How Do You Know When It’s Time For Residential Treatment?

6 Signs That Give You A Clear Answer.

It’s one of the worst decisions you may have to make for your child on the journey of foster care and adoption. Placing your child in a residential treatment facility is never easy. But how do you know when the time is right to do so?

Man at the sunrise

We’ve been down this road 3 separate times in the past. We know exactly how it goes: Your family is on pins and needles. You cautiously move through your house on a daily basis as if you’re walking across a frozen lake that may collapse at any moment. Looking at your child the wrong way could send them into a tirade. Your spouse, and other children, have experienced so much secondary trauma you hardly know how you’ll recover as a family.

A therapist mentions residential treatment as an option because he or she can tell your family is falling apart fast. You suddenly find yourself in the middle of a wrestling match in your mind. On one side, the loving parent in you speaks: “I love this kid. I brought her into my home with love and I feel like I’m giving up by choosing residential treatment. Could I live with myself if she were hours away from us?” On the other side, the human being in you speaks: “I’m so tired. I can’t do this anymore. I want to quit. This is not what I signed up for. My family is traumatized. We need a break, and she needs help!”

We wrestled these thoughts to the ground five years ago. We were hanging on by a thread. We faced a tough choice. Our son’s behavior was out of control. He was lashing out daily and our family was paying the price. He needed help. Our other children needed some peace. We needed a solution and fast!

But, residential treatment? Was it the right move? Would sending him away from our home help him, or harm him? After all, he had already experienced severe trauma when he was removed and placed in foster care with us. Would this actually help to change him?

Seeing the signs.

Let me be the first to say…this is a tricky balance. On one hand, you are tired, exhausted and ready to quit as a parent. It’s easy to let those feelings drive the bus of your reasoning. We understand because this partially drove the bus for us each time we were faced with this choice. But, at the same time, there are warning signs that give us a clear indication if residential treatment is the right step. Below are 6 key signs followed by key questions to ask yourself:

  1. Behavior that is harmful to themselves. Is he or she making choices that puts their life in jeopardy?
  2. Behavior that is harmful to others. Is he or she making choices that puts others in jeopardy?
  3. Secondary trauma in your other children. Is his or her behavior causing trauma in other members of your family?
  4. Apathetic toward their choices or behavior. Does he or she display an uncaring attitude toward their choices or the repercussions of their choices?
  5. Unwilling to change. Is he or she unwilling to change?
  6. Addictive. Does he or she have an addictive personality? 

By the third time we faced the reality of residential treatment, we learned to look for each of these signs. We were able to go down the list systematically and clearly answer each question. This was critical because we did not want to make the decision to send our child into treatment solely out of our own exhaustion (which is easy to do depending on the severity of your situation). In full transparency, our exhaustion was a big influence on our decision early on. It’s completely understandable. You’re tired. And, you’re human! (More on this in a minute)

Knowing, not knowing.

What about choosing a facility? How do you know which one is right?

It’s one of the biggest questions we receive, and it’s an important one. After all, your child will be living there. This is not like selecting a hotel or a summer camp (which also needs to be done with caution as far as we’re concerned).

In 2011 our son went to a facility funded by Medicaid. It was a great experience, as residential treatment facilities go. The staff was warm, caring, and focused on helping our son get better, develop coping skills and more, which he did, just 4 months after his admittance. But unfortunately, with state funded facilities there is much turn-over and political dictation. When we had to make the unfortunate choice again to send him to residential treatment,  we chose the same facility. This time, it was a disaster. They had a totally different staff, different program, different policies, and no one had our son’s best interest in mind.

So, how do you make the right choice?

The best thing you can do is research. Do your homework. Look up each facilities online, ask questions of former (or current) families who’ve placed their child their, read online reviews, and inquire from professionals who are familiar with the facilities. Homework, homework, homework. We can’t stress this enough. We live in the age of the internet so everything is available online. Again, this was a lesson we learned after our first and second go around with residential treatment. We wish we would have known this in the beginning.

Our duty as parents.

When it comes down to it, we have a duty as parents to protect our children and ensure their well-being. While our own emotions and exhaustion are real and relevant, they must take a seat behind our children’s well-being, including the child who may be headed for residential treatment. If he or she is behaving in a way that brings danger into their life or our home, it’s our duty to protect them and our family. We signed on the dotted line the day we became parents.

But let me be clear about one thing- our well-being as parents (and human beings) is in the seat right behind the well-being of our children. We have one other important duty as parents: Taking care of our own health. Keeping our children safe and cared for comes first. But our well-being as parents comes in at a close second. If you and I are not healthy, we can’t expect our family to be healthy either.

At the end of the day, the choice to send your child to residential treatment must always be entered into soberly, with lots of consideration, dialogue, prayer, and thought. It has to be. It’s the only way your child, and your family, will achieve maximum health.

Question: Have you had to make the choice to send your child to residential treatment? Are you considering it? Share your story with us in the comment section below. You can leave a comment by clicking here.

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  • Jennifer Whittemore

    We had to have our child hospitalized for being suicidal, and when they told us she was at the highest risk for suicide and were going to send her home, we were frantic. Thankfully our guidance clinic was able to find a good residential treatment center and although we feel she processed very little, she has learned some coping skills. She also fell in love with a 16 year old boy with a 3 year old daughter who is constantly getting in trouble. Hoping it was the right choice, but at the time didn’t feel like we had any other choice. She has been there 4 months and is scheduled for discharge home July 21st.

    • Jennifer, we are so glad to hear that she’s learned valuable coping skills. They will produce good fruit in time. 😉

    • Lenore Paletta

      Does she have any older adoptees she can speak with? I think that would have helped me a great deal when I was a teenager. It’s hard enough going through puberty without the added stuff from the past. I’m 50 now and very capable of he;ping out a fellow adoptee.

  • Shanna Osman

    We have a son that we have had since he was two months old, we adopted him when he was two yrs old and he is 7 now. He has fasd, bipolar disorder, and odd. So you can imagine our frustration. But at what age would you even consider residential care? When is it appropriate after you have wayed all the other options? My name is Shanna osman by the way, thank you so much for this great read :-).

    • Shanna, our son was 8 years old when he first entered. In retrospect, we probably jumped the gun on placing him there. He was displaying very aggressive behavior but there were some things we could have done differently as parents that may have made a big difference.

      • Shanna Osman

        Thank you so much for replying to my message. To clarify, my husband and I have been working with mutiple groups over the years. From children’s village to counselors to phycyatrists to family sites and so on. We have gone threw 7 different meds, and we just now have had the genetics testing done. So we have been round and round. Our son is very aggressive, loses his temper at the drop of a hat, and has mood swings beyond beliefe, but at the end of the night he always says he loves us, and sometimes apologizes for his actions earlier in the day. So I know that we are doing something right lol, but there is never a moments piece, ever and I can’t even get into the not sleeping part lol.its just so hard to know what would be best for him.

        • Kym Faulkner

          i’d like to suggest a very short book with great info – From Fear to Love: Parenting Difficult Adopted Children – Post Institute. It really addresses “Trauma Brain” and what may be going on with your child.

        • Lenore Paletta

          What sort of genetic tests? Get him tested for Mthfr gene mutations. No dangerous meds needed for that gene variation. That and his early family life can wreak havoc on a poor child. Wish you the best. Reach out to me I can provide you with links to issues with mthfr.

  • Yes. Our daughter was 10 when we had to make that most difficult of decisions. She was raging every other day or two, for an hour or two at a time. I would physically restrain her while she hit me, kicked me, scratched me, and screamed . . . for 2 hours straight. I had 4 other children at home, between the ages of 10 and 15.

    I calmly maintained my composure, hour after hour, day after day. The tipping point for us came when she looked me in the eye and coldly said, “Sometimes I want to kill you.” A couple of days later, she threatened to kill her bio. sister (whom we had also adopted). We knew than that something had to be done.

    She was diagnosed with RAD and Major Depressive Disorder. She has lived the past 4 years in an out-of-state Residential Care Facility (where all 50+ children are adopted children with RAD, and other disorders). While we are sad that she is no longer in our home, we know without a doubt that this is the best place for her.

    • Such a hard decision to make. We understand completely. Glad to know she’s in a place that can help her.

  • Jennifer Griffin

    Back in Oct 2015 (Canadian Thanksgiving weekend to be exact) our son who was 10 at the time had yet another major meltdown which sent him back to our local hospital. We had been working hard with our team of professionals trying to get things in place to have supports needed for our son (ARND, Intermittent Explosive Rage disorder, ADHD, Sensory Integration disorder, anxiety, and a few other diagnosis. I have been his main target since he was 4 (now 11) and have sustained many injuries (all minor no lasting consequnces from countless attacks, not to forget all the broken things in our home, including walls and windows, and personal belongings of mine. The decision was made that weekend that we had to go the route of a group home until we could get things settled at home, get him stabilized and give all 3 of us a chance to put our pieces back together both individually and as a family in whole. Our story does however have a happy ending and with the right meds in place, being closely monitored by our local FASD Clinic and his psychiatrist, we brought our son home on June 24th 2016. It was both the best and worst decision to have to make. It broke my heart, no it shattered my heart to sign the paperwork that allowed him to be placed in the group home, but we have been able to put our family back together and have been blessed with a fresh start.

    • Jennifer, we are so sorry to hear this. We know that pain full well. Every time we had to fill out the paperwork we cried. No body wants to face this. I am so glad to hear that you have brought him home. That’s a win!

  • sheluvskids

    This a tough topic, and it truly needs more discussion in the adopotion community. Many of us need to hear that we aren’t bad adoptive parents because our kids can’t safely be in our homes!
    Often these kids come from horrendous abuse and neglect, and they can’t safely live in a new family. They need things that a family can’t provide like highly trained 24 hour staff.
    Our youngest two kids have been placed in group homes indefinitely. It breaks my heart to even write that! It isn’t an outcome that we even thought of when we adopted them at 7 & 9. After almost seven years of every therapy available, and several residential programs it was the only option left for my safety.
    In my desire to love and nuture them I have been bruised and injured countless times. I have had serious injuries that have required hospital care and surgeries. The secondary trauma has been enormous, and I had to place myself in therapy.
    We know, with no doubts, we were called to adopt these two. Our youngest of 8 kids. Even though they don’t live with us we love them! We are their parents.
    Believing that nuturing families gives these kids the best chance for healing doesn’t mean it’s always possible.

    • You are so right. Sometimes the hardest thing to do is pour out our love for our children only to receive the bumps and bruises of painful decisions and outbursts. Thanks for sharing.

  • We actually placed our son in a residential facility yesterday. I am feeling all the emotions today, of course, but your post was timely. He was a resounding “Yes!” to all six of those questions.

    I wrote about our experience here:

    • Ginger, good stuff right there. Thanks for sharing. I am so glad our post hit the mark.

  • Kym Faulkner

    I just retrieved our son from RTC yesterday. We are so happy with the changes we’ve seen through the last 5 months at Provo Canyon School, UT. Fantastic facility where he was therapeutically treated. Prior to going there he was at a facility where he was treated like a criminal. He had access to other clients meds, fought with the staff because he didn’t feel safe, etc. Please don’t send your child to Desert Hills in NM! We took him out of there after 4 months and he ended up at the local psych hospital. No other RTC would take him with his history at Desert Hills except Provo. I am so glad they did!

    • Kym, this is so great to hear! Love that your experience (and his) was a good one.

  • Dear Mike and Kristin,

    Unfortunately, there is no easy answer to this dilemma. And playing the “Do I or Don’t I” question game doesn’t make things any easier. I have never had to actually make a decision like that even though my wife and I came close to doing so with her youngest daughter. Talk about unruly; wanting things her way or else, bringing boys home at all hours, staying up all hours to the point where we ended up going out looking for her, getting shot at and lying about it even though you could see the bullet hole in the fender of the car.

    We were strongly considering sending her to OAK RIDGE MILITARY ACADEMY in Oak Ridge, NC. The academy has a stellar reputation for changing the actions of youth around to the good and it is coed. But even with a positive report card, my wife especially wasn’t sure how to handle getting her daughter ready for such a drastic change and of course, worrying how it would affect her both short term and long term. Unfortunately, the opportunity to send her never materialized due to the fact she moved out of the house on her own volition with her then boyfriend, got pregnant, actually got a job and life went on.

    To make a long story short, she has turned out to be quite a woman, but getting there took a lot of patience on my wife’s part and mine. I am truly thankful to God for working in the background making necessary changes occur that guided her in a positive direction.

    As you stated in your blog, “the choice to send your child to residential treatment must always be entered into soberly, with lots of consideration, dialogue, prayer, and thought.” And research, research, research. Don’t assume anything, because as you found out the second time you sent your son to the same treatment facility, things were not the same and the end results were disastrous.

    To me the spiritual hierarchy goes from God to husband to wife to the children. But putting your trust and faith in God is number one. He can and will work things out, maybe not exactly according to your expectations, but know that:

    Romans 8:28 (NIV)
    28 And we know that in all things God works for the good of those who love him, who[a] have been called according to his purpose.

    a. Romans 8:28 Or that all things work together for good to those who love God, who; or that in all things God works together with those who love him to bring about what is good—with those who

    Thank you for allowing me to put my two cents in and God Be with You and Yours.

  • Adam

    We have a daughter that is diagnosed with RAD and unspecified bipolar. She has been in a local hospital for 8 days and came back great but that was 6 months ago. Now we are in the situation where it is even worse. It is an everyday situation. Syptoms of ODD. We literly are stressed to our max. We are adoptive parents of 4 including her and have 2 foster children in our care. We have called the crisis center twice in the last week. The crisis line does nothing because it takes an hour and a half for them to get here. She is normally asleep by then by her episode. What do you suggest? We are to the point of sending back to the hospital if we have too.

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  • Jody Gustafson

    We are parents of a 15 year old son whom we have raised since he was 5 days old. Just recently diagnosed with FASD. We have discussed residential since he was 9 but have never followed through. Much because of the financial ramifications (couldn’t afford it) and also for the reasons mentioned above (feeling the guilt on “good days” and not wanting him to be abandoned again). Now we are in a place where the school district may possibly be open to discussing the option and we are increasingly feeling helpless to keep him from harming himself and others. We are also exhausted and traumatized. I don’t even know how to begin to research facilities. The school says we need to call the police more and hospitalize him more. We are loathe to do so because it seems to only make matters worse, and in-patient treatment is useless for a kid like him. Not even sure if residential treatment would help him – so then it feels like a betrayal that is only for us because we feel like we can’t do this anymore.

  • Cori CW

    We are currently starting to research RTCs for our 12 year old son… again. He was in an RTC about 4 years ago and it was horrible. He came home after 3 months worse than when he went in (although he was no longer talking about killing me on a daily basis). Now, I am back to trying to sleep wondering if I will wake up to him stabbing me (over the past 6 months, I have found knives, screwdrivers & other things that he’s taken and put into his bedroom to use to “make us pay”). He has been hospitalized 11 times for homicidal and/or suicidal behavior. Doctors and therapists tell us how “complicated” he is. Our other 2 children are beyond frustrated and suffering trauma from his behaviors, too.

    As I look at the 6 questions – my answers are either a tentative yes or a definite yes. And my husband and I are exhausted trying to get other services for him. And we are exhausted trying to maintain him while we are hoping that an appropriate therapy *might* come through for him. We have yet another open case with Human Services (who we adopted him through when he was 3) and I emailed our caseworker today saying that we are ready to look at RTCs, even though I have no faith that there is one that will meet both his cognitive needs and his psychiatric/mental health needs.

    I feel like this is the first step towards giving up on him, and I hate it. Our other choice, though, is to continue to have our family destroyed one day at a time and I fear that we are quickly nearing the point of no return….

  • Lori Frost

    Hi. We are currently working through the necessary steps to gain a residential treatment program for our 9 year old son. He is our biological son, but this is the only page online that I have ever found in relation to Residential.

    For 6 years we have struggled immensely with behavior. At 3 he broke windows and peeled paint in his bedroom so badly that he peeled right to the drywall. (We were renting and were sued as a result of the damage)

    Over the years we have seen so many diagnoses, ex..// ODD, ADHD,ASD, etc.
    Currently he’s diagnosed severe treatment resistant ADHD, DMDD and borderline intellectual disability.

    Around 5/6 is when things really started to get bad…
    he would lie to anyone who would listen to him (lies about suffering child abuse at school and home)
    Severe temper tantrums that lasted hours. He destroyed personal belongings of the families. Everyone in the neighbourhood knew our family by our son. At 7 our cat had kittens and he put them in a large rubbermade bin, filled it with water fastened the lid and drowned them. When asked about it, he stated they needed a bath. After that he threw one of our cats down the stairs causing her to break her leg.
    He was kicked out of 3 daycares before age 7 due to aggression towards other children and lying about staff.
    In the last two years we’ve seen aggression towards siblings, aggression towards parents, running away (never far but always disruptful and concerning), breaking and entering (he broke into a neighbors camping trailer) fire starting (used matches and attempted to light the garage on fire, lit a fire in his bedroom scorching his bed and almost completely melting a electrical socket cover.)

    He has uttered threats towards all members of the family ie// wanting to hold younger sisters’ (3 and 18months) heads under water until they stop kicking. He’s pulled a knife on me telling me how much he wants us to die.
    There have been self harm behaviors since the age of 7, that are escalating in severity.

    He often seems so spiteful and angry. He seems to do things that he knows will hurt us. Destroys my autistic sons Pokémon cards. (Pokémon is my sons everything)

    In order for me to gain access to a RTC I have to convince child services aka… child welfare, child protective services…. if they agree to my son needing this placement I have to sign a joint custody agreement or temporary guardianship order.

    • Lori, Oh my heart breaks for yours. You must be so tired and mentally exhausted. Please know we accept you here with open arms. You have been brave enough to share, and we are grateful for that. I believe there are more in your shoes. Whether it’s adoption-related issues or mental health issues, it’s still “special needs.” This is what unites us. We hope you find more hope and healing and camaraderie through our site.