If Your Child Needs Inpatient Treatment

A Quick Review Of Inpatient Treatment Options

Your child stays overnight in the hospital or treatment facility.

Emergency Hospitalization: Provided by a public or private hospital. Approximate length of stay may be from 2-10 days. Usually occurs following a psychiatric or substance abuse emergency during which an individual is at risk for harming oneself or others. The primary goal of hospitalization is to ensure the individual’s safety, stabilize acute physical and/or psychiatric symptoms and educate the patient and his/her family about the nature of the diagnosed condition. Treatment primarily includes medication, medical evaluations/monitoring, psychiatric evaluations/monitoring and patient and family education.

Intensive Inpatient Treatment: Provided by a publicly funded or privately operated inpatient treatment program. Approximate length of stay may be from 5-28 days depending on the treatment program. Usually occurs as a result of failed attempts at less intensive treatments (individual outpatient, intensive outpatient, partial hospitalization) or following an emergency psychiatric hospitalization. The primary goal is to educate and assist the individual in developing a long term plan and strategies for effectively coping with the diagnosed condition. Treatment primarily includes supervised living, academic education (coordinated with patient’s school district), medical evaluations/monitoring, psychiatric evaluations/monitoring, behavior modification and individual, group and family counseling.

Extended/Long-Term Treatment: Provided by a publicly funded or privately operated extended/long-term care program. Approximate length of stay may be from 2-18 months. Usually occurs as a result of failed attempt(s) at intensive inpatient treatment and/or when the nature and severity of the psychiatric disorder requires longer treatment. Treatment primarily includes supervised living, academic education (coordinated with patient’s school district), medical evaluations/monitoring, psychiatric evaluations/monitoring, behavior modification and one-on-one, group and family therapy.

If Your Child Is Experiencing Ongoing Psychiatric Or Substance Abuse Difficulties And You Are Considering Inpatient Treatment:

Inpatient treatment may be appropriate for ongoing psychiatric or substance abuse difficulties when an individual is experiencing life impairment and/or has had previous treatment attempts that failed to improve his/her condition. The decision to place an individual in inpatient treatment is a serious one that is subject to strict insurance guidelines and mental health legislature. It is not easy to have someone placed in inpatient treatment against his/her will. Inpatient treatment is most often utilized as the last line of treatment for ongoing psychiatric or substance abuse difficulties typically administered after prior treatment attempts have failed. There are exceptions to this protocol. If an individual is suicidal or homicidal or if there are other serious potentially self-injurious symptoms (including severe drug addiction or dangerously low body weight due to an eating disorder), inpatient treatment may be used as the first line of treatment.

If you have the financial means to pay for inpatient treatment, you can choose to have your child admitted into a private facility without the approval or guidelines of your insurance provider. In such cases it is important not to resort to inpatient treatment too quickly out of fear, anger or frustration. The risk is that you will utilize this powerful treatment tool at a time when your child’s level of impairment and treatment readiness might not warrant it. In the process you would be expending a limited resource (the cost of inpatient treatment is often so great that even financially secure individuals would have difficulty paying for it multiple times) that will perhaps then not be available to you at a time when it could have the greatest therapeutic impact. To research available private programs, speak to your child’s treatment provider, primary physician and/or school counselor.

If you have to depend on your insurance provider to pay for inpatient treatment, you will have to follow their protocol and guidelines for determining when inpatient care is appropriate and which facility to use. Since insurance companies and policies vary so greatly, you will need to speak to your insurance representative to determine how to proceed in getting your child inpatient treatment. If your insurance provider denies your request for inpatient treatment and you believe that it is necessary to your child’s well being, I strongly urge you to be assertive in advocating for your child. Request to speak to a supervisor and inquire about how to appeal the initial denial of services. Be diligent in asking the names of the insurance representatives to whom you speak, documenting your correspondence and following through with the necessary procedures.

If your child is a minor and is uncooperative in being placed in an inpatient treatment program the treatment facility you choose may be able to assist you in getting your child to agree to the proposed inpatient admission. In selecting a program and scheduling an admission date, inform the admission counselor of your child’s anticipated resistance. Ask them to advise you on how you should proceed in getting your child to their facility, how they will handle your child’s resistance and how you can best support them in doing so. Admission counselors have a lot of experience in working with resistant admissions. Through the use of “therapeutic leveraging” techniques, they have a good chance of being able to convince your child to enter their program. However, if your child refuses to agree to the inpatient admission, you will not be able to force your child into treatment. In such cases you may choose to seek an involuntary commitment or court order that mandates that your child enter into inpatient treatment.

If your child is of adult age (18 years or older) and is uncooperative in being placed in an inpatient treatment program you can follow the same strategies outlined above, for a minor that is resistant. However, be aware that treatment facilities are typically less effective in persuading adults into treatment than minors. To give yourself the best chance with an adult child, you may need to utilize other resources. One option is to seek the services of a private therapist who can facilitate a formal “intervention”. A formal intervention involves planning and preparing for a meeting during which you and other family members and friends “confront” your child. You prepare for the meeting by working with a therapist who assists you in communicating in the least threatening and most powerful way. Without your child’s prior awareness, he/she is brought to the meeting during which time everyone expresses their concern and encourages your child to get “help”. At the conclusion of the meeting, you attempt to immediately take your child to a treatment facility that you have pre-selected and scheduled an admission with. If your child refuses, you cannot force him/her into treatment against his/her will. In such cases you may choose to seek an involuntary commitment or court order that mandates that your child enter into inpatient treatment.

An involuntary commitment is when an individual (minor or adult age) is forced by the mental health system to enter inpatient care against his/her will. It is very difficult to have a person “committed”. Your best chance of doing so occurs when there is a psychiatric emergency in which your child is overtly expressing thoughts of suicide or homicide, appears psychotic and or is engaging in potentially dangerous behaviors. If your child is experiencing a psychiatric emergency, follow the instructions outlined in Section 7. In addition, inform the evaluating mental health professional that you believe your child is in need of inpatient care and should be involuntarily committed. Another process by which an individual can be involuntarily committed is when a treating psychiatrist determines that inpatient treatment is the most appropriate level of care. In such cases your treatment provider should work with you in making the necessary arrangements for hospitalization and inpatient placement.

A court order for treatment is when an individual (minor or adult age) is mandated by the criminal justice system to enter treatment or face more serious legal consequences. If you want to generate a court order for treatment to be imposed on your child, you will need to follow a “tough love” parenting philosophy. When your child is involved in criminal activity including substance abuse, you notify the police in order to initiate your child’s involvement with the criminal justice system. Once your child is involved in the criminal justice system, you work collaboratively with the judge and/or probation officer assigned to your child’s case. By informing and/or keeping them abreast of your child’s criminal behavior and asking them for help, you will increase the likelihood that the judge and probation officer will impose a court order for treatment (possibly inpatient care).

If you are attempting to generate a court order for treatment and your child is a minor, find some reassurance in knowing that the juvenile justice system is set up to rehabilitate rather than punish. Juvenile records are typically expunged at the age of 21. By getting your child involved with the juvenile justice system, you will be providing him/her with a level of consequences that are mild in comparison to the consequences that may occur as a result of his/her disruptive, dangerous and/or substance abusing behaviors when he/she is older. In the process you will be taking advantage of a window of opportunity that only exists until your child’s eighteenth birthday and can possibly give you the leverage needed to motivate him/her to enter and participate in treatment.

If you are attempting to generate a court order for treatment and your child is an adult (18 years or older), the decision to do so will be a very difficult one. The adult criminal justice system is more punitive than the juvenile system. You will have to decide between the lesser of two evils: let your child act out and risk major life catastrophes or death; or generate legal consequence that may result in incarceration and/or a permanent criminal record but could motivate or force your child to get help.

 Once you have a plan and are ready to try to get your child into inpatient care, contact the treatment facility you are considering and proceed as follows:

• Ask to speak to an intake/admissions counselor.
• Begin by providing all the necessary insurance information and ask if they accept your coverage.
• Be prepared to spend several minutes on the telephone answering intake questions concerning demographic information and the history and current status of your child’s difficulties.
• Ask for their admission criteria and if they will contact your insurance provider to determine treatment eligibility and ongoing case management.
• Ask how any outstanding bills at the end of treatment will be handled. Who would be responsible – you or your insurance company?
• Ask how they handle patients who resist admission.
• Ask if they have counselors in your area that can assist you with an “intervention”.
• Ask what the average length of inpatient stay is and what are the typical aftercare options.
• If your child is from age 18-21, ask on which unit your child will be placed, adolescent or adult.
• Schedule your child’s intake. Ask that the intake process be explained to you thoroughly. Ask what you need to bring including any necessary paperwork and personal items your child will need during his/her stay.
• In getting your child to the treatment facility, follow the strategies outlined in section 6. In some cases with minors you may not want to inform your child of your plans until you are in the car driving to the treatment facility.