Residential Treatment

Residential treatment programs are appropriate for some children and adolescents with psychopathy if home-based treatment methods have not been successful.
Youths in residential treatment live in a facility for weeks or months while receiving intensive treatment aimed at improving symptoms and behavior. Research has shown that it is preferable to treat children and youths in their homes and communities when this is possible. However, because of the complex issues involved in treating youths with psychopathy (including safety concerns, lack of community support, and low access to effective treatment options) residential treatment is a necessary option for many families.

Parents should work closely with their child’s healthcare provider when deciding whether a child needs residential treatment. Residential treatment facilities vary widely in quality. They are not always well-regulated. Thus, there are risks inherent in placing a child in residential treatment that parents should carefully consider. However, high-quality residential programs can provide youths and their families with valuable, and, in some cases essential, support.

Issues that parents may wish to consider when researching residential treatment options include: 
Funding Residential Treatment
Residential treatment can be expensive. Thus, when considering residential treatment it may be necessary to consider how this treatment can be funded. Funding options differ depending on the specific program, the family’s state of residence, and family resources. Possible sources of funding include: 
  • Private insurance
  • Medicaid (some states provide waivers for youths with serious emotional disturbances that increase access to Medicaid beyond typical family income-based limits)
  • State funded programs for residential treatment
  • Education-based placement through an Individualized Education Program (IEP) from the child’s school district  
  • Post-adoption support for adopted children (this varies by state)
  • Private payment
Unfortunately, there are severe, chronic shortages of publicly funded residential treatment options for children and adolescents in most states.
Type of Residential Treatment Program
Residential treatment programs vary in the type, intensity, and length of care they provide. Residential program types include:
  • Psychiatric residential treatment facilities (PRTF) - These programs typically provide the highest level of care. They can be very costly if families are paying privately, but some private insurance plans and Medicaid will cover placement in these programs
  • Non-psychiatric residential treatment facilities (non-PRTF) - These include a wide variety of program designs and treatment options. They are typically not covered by Medicaid, but private insurance plans and other funding sources may support placement in these programs depending on medical necessity
  • Group home models - Group homes provide a lower level of care and less structure, and they allow more connection to the local community
How to Find the Right Program
Determining what funding sources and financial resources are available is an important first step for guiding the search for residential treatment options.

It is also important to talk to your child’s healthcare provider to determine what type of program would best suit your child. Some children require more relational-based treatment models whereas others do better with a more cognitive-based approach. Some children need a program with very high levels of security. Some children simply need short-term stabilization, whereas others need a longer-term stay. 

Families should create a list of priorities for what they are seeking in a treatment program. Priorities can include the specific treatment approach, out-of-pocket costs, proximity of the program to the child’s home, living arrangement (for example, will the child have roommates), and school options (online, on-campus school, local public school). It may not be possible to find a program that meets every criteria you are seeking, but prioritizing may make it easier to choose among programs.

Families should also reach out to local and state mental health advocacy organizations. One starting point can be your state chapter of the National Alliance on Mental Illness (NAMI). These organizations can often provide information about how families can access residential treatment programs and might be able to connect families with other families who have placed children in residential programs. Another useful starting point is Building Bridges.

It is important to talk directly to representatives of the programs you’re considering. A program’s website can provide important information about their treatment focus and the types of children they accept. But the best way to determine whether a program is a good fit is to call them directly and visit, if possible. Admissions staff at most residential programs are knowledgeable and helpful. If their program turns out not to be a good fit, ask for their suggestions about other programs.