CHOOSING A PROGRAM—KEY ISSUES & QUESTIONS
Choosing a program for a struggling son or daughter is an anxious process. The decision-making is all the more stressful when a choice must be made quickly.
The goal is to find a good “fit” between problems and program. Most parents (fortunately) have had no prior need to learn about adolescent programs, but unfortunately most outpatient clinicians are uninformed, albeit they may understand a son or daughter’s problems with great sophistication. Most psychiatrists and therapists simply have little time and no occasions to read about, much less to travel to visit, the diverse, widely-scattered available programs.
For these reasons, an expert independent educational consultant is often indispensable. For an experienced consultant visits tens of programs, knows clinicians and schools, recognizes a program’s strengths and weaknesses, and so can narrow the search and teach parents what to look for. Their metier is to fit a competent program to a teenager’s unique mix of problems.
When parents assemble a short list of prospective programs, they should visit the top choices. This exploratory visit should be a careful exercise in due diligence, not a perfunctory once-over. Parents should talk with a program’s senior clinicians—to hear how they frame a daughter’s or a son’s difficulties and learn how the program operates. Parents should expect to provide a history, so that program staff also can gauge the fit. During that visit parents should make sure they understand, beyond platitudes, and that they accept, beyond generalities, the program’s approach to a son’s or daughter’s clinical, academic and interpersonal difficulties. For once parents make a choice, they join the treatment team and must back that program.
As parents frame the choices with expert help, there are a few key issues to keep in mind:
• Programs vary in structure, containment and protection. It is important to consider where a program sits on the continuum from a secure (hospital-like) residential treatment center to an open campus. For a particular teenager, what is the needed level of care? Does a son or daughter need locked doors, intensive supervision and the structure of an inpatient unit, or can (s)he safely be enrolled on a more open campus? Do they need a single gender or co-ed campus (see Letters from Lost Prairie, “Get Thee to a …”). The risks (e.g., of run-a-ways, suicide attempts, or sneakiness) must be balanced against the program’s structure and supervision. For any particular teenager, some programs will be too loose, others too restrictive. The question is not what a daughter or son wants, of course, but what structure and supervision a struggling teenager needs.
• What is the “feel” of the campus and community? Do young people enjoy affectionate relationships with teachers, therapists and supervisory staff? Do they know one another well and trust and like one another? Do recent arrivals feel hopeful? Are more senior students changed, e.g., more considerate, goal-directed, confident, competent and ethical?
• Relative to other campus activities, how much does a son or daughter need first-rate psychotherapy? In a particular program, what role does psychotherapy play? Do therapists have authority on campus? Do they shape a teenager’s life on campus—in terms of tasks, options, privileges and constraints? Are therapy sessions scheduled and required, or merely adjunctive, arranged beyond the perimeter of the program or as a matter of chance encounters with “available” counselors, or only as a function of a teenager’s own impetus and volition? Is therapy separately billed, an add-on, or an elective, which is conceptualized separately from behavioral and academic aspects of the program? Are therapists on the staff, well-trained, suitably-credentialed and licensed? Are there enough therapists to go around, and is enough time devoted to individual, group and family therapies?
• Does the program aim to understand young people and to promote character development? Or is a student’s progress conceptualized in terms of symptom relief, superficial compliance or “good” behavior?
• What is the quality of the school? What weight is given to academics? Are teachers first-rate? Are academics in balance (neither over-emphasized or under-stressed) relative to other key aspects of a teenager’s psychological and social development? Are the curricula various and challenging? Is the required work substantive? Are the academics integrated with emotional-growth and clinical work? Are teachers influential in students lives? Do they have an integral role in gauging a student’s progress and determining his prerogatives? Is the school accredited? Are the courses taught by credentialed teachers?
• How important is the individual student? Is the clinical understanding of a particular young person integrated into other dimensions of life on campus? Is the treatment individualized? Is a young person’s progress dependent upon his volition, effort and goal-directed enterprise, or do all students just pass through a common, pre-scheduled sequence of dish-washer cycles?
• What kind of help does a son or daughter need with substance abuse and other compulsive behaviors? Is it already obvious that addiction is a risk? Are compulsive habits (e.g., video-games) already interfering with academic mastery and interpersonal relationships? If so, what is the program’s approach to these problems? Is that approach suited to a teenager’s stage of development? Does it require a teenager to agree at the outset that (s)he is already an addict?
• Finally, is the program licensed and accredited by state or national agencies that conduct site visits to accredit both academics and clinical competency?