Key Components of Behavioral Treatment Centers for Teens

When your teenager needs treatment for a mood disorder, a behavioral disorder, or an alcohol/substance use disorder (AUD/SUD), finding the best help and support can be challenging. It’s a different search than finding the right urgent care clinic for a nagging cold or a bout of food poisoning. It’s also different than finding a physician for other types of significant health issues. Finding treatment is not like finding an orthopedic surgeon to fix a broken wrist or an injured knee. Nor is it like deciding which neurologist to see when they get a concussion from hitting their head.

It’s an important decision.

Depending on the severity of the issue, it’s more akin to finding a specialist for a chronic health condition than for a short-term injury or illness. That’s why it’s important to take your time. You need to do your due diligence. When you do, you can find a treatment center that’s a good fit for your teenager and your family.

Before we get into the clinical details – meaning a discussion of the types of treatment you can expect to find for an adolescent with a mental health disorder, the various types of therapies proven effective for teens, and the various levels of care available for teens – we’ll review the basics.

Seeking Support: The First Steps

When you start your search, you need at least three things:

1. An accurate diagnosis from a licensed, qualified mental health professional. Preferably with experience supporting adolescents.
2. A recommendation from that same professional – or another, if you get a second opinion – for a course of treatment. This typically involves a referral to a specific level of care, which we’ll explain below. For now, you need to know that level of care refers to the frequency (amount per day/week/month) of treatment, the degree of treatment immersion/intensity, and the length of treatment your teen receives.
3. An idea – influenced by items (1) and (2) – of where you want your teen to receive treatment. For example, if your teen receives a referral for outpatient treatment one day a week, you may find several therapists within easy driving distance. Therefore, your process involves screening the therapist or psychiatrist for availability, compatibility, and convenience. On the other hand, if your teen receives a referral for inpatient treatment at an adolescent psychiatric hospital or a residential treatment center for teens, that changes your search.

Let’s expand on that last point. If a mental health professional recommends an immersive level of care such as residential treatment, you may need to consider sending your teen to a different place altogether. By place, we mean geographic location. For instance, if the best residential treatment center for adolescents with your teen’s specific condition is out of state, that changes things. As hard as this may be to wrap your mind around, you may need to consider that option. You may need to send them out of state so they have the best possible chance of making a full, sustainable recovery.

A Quick But Important Note: What Exactly is Recovery?

To clarify that statement, by full sustainable recovery we mean when your teen reaches a point in treatment where they’re able to manage the symptoms of their disorder without those symptoms causing significant disruption or preventing them from participating in the common daily activities and responsibilities of teenage life. It’s important for you, as a parent, to understand that recovery for/from most mental health, behavioral, and/or alcohol/substance use disorders is a lifelong process. Recovery is a journey with no clear endpoint. It’s a process that requires constant revision, adaptation, and innovation.

This is as true for a case of mild depression as it is for a severe addiction. In each case, the teen with the disorder needs to develop the skills to manage the symptoms of the disorder. The skills need to be durable, practical, and useful across their lifespan: mental health issues do not simply disappear after six months of outpatient treatment or a month of residential treatment. Treatment teaches a teenager to manage their disorder. Over time, it may appear that a disorder is cured, but what that really means is that the person with the disorder – in this case, your teen – has become so skilled at managing their symptoms that the disorder is almost a non-issue.

If we’re being honest, though, we must say that mental health issues almost never completely disappear. Symptoms that stay dormant for years can reappear in response to stress, life changes, or other events in life.

Now, with all that said, we’ll backtrack and pick up where we left off before the quick note about recovery. We’ll walk you through how to get an accurate diagnosis, how to decide on a level of care, and finally, end with a list of the components common to the best adolescent treatment centers in the country.

Mental Health Treatment for Teens: The Importance of an Accurate Diagnosis

Teens who receive treatment at specialized adolescent behavioral health centers can make significant progress and get their symptoms and disorder under control. That’s the goal of treatment. However, teens in treatment don’t always make the progress they expect. Nor do they always meet the treatment goals they set at the beginning of their journey.

This happens for a variety of reasons. For some, it’s a lack of commitment to the process. For others, it’s a mismatch between the diagnosis and the level of care, or a mismatch between the diagnosis and the type of treatment.

And for many – especially teenagers – the problem is an accurate diagnosis. In teenage boys, for example, depression sometimes appears as anger, hostility, and chronic irritability. In that case, even an experienced clinician might mistake a mood disorder like depression for a behavioral disorder such as oppositional defiant disorder (ODD). This could lead to months of frustration, because the best treatment for one is not necessarily the best treatment for the other.

That’s one example – but there are more. We won’t detail all of them, because the solution is an accurate diagnosis. The best way to get an accurate diagnosis for your teen is to arrange for a comprehensive biopsychosocial evaluation administered by a qualified mental health professional.

If you’ve never heard of a biopsychosocial evaluation, here’s a good beginning definition. A biopsychosocial evaluation:

“…presumes there are varying levels of physical, cognitive, emotional, behavioral, and environmental factors that contribute to every individual case. Multiple domains are seen as contributing varying amounts of influence to the overall conceptualization of an individual case.”

When a clinician administers a full biopsychosocial evaluation, these are the domains for which they collect as much data as possible:

Biological Data:

• Full family biomedical history
• Record of family mental illness
• Alcohol or drug use history
• Developmental milestones
• Present state of physical/mental wellness

Psychological Data:

• Present mental health symptoms
• Past mental health symptoms
• Present mental health/diagnostic circumstances
• Family mental health history
• Present medication or treatment for mental health/substance use
• Past medication or treatment for mental health/substance use
• Present emotional/mental/life stress
• Past trauma

Social Data:

• Present level of social function/ability
• Present family or home circumstances
• Family, social, relationship circumstances
• Gender and sexuality identification
• Family details
• Past trauma
• Education, legal, and work history/status
• Risk factors
• Strengths and protective factors

In recent years, many clinicians started collecting information about spiritual and cultural domains, as well:

Spiritual:

• Spiritual and/or religious traditions
• Level of participation in spiritual and/or religious traditions
• Supportive and/or protective resources related to spiritual/religious practices

Cultural:

• Details on personal/family cultural traditions and practices
• Degree of identification with/practice of cultural traditions
• Cultural norms related to medicine and/or medical/mental health treatment
• Supportive or protective cultural practices and/or resources

All this information helps a clinician get a complete picture of what’s going on with your teenager at the time they receive the assessment. The historical data is critical because, although it’s not what’s going on right now, it’s part of the story of how your teen got to where they are now. The historical family information is critical for a similar reason: no one grows up in a vacuum, and the details of your teenager’s family and home life are essential in helping a clinician understand who your teen is and how they see and experience the world.

An experienced clinician uses the data they collect in a biopsychosocial evaluation to arrive at a diagnosis. When they reach a diagnosis, they also recommend a course of treatment. A recommendation for a course of treatment should include a referral for a specific level of care – and approach to treatment – that matches the diagnosis.

Next, we’ll discuss the different levels of care.

Treatment for Teens: What Are the Levels of Care?

As we mentioned above, level of care refers to the frequency, degree of immersion/intensity, and the length of treatment your teen receives.

Your teen’s assessing clinician will recommend a level of care based on:

1. Symptom acuity. Your teen’s level of acuity refers to how serious their symptoms are at the moment of assessment.
2. Symptom disruption. If your teen experiences extremely disruptive symptoms – meaning they prevent them from participating in typical daily life – then you can expect a referral for an immersive/intensive level of care.
3. Previous treatment. If your teen has engaged in treatment at an entry level of care – without success – then the assessing clinician will likely refer them for a more immersive/intensive level of care.

With the exception of teens who are in immediate crisis and need emergency care in an inpatient psychiatric hospital, there are four general levels of care: outpatient programs, intensive outpatient programs (IOP), partial hospitalization programs (PHP), and programs at residential treatment centers (RTC).

Here’s a brief description of each of these levels of care:

Outpatient Treatment

This level of care is typically appropriate for teens with symptoms that are difficult, but not extremely disruptive. If your teen can participate in all the activities related to family, social, and school life, then this is likely where they’ll start. Most teens in outpatient treatment see a therapist in an office setting once or twice a week.

Intensive Outpatient Treatment (IOP)

This is one level up on the treatment continuum from outpatient treatment. If your teen experiences disruptive symptoms that do not prevent participation in family, social, or school life, they may start at this level of care. Teens in IOP programs receive treatment 3-5 days a week for 3-5 hours per day. If you admit your teen to an IOP program, they will likely continue living at home while in treatment

Partial Hospitalization (PHP)

This is one level up on the treatment continuum from intensive outpatient treatment. intensive outpatient program. If your teen experiences disruptive symptoms that prevent participation in family, school, and social life, they may receive a referral for this level of care. Teens in PHP programs participate in treatment five days a week for 6-8 hours per day. If you admit your teen to a PHP program, they will likely continue living at home while in treatment.

Residential Treatment (RTC)

This is one level up the treatment continuum from a partial hospitalization program. Short of emergency hospitalization in an inpatient psychiatric hospital for adolescents, this is the most immersive level of care for teens with mental health issues. If your teen experiences symptoms so severe they need total immersion in treatment, they may receive a referral for a program at an RTC. Teens in RTC programs benefit from full-time monitoring and support. That means 24/7, around the clock. In an adolescent residential treatment program, your teen will participate in a full day of treatment, Monday through Friday. Weekends in RTC programs are treatment days, but the schedule is often modified to add family visits, more downtime, or special outings and events. If you admit your teen to a PHP program, they will live on-site for the duration of their treatment.

Once your teen receives their assessment, an accurate diagnosis, and a referral for a level of care, you’re ready to start your search for a treatment center. The first place to start is any center the referring therapist recommends. Next, we suggest asking friends and family for any suggestions. A word-of-mouth recommendation from someone with direct experience at a treatment facility is worth its weight in gold. After that, we suggest getting online and using your research skills: they got you to this article, and they can help you find an appropriate treatment match for your teen.

The Ten Components of the Best Adolescent Treatment Centers

Last year, the Substance Abuse and Health Services Administration (SAMHSA) published a paper called “Treatment Considerations for Youth and Young Adults with Serious Emotional Disturbances and Serious Mental Illnesses and Co-occurring Substance Use” that assesses, reviews, and updates two previous publications – one published in 2004 and one published in 2017. The new publication contains information on the best evidence-based practices for adolescent mental health and alcohol/substance use treatment discovered over the past fifty years.

When you search for mental health treatment and support for your teen, keep this list by your side. Any treatment center you consider should offer all ten elements listed below. If you research a treatment center, and during your research, you learn it doesn’t offer or include each of the ten elements on this list, we recommend crossing that center off your list and continuing your search.

High-Quality Teen Treatment Centers: The Ten Essential Components

1. Comprehensive Assessment

Although your teen received a full assessment in order to receive an accurate diagnosis, a quality treatment center should repeat the process and develop a complete biopsychosocial profile for their records. These assessments confirm and augment the previous observation of clinicians with regards to your teen and identify any new issues they need to address during treatment.

2. Individualized Plan

Any treatment center you consider should design a custom plan tailored to meet your teen’s specific needs. Clinicians should work with you, your teen, and other relevant family members to create a plan that addresses the issues identified in the biopsychosocial assessment.

3. Integrated Treatment

The treatment plan should address any and all disorders, conditions, or issues your teen faces. This includes dual diagnosis for co-occurring disorders. A co-occurring disorder is one that’s present alongside another. For instance, addiction and PTSD often co-occur. Plans that address one disorder only are incomplete and can impair treatment progress and delay recovery.

4. Family Participation

When you and other relevant family members take an active role in treatment, evidence shows that your teen will have a greater chance at treatment progress and success. An individualized plan you’re your teen should include the input of family members and other adults actively involved in your teen’s life.

5. Age-Appropriate Treatment

A treatment plan should include therapeutic approaches that are teen specific. Treatment centers should adapt any treatment modality to accommodate the adolescent population. Some treatments that are appropriate for adults are not appropriate for teens, and vice-versa.

6. Commitment and Buy-In

Clinicians at any treatment center you consider should work to build trust a relationship based on trust and respect. When your teen commits to and fully engages in treatment, they’re likely to complete their recommended time-in-treatment. Evidence shows a combination of commitment and time-in-treatment substantially increases the chance of long-term recovery.

7. Qualified Clinicians

The working clinicians at any adolescent treatment center you consider should be experienced in working with the adolescent population. They should understand teen development. They should be conversant in the issues relevant to teens today. Finally, they should know how to adapt and craft any therapeutic approach to the unique needs of teens in general, and your teen, specifically.

8. Cultural Fluency

The working clinicians at any adolescent treatment center you consider should understand the issues unique to your teen. They should know how to – and have experience in – tailoring treatment to meet varying needs of LGBTQI + populations, cultural/ethnic minorities, and the needs specific to teenage boys and teenage girls.

9. Ongoing Care/Aftercare

Any treatment center you consider should provide a custom aftercare plan for your teen upon discharge from the program. Evidence shows that an aftercare plan should prioritize family participation. It should include outpatient treatment when needed. It should also include community support, such as 12-step-type programs for teens with alcohol or substance use disorder. In addition, a quality aftercare plan should include a list of effective recovery skills and any lifestyle modifications – such as yoga, healthy eating, or journaling – that worked for your teen while in treatment.

10. Self-Assessment

The treatment center you consider should engage in a continuous process of self-assessment and improvement. Treatment centers with formalized assessment processes can stay up-to-date with current best practices. They can also monitor their staff for their ongoing professional development needs – and watch for therapist burnout.

When searching for treatment for your teen, we suggest keeping this list by your side. Get on the phone and ask a representative about every item on the list.  If the adolescent treatment center you’re considering does not include all ten components – and the representative cannot answer questions about the absence of these components or discuss them intelligently when they’re present – we suggest dropping that center off your list.

We know you can find a treatment center that meets all these criteria. In our work, we put them into action every day. We know they’re effective. We’re confident that a treatment center that meets these criteria can help your teen begin their journey to long-term, sustainable recovery.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.