“He’s driving us insane, clearly needs help but almost finished classes. When should we place him in residential treatment?”
My client’s mother summed it up perfectly. Their son was not in danger, he was making decent grades but definitely needed more help than what we could provide at home and in an outpatient setting (eg. individual therapy), so what was a family to do when there are holiday parties, family coming into town and gifts to exchange?

Let’s organize this and then we’ll have an answer.

Safety: If there is an imminent (immediate) safety issue like plans for suicide, extreme drug use or some other acute issue, placement happens asap. The family and friends will all understand if plans change, especially if they know your son or daughter needed help. If safety is an issue, contact a therapeutic placement consultant or educational consultant to help navigate the process. It can get more complicated than one would imagine. Has your kid been to the hospital? Do they have a psychological evaluation? Is there a summary from his or her therapist about diagnosis, prognosis and treatment recommendations? Have you contacted your insurance company about coverage for care? Trust me…don’t go it alone.

If there is no safety issue but there is a chronic issue (eg. ongoing pot use, bad grades, acting out behaviors), the difference between placing your son or daughter now versus the week after New Years is probably negligible.

Money: Sometimes, families need to wait until the new year for tax or financial purposes. Sometimes, the opposite is true – they need to use up money in an HSA or FSA before the end of the year or they are trying to capture some medical deductions. I always ask parents to consider the pros and cons from a financial perspective, not just behavioral health needs.

Availability and Timing: Therapeutic boarding schools, wilderness therapy programs and residential treatment programs often have waitlists in late Fall. Many families try to pull their kids around the holidays either because they’ve met the treatment goals or, the parents just can’t imagine the family gathering without their kid. This pattern can be used to figure out the best time for a kid to start a program. If things are really bad at home and the kid’s behavior warrants it, the week between Christmas and New Years can be a great time for placement since there are more openings in programs. Another good week is immediately following New Years.

Another consideration is school or important activities. If a kid is just about finished a semester at college or has a week of high school classes remaining, pulling them from school may not have a high return on investment. Again, are their significant enough clinical or safety issues that trump their need to complete classwork?

Discussion: More often than not, I’m coaching parents on how to hand responsibility and control over to their kids. But when it comes to therapeutic placement, I recommend a more conservative approach with a ‘need to know’ mentality. Just because the treatment will directly impact your son or daughter doesn’t necessarily mean they should get a vote in whether they go or not. In most instances, I don’t even recommend disclosing or discussing the idea of higher level of care. Once a decision is made by parents that the kid will be going to therapeutic placement of some sort, life should go on as normal as possible until the day of admissions. “But how do you get a kid to go to treatment if they are never told about it?” Most of the time, I recommend they are escorted by therapeutic transport from home to the program. Parents stay behind and follow-up later eithe by phone of a later visit. Most program also prefer parents not participate in intake. Engagin in therapeutic placement is always hard, but having parents try and escort their own kid makes things WAY harder.

Decision: You only need to be 80-90% decided on therapeutic placement for your kid to move forward. Rare are the parents whom feel 100% certain it’s the right decision. Yes, your kid will hate you (for about two weeks). Yes, you will cry and feel like terrible parents. Yes, you will feel powerless in the first few weeks. But this is what’s necessary to get through the process which can have life-changing impact. You may not have chosen for your son or daughter to abuse pot, get bad grades, and not be able to fully engage in life, but you do have a choice on how to fix things.

There’s never a perfect time to make tough choices but hopefully my insights can help your family figure out if and when to find care for your struggling teen or college kid.