Residential Treatment Programs for Children:
What Parents Should Consider

A residential treatment program is a 24 hour-a-day, year round program that provides intensive help for children or youth with serious emotional, behavioral, or mental health needs.

Residential treatment centers (RTCs) are usually located in the community and offer various on-site treatment services such as:

• Evaluations to determine emotional, behavioral, educational, mental health and medical needs
• Development of an individual treatment plan
• Individual and group therapy
• Support from a child and adolescent psychiatrist or psychiatric specialist who can prescribe medication
• Family-involved therapy
• Educational services (onsite or at a local school)

The length of stay can vary from a few weeks to a few months, and for some children, may be longer.

Why Might a Residential Treatment Program Be Needed?

Other treatment options are usually considered first because these are 24-hour-a-day programs located away from the child’s home and school. When your child’s mental health, and emotional or behavioral problems become so severe that your family is unable to keep him or her at home, your child may be placed in a hospital or residential treatment program.

Residential treatment programs may be considered for a variety of reasons, including assessment and diagnosis, crisis intervention, psychiatric treatment, substance use, abuse prevention, or education.

How Are Children Placed in a Residential Treatment Program?

There are three ways that children may be placed in a residential treatment program: voluntary placement, by the child’s Individualized Education Program (IEP) team, or court-ordered placement.

Voluntary Placement

You may choose to place your child in a residential treatment setting because it has been recommended by a therapist, county social worker, other mental health professional, or because you have done your own research. Minnesota requires health plans to cover medically necessary services, so working with your child’s mental health providers to document medical need is the first step.

If you decide to pursue a residential treatment program, a mental health clinician must make a formal recommendation to either your health plan’s Utilization Review (UR) team, the county human services out-of-home placement screening team, or both, depending on how your child’s health care is funded. Health plans have requirements of their own when authorizing a residential treatment program, and some plans will require an out-of-home placement screening through the county.

Individualized Education Program (IEP) Team Placement

IEP teams, which include parents, may determine placement is needed in a residential treatment setting so that your child can make educational progress. This means that the IEP team has determined that your child needs a therapeutic setting such as residential treatment in order to receive educational benefits from their IEP services. Under this type of placement, the school is required to pay for the entire treatment program, including education. Schools are also required to pursue insurance coverage to fund treatment, room and board.

Court-Ordered Placement

A court may order a child into a residential treatment program to ensure their safety or access to treatment. If your child is court-ordered into a residential treatment program, you retain custody of your child unless there are child protection issues. If the court determines the state should have legal custody of your child under a CHIPS (Child in Need of Protection or Services) petition, they will hold a disposition hearing to determine whether or not the child is in need of protective services and decide what needs to be done. Parents in this situation should call a PACER advocate for more information on custody.

Here are the steps to pursing voluntary placement in a residential treatment program:

1. Start by contacting your health insurer, and ask the following questions:
   • Which services and providers are covered under our plan?
   • Are there coverage limitations?
   • How can a mental health clinician make a formal recommendation to the plan’s Utilization Review team?
   • Do you require a county out-of-home placement screening?
   • Are there other requirements for authorizing residential treatment services?
2. If your health care plan does not cover residential treatment settings and you cannot afford to pay for it, you will need to call your county mental health services division to see how to qualify for publicly funded programs or county payment for treatment

Important Information: Treatment Funded by Medical Assistance or the County

• If your child requires an out-of-home placement screening for residential treatment program approval, your child’s county case manager will gather necessary documentation and write a summary of the recommendation
  • At the screening, the case manager will usually present the information to a team of providers who will review the medical necessity criteria, and decide if funding for a residential treatment program will be approved
  • You have the right to attend the screening. When you attend, share information about your child’s goals, challenges, and how you believe a residential treatment program will help
  • Some health plans are invited to participate in these screenings by phone
• If your child is covered under Medical Assistance, the county will be involved in the decision regarding a residential treatment program
• You do not have to give up custody of your child or make them a ward of the state in order for the county to pay for the treatment
  • According to state law (Minnesota Statue 260D), a determination for mental health services and treatment through a residential program is based on medical necessity (your child’s need for treatment).There is no federal requirement that parents give up custody, but some counties may insist that parents give up their rights in order to receive a county-funded residential placement. You need to use extreme caution in these circumstances and should seek the assistance of a PACER advocate or an attorney before giving up your parental rights.

Making the Decision

Deciding to place your child in a residential treatment program is difficult. When making a decision about a residential treatment program, it is important to consider the following information about your child:

• Evaluation data
• Current symptoms and behaviors of concern
• Previous treatments and interventions
• Reasons why other less restrictive program options such as intensive outpatient therapy, intensive in-home therapy, day treatment, or hospitalization are being ruled out

Trust Your Judgment

Some parents in this situation feel as though they have failed their child. Remember that this is about choosing an option for a more structured setting to help your child be more successful. There are also many other issues that need to be considered when making this decision: impact to your family, accessibility to treatment, and safety. Making this decision with support and input from your family, friends, and mental health professionals who know your child best will help you feel confident that you have done what you can to help your child.