Troubled teens need proven intervention, not boot camp
7 questions to help parents find a safe and effective alternative

By Michael J. Merchant
March 1, 2006

The decision to seek help for a struggling child is one of the most difficult and important choices a parent may face. When inpatient or residential treatment is recommended, parents must consider a variety of options-from psychiatric hospitals, to alternative or therapeutic boarding schools, to wilderness treatment or outdoor behavioral healthcare providers, to "tough-love" programs. With few resources to aid them, desperate parents are often confused. Many are also troubled by the well-publicized tactics of a few programs using an in-your-face, boot camp philosophy.

How do caring parents find the program most appropriate for their child and family? They must first understand that not all inpatient and residential programs are alike.

Some boot camp-oriented programs employ degrading confrontation, deprivation of basic needs, and a philosophy advocating that resistant teens must be broken down before they can be helped. These programs only hurt children and further alienate them from their parents.

There are, however, residential and outdoor behavioral healthcare providers who offer nurturing and caring environments with evidenced-based psychotherapy, drug and alcohol counseling, parent education, social-skills training, and other proven interventions. When outpatient therapy is unsuccessful, these programs can help facilitate change, strengthen families, and even save lives.

To know the difference, parents should ask the following questions:

1. How does the program regard the children it serves?

According to researchers, a key success factor in the effectiveness of any treatment intervention is the "therapeutic alliance"-in other words the relationship between the caregiver and the child. If the caregiver regards a child as a person of worth and potential, the caregiver is more likely to understand and treat the child in a way that he or she would want to be treated in similar circumstances. The caregiver who regards a child as a problem-or inferior-is less likely to be responsive to the child's needs.

Perhaps most importantly, the nature of the caregiver also determines the influence of the caregiver's interventions. Because children can sense our motives, they are more likely to cooperate with a caregiver who understands and be resistant to a caregiver who is trying to manipulate or change them.

When a teen is resistant in a program where caregivers regard children as problems to be fixed, caregivers feel justified in using punitive tactics to obtain cooperation. This only provokes more resistance and escalates risks of injury or even death. Parents should ask, "How will your program respond if my child does not cooperate?"

2. Does the program have the competencies to effectively treat the needs of your family and child?

Whenever possible, parents should seek an independent assessment by a qualified professional before placing a child in an inpatient or residential program. This can aid the family in finding the most appropriate intervention.

Some diagnoses are effectively treated by programs skilled in behavioral therapy and parental education. Others may require psychiatric care and in some cases medication. The best programs provide comprehensive aftercare planning and follow-up.

3. Does the program involve parents and align with your family's personal values and belief system?

Each child is part of a family-family relationships will carry on long after program completion. Troubled teens often use their strained or severed family relationships to justify self-destructive behavior. Effective programs will provide resources and tools to help heal family relationships and will not divide children from their parents by promoting conflicting values or beliefs.

4. Is the program regulated by a licensing and/or accrediting body?

To maintain state licensure or national accreditation, a program is required to meet approved standards of care, report incidents, and be subject to periodic (often unannounced) on-site reviews and audits. Parents should contact licensing and accrediting agencies to learn of the program's safety record and current standing.

5. Are therapy and medical care provided by independently licensed practitioners?

Independent licensure requires education, training, supervision, and verification of competency. Thus, the employment of licensed herapists and medical professionals provides programs with an additional level of accountability. Registered nurses, board-certified psychologists, and licensed social workers are not likely to place their own licenses in jeopardy by working for a program that uses questionable practices.

6. Does the program allow confidential communication to family and child protective services?

Programs must give children a way to freely and confidentially communicate concerns of abuse or neglect with parents and regulatory agencies.

7. Can the program provide you with independent outcome statistics?

In addition to informing parents and professionals of program effectiveness, independent outcome research is often an indicator that the program is actively engaged in continuous program-improvement initiatives.

Parents can learn more about programs and best practices through the National Association of Therapeutic Schools and Programs (www.natsap.org) and the Outdoor Behavioral Healthcare Industry Council (www.obhic.com).

Michael J. Merchant is president and executive director of ANASAZI Foundation, a non-profit and nationally accredited outdoor behavioral healthcare provider. He serves as chairman of the Outdoor Behavioral Healthcare Research Cooperative (www.obhrc.org) and is a frequent lecturer on standards of care and the importance of effective parent-child communication. Mr. Merchant has chaired numerous councils and committees focused on best practices for adolescent behavioral healthcare providers. In 2004, he developed the communication component at the heart of the Emmy-nominated "Take the Time to Talk" substance-abuse awareness and prevention campaign.

"Though many of my Anasazi memories have faded, I will never forget what I learned there. I learned that I have a choice. Whether I make the wrong or right choice, I know I have one. And, I also know which one is right and which is wrong."
--Young Walker, Texas