Insider’s Guide: Educational Consulting and Therapeutic Placement

It was warm, breezy day in the little cove where the treatment center was located where my client and her parents were standing. We were all on the back deck of the main building and the parents and I had just arrived. The client smiled after a few minutes of small talk and said, “Um, not to be rude or anything, but who are you?” Her parents looked mortified and embarrassed that she didn’t know who I was.

“My name is Rob Danzman and we’ve met several times before you came to treatment. I helped your parents find a healthy place for you.”

The client, after pausing for a second smiled again and said “I think I was so high I don’t even remember you. Thank you.” She started crying. Her parents started crying and they hugged.

There is a deep and broad gap between what families need and all of the treatment options available. There are a ton of variables to consider when your son or daughter need treatment, whether its outpatient therapy or residential treatment. Insurance, location, modality, diagnosis, and housing options are just a few things families need to consider when figuring out what’s best.

There is a dramatic range in expertise and costs and they are not often aligned. Some of the most expensive consultants with whom I’ve worked have minimal understanding of psychological conditions and the evidence-based approaches that best treat them. The goal of treatment is either assessment, intervention or maintenance of a behavioral health issue. If a consultant does not have a combination of academic and experiential background they may not serve clients well. In fact, my agency has worked with clients who were given terrible advice on what types of service to use. You would never have a mechanic give advice on spinal surgery because, while the mechanic may be really well-intentioned and personable, they may due considerable harm. The same is true when dealing with behavioral issues, many of which either in the short or long term may have life and death implications.

Evidence-based interventions need to be well understood and require clinical expertise. Therapeutic placements do a great job of presenting themselves as comfortable, safe and a good value yet many do not provide evidence-based treatments. Evidence based treatments are not for broad spectrum of psychological issues.

Another confusing aspect is the terminology. Decades ago, educational consultants did a few things and did them well – they focused on private school and college prep admissions. They provided deep advice on testing strategy, applications, and how to write a great essay. They coached clients through interviewing and often the whole education process. But over the years, ECs expanded their service offerings, often outside of their area of expertise. ECs without credentials or appropriate degrees started advising parents on treatment recommendations, presumably assuming that applying to a treatment center is similar if not the same as applying to college. Since those wild-west days of ECs pushing kids into cookie-cutter programs and charging a fortune, more clinicians with actual therapeutic experience have entered the EC world. Granted, there is still the old guard of older, white women who had their own children placed in a treatment center and saw an opportunity to help other families while making good money in an unregulated field. There are essentially only one entity that oversee ECs – the Independent Educational Consultants Association. The division continues to widen between those serving families

EC should not receive gifts from treatment centers though it’s not unusual for them to have travel expenses covered when they are touring programs.

There is a symbiotic relationship between treatment centers and ECs. Treatment centers count on ECs for referrals. ECs count on treatment programs to cover travel expenses and, sometimes, provide referrals back to the ECs when a client needs a different placement or the family needs advice on treatment options.  

Where to Find These Magical Beings

First thing to do is just google the terms “educational consultant” and “treatment.” You should get plenty of options that pop up. You could also just contact my agency but I’m a bit biased since I believe we do great work for a fair price.

Next way to find a placement consultant is to go to the Independent Educational Consultants Association (IECA) website (below in the Resources section) and look for the ‘Search’ option under the Parents tab. All of the people listed in this resource are paying members of IECA and met the IECA’s criteria. If you are going this route, I encourage you to, at a minimum, look for a consultant who has a graduate degree in a behavioral health discipline like counseling, psychology or marriage and family. Pastoral counselors or ‘Qualified Mental Health Practioners’ are not nearly qualified enough. It’s even better if they are a licensed professional (eg. Licensed Professional Counselor, Licensed Marriage and Family Therapist, Licensed Clinical Social Worker).

Do Your Homework

A great EC can support your family through the most difficult times while a bad EC can cost your valuable time and money and have nothing to show for it or set things back even further with a terrible placement.

Consult: If you can’t meet them face to face, then schedule a call with them. Before you go into any details, dig into the business end of their service first. Do they offer therapeutic placement consulting or do they focus on prep school and college? What are ALL the costs associated with what they do. What is their degree in and what active licenses do they hold. Ask if they are a member of any associations and if they have any disciplinary actions against them. Ask when and how they got into educational consulting. Ask what the scope of their work is – Do they meet clients at treatment centers for admissions? Do they continue to work with families while the client is in treatment? Do they assist with discharge planning?

Payment: Another thing to consider is how the ED gets paid. It’s important to understand whether the EC sends you an invoice and bills as they go along or do they receive a retainer upfront. Though not a deal breaker, I don’t like asking for retainers from clients for the same reason I don’t like attorneys collecting a retainer from me. They have my money and pull from it as they do work. I’d prefer to pay for things as we go along through a project. We only accept credit cards so that a) there is protection for the client and b) we don’t need to run after clients to pay an invoice. We also itemize every time we charge a client’s card so that everything is 100% transparent. Ask about how folks get paid before you agree to work with them. If they can’t agree to provide itemized billing or seem too focused on money upfront, you may want to consider working with someone else.

Guarantee: It’s unlikely anyone is going to offer you a guarantee for their services but it doesn’t mean you can’t ask about their responsibility if a treatment option doesn’t work or a treatment option can’t be found in a reasonable amount of time.

Cost

Take a deep breath for this section. Expect to pay between $10,000 – $300. Yes, I know that’s a ridiculously large range but there are no regulations on what an EC can charge. The spectrum of fees is truly that big. Some charge as much as $10,000 for a placement. They may put in 5-10 hrs but their rate doesn’t change. Other ECs charge a lower rate but most have a basic flat fee which covers support and advice through the admissions process. In my humble opinion, a lower flat fee or hourly rate is more fare. For instance, my agency has a free consultation to determine if someone really needs an EC. If we determine the client really can’t find an appropriate treatment option on their own, we charge $179 per hour and use as few hours as possible. We’ve had client come to us after spending $25,000 on placement services only to realize the ECs they were using had no clue about severe clinical issues like substance abuse and schizophrenia. Fortunately, we quickly found them services and billed them less than $500.

FAQ

Q: I know how to do internet researching. Why can’t I just find a treatment program on my own?

A: You could totally do this own your own. There are three easy steps. First – get a graduate degree in some counseling or psychological discipline to learn the clinical aspects of behavioral health and intervention. Next – work in the behavioral health industry for about five years so you can see what makes a program great and what makes a program terrible. Finally – go and visit 50 treatment programs. Granted, that will take a few years, and by the time you’re finished visiting, staff at each program will likely have changed (so start over). Ultimately, this experience  will be very helpful in determining which programs are good and which ones you would not trust to take care of your house plants. After all these steps, you should totally do some internet searching to decide which program is most effective at serving your loved one.

Resources

Independent Educational Consultants Association – https://www.iecaonline.com/

FREE Parent Support Group: Residential Treatment and Higher Levels of Care

If you are a parent who wants to learn more about residential treatment for your teen or young adult child, our Parent Support Group is for you. This group is specially designed for Parents of Teens and Young Adult Children either in residential treatment or in need of residential treatment. Whether you have an acting out teen obsessed with gaming or a daughter exhibiting what seems like an eating disorder, residential treatment may be an option. But how do you choose? How do you know the good ones from the bad? We will walk you through the basics of the therapeutic program world through a discussion format. 

Topics will range from residential and treatment options, how to creatively pay for programs and use insurance, myths vs reality of treatment, parenting advice and skill building, and finally, sharing and venting. This is also an open forum to address any other problems related to acting out teens/adults – you’re not alone. 

WHEN

Mondays 7:00pm Starting September 8

WHERE

Fonthill Counseling Conference Room – 141 Providence Rd Suite 160 Chapel Hill NC 27514

COST

Free

FACILITATOR

Licensed therapist with expertise in residential treatment, counseling and parenting education will lead didactic, interactive and experiential sessions.  

RSVP

Due to limited seating, preregistration is required. Please email us at help@fonthillcounseling for sign-up instructions. 

Program Review: Timberline Knolls Residential Treatment Center

You may have recently heard of Timberline Knolls for the high-profile admission of Ke$ha on Friday, January 3, 2014. Or maybe you heard of Timberline Knolls when Demi Lovato was raving about it to MTV when she was discharged several years earlier. Both of these and many other celebs are drawn to Timberline Knolls for their quiet, discrete environment with a good reputation for getting young women healthy.  imgres

Reviews

We take reviews from the internet lightly since they could have been written by competitors (yes, that really happens), written by staff posing as program alums or written by actual alums. Unfortunately – there’s just no way to know for sure so be cautious when considering the reviews. Most of the negative reviews for Timberline Knolls across these sites indicates pretty good clinical program, really nice setting, but super high pricing which may not be very transparent (not currently listed on their site) and significant problems with the Timberline Knolls administration for various issues. 

Google Reviews: 2.8/10 (10 Reviews)
Yelp Reviews: 5/5 (2 Reviews)
EdTreatmentReviews.com: Mixed
BBB.com: 8 Complaints
ComplaintsBoard.com: 6 Complaints 

Who They Serve

They admit women ages 12 – 60’s to extremely discrete care (lots of celebrities). Timberline Knolls recognizes that recovery from eating disorders, addiction and the other conditions is a lifelong process for women. Women require different tools as they move through different phases of life. Their customized program addresses the unique treatment needs of women at various stages of life. 

Many adult women come to Timberline Knolls after having been in recovery for many years. They offer programming tailored to the specific needs of mature women, including those of mothers with children at home. Many clients come to them having been triggered by complicated life events like a death in the family, divorce or significant career challenges.

Residents live in separate lodge settings based upon their age. Adolescent girls attend school at the state-approved Timberline Knolls Academy. They benefit from the tight integration between the classroom and a therapeutic living environment that supports their social, developmental and clinical needs. Check out their video here

Location

timberline-knolls-campusTimberline Knolls (40 Timberline Drive Lemont, Illinois 60439) is located on 43 wooded acres just a few miles southwest of Chicago, less than a half-hour’s drive from either O’Hare or Midway Airport. An interesting side-note: The campus received recognition for its beauty from the American Institute of Landscape Architects. The tranquil grounds contain a lake and reflecting ponds, an historic art studio, comfortable contemporary residential facilities, and outdoor activity fields.

Residents are housed in one of four residential lodges, (Oak, Maple, Pine and Willow), which are staffed 24 hours a day with nursing and clinical support staff. Timberline Knolls also employs on-campus security staff 24 hours a day to protect the safety and privacy of both residents and staff.


Fees, Insurance and Financing 

$875 per day. The daily rate is inclusive for all clinical, educational, psychiatric, behavioral/milieu, nursing, and expressive therapeutic services on a 24 hour, 7 days a week basis. Individual, family, and group therapies are included. It also includes all meals and lodging. The daily rate is based on a tuition model of monthly billing. Non-included services are off-site medical services such as pediatrics, gynecology, dentistry, dermatology, hospitalization, urgent care, emergency care, urine/blood/lab work, etc., and medications. If any of these services are required, the specific provider of those services will directly invoice the parent(s)/guardian(s) or their insurance. 

If applicable Timberline Knolls works with a client’s insurance company (some in-network, some out-of-network) to get as much of the fees covered. Admissions counselors will help clients investigate their benefits.

If insurance is not an option and out-of-pocket is out-of-reach, contact Timberline Knolls and ask about financing.

Final Thoughts

Timberline Knolls had a bumpy start when they started in 2005. The original founders were two pretty shady characters who have since been replaced by reputable investors that seem to be focused on providing a good quality program to upper and middle class women. Most of the feedback we gathered from online and colleagues was that they do a descent job working with the clinical issues but could be a lot more upfront about expenses. They also received several negative marks for having difficult admin staff. These issues could be more about personality (clients as well as the staff) and less about policies that impact every client.

Overall, we encourage perspective clients to take a tour and consider the program. It’s best to higher an educational consultant or case manager to go with you. They will ask detailed questions you may not think to ask or just feel way too uncomfortable to ask. This is a decision you should not make alone. 

Virginia Senator Deeds Stabbed by Son (…And How it Could Have Been Avoided)

Virginia Senator Creigh Deeds was Stabbed by his 24 year old son Austin (Gus) Deeds  who then killed himself with a shotgun at their rural home just West of Charlottesville, Va.. Austin Deeds had just been ‘psychologically’ evaluated just hours before at Bath Community Hospital under an Emergency Custody Order (ECO). The ECO is only good for 4 hours with a possible 2 hour extension if ordered by the magistrate.  Hospital staff stated, working within the maximum 4 hour window, they were unable to find a treatment facility to address Austin Deeds’ psychiatric needs despite several hospitals reporting they did in fact have availability.

Here is some analysis/questions from someone (me) that’s been in this profession for years. I also provide some ideas of solutions if you know of someone struggling with a similar situation:

1. Diagnoses: If the hospital was looking for a treatment facility this means that something the evaluator found indicated Austin was either a threat to himself or others or needed a a level of medical intervention not available at the current hospital. I’m also thinking about the type of evaluation that was conducted and why it was even done at BCH, what the evaluator’s credentials are, and how it was reviewed with Austin and his family. 

2. Discharge: If there were no options (which there clearly were), I wonder if and how the hospital communicated their findings from the evaluation as well as their concerns about safety to the parents and authorities. I’m also wondering what kind of discharge meeting took place. When a client is stepping down from a hospital or residential setting, we always facilitate a comprehensive treatment team meeting to talk about discharge so everyone leaves understanding what the next steps are – action steps. When we work with families struggling with similar issues, we don’t wait for the hospital to give updates. But as mental health professionals, we are able to navigate the bureaucracy much easier and get clear answers much faster. 

3. Responsibility: Providers, whether big hospitals or little, ole’ therapists, have an ethical and legal responsibility to communicate to authorities if a patient is in eminent danger. So who is responsible here? If you ask the hospital, they’ll probably point fingers until the next news cycle. If you ask an attorney, they’ll go through the policy and procedures for the hospital regarding intake, evaluations, referrals, discharge, etc. and anyone of making decisions in that chain could be liable.

4. Intervention (Placement Options): The hospital staff at BCH clearly did not consider referring outside of the traditional placement list (psych beds at hospitals). It’s unlikely that it was due to financial constraints and certainly not due to a lack of treatment centers as some have speculated (Yes, there are certainly a lack of medicaid-funded psych units in VA). There are facilities all over the country that are extremely well-equipped to accept, stabilize and work with patients just like Austin. Most hospitals, though, follow a tired, out-dated protocol of calling three near-by psych hospitals to find out if they have a bed avail. If they here no at all three, patient is discharged with a list of therapists to contact to set up an appointment. Sound ridiculous? You’re right. 

5. Solutions: In my humble opinion, Austin would be alive today if earlier intervention had been provided by a treatment team including a psychologist, psychiatrist, therapist, and case manager. The psychologist provides the initial psychological evaluation to identify the issues, what is causing them, and create a specific list of interventions for the rest of the team. The psychiatrist (though in limited supply in Bath Co, VA) performs an initial psychiatric (medical/medication) evaluation and identify what, if any, medication is necessary to compliment any individual counseling being performed. The therapist provides weekly counseling either in-office or in the family’s home to address areas identified within the psychological evaluation. The case manager is the project manager for everyone and is on-call 24/7. This person also facilitates regular treatment team meetings to ensure updates are provided to the family and all professionals. For instance, if the therapist starts seeing signs of bizarre thinking patterns which are historically correlated with dangerous behavior, the case manager can alert the rest of the team and monitor the client more closely while also increasing the frequency of support. If a higher level of care (ie. psychiatric hospitalization) is recommended by any member of the team, the case manager not only identifies a placement but completes all intake paperwork. The case manager also provides psychoeducation to the family to help them understand the client’s diagnoses and what they can do to most effectively support him. 

If you or someone you know is in a similar mess, do not assume your local hospital has the expertise to handle the situation. Contact a mental health professional to find services that can manage the entire project from assessment to placement to discharge and aftercare.