What to know.

What to ask.

What's the difference?

As a therapist or parent, if you do a web search for treatment centers, boarding schools, wilderness programs or other types of out-of-home programs for an emotionally troubled child or teen, the resulting list will be so long both you and the child will be in retirement homes before you have time to review all the information.

Add to that the myriad of conflicting opinions, costs, types of programs, pros and cons, horror stories, blogs and funding sources and you're guaranteed either to have a headache or need out-of-home placement yourself.

There are hundreds of websites featuring on-line mar- keting videos, testimonials, FAQs, downloadable forms, checklists, helpful hints and true life stories that give reality television a run for its money.

Out-of-home placements are usually considered when a child or teen has seen an outpatient therapist for a long time without sufficient change; has been tried on numerous medications with little improvement; has been hospitalized one or more times due to a suicide attempt or danger to others; has been failing in school; has been abusing drugs and/or alcohol in efforts to self-medicate; can no longer be managed safely at home, or similar challenging situations.

Selecting an out-of-home placement depends on the child's psychological, behavioral and academic needs, and on the parents' financial resources, namely private insurance, savings accounts or access to school-based funding. Many programs take credit cards.

Bottom line is that finding an out-of-home placement for a troubled child is confusing at best. But it's not impossible.

Here's a basic primer on the types of placements out there. Be advised that any list of specific programs cannot be conclusive as programs change, close down or are added on an almost daily basis. One place some parents and therapists have found helpful for researching different programs is www.strugglingteens.com.

Types of programs

Boot camps, wilderness programs, therapeutic boarding schools (TBS), military schools, traditional boarding schools, Christian or other specialty boarding schools, emotional growth programs, residential treatment centers (RTC), substance abuse treatment centers and others.

Locations of programs

Throughout the US and the world.

Size of programs

Varies, from four or six beds per program to several hundred beds. Many are co-ed. Some take only teens; others take latency age kids as well.

Duration of programs

Varies from weeks to years.

Focus

Some are strictly behavioral, others mostly academ- ic. Some offer a limited amount of psychotherapy, others are structured on a medical model with individual, group, family, psycho-educational, recreational and medication therapy. Some address substance abuse as a primary focus while others view it secondarily. That also applies to eating disorder or other specialty programs. Some treat youths on probation, sex offenders or other court-appointed children.

Important questions to ask about any program being considered

• Is it licensed? Through which agency or government entity?
• What is the success rate? Who compiles those statistics?
• What forms of discipline are used and when?
• Who runs the program? What are their credentials?
• How long has the program been in business?
• Are there any lawsuits pending or a history of lawsuits? What are/were they for?
• Is the school accredited?
• Will transcripts be accepted at the home school?
• How are special education needs addressed?
• What is the treatment philosophy?
• What is the ratio of staff to child?
• Is the program locked? This varies by state law.

Once the decision is made and the child is in placement, it is helpful for parents and siblings to attend their own therapy while the youth is away, as well as participate in family therapy at the placement either on site or via conference call. This will facilitate the child's return home to more functional family system.

One example of an out-of-home placement option that parents and providers in Southern California need to know about is Willow Springs Center, a 76-bed locked psychiatric residential treatment program founded in 1988 for males and females, ages five through 17, in Reno, NV. Most California- based residential treatment programs are not locked, and few take children as young as age five.

Willow Springs accepts most private insurance (HMOs, PPOs), TriCare (military insurance) and private pay. It is the closest TriCare-approved, locked program to Southern California for children.