Length of Stay Guidelines
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F
amilyLightsm supports the principle of keeping children and teens at home and turning to out-of-home resources only when the home resources clearly aren’t meeting needs, but once a young person is in residential service it is important that he or she remain until certain gains are achieved. 

Use of residential placement of any kind is like using a powerful medicine that has both significant benefits and negative side effects.  We expect referral sources, schools, and programs to join with us in alerting parents that by using residential placement, the parents are exposing their son or daughter to "side effects"  they must be prepared to address before their son or daughter returns home, even for visits. We caution parents to beware of the credibility of program admission and marketing staff who fail to communicate this up front – and beware the programs they represent.  Please see guidelines on admission and promotion.

We definitely support the principle of turning to residential programs when necessary.  However, when families decide to place a child outside the home, certain stresses enter the picture. Once that happens, the family needs to be prepared to maintain a residential stay until the client is self motivated to move to a more normalized environment and has the skills to function responsibly under those conditions.   At the same time, we do not want schools and programs to prolong stays longer than necessary.  Students/clients in residential care are sheltered from some experiences and therefore learning experiences of normal life. So, even before we get to financial considerations, placement in residential services should never last longer than needed. But the correct length of stay is a balancing act between these two somewhat conflicting pressures.

As we attempt to balance those pressures, we need to keep in mind that the readiness to return home depends not only upon what the student/client in residential placement accomplishes but also the readiness for the next less structured environment to receive them.  Usually, in plain language, that means that the family has made parallel changes to keep pace with the young person in treatment.  A family that sends a child or teen to residential treatment without participating in a coordinated process of family therapy while the child or teen is in that program is placing that child or teen at serious risk of returning to old patterns upon return home.  

Some schools and programs have pre-determined lengths of stay, set by the calendar.  The former Cedu programs, at one time had a thirty month pre-set length of stay which continued until competitive pressures forced a change to something shorter.  With three exceptions, pre-set lengths of stay, regardless of the length, are contrary to our guidelines.  In situations with short pre-set lengths of stay, students/clients tend to simply wait out the situation with little progress or at least less progress than they would make if they needed to work toward specific changes in order to get home.  In situations with longer pre-set lengths of stay, students/clients students tend to make less progress than what they might until near time for discharge. 

The three exceptions are (1) short-term programs that are intended as a first step toward a longer term intervention, (2) when government regulations require discharge at a certain age (such as 18), and (3) therapeutic boarding schools that pre-set minimum lengths of stay according to educational completion (such as high school graduation) and the program progressively normalizes the environment and reduces charges while the young person makes therapeutic progress,  .  

In situation (1), students/clients know that although they are in that program for a fixed period of time, they are in residential placement for an indeterminate length of time that depends upon their progress.  That way the motivation to make progress is in place just as it would be in a variable length program.

In situation (2), if there is any possibility of a student/client running into a required discharge at a certain point – for example the 18th birthday – when that might not be the time when discharge would otherwise be optimal, we expect full transparency with the parent and referral source at time of inquiry/admission.  We understand that in Utah, especially, programs are not, in many cases, informing parents about the potential for an required discharge upon the 18th birthday, expecting a waiver to be granted, failing to note that waivers, even if customary,  are not automatic. This sort of thing amounts to deceptive marketing and misrepresentation.

In situation (3), we have a therapeutic school respecting that fact students are at an educational disadvantage if they must transition to a new school at an odd time. There is usually some disadvantage to transferring to a different school for any college bound student between the beginning of grade 11 and high school graduation. When therapeutic boarding schools set a time specific point of departure that is farther into the future than expected completion of the therapeutic goals and plan to increase normalization, while reducing costs and structure very significantly in accordance with completion of therapeutic goals, to the extent that students would eventually be living (and parents paying) much as would be the case in a conventional boarding school.    We also note that there are transitional boarding schools created to come close to this service for students whose therapeutic boarding schools cannot normalize the environment to that degree. 

In setting lengths of stay, our guidelines call for schools and programs to define the point of discharge (or the point or point where structure would be altered toward normalization of the environment and the specific changes in the program are to occur at those points, if we are in situation 3 above).  The exact point that each student or client must reach needs to be defined specifically for each student client in his/her treatment or service plan but the general sense of where they need to be for discharge needs to be explained up front. 

For example,  if the general discharge criteria of a therapeutic school call for the student to demonstrate that he or she is stable on medications, and the student in question carries a bi-polar diagnosis, that student’s specific discharge criterion related to medication stability might be that she must demonstrate absence of behaviors that suggest depression or a hypo manic or manic state for a continuous period of three months.  If they call for students to demonstrate control of anger, and student X has had a history of doing property damage every time someone mentions his mother, a specific criterion for him might indicate that the person must demonstrate twelve different situations over a span of three weeks in which Mom was mentioned and no damage occurred. 

The point is that schools and programs should state what they expect in order for a person to be discharged or moved to less structure in a manner that is clear enough that parents and referral sources and the student/client himself/herself knows what is expected when choosing the facility, but the facility will then restate the requirement specific to that person in a treatment or service plan in measurable terms.  Then they should stick to those criteria.

Criteria need to include at least two successful extended visits home with evidence that behaviors and application of resources that should be used post-discharge are actually practiced.  Criteria should also include progress in the family back at home and evidence that there is a supportive environment ready to receive the young person. 

Criteria should be attuned to making maximum use of transition services to shorten lengths of stay in more restrictive environments. 

Criteria should be subject to constant revision based upon outcome studies, aimed at determining shortest length of stay consistent with successful outcomes.

Feedback is invited. We will publish selected feedback.  Email FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last updated January 17, 2009

 
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