What should a parent know about teen therapy?

By Stephen C. Schultz

"Those who cannot remember the past are condemned to repeat it."
George Santayana (1863–1952), U.S. philosopher, poet

Remember the days of “Drive By Child Birth”? In 1995 hospitals were adjusting to the downward pressure of the insurance industries cost cutting and managed care. Some HMO healthcare plans routinely discharged a mother prior to 24 hours so it could be billed as an outpatient procedure. Only after continued mother/baby complications at home, law suites and government legislation did the standard post partum stay remain at two days.

Within the psych industry, we experienced the psych hospital collapse of the late 80’s & early 90’s; Charter Medical, Community Psychiatric Centers, Brown Schools and others all faced financial downturns. Some families found themselves with students admitted to programs that were literally closing down operations with students still enrolled. Managed care was certainly instrumental in facilitating the demise of the psych hospital industry, but it also spawned the Parent Choice/Private Pay programs of today. Even though the insurance dollars dried up, the need for services never went away.

Now, with the current Parent Choice “market” having matured in terms of excess capacity or “bed space” available, the parent choice/private pay service providers (programs and educational consultants alike) are facing a similar situation. There are more program options than ever before, yet the economy as well as private finances of the general public is stretched precariously thin.

As financial times get lean in the treatment world of troubled teens and their families, what are some common practices we see in terms of “cost cutting” measures amongst treatment providers? How will parents and Educational Consultants recognize these cost cutting efforts by financially stressed programs as what they really are? Many programs will re-invent themselves and “market” as the latest “therapeutic breakthrough”. Others will cater to the “luxuries of life”, suggesting they are tailoring their services to the “softer” kid. Some will reduce their staffing patterns, lay off employees, consolidate services or simply close down. Still, some treatment organizations will “buy out” programs to increase “market share” so they can satisfy investors. Many, if not most, will start reducing their prices. Unfortunately, many will also fall to the temptation of “bad mouthing” the competition. It is important to remember, none of these activities increases the quality and effectiveness of care provided to the teen and their family. Again, the question must be asked, how is a family or educational consultant to know which treatment programs are on solid ground financially as well as clinically.

Educational Consultants, by the very nature of their profession, have a clinical as well as financial responsibility to the families they serve. They must be knowledgeable about the issues the families come to them with and confident in the solutions they recommend. Over the last few years it has become more and more difficult to intimately know and understand the many new programs that have popped up. Because there are so many new treatment programs, it has become increasingly difficult for educational consultants to visit programs and understand the differentiating aspects of each one. So, the standard practice has evolved into developing a relationship with a few therapists that the educational consultant trusts to provide good care. On the surface, this would appear to be the wisest and most efficient use of time and resources. The educational consultant has someone they trust to work with the family and the stress of learning about innumerable programs is reduced. A win – win for all…it would seem.

However, there are a few errors in this line of thinking. To place the main focus on the therapist is to minimize the positive effect the rest of the treatment team has with the student and family. Therapists generally work within a system, whether it is an RTC, Wilderness Program or Therapeutic Boarding School. Because some therapists are perceived as more “Popular” than others with educational consultants, they often have a perceived “Value” by either themselves or the organizations they work for. Maturity and longevity of the treatment team should be taken into account based on the level of care provided by the program. There should also be caution exercised when dealing with therapists willing to “shop” themselves to the highest bidder and treatment programs willing to pay it.

There is an inherent risk for Educational Consultants to follow therapists from program to program. First, the financial stability of each program is different. Just because a program “hires away” a therapist and increases their salary does not mean the program is financially viable. Second, programs that are well established have a history of leading in the industry and are based on sound business practices. They operate by ethical principles and will have structure in place to encourage growth in the staff, both personally and organizationally. These solid programs foster independence and creativity with the therapists and tie it all together with internal systems so it truly is a team approach. This team approach is what provides consistency and predictability of outcomes for the student and their family. To refer to a therapist in a wilderness program that “runs their own group” is to rob the student and family of the benefits of a fully integrated treatment experience. Again, it is the integrated team approach that fosters consistent and predictable outcomes.

As parents, treatment programs and educational consultants feel a financial pinch, it is imperative we not forget the lessons of the past. Our responsibility as treatment providers is to assist families who find themselves in an “acute” situation to have the most cost effective, value added treatment we can provide. This doesn’t mean the cheapest or least expensive. It means a therapeutic experience with a treatment team that is principle based, systems oriented and outcomes driven.