How to Find a Residential Facility

[ncmoms]

We have begun the search for a residential facility for our daughter who just turned 14.  We do have insurance that will cover the cost of residential treatment up to a point.  The problem we are having is that we have no idea what we are doing in looking for a facility.  It seems that each of the places on the insurance company's list has things we really don't like.  Almost all of them are co-ed, with violent sexual offenders and reports of problems.  We don't want to put her someplace where she's going to become worse just from the environment she's in!

How do we do this?  None of the doctors or hospital social workers we've talked to seem to want to help.

We are in North Carolina and at this point are looking almost anywhere.

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

[lbjnltx]

Hello ncmoms,

Glad to have you here and happy to help any way that we are able.

I have had experience with weeding through the maze of choosing RTC for my daughter when she was 13.  It is a complicated and time consuming task.

My first question would be:  Will the insurance company make exceptions to their list of approved facilities?

The second question would be:  Does the insurance require the facility to be JAHCO(sp?) certified?

Meaning a licensed psychologist on the premise 24/7.  Might there be exceptions to that rule as well?  If you must work within the confines of Insurance coverage the weeding process will be considerably more limited.

Can you tell us more about the treatment models your d13 has participated in up until now and what she has been diagnosed with?

I will wait for your reply.

lbjnltx

[ncmoms]

The insurance company may make an exception for a place that is IN North Carolina, the trouble with that is there are no places we actually like in North Carolina. 

My daughter started falling apart in the spring of 2012 when she was 12.  We had to hospitalize her for 2 weeks for suicidal ideation at that point.  She had been going to counseling prior to that for depression.  The doctors at the hospital put her on Zoloft which did nothing for her depression but increased her anger off the charts.  After about a month on that we put her through some psychological assessment testing, which indicated some type of mood disorder, probably bipolar.   Her psychiatrist then took her off the Zoloft and put her on Welbutrin and Abilify. 

She seemed to stabilize somewhat but was still having a lot of anxiety.  Then around Thanksgiving of last year she went into a depression again and we hospitalized her for another 2 weeks.  This time they stopped the Welbutrin and added Lexipro.  She seemed "ok" for a few weeks, but over Christmas she had a full blown mania attack.  She started cutting again, and we were very concerned.  Her therapist and I talked to her about the possibility of residential treatment if she didn't stop the cutting, which she refused to do.  That night she went home and attempted suicide.   So she went in for yet another 2 week hospital stay.   This time the doctors at the hospital actually started using the term bipolar, and took her off the Lexipro and put her on lithium. 

Well, about 3 weeks on the lithium and you would have thought there was never anything wrong with the child.  She was her old happy, cuddly self.  It was amazing to see.  Unfortunately, she started gaining weight rapidly, and for a teenage girl with self image problems, that was not going to work.  So they switched her from lithium to Saphris, which she's been on since.  It seems to have stabilized the mood swings, but there are still things that are bothersome, such as hallucinations, paranoia, OCD, and self image issues.

Her therapist has told us she feels she is not able to help her, and that we really need a residential program for her.  Her psychiatrist is telling us the same thing.   So here we are.

[ncmoms]

Ok, I hit the post button before I completed what I was going to say!

The most recent assessment by both the therapist and her psychiatrist is BPD.  We have suspected it for awhile, based on living with her day to day.   This is why we are anxious to get her into intensive treatment as quickly as possible, to try to make as much progress as we can while she's still so young.

[lbjnltx]

You are dealing with quite a lot of issues and severe behaviors.  

Has your d participated in her own therapy? What kind of therapy has she been in?

There are therapy models that are used for patients who are both Bi Polar and BPD (or one or the other).

The most intensive inpatient program that I am aware of is the Adolescent Unit at Harvard McClean.  It is a full DBT program.  Is this the type of clinical placement you are looking for?

[Reality]

Hi ncmoms,

I live in Canada.  We lost our son a year ago to misdiagnosis and too-late diagnosed BPD.

Nonetheless, I have found the RTF here in Ontario that I was looking for years ago when my son was 15 and started de-railing.  

Obviously, it wouldn't work for you; however, I thought you might find it useful to look at the website at pineriverinstitute.com as a prototype.  Their success rate at returning young people to functional living and hope is impressive.  Founded by a professor of economics and her daughter.  The research link to the Annual Evaluation has tons of information and it might serve as a guide for questions to ask and research when you are looking.  It has an integrated wilderness programme of two months, great nutrition, lots of time outdoors and the staff are down to earth, highly-skilled and compassionate while firm.

Just an idea.

Reality

[ncmoms]

Thank you Reality!  I'll give it a look.

Right now we are looking at Timberline Knolls in the Chicago area.  Our requirements are DBT based and lots of activities.  Some of the places are very much like hospitals in that the kids hardly ever leave their ward.  I think that might be counterproductive in my daughter's case.

So far she has just had once a week cbt therapy.  We have been trying to find a dbt therapist or group in our area for months with no success.   She really likes her therapist, and there are times when she does what's asked, but usually she just wants to unload her thoughts and not take any feedback in.  Which, again, is part of her diagnosis.

Does anyone have any experience with Timberline Knolls?

[lbjnltx]

I heard mixed reviews on Timberline Knolls.   My daughter did not attend TK.  I did not choose a DBT program for her as she had participated in outpatient DBT for almost a year without success.  I chose a balanced program for her that includes learning and practicing some of the core DBT skills.  I know of one other member here whose daughter attended the same program and had success.  The program is at Falcon Ridge Ranch in Virgin Utah.

I developed a search criteria for what I believed my daughter needed based on my knowledge and experience. 

Can you do the same?  When you come up with this criteria it will help you determine the best option for her and you can go to work on the insurance company to get coverage.  How long will the insurance company cover her stay?  Do you have other payment options (IEP or medicaid)?

[ncmoms]

Well, we saw some very sketchy reviews on Timberline Knolls and have scratched them off the list.

We are back down to one place in South Carolina called New Hope Carolinas and one in Atlanta called Laurel Heights.   They are both covered by our insurance.  Our plan pays for short stints at a time, and they will keep extending it probably up to 3 months max.  We would need to get Medicaid to cover any additional stay.  New Hope told us they would help us with the Medicaid stuff.

As for what she needs, the only thing we feel at this point is DBT as opposed to CBT.  That's what our doctors keep telling us.  We know her symptoms, but other than that, I have no clue what type of treatment she needs.

Falcon Ridge looks amazing, but I don't think we could even begin to afford the transportation costs.

[lbjnltx]

3 months isn't very long ncmom.  Does your d have an IEP through the school district?  Have you explored getting the school district to fund RTC?  Sometimes they will only pay the educational portion and insurance covers the treatment/resident portion.

Also, there are low interest rate loans through Clark that can be had.  Many parents get second mortgages to cover costs or use their child's education fund (if they have one).  These are all just options.  Each family has to do what is best for everyone in the family when it comes to mortgaging the future.

Most RTC's will work with any insurance company to continue funding care.  They are usually quite skilled at it.