Therapeutic Boarding or Residential Treatment after Wilderness?

We have spoken about therapeutic wilderness programs and how effective the good ones can be, but why isn't that enough? What if a family can't financially swing both wilderness and aftercare? What if the child or young adult has conditions that preclude the referral to a short term outdoor program or even a short term diagnostic program that is not outdoors? What is the difference between a residential treatment program and a therapeutic boarding school? What about transition programs and "regular" boarding schools? Where do all of these fit in our world?

There is such confusion about the nomenclature because the licensing differs from state to state, but for our purposes here we will include small residential programs that are highly clinical as well as larger sub-acute facilities when describing a residential treatment center (RTC). RTCs offer similar care and therapy to what used to be lengthy psychiatric hospital stays years ago before managed care took those away. The respected RTCs of today are wonderfully nurturing, have psychiatrists working with the students on a regular basis (most on a consulting basis) and the emphasis is on individual, group, and family therapy although each has an accredited school as well. The way I differentiate these from the next level down (often called therapeutic boarding schools) is this overly simplistic way:

• RTC or similar programs typically have a 75% emphasis on therapy and 25% pm academics

• Therapeutic boarding schools (sometimes referred to as emotional growth schools) typically might have an equal emphasis on therapy (50%) and academics (50%)

• Transition or step-down programs may have 75% emphasis on academics and 25% on therapy

• Traditional or mainstream boarding schools who might be likely to consider students after a therapeutic setting of any kind would not have therapy as part of their program but may have therapists nearby in the town or consulting to the school.

But how do we know what kind of school or program our child needs? There are many ways of determining the needs of our kids. A really good complete neuropsychological or psychoeducational evaluation that includes projective and personality testing is one piece. Another would be the use of an instrument like our in-house Goldberg Educational Placement Inventory (GEPI) as well as speaking to the professionals who have worked with the adolescent or young adult, as well as a face-to-face meeting if appropriate. Often a short term intervention like wilderness offers amazing insight into the needs for the next step.

This is a very basic explanation of the "lay of the land" in the world of the therapeutic settings. Should you need more information please call and set up a phone call with one of us at the Goldberg Center. If you would like to share your perspective, please leave a comment...