When Holding On Means Letting Go

–by Sara Borgstede

This was originally posted on the author’s website, The Holy Mess – Balancing Faith, Family, and Fitness, on June 4, 2017.

As we drive through the beautiful rolling hills of western New York, my husband reaches over to grasp my hand. I glance over and see a stream of tears run down his cheek as he navigates the car.

My eyes are dry. I’ve cried so much over these days, I have no tears left.

We are driving our son to the residential treatment center where he will live for the next year, and each mile takes our boy farther away from home. How is it possible that loving someone means days like today — when holding on means letting go?

Residential Treatment: Never the Goal

 No one gives birth or adopts a child with the hope that residential treatment will be in the picture someday.

Residential treatment is when a child lives in an institutional setting 24 hours a day/7 days a week under careful supervision.

What’s ironic and unfortunate is that kids do better in families. Certainly, children with attachment issues NEED to be with families.

How will my son learn to attach to his parents if he is not with his parents?

Yet there often comes a day when safety supersedes all else. Yes, the goal is family preservation, but not at any cost.

Residential treatment wasn’t initially in our plans, but for the last several years we have know this was most likely coming for our son. These last few years his behavior has continued to spiral out of control.

Therapy and tight supervision helped. We saw progress. Improvements were made.

Then — one afternoon our son made an incredibly poor decision, shifting our whole world dramatically and instantly.

For the sake of our family’s privacy, I’m sure you understand that I don’t share specifics. In my last post I told about one mom’s courageous story of living with her son’s behaviors. This gives a realistic idea of the types challenges we face.

Residential Treatment: Nearly Impossible to Obtain

When parents feel their child needs residential treatment, what are the next steps?

Unfortunately, the path from when parents make the decision to place their child in residential treatment, and when a child actually goes to residential treatment, is often a winding, bumpy road. We knew getting a child into residential treatment was challenging, but we had no idea just how difficult the steps involved.

As one therapist told us, “What we do to parents in our country who are seeking treatment for their children with mental health issues – it borders on criminal.”

From the time we knew our son needed residential treatment until the time he went to residential treatment was 2 1/2 years.

We applied and were denied multiple times.

We tried different funding sources.

We advocated through agencies.

We hired an attorney.

We went to court.

We were threatened and threats were made against us in regard to our reputations, our jobs, and the security of the other children in our home.

We were mocked. We were belittled. We were patronized.

The pressure placed upon us to walk away from all of this and keep our son in our home — despite the fact that he was a danger to himself and others – was massive.

Residential treatment is incredibly expensive and sadly, at the end of the day much of the conflict comes down to who will pay. There are several ways residential treatment is funded:

  1. Insurance. Because private insurance will eventually run out, children who are privately insured will need to apply for Medicaid. With a mental health diagnosis, a child can be placed in a residential setting if he meets certain strict criteria.
  2. Court systems. If charges are pressed, a judge can order placement in a residential setting.
  3. Foster care. Parents may voluntarily place a child in foster care. The foster care system will now have physical custody of the child but parents retain parental rights. If no suitable foster home is found, a child may be placed in a group home or residential setting. The goal is reunification after the child has received proper care. The child may also age out of the foster care system.
  4. Relinquishment of Parental Rights or Termination of Parental Rights (TPR). When parents no longer wish to maintain a relationship (most often this is the case with an adoption situation), they move to relinquish parental rights. Depending on the state, relinquishment is not easy to obtain. Typically another adoptive family needs to be arranged before a judge will grant relinquishment. Adoption is legally binding. However, in the case of a child with severe mental health or behavioral issues, a judge may grant relinquishment in order for the child to receive needed services.
  5. School districts. Although rare, it is possible for a school district to pay for an out-of-district placement if parents can prove this is the least restrictive option and no in-district option is suitable to meet the needs of the child.
  6. Private pay. Parents may pay privately for residential care.

Residential Treatment: When Holding On Means Letting Go

The facility where my son is – it’s a good place. The staff cares about the kids and they welcome us as part of our son’s treatment team.

The program is surrounded by beautiful countryside.

This is good.

It’s not home, though.

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