Treatment Settings
Therapy and medication management are considered outpatient treatment. If those methods have been exhausted or are not working, there are three treatment options for a child who needs more help: day treatment, hospitalization, and residential treatment.
Day Treatment
Day treatment is a step up from outpatient therapy. For example, if your child is seeing a psychologist for therapy, she is likely meeting with him on a weekly or bimonthly basis. Most therapists have a difficult time fitting in more than one session per client per week. If your child needs more intensive help than the few hours she gets each month, day treatment is an excellent option.
Day treatment usually occurs in a hospital or another facility that has a team component. This means that your child will be seen by more than one treating professional. A treatment team can include doctors, psychologists, and other professionals. Individual therapy is a must, and group therapy with other children experiencing the same problems is usually offered. Sometimes family therapy is included or required.
A child who enters day treatment can expect to be at the facility four to five hours each day for three to five days a week, and some facilities offer academic programs so that your child doesn't fall behind in his studies. He is allowed to return home each day, and the ability to be at home at night gives parents comfort and makes this an attractive treatment option.
Fact
You do not have to lose the professional who has been treating your child in his office! This is the person who will likely refer your child to day treatment and provide the facility with information about your child. Upon her discharge, she is typically sent back to her original therapist.
Sometimes you can hold on to your child's therapist if he has privileges at the treatment facility where your child is attending. If not, be prepared to start over with a new therapist, at least while your child is there. Once her condition is stabilized and she is on the road to improvement, she can return to an outpatient office.
While some parents prefer to have their children home at night, there is a downside. You are responsible for his safety when he is with you. If you are particularly worried about his impulse control (cutting, suicidal gestures), having him home at night may be too uncomfortable and frightening for you. Do not be afraid to address this with the facility you are considering choosing.
The other disadvantage to having your child home at night is that he is back in the environment that potentially caused or contributed to his depression. These are factors that you must consider before you choose this option.
Hospitalization
Inpatient hospitalization requires that your child stay at the facility day and night. She will be constantly monitored and will receive treatment from a team that can include a doctor, therapist, group therapist, and other professionals such as social workers and recreational or art therapists. The program is quite comprehensive and almost always has a component that requires the family members to participate in the child's treatment.
Psychiatric hospitalization typically lasts from a few days to two weeks. This is why the treatment team has to move quickly and effectively to provide your child with every opportunity to get better. If medication was a problem before your child was hospitalized, this is an excellent way for a doctor to try more aggressive medications because he will be able to observe your child carefully and continuously.
Residential Treatment
This is the most serious of treatment options outside the home because the child is there for an extended length of time. When other treatment methods have failed, residential treatment must be considered.
Residential treatment means your child will be living at a facility that operates much like a home. A length of stay is anywhere from three months to a year. Your child participates in intensive therapy, school, and physical activity. A facility like this tries to help a child live in a family-like atmosphere while learning new ways to interact with others and resolve his own emotional issues.
Essential
Don't be surprised if your child's residential treatment prohibits your contact with your child for a specified length of time. Your child needs to get used to the facility and completely removed from his environment. It's hard to get used to being away from home, and forcing the child to focus on treatment is the best way to assure success.
A benefit to residential treatment is that your child is immersed in an environment that makes him feel more at home and teaches him how to be a productive member of a family while addressing his own problems. Also, if your child was extremely disruptive and damaging to the rest of your family's functioning, this will provide everyone with a chance to get back to normal. Children who go to residential centers have drained and exhausted their parents to the extent that the other children were probably neglected. You should not feel guilty if you are relieved somewhat. Now you have some time to attend to the rest of your family.
Do not be fooled when you talk to your child living at a residential treatment center. He may be trying to convince you and the treatment team that he really doesn't need to be there. He may beg you to take him home, which will tug at any parent's conscience. Leave it up to the treatment team to make that decision since they are not emotionally invested like a parent.
Also, remember that the decision to place your child in an inpatient setting should include the awareness that what you were doing was not working and that your child seems incapable of controlling his impulses to hurt himself or others.
