By Brenda Wychulis

It may be easier to define what a residential treatment center is not. It is not a school where kids just happen to have dorm rooms and can spend the night. It is not a place where a child goes because he has trouble staying on task or following directions. It is not a facility where a child is sent to be disciplined for something he or she has done wrong.

A residential treatment center is a place that takes a multi-faceted approach to addressing a multitude of problems that extend beyond the classroom and into a child's daily life with his or her family, peers, and the rest of the world. Residential treatment is serious stuff and the decision to place your child in one should never be made lightly.

When to use one
Residential treatment should, in many cases, be considered the "last-ditch" approach to helping a child with severe problems. It should be considered only after less intense interventions have either been tried or ruled out. Anytime a family can address their needs and those of their child through less expensive and intrusive means, they should pursue those avenues.

Residential treatment centers are typically designed to house, treat, and educate children whose problems are severe enough that they require an environment that is supervised 24 hours a day, 7 days a week. Typically, these centers include doctorate-level clinical staff, psychiatric intervention, and in some cases, locked facilities. This isn't to say that all residential treatment centers take only the most severely troubled kids. However, many of them do and if your child doesn't need that type of setting, then he or she should not be there.

Of course, there are also centers that work with less troubled kids, while still providing a therapeutic approach. However, they may not include things such as psychiatry or on-grounds therapy. When researching facilities, find out how extensive the available services are. A good rule of thumb is that the more expensive the facility, the more services it is likely going to offer — although this isn't always the case. Some facilities simply overcharge; others maintain a basic but unsophisticated clinical program while providing nicely manicured lawns and state-of-the-art recreation facilities. They may all be good facilities, but you should find out exactly what you're paying for.

What they do
The purpose of a residential treatment center is to effect long-term internal and external changes in a very troubled child. This is achieved by creating an individualized and consistent plan for addressing problems through three different areas of influence: the classroom; clinical treatment; and the therapeutic milieu, or living environment. These three areas are tightly linked, with professionals in each area playing an important part during each child's treatment term. This is an approach which covers all the bases, allows less room for a child to slip in one area and excel in another, and keeps everyone informed of what is going on with each child every day.

In a treatment center, communication is a key element. It ensures that weaknesses or concerns in any one area are addressed and supported in the other areas. For example, learning disabilities may play out in the living environment when a child seems unable or unwilling to follow a simple directive, or clinical concerns may manifest in the classroom as an emotional or behavioral outburst. Conflicts with a peer in the milieu may result in an exchange of harsh words during a group therapy session.

Because problems are identified quickly and addressed at all levels, residential treatment can be an intense and intrusive experience. However, in a facility that really knows its stuff, it can be life-altering. In a treatment environment that deals with profound issues, anything and everything is possible, so in a residential treatment center, the very nature of the problems being dealt with requires a multidisciplinary approach to every aspect of the residents' lives.

A residential treatment center is not just a fancy school
I have worked with some parents who believe a residential treatment center should function first and foremost as a school. On more than one occasion, this was a detriment to their child as the parents were reluctant to accept that their child needed a different environment, one that didn't have such a high level of severity or supervision. In their minds, schooling was separate and could be kept separate, but that's simply not the case in a treatment center.

It's certainly appropriate to view your child's education as a very important thing. However, in a residential treatment center, clinical issues must be tended to first so that issues with schooling may be addressed effectively as a child stabilizes. This might include addressing medication needs, clinical requirements for supervision levels, or even the types or frequency of interactions a child may have with adults or peers.

Clinical needs are actually one of the main reasons that residential treatment centers have their own schools on their grounds — the schools are equipped to deal with severe problems and have the resources nearby to address any problems that may come up, such as extremely disruptive behavior in the classroom, aggression, or even a suicide attempt. For a child with mental health and/or behavioral issues, they don't set aside problems during the school day and focus all their energy into getting their work done. It's often just the opposite.

If you're not sure that this is what your child needs, by all means, ask! A good facility, particularly an accredited one, will tell you if your child requires a less structured setting. They don't want to see your child there if he or she doesn't need to be there — that doesn't help anyone.

Brenda Wychulis is the former Admission Director of a residential treatment center for adolescent boys and holds a Master's in Public Administration from the University of Colorado. She has 16 years of experience working with  mental health, child welfare, and juvenile corrections systems throughout the United States.