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Making residential treatment work: effective communication is crucial.

Article Excerpt
For many adolescents, entering residential treatment may be the first sustained time away from family, home, or familiar geography. Adolescents with psychiatric issues severe enough to need residential treatment often have attachment problems and abandonment fears, and their families often have multiple dysfunctions. Adolescents also fear potential negative reactions from peers to their need for residential treatment.

For these reasons, the prospect of residential treatment can be frightening for adolescents and their families. Patients and/or families may therefore attempt to resist admission to or sabotage ongoing stays in residential treatment. Careful planning for the transitions to and from residential treatment can avert such sabotage and increase the chances of residential treatment success.

Preparing for the Possibility of Residential Treatment

Providers can turn to the American Psychiatric Association, other professional organizations, and illness-specific associations for guidelines on a disorder's level-of-care transition criteria, but general principles can be applied to all conditions. Starting with outpatient settings, providers should make patients and families aware of the limitations of treatment and what can be expected. Important, too, is a review with stakeholders of criteria used to make level-of-care decisions (such as thorough assessments of illness severity and co-occurring disorders). Keeping the patient and family up-to-date on patient status should never stop, because progress reports help prepare them for possible inpatient care. Providers suggesting inpatient care must be ready to answer questions about recommended facilities, why inpatient care is needed, and the regulations, restrictions, and monitoring that can be expected. Often outpatient providers avoid this step, fearing patients will refuse treatment. Yet this information is crucial, especially for parents, because adolescents often agree to inpatient care initially, only later to...

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