how to pick a RTC

[jellibeans]

I am reading that some go to a center for a short amount of time and some for a longer time... .  when looking how do I know where my dd15 should good... .  should I look for a therapeutic boarding school... .  or a short term place... .  how do you know where? My thought here is I don't want to start off in one place then have to move her to another long term school?

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Reality]

Hi jellibeans,

Lbj found a RTC for her daughter after extensive research.  Interestingly, she said the equine therapy and the positive peer culture were key highlights.

Recently, I found Pine River Institute, the first RTC in Ontario founded in 2006.  I visited the place last week with some friends and there was a complete meshing there with my understanding of what my son needed as an adolescent.  (Sadly, I never heard of PRI when my son was that age.)

Pine River uses DBT, yet also positive peer culture.  The executive director said it was crucial that there was complete safety for each person. 

My son went to many facilities.  Pine River is the only place where I agreed with the approach, the people, the understanding.  The staff are very kind, very validating and they have a sense of humour.  They are also very knowledgeable. 

It had a good vibe. 

Take your time and find the place that feels right to you.

Reality

[jellibeans]

Reality

when I go to the pine river website it doesn't mention BPD... .  I was just wondering why you picked this place... .  looks wonderful... .  I live in Texas but born in Canada... .  looks like this place focuses more on the addict? not sure ... .  I guess I am still wondering if I should be looking at a long term solution or short term... .  

[lbjnltx]

Hello Mrs.jellibeans,

I would suggest that you determine what the limitations are for coverage from the IEP or insurance (if that is how the program is funded).  Some insurance co have requirements that must be met for funding, IEP often limit too... .  though those can often be negotiated with the help of an Educational Attorney or Education Consultant representing your d's best interest.

If it is going to be self funded then there are more options and less limitations.

What is the situation for funding?

[jellibeans]

lbj

I am going to research that this week and talk with my insurance co... .  but I do want to send my dd to the right place regardless of coverage... .  I am just not sure how much helps she needs? can she go to Merridell for a few weeks then do we wait and see how that goes then look for a therapeutic school? I don't know how much help she will need so I find it hard to look for a place when I don't know how she will respond to therapy... .  she might only need to go for a few months then return home and go back to school etc... .  how to proceed is the question... .  maybe I am just having award time letting go... .  but I don't want her gone more than she has to be... .  

[jellibeans]

lbj

I am going to research that this week and talk with my insurance co... .  but I do want to send my dd to the right place regardless of coverage... .  I am just not sure how much helps she needs? can she go to Merridell for a few weeks then do we wait and see how that goes then look for a therapeutic school? I don't know how much help she will need so I find it hard to look for a place when I don't know how she will respond to therapy... .  she might only need to go for a few months then return home and go back to school etc... .  how to proceed is the question... .  maybe I am just having aw hard time letting go... .  but I don't want her gone more than she has to be... .  

[lbjnltx]

Something you may want to get a clearer understanding of is that many programs are called Residential Treatment Center and Therapeutic Boarding Schools.

There is a difference between Clinical RTC's and RTC/TBS.

Some insurance companies require facilities to be Jaeco(sp?) certified for coverage.

That basically means there is a therapist on site 24/7.

This will narrow the search.

How long will she be gone?  That depends on her and how quickly she takes ownership of her recovery.  My d's pdoc told me "don't mortgage the farm for a 90 day program".  I think he is correct.  What we are asking for is real and lasting change for our kids.  That isn't going to happen for a pwBPD in 90 days.  It just isn't enough time to work through the complexities of their disorders, learn and then  own the skills and then gain confidence in the skills with practice over time.

Honestly... .  I wouldn't do it if I was not able to see it through to the end... .  9 months minimum.  I know that is not what you want to hear.   Honestly... .  Mrs.jellibeans... .  this isn't about what you want or what she wants, it is about what she needs.  A high quality facility will not keep her past the time she is ready to go home.



lbj

[cfh]

Mrsjellibeans,

I have to agree with lbj... .  30/60/90 days just isn't enough time for a pwBPD to acquire the skills and start putting them into practice.

My ds 29 has been court mandated to a 12-18 month rehab.  I would have preferred it to be a place that was more geared towards a pwBPD but something is better than nothing (or prison) and he is a drug addict.

I was recently talking to a pdoc about how people with a mental illness were treated a century ago.  He said that the unfortunate ended up in an asylum but the fortunate ones went to a "retreat" where they could rest their minds and souls.

These were usually beautiful places, full of peaceful activities like gardening.  But his main point was that the length of stay was about a year. 

He said that it is the insurance companies that are responsible for such short stays now.

[Reality]

Hi jellibeans,

BPD isn't well-known in Ontario.  The woman who started Pine River calls the clients troubled teens.  It is my humble opinion that these troubled teens would meet criteria for BPD.  Yes, the kids have problematic substance issues, yet they are not seen as having a concurrent disorder.  12 steps is not used at the facility.

The point I was making is that they establsh positive peer support and the model is rather atypical, I think. 

The kids used to stay for a shorter time and there was recidivism.  The typical stay is 12 to 14 months.  The success rate is unique:80%.   The key goal for the staff is that the adolescent stays at the facility.  Each person is treated as an individual. 

It sounds more like the places cfh was mentioning, excellent food, a beautiful setting, very clean and organized.  Most importantly, the staff are very kind. 

Just some ideas... .  

Reality

[sunshineplease]

Mrs. N1962, we were looking, at first, for a short-term stay for our ud17. But our family therapist pointed out that it had taken years for our daughter to get to this point, and it wasn't realistic to think she could get better in a few months, no matter how hard she tried. We figure our daughter will be at her RTC for around a year, based on what we're hearing from family therapists, the RTC, and the wilderness therapist. And she'll need major support even after that.

I also agree with what Reality says. You'll know when the vibe feels right.

[Being Mindful]

Hi Mrs jellibeans,

When we placed our d in a RTC it was estimated that she would be there 9-12 months. It turned out to be 14, but she still wasn't ready to move home. Directly from RTC she moved to a therapeutic fostercare home and stayed there for 7 more months. I don't want to scare you, but we found the time to be absolutely required. It was horrible AND necessary.

Being Mindful

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[jellibeans]

I have been really looking and talking to RTCs. I have narrowed my search... .  I still need to talk with insurance but I will be doing that this week.

... .  in the meantime my dd15 is struggling... .  failing school and she is stressed... .  today she fainted at school and I was called to come get her... .  she has hit the wall and I have seen this way too many times before... .  it breaks my heart... .  I took her to Doctors just to be sure there was nothing really wrong with her and they couldn't find anything... .  as we waited for results she says she thinks it was just all the stress and that she felt she might have been having an aniexty attack. I was supportive and calm... .  she told me she was sorry and I told her "there was nothing to be sorry for. I know you are struggling and under a lot of stress and that she was doing the best she could" and that is the truth... .  the trouble with that it is just not good enough and it is pretty clear she needs more support than what she is receiving right now.

I am not sure how to approach this topic with her... .  I am not sure she will go willingly... .  I could use some advise on how you all did this part... .  I would really like to take her to the place but I am not sure she will go willingly and that makes me sick to my stomach to think of strangers coming to our home and taking her by force... .  it really just doesn't get better

[Being Mindful]

Hello Mrsjellibeans,

We had everything all lined up first... .  the RTC was chosen, they had a bed for her, insurance was approved, date for her being there was given. Our plan in telling her. My dh and I, along with her therapist who she knew very well and trusted met with her on a Monday night. We told her the plan that she was going. RAGE, RAGE, RAGE. Therapist helped her to calm. We told her that the very next day we were going for a visit which is a 3 1/2 hour drive. We would visit for the day, she would meet the therapy team, see the grounds and school. We would come home that night. Originally, she fought doing this and we told her that was okay, but that she would still be going on Friday. We explained that we thought it would be better that she could see it, see her room and would then be better informed about what she wanted to bring.

Wednesday and Thursday were spent getting her ready and packing. We shopped for a few new things to bring along. She spent 1/2 of Thursday at her school saying goodbye. Her IEP manager basically walked around with her. That was the only time she attended school that week. We didn't want to give her too much time to make plans to run but also wanted to give her closure. That went well. Friday morning, dh and I, plus her therapist drove to the RTC. Her therapist was with us every step of the way which was a huge help. She helped in the admission process and turning over all of our d's records. It was a HUGE gift from her that we will never forget. The admission process took about half the day. DH, myself, daughter and therapist went out for lunch off the grounds. Then, did a last minute run to Target for things we realized she needed but we didn't bring. We had to have her back for the dinner hour around 5:30. We said our goodbyes after moving her stuff into her room.

Toughest day of my life.

[sunshineplease]

I'd welcome information on what you have to do to get insurance to foot some of the bill for an RTC!

[jellibeans]

sunshine

It is my understanding that insurance will pay for the therapy part of the stay but not the school part... .  I am not sure yet but I am researching this right now and I will let you know... .  My husband thinks we should sell our house because my older daughter heads to college in the fall and if dd15 is in RTC then we should downsize and that also makes me sad to think about leaving my  home.

being mindful... .  i cry every time I read your post... .  my heart is hurting for my daughter.

[sunshineplease]

Thanks, jellibeans I'm going to ask about that!

[lbjnltx]

Hello jellibeans

How is the research and funding process going?  


lbj

[Being Mindful]

I'd welcome information on what you have to do to get insurance to foot some of the bill for an RTC!

What worked for us was an extremely well written document that included our d's history... .  everything from behaviors, risk, vulnerability, safety to the family, therapies tried, hospitalizations, outpatient programs, interventions, school issues, diagnosis, GAF, the RTC that we picked and why we picked it. This was done by her therapist. It was detailed but also concise. Therapist faxed it and we had approval in 2 hours! What we understand now is that was record time.

Being Mindful

[jellibeans]

I am still actively searching... .  I have been talking to Kara athe Falcon and also a few other places. I am researching quite a bit but somedays are better than others. I have an older daughter that has health issues too and somedays I am at the doctors for her.

I did call one number that I thought was a school but it turns out to be a student advocate... .  I first had to talk with one person that was really annoying... .  real salesman... .  then was called by another person and asked to do a quiz so they can determine what school or center would be best for her... .  what I finally learned was that they were a student advocate and I believe they get a commision from the school... .  they were going to send me some info but I have not heard back from them. I really didn't trust them at all. Some the things they said were just plain lies.

I also talked with Merridell again... .  they seem to think that my insurance would want to see if I tried an out patient school... .  there is one is south Autin called the Ranch and I am calling there to see if Remy would be a good fit... .  I could still keep her home and she could get counseling everyday.

I do think my dd15 has improved... .  she had three suicide attempts last year and ran away aleast 4 times... .  was raging almost daily... .  this year she ran away Feb 6th... .  the really problem has been her constant illness but at least she is not cutting.

She seems to replace one poor coping skill with another... .  I am working on it... .  I will keep you posted... .  I am kind of dreading spring break... .  I hope she can find a friend to hang out with or she will sleep the week away.

thanks for everyones support... .  

[Cici]

Here are two resources I just found, good questions to ask the first is an article written on the FTC website and the second is a link to

ASTART which the FTC references as a source of information for parents.  You are being so smart taking the time now to do your research... .  

www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens

www.astartforteens.org/warning-signs

Hope Spring break goes ok... .  

[sunshineplease]

Being/jellibeans: Thanks for info!

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders