Navigating Treatment Choices for Your Child: Asking the Right Questions and Understanding the World of Insurance

Introduction

Finding help for a loved one in need can be a stressful process.  While today’s healthcare consumer has more information and resources at their disposal than ever before, making sense of the information and choosing the right provider can be overwhelming. While an internet search for help will yield a wide range of options, how do you know which one is best for you or your family’s needs, especially during a time of crisis?  The first several options in an internet search will yield paid advertisements, while three to four options down the page, other relevant providers will appear. Regardless of which option you click on, most websites will provide well-presented information about who they serve, where they are located, their program and services, and funding options for care.  Each website will espouse the virtues of their specific approach to care, and often share information to educate you on the experience and quality of care they provide.  They’ll refer to various levels of care for treatment, types of therapy they employ, and what differentiates their approach and offerings. Well-presented information may include measurable outcomes demonstrating the impact and efficacy of their care and services, or testimonials from persons served about their experience. 

While much of this information is designed and presented to help you make an informed decision, all of the information is available to help you establish safety and build trust.  All of the information is intentionally designed to motivate you to a “call to action,” whether that action is scrolling through additional pages to learn more, read linked blog posts and articles, or engage a chat bot for more information. Ultimately, you may choose to complete an online inquiry form to learn more, or more likely, call an admissions representative to speak to someone directly. 

Once you make a call to action, you’ll receive more information, be presented with a nearly exhaustive list of questions, and ultimately face the task of choosing the right care for your child. Making that choice means understanding the quality of care each program provides and ensuring your needs are met within your available means and resources. What is the best choice for you and your child?

Making the best choice is always made when one has as much information as possible and takes a proactive role, asking questions, engaging fully in their loved one’s care and determining and taking accountability for the path of recovery. As a recognized leader and trusted behavioral health industry advocate, C4 Consulting offers the following considerations as a guide to help you make the best and right choice. 

You’re facing potentially the most important decision of your life – where to find the best possible care for your child who is struggling with mental health or substance use. It is important to make your decision not only on financial cost but the comprehensive clinical offerings that will position them for long term success. Be well informed, clear about what you want, clear about what your child is going to receive during treatment, and what you expect the outcome to be for your child at the conclusion of treatment. The family’s health is equally important in the successful journey of your child. The more included in the process from the beginning with the treatment program the more likely your whole family’s success. 

What is effective treatment –
how do you know, what should you ask?

There are key questions you can ask prior to treatment that will help you make an informed decision for your loved one. At its highest perspective you want to understand clearly what the treatment experience will be like for you and your child as well as what will happen after treatment when your child returns home.

  1. Getting Started. 
    1. A good starting point is whether the program licensed is by their state and are they accredited by a national independent organization such as The Joint Commission (TJC) or the Commission on the Accreditation of Rehabilitation Facilities (CARF)
    2. How big is the program – how many clients does it serve at one time? Is it a gender specific or mixed gender program?
    3. Ask the program what their experience is working specifically with your child’s behaviors. As an example, if your child has experienced trauma, ask them specifically how and when they address trauma in treatment.
    4. You want to know that family involvement is a significant part of your child’s treatment experience. It takes work on everyone’s part and you want to know that the treatment center is investing in your whole family’s wellness. Does the family get a separate therapist and do their own therapeutic work? What does the full family program look like?

2. How “good” is this treatment program? How effective is it?

    1. Ask them how they measure success and to share the specifics of that with you. Some programs may post this on their website. This is not a substitute for program staff being able to articulate it to you verbally.
    2. What do they do to protect against adolescents “leaving against medical or clinical advice” (AMA or ACA) or “eloping”? While this can be dependent on different influencing variables, how the program answers will tell you as much as what they answer. The adolescent population is often challenged by these variables as adolescents often do not choose to or want to go to treatment – the organization should be speaking openly about their interventions to manage this expected behavior.
    3. What is included in the aftercare, follow-up and alumni programs? How do they help you sustain gains made in treatment? Do they make use of technology for this?

3. What happens in the care experience for your child? 

    1. How many licensed professionals are on staff and what is the ratio of licensed staff to the clients? The staff at any given program has a tremendous impact on the quality of your child’s care. Ensure the team has licensed therapists, psychologists, doctors, and educators.
    2. Will your child’s individual therapy be with a licensed therapist?
      You would like your child to be seen by a licensed therapist at a minimum of once a week for a full hour. It is important to be sure that your child receives a full hour of actual therapy – in some programs this hour can be more of a check-in and lessor quality programs use interns to provide this service. 
    3. Will my child receive psychological testing and, if so, what is the added cost?
      It is critical that your child’s treatment team accurately identify the mental health diagnoses so that they can develop an individualized treatment plan to support long term success. Be sure you understand the cost of the testing up front. 
    4. How often will my child see a doctor? Is there nursing on staff?
      It is important to ensure your child’s medical needs are being met while in treatment, including management of any current or future medications. If they have been using nicotine, marijuana, or other substances on a regular basis, it is likely that they will experience physical withdrawal symptoms and should be routinely evaluated by a medical professional.
    5. What therapies are used? You will want the organization to be able to explain this in clear and understandable terms.Some of the therapies proven to be effective with teenagers are:
      Dialectical Behavior Therapy (DBT); Cognitive Behavioral Therapy (CBT); Contingency Management (reward system); Community Reinforcement Approach. Furtherevidence-based practices: Motivational Interviewing (MI); Family-Based Therapy (FBT); Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT); Mindfulness-Based Interventions; Twelve-Step Facilitation (for substance use).
    6. Does the program offer school onsite? Is the school accredited? How many hours of classes a day? Will it count towards your child’s home district requirements? Are they able to collaborate with your child’s current school? Ensuring your child’s education remains a vital and important part of their life. Ask questions regarding the educational component of treatment.  

Understanding the Difference in the Treatment Experience Between In and Out of Network Care

How that care manifests itself in a treatment program is affected by many nuances. The quality of a program is determined by many factors. Its clinical offerings, quality of staff, depth of varied activities and amenities, and the overall quality of the physical environment are all dependent upon the daily cost of treatment, and how much the program reinvests in all those component areas.  

Environment, Clinical Care & Amenities

With more resources available, Out of Network programs are consistently able to provide a higher quality and deeper level of care to your loved one. Ways this will manifest in comparison between in and out of network programs:

Out of Network

In Network

Staffing Skill

  • Optimal client-to-staff ratio

  • Greater depth of licensed clinical staff, both in depth and quantity

  • Elevated levels of staff experience and training and certification. This is seen across the staffing patterns of all shifts

  • Comprehensive medical care delivered by skilled physicians and psychiatrists ask about frequency

  • Ask the program what their experience is working specifically with your child’s behaviors. As an example, if your child is physically aggressive, ask them specifically how and how successfully they manage aggressive behaviors
  • For in-network programs, the staff-to-client ratio may be lower, potentially impacting personalized attention

     

  • It is common for in-network programs to rely on a minimal licensed clinicians and associate therapists working towards their licensing requirements for direct care. This structure might influence the overall depth and diversity of the clinical team

     

  • It is crucial to inquire about the medical care provided in in-network programs. Understanding the qualifications, experience, and specialty of the medical professionals delivering care becomes particularly important in this context

Clinical Service Offerings

  • Psychological testing to gain clarity on accurate diagnoses

  • Enhanced specialized direct and supportive clinical care, including practices like experiential therapies and DBT. Activities may extend to adventure-type experiences and equine therapy

  • Device care management takes a balanced approach, avoiding punitive measures and restrictions. The focus is on facilitating a smoother transition for your child when returning home with the device, aiming for a less chaotic experience

  • A diverse range of individualized educational resources, spanning technology and trade training, adds to the richness of the program

  • You want to know that family involvement is a significant part of your child’s treatment experience. It takes work on everyone’s part and you want to know that the treatment center is investing in your whole family’s wellness
  •  In network programs may not offer psychological testing and, if so, only provide it case by case for an added cost

  • For in-network programs, the diversity of clinical care programs may be comparatively limited, impacting the range of services available for your child’s experience

  • Device care management is often unavailable due to the need for oversight and lower staff-to-client ratios. This can result in a more challenging management approach. Some programs may adopt a zero-tolerance policy, completely restricting the use of electronics

  • There might be fewer resources and a shallower depth of educational offerings in in-network programs. This aspect is significant, especially when considering the integrated educational component

Amenities

  • Emphasis on physical fitness and its clinical and developmental benefits, through activities onsite and off campus, ropes courses, and various recreational pursuits

  • Scheduled therapeutic outdoor activities play a vital role in identifying areas for further client development and facilitating a smooth transition back to a healthy teenage lifestyle

  • Specialized food and nutrition services with significant resources ensure a higher quality and diverse selection of food
  • Physical fitness resources at in-network programs may vary. However, the investment in external outings and specialized components like kayaking, ropes courses, etc. may be significantly limited

  • For in-network care environments, specialized nutritional services and the overall quality and variety of food are often lower. It’s advisable to inquire about the approach to gain insight into the nutritional offerings

Environment of Care

  • Out-of-network programs consistently allocate more resources to enhance your child’s overall experience. This commitment is evident in various aspects, including:

  • High-quality furnishings to ensure a comfortable environment

  • More square footage per client designated for both individual bedrooms and communal spaces

  • Abundant recreational resources encompassing games, sports and workout equipment. There’s a rich array of artistic offerings, including music, dance, and art. Outdoor activities like fishing and hiking, along with programs promoting mindfulness through yoga and meditation, contribute to a comprehensive experience
  • While in-network programs can provide a comfortable environment, the quality of furnishings may be affected and in most cases do not compare to an out of network setting. The environment can often feel more institutional

  • The ability of the program to fund and facilitate outside activities, including transportation and staffing, may be limited due to financial constraints

Educational Services

While not always differentiated by In and Out of network programs – there is an important component and nuance of this part of your loved one’s experience. The most effective and comprehensive delivery of care to your child occurs when the educators facilitating the academic component of your child’s care are integrated with the clinical team and a part of the entire therapeutic experience.
Some programs will utilize teachers from the local school district who, while providing quality educational services, remain disconnected from the day to day life of your child’s treatment experience. 

In programs where the teachers are employed by the program there is significant give and take between the educational and therapeutic staff making for treatment that is integrated and responsive. 

Final Thoughts

Navigating the realm of substance use treatment for a teenager can feel like an overwhelming journey, filled with uncertainty and tough decisions. Through our understanding of and extensive experience in the field we’ve distilled key findings and considerations into actionable guidance tailored to empower your decision making. 

Our aim is to create a space of support and reassurance, acknowledging the weight of this decision while providing clarity and direction. As you embark on this journey, remember that you’re not alone. There are individuals who will help you navigate the complexities of substance use treatment for your loved one, ensuring the best possible outcome in treatment and for the future. Your dedication and love for your child is the cornerstone of this journey.