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/

Insider’s Guide: How to Pay for Therapeutic Boarding School (UPDATED for 2015!)

Before we dive into understanding the options for Therapeutic Boarding Schools, let’s quickly review what they are

The Rise of Therapeutic Boarding Schools

As public schools across the country have slowly been pruned back by state legislatures, funding for behavioral, emotional and academic support have nearly dried up. Therefore, it’s not surprising private institutions like boarding schools and private schools have exploded. One of the fastest growing kinds of boarding schools is called Therapeutic Boarding Schools. Therapeutic boarding schools maintain the advantages of traditional boarding schools such as intimate class sizes, individual attention, great academics, developing student self-reliance, and the fun of living with peers in a completely “child-friendly” environment.

Some therapeutic boarding schools specialize in helping teens overcome certain psychological problems such as Attention Deficit Disorder, Bipolar, Asperger’s and even Depression. Others have programs for overcoming substance abuse problems or achieving weight loss. Some specialize in helping students who lack motivation get a fresh start in a nurturing environment. Most have some sort of family or parent involvement piece to ensure a team approach (ie. Weekly family therapy via phone or Skype).

Expense or Investment?

Parents often find themselves in a desperate situation with a troubled teenager. Their daughter runs away from home again, gets caught with the dealer down the street, crashes another car, and has yet another arrest. Parents become afraid for their teen’s lives as their teen’s risk-taking and lifestyle keeps becoming more extreme as the parents’ ability to set boundaries and expectations seemingly erodes.

It’s hard to think clearly and find solutions at times like this. Therapeutic boarding schools and therapeutic wilderness programs can provide answers, but they come at a price, with some programs running upwards of $50,000 a year.

But cost doesn’t have to be an insurmountable obstacle in getting your teen the help they need. We have helped countless parents in similar situations come up with creative ways to finance therapeutic boarding school, knowing that their child desperately needs an intervention. Therapeutic boarding schools are no longer exclusively the domain of the wealthy.

Top 10 Ways to Pay for Therapeutic Boarding School

Here are 10 ways families just like yours found to finance their teen’s therapeutic program:

1.   Hire a Case Manager: Say what? More money? Yes. Just like a good tax professional can save you big time when filing, a good case manager can be well worth their weight in gold. Make sure they are UNAFFILIATED with any program and have the clinical expertise to help advise and guide your family through the whole process. Some clinical educational consultants that specialize are able to handle this. A great case manager will be able to create a treatment plan, explain the process for getting a comprehensive psychological evaluation, walk with you through the intake process, support you while your teen is in the therapeutic boarding school, and coordinate discharge planning to ensure a seamless transition back to home or college. The last piece is essential – making sure your teen has everything they need to succeed after they return. Great case managers also know how to secure reimbursement from insurance providers for teens that attend therapeutic boarding schools. There are definitely some tricks (eg. Hire a case manager that’s also a licensed professional counselor and much of their work could be paid for by insurance) and inside knowledge necessary to make this happen.
Typical cost: $95 – 350/hr (some charge a flat fee of several thousand). 

2. Find the Program’s Financial Aid Officer: The private school or wilderness program should have a financial aid officer who can advise you about how to finance your child’s education. You should ask this person what programs, loans, discounts, or financial aid the school offers. Find out exactly what is included in the tuition and board bills, and if there are additional expenses such as buying uniforms or paying special fees for sports.
Typical Cost: Nothing – programs provide this to try to entice you into signing up. Beware of anything that sounds too good to be true – verify any claims they make about coverage from insurance, student grants/scholarships or loans. 

3.  Public School Funding: You may qualify for a loan through a kindergarten through 12th grade educational loan program. These loans work the same way as college loans, in that you pay what you can while your child is enrolled in the private school, and pay the rest off later. The terms of some loans let you spread out payments over 10 or 20 years. Your credit history will be a factor in securing a loan. Your school’s financial aid officer should be able to help you find such a loan.
Typical Cost: Your sanity – they will drive you crazy with the bureaucracy and take loads of time during your work day since everything in public school shuts down by 3:30pm. 

4.  Discounts for Upfront Payment: Some schools offer discounts if you pay by the year, instead of by the month. The average student stays at a therapeutic boarding school for less than two years, and wilderness programs are even shorter.
Typical Cost: More money upfront but no other associated costs. 

5. Tap 529: Consider using your child’s college fund first. Think of the therapeutic program as a way to get your child back on the right path toward college. Without intervention, she won’t have the grades or motivation to get through college and use her fund.
Typical Cost: Make sure there are no withdrawal penalties for use for therapeutic boarding school. 

6. Put it On Plastic: When you enroll your child in these therapeutic programs, there will be upfront expenses such as processing fees and deposits. Some parents borrow these initial payments from credit cards, especially ones that offer “frequent flier” miles. This way their child is immediately enrolled. They use their free mileage for transportation to and from the school.
Typical Cost: Beware of high interest rates if you don’t pay off your balance in full. 

7. Angel Investing: Some parents borrow the necessary funds from employers or relatives, and pay them back after securing educational loans or home equity loans.
Typical Cost: If you go through a peer-to-peer or crowdfunding site like The Lending Club or Kickstarter, count on a 5% fee for total amount funded. 

8. Health Insurance Reimbursement: Your health insurance policy may cover part of the cost of a therapeutic program as a medical expense. When you hire a case manager, they will be able to tell you how to file the paperwork and what you need from the program to ensure a speedy reimbursement.
Typical Cost: Sanity… totally lost if your insurer are jerks that don’t reimburse when and how they should. You are attempting to pull money from their cold, dead hands. Expect a fight.

9. Consult Your CPA: Some expenses for therapeutic schools and wilderness programs can be deducted from your income tax return as medical expenses. If you own your own business, you likely have WAY more creative options for deducting medical expenses. 
Typical Cost: $200/hr for a good CPA to walk you through if and how to deduct from taxes. 

10. Tap Home Equity: Parents have taken out second mortgages or home equity loans and then deducted their interest payments on their income tax returns.
Typical Cost: Fees, closing costs total 2-6%. It also bumps the timeframe for paying off that home back several years.

11. Public School Funding: We lied – there turns out to be 11 ways to pay for therapeutic boarding school. Is your child enrolled in public special education classes because of problems like attention deficit disorder and learning disabilities? Does your child have an “Individual Education Plan” at a public school? Do you suspect your child has learning problems that the public school cannot address? In certain cases, public school districts have to reimburse parents for private school tuitions. The Supreme Court ruled on June 22, 2009, that an Oregon school district had to reimburse a family for private school costs because the child in question could not achieve a free and appropriate education within the district. The child had not been enrolled in special education classes but was diagnosed later with attention deficit disorder.

When it comes to what matters most parents are unstoppable in finding ways to get the services and support they need. Don’t let cost be the determining factor. If your teen needs help, speak with a case manager, your trusted CPA as well as a therapeutic boarding school you’re considering and work together to find a way to get your teen back on track.

Insider’s Guide: Getting Insurance to Pay for Residential Treatment

imagesThis is our second installment on how to get insurance to pay for residential treatment and therapeutic programs. Below is some great information to help you beat the insurance companies at their own game. Insurance companies count on your ignorance, laziness and distractibility to avoid paying for services they are legally obligated to cover. 

With the Affordable Healthcare Act and the Mental Health Parity Act in full swing it’s time to learn how to get the most out of the insurance you pay for. We’ve included some tricks, strategies and how-to’s to help you out. Though we’re focusing on Residential Treatment for our discussion here, this info is applicable to therapeutic programs like wilderness programs, therapeutic boarding schools and intensive outpatient programs.

Ok, let’s get started with some basics… 

What If I Need Additional Help?

First, read through everything below. These strategies are time consuming and require steady attention but they are not impossible. If you still don’t feel confident in holding your insurer accountable, contact us for a free consult and we’ll help you figure out how to move forward. 

What is the Insurance Company’s Criteria for Residential Treatment?

…Or more importantly, how does an insurer define residential treatment? Each insurer has their own definition but most have virtually identical criteria. For our purposes, residential treatment is defined as specialized mental, behavioral health or substance abuse treatment that occurs in a residential (overnight) treatment center where the provider is responsible for clinical service, safety, shelter, and food.

Licensure differs by state, but these facilities are typically designated either as residential, subacute, or intermediate care facilities and may occur in care systems that provide multiple levels of care. Residential treatment is 24 hours per day and often requires a minimum of one physician (or psychiatrist) visit per week in a facility based setting. 

What Specific Criteria Do They Look For?

Now, let’s drill down a bit more and look at some of the more common criteria requirements insurance companies are looking for when determining whether to pay for residential treatment to a struggling teen or young adult. 

  • Was there a sincere attempt to first use evidence-based outpatient therapy in the home community by a licensed professional before residential treatment was requested and outpatient therapy did not work? Basically, they want evidence that you tried outpatient therapy with weekly sessions (or more often) and because it was not effective, a more intensive level of care like residential treatment was justified.
  • Prior to admission, did you contact your health plan for list of in-network residential treatment options? More on this later – what to do if you can not find a good option.
  • Is there uncontrollable risk-taking to self or others or other dangerous behavior?
  • Has there been a documentable and rapid decrease in level of functioning in one or more life domains. Another way to describe it is a decline in functioning resulting in the ability to perform self-care. 
  • Is there a likelihood of no improvement in current environment (ie. home or college)
  • Is there a reasonable expectation that patient will improve in residential setting and be able to return to outpatient therapy for aftercare? 

How to Request this Higher Level of Care?

Now that you understand the criteria, let’s talk about how to actually request residential treatment. 

  • Write a letter strongly recommending admission to residential treatment 
  • Provide copies of assessments and testing performed by a licensed professional that indicate 1) a formal diagnosis and 2) specific recommendations that list residential treatment.
  • Explain how outpatient therapy has not been successful
  • Explain why current circumstances make it unlikely that patient will show improvement (ie. Improvement is not likely in home setting due to social stressors such as negative peers that sell drugs but remain in the environment)
  • Document unsafe, declining behaviors – show symptoms and behaviors that represent a decline from usual state and include either self-injurious or risk-taking behavior that cannot be managed outside of 24 hr care. Can your kid maintain abstinence outside of 24 hr care? 
  • Explain that the residential treatment program uses evidence-based clinical interventions.
  • Request the residential treatment program directly contact your insurer for pre-authorization. Pre-authorization is the insurance company’s way of giving formal permission to use a higher (and more expensive) level of care. Make sure to obtain the tracking number and verification of the call from the residential treatment program. If approved, obtain written authorization confirming admission approval.

After you send off your request, your insurer should should respond in 5 days. Don’t wait that long – call them every day to find out the status of your request. Yes, seriously – call every day. 

Accepted! Now Some Additional Insurance Mandates

The insurance company accepted your request (more below on what happens when they do not accept it) and a wave of relief comes over you planning for some quiet time once your kid is safely transitioned. But before you get too comfy, there are a few things you want to make sure the residential treatment program will do to ensure insurance covers as much as possible. It’s easier to ask these questions during the admissions process rather than at discharge. Here’s a list of what to look for or ask for:

  • A basic physical during admission (urine screening for drug facility)
  • Onsite nursing and 24hr access to med care
  • Multidisciplinary assessment (also called a Biopsychosocial Intake) performed within 72 hr of admission, including information obtained from patient’s previous providers (ie. therapist, primary care physician)
  • Individual therapy with a licensed therapist (ie. LPC, LCSW, LMFT) at least one time per week
  • Weekly meetings with doctor for medication management
  • Weekly family therapy
  • Discharge plan created one week after admission which acts as a set of exit criteria
  • Licensed in the state in which they are located. Some facilities are owned by huge companies in another state. Make sure they are credentialed and licensed.

Denied. Now on to The Appeal Process

Denials are just a way of life in the therapeutic treatment world but it’s certainly not the end. Here are some information on what to do when you experience a denial.

  • First Thing – Do not let the denial get you mad and do not attempt to use logic, common sense or science to understand why. Insurance is a business and their business model is take in money and pay for as little service as possible – period. 
  • If residential treatment is verbally denied, request written denial. They must deny in writing and often will send the residential treatment program as well as the insured person a copy. 
  • Do not just ignore the denial and send your kid off unless you are willing to pay out of pocket and work your tail off at discharge to get the insurer to pay for it.
  • How to appeal depends upon the reason for denial. The insurance company will likely list specific criteria either your kid or the residential treatment program did not meet.
  • If the insurer states that residential treatment is not a covered benefit but they offer  other mental/behavioral health benefits, they are required by law to pay. In Harlick v Blue Cross of California – On August 26, 2011 the court confirmed that California’s Mental Health Parity Act requires health plans to provide coverage of “all medically necessary treatment” for “severe mental illnesses” under “the same financial terms as those applied to physical illnesses,” and are obligated to pay for residential treatment for people with eating disorders even if the policy excludes residential treatment.

And It’s Still Denied – What Next?

If you submit an appeal with additional information and site the law but still are denied or hear nothing, you can request an independent review from your state’s regulatory body that oversees insurance compliance. It’s amazing how quickly insurance companies can ‘find missing paperwork’ or reverse a denial when regulators and attorney’s get involved. 

  • Send a certified-mail cover letter describing the dispute
  • Provide all relevant evaluations, assessments and testing you already sent to the insurer
  • Submit a doctor’s letter stating care is medically necessary
  • You can also hire an attorney that specializes in insurance issues like this. They are often worth their specialist price tag.

Plan B – If You Can Afford It

If residential is denied and you don’t want to push the insurer for whatever reason, you can pay out of pocket for room and board and try to get the clinical services covered. This approach is often what is equivalent to out-of-network coverage. The insurer is more likely to cover outpatient therapy, group therapy and medication management (virtually the same as if client was living at home and going to therapy).

You can also request that the residential treatment primary therapist get a single case agreement which forces the insurer to pay at in-network rate and you only owe the copay, as usual. 

What if Our Family Member is at Therapeutic Boarding School?

With the growth of therapeutic boarding schools, we’ve received a ton of questions about how insurance pays for the clinical aspects of these hybrid programs. Here are some tricks we’ve picked up over the years:

  • Think like the insurance company – they want to hear your son or daughter is being referred to as a patient and not a student.
  • Make sure to request a physical assessment is done at admissions. This promotes the perspective that he/she is a patient and not a student. Remember – we want the insurer to understand this is a therapeutic program, not as much an academic program.
  • We also want to ensure the program is keeping daily records such as treatment plan updates, nursing and medical notes and service notes – health plans will want copies. We want to be documenting progress as well as setbacks. 

When we conduct placement services, we always request the therapeutic program develop a treatment plan with some specific exit criteria. The first day of treatment is the first day of discharge planning. Some plans will want exit criteria so err on the side of having the program provide it early on. It’s also a good clinical practice to give the providers a clear target. 

In Which State Should Insurance Regulators Be Notified if Insurance Refuses to Cooperate?

The state in which treatment is being provided is where insurance regulators should be contacted if your insurance company refuses to play nicely. The state in which you live may be where your insurance is attached, but legal oversight for provision of service and insurance regulation is in the treatment state. 

Can Insurance Pay for Services Retroactively?

Theoretically, yes. Practically, it’s pretty difficult and will require regular attention and contact with the insurer. They will likely ‘lose’ applications, claim forms and anything else you send. If you get insurance to agree to pay for residential treatment or other therapeutic services after treatment has started, you can request for retroactive coverage. It’s best to write a letter (and send it certified mail and keep a copy for your records) stating why you didn’t understand or it was not stated clearly in a policy that treatment was covered. 

Will Insurance Cover Partial Hospitalization Programs (PHP)?

Partial Hospitalization Programs or PHPs is typically a level of care designed for individuals who need structured mental health, behavioral health or substance abuse programming but do not need 24-hour supervision (ie. inpatient or hosplitalization). Many hospitals and residential treatment programs offer partial hospitalization or day treatment services. Good PHPs are designed to provide support, education, medical monitoring and accountability during the hours of the day often identified as most troublesome for patients. Patients participate in therapeutic groups, structured activities and discharge planning similar to those offered in the inpatient and residential programs. Many patients who have been in an inpatient or residential program can “step down” to this level of care because it continues to provide a high amount of structure and support. 

Insurance generally covers PHP at a per diem rate (daily rate) but will not cover overnight which the hospital or treatment program may charge extra for. Make sure to clearly understand how the treatment center charges for PHP before signing up. Also make sure insurance covers it and what portion it covers. 

So we covered several of the topics and tricks that can help you navigate the insurance company maze when it comes to paying for residential treatment. If you need additional help, contact us today – help@fonthillbehavioralhealth.com 

Program Review: The Renfrew Center

Renfrew PicMany years ago I had the pleasure of visiting The Renfrew Center just outside of Philadelphia, PA. At first, I wasn’t sure if this was a gigantic private residence with it’s ancient stone farm house, stables, and quintessential barn. Definitely one of the more beautiful suburban locations for a treatment center I’ve seen. I had my tour of the grounds which look more like an upscale farm (in a good way), talked with the Executive Director about mental health under a giant oak tree, and got to know the program schedule as young women shuffled in and out of the various buildings. Below are more details on Renfrew with my Final Thoughts at the end. 

Background

The Renfrew Center is headquartered in has been serving women with eating disorders and behavioral health issues since 1985. As one of the nation’s first residential eating disorder facility, with 16 locations throughout the country, Renfrew claims to have worked with more than 65,000 women since their founding. The Renfrew Center has experienced it’s most significant growth in the last decade and a half have with the additional of programs across the country. 

Services

The Renfrew Center offers a full continuum of care that supports patients well beyond a residential stay. This comprehensive range of services available at most of their locations, includes day treatment, intensive outpatient and outpatient programs. The services are tailored for each patient and with her referring therapist to develop treatment plans and goals based on her unique needs.

Renfrew maintains continuity in philosophy and approach throughout the individual’s treatment, while facilitating timely transitions from one level of care to another in order to maximize treatment and insurance benefits. 

Residential services are only offered in their Philadelphia, Pa and Coconut Creek, Fl locations. 

Clients

Renfrew works with women over the age of 14 suffering from anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified (EDNOS) and related mental health problems.

Locations

Cost
Residential – $8050 per week
They work with most insurers so a significant portion of services may be covered. 

Reviews
Employees on multiple sites give Renfrew some terrible grades for working conditions, diversity of the work force, and work-life balance. Most notably were many comments on Renfew’s seeming focus on profit and not much focus on treatment. They also described poor, untrained supervisors that did little to organize chaotic situations. 

Clients on the other hand often report having a positive experience and feeling somewhat nurtured. There were dozens of reports from clients going back to Renfrew multiple times for support. This could be viewed as good or bad. 
The New York location stood out with many, many negative reviews which highlights an ongoing theme among larger providers like Renfrew – when it comes down to actual effectiveness of a program, everything has to do with the clinicians at specific locations and very little to do with the corporate handlers up above. 

Contact

Here is a link to their online contact form which is probably the best way to get ahold of them. 

Final Thoughts
Oh how I wish programs like Renfrew could just slow down and focus more on quality. I’ve known too many therapists over the years who think poorly of Renfrew’s clinical integrity to feel comfortable referring clients that come to Fonthill. That said, it doesn’t mean women struggling with an ED should avoid Renfrew. I think programs like this have a place in the menu of options, especially if you want treatment close to a major metro area like Philadelphia. Just make sure to make a decision on more than what the admissions folks at Renfrew tell you. Look up reviews, talk with outpatient eating disorder specialists (like Dr. Joanna Marino in Washington, DC) or placement specialists (…like Fonthill ) and do your homework. It’s expensive and takes a huge amount of time to go to Renfrew so don’t rush in. 

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. 

Treatment 101: Therapeutic Boarding Schools and Residential Treatment Centers

Today we examine some of the basic differences and similarities between therapeutic boarding schools and residential treatment centers (or programs).

 

THERAPEUTIC BOARDING SCHOOLS

Also known as Emotional Growth Boarding School (not used so much any more), is a boarding school based on the therapeutic community model that offers an educational program together with specialized structure and supervision for students with psychological, behavioral, substance abuse, or learning difficulties. Another newer term is Academy which lends some gravitas and impressions of legacy. Basically, it sounds fancier. 

In contrast with Residential Treatment Centers, which are more clinically focused and primarily provide Behavior therapy and treatment for adolescents with serious issues, the focus of a TBS is toward emotional and academic realignment involving clinical and academic oversight for physical, emotional, behavioral, family, social, intellectual and academic development. Therapeutic and educational approaches vary greatly; with the approaches best described as a combination of interventions often based on the founders’ perspective. The typical duration of student enrollment in a TBS range from one to two years with many schools mandating a minimum stay of at least 1 year. Students may receive either high school diplomas or credits for transfer to other secondary schools. Some therapeutic boarding schools hold educational accreditation within their respective states. TBS’s may be for-profit or non-profit entities and might also be owned by a much larger company (eg. Aspen Education Group, Red Cliff Ascent, Universal Health Services to name a few). 

Therapeutic boarding schools are generally middle schools and high schools that have comprehensive therapeutic interventions (medication management, individual/group counseling, life skills) for the students and a program to help them with self-esteem and problem behaviors. Some are more therapeutic than others while some boarding schools are actually therapeutic but will not list themselves in that category to avoid any negative connotation. 

Most of the therapeutic boarding schools do not have a medical plan for bipolar disorder, and do not provide psychiatrists on staff. If you want your child to attend a therapeutic boarding school he or she needs to be stable enough to attend school with therapy support (typically includes individual counseling 1-2x/wk, group counseling 1-2x/wk and 1 weekly phone conference with parents/therapist), while maintaining a relationship with an outside psychiatrist. Additionally, some schools do not wish to administer psychotropic meds. Ask the admissions folks if this is something important for you. 

 

RESIDENTIAL TREATMENT CENTERS

Sometimes the school that best meets the child’s needs just doesn’t exist anywhere near home, or the child may become too unstable to stay at home and attend school. It may become painfully obvious that a change in environment with a twenty-four-hour peer group and non-parental authority figures may help the child grow and mature in a safe environment. Maybe they are a danger to themselves or others and they need to be in a setting that can monitor their illness and behavior, as well as provide them with tools to understand and deal with their illness while not losing ground in school.

Residential Treatment Centers (RTCs) are medical facilities (most of the time). They should have psychiatrists and nurses on staff. They administer medications, make medication adjustments, and provide therapy and schooling. They are required to follow a student’s IEP.

Residential schools can cost anywhere from $56,000 to over $125,00 per year. A school district may pay part or most of the fee of such a placement, but typically only after a due process hearing. This process is not recommended for parents – Definitely bring in professional support for this (yes, a case manager or educational consultant with expertise in IEP/504 process and laws within your state). 

If you have not noticed the theme, here it is – Parents should ask for help from a clinical case manager or educational consultant. While the vetting and application may seem like an easy project for accomplished parents, the timing, financial and clinical complexities can create significant challenges. The case manager should have any professionals working with your child contribute to the discussion on placement strategies and options. Leave this to the professionals. It costs money on the front end but will save you thousands of dollars over months and years and also help you to understand your child, family and the education/psychological process much better. 

Here are some additional resources:

Program Tour: Pros and (Not Many) Cons of Edge Learning Community

Findings of a Summer Day Tour at Edge Learning and Collegiate Community in Chicago

Among the towering buildings and rattle of platformed trains in downtown Chicago is a vibrant support community for young adults called Edge Learning Community. I met with their Director of Business Development, Chris McClaughlin, on a toasty Summer day recently. He was kind enough to meet me in the downstairs lobby  – a modern but elegant entry convenient to one of the major stops for the Chicago Transit Authority (map here).  

Up we went to their expansive and deceptively large common area. Sleek, clean furniture juxtaposed the industrial feel of the exposed brick walls and weathered hardwood floors. This was just the beginning of an exceptional space and community.

To the left, Chris escorted me to their rooftop ‘backyard’ area complete with grass (actually astro turf), outdoor projector for movies, lounge chairs and hot tub. Sweet views of Chicago were the bonus. The space felt way more private than you would imagine. Despite giant glass and steel over shadowing the old building on multiple sides, one has a sense of serenity. Not a bad start to a tour.  

After talking about some of the history of the buildings and infamous Chicago characters, we cut through the inside common area out onto another patio on the West side. This was a super-call outdoor bar and grilling area which felt more like a bistro than therapeutic program. Chris pointed out the buildings where Al Capone had secret get-a-ways, we talked about the history of the city and then, after the late-morning sun started to cook us, we got around to talking about the program. It’s center around what they refer to as Core Competencies: Whole Brain Thinking (Rational & Irrational Thinking); Creativity and Continuous Learning; Effective Communication; Leading within Teams; Community Stewardship; Sustaining Healthy Relationships; Self Care; and Management of Resources and Technology. Rather than cutting and pasting from their site, I recommend going to their site to read through the details.

After lunch in the kitchen/dining room, we toured the rooms that, to be honest, felt way more like high-end apartments with large kitchens. High ceilings and plenty of space for single or multiple students make each room a great space for studying, hanging-out and even cooking. Chris and I spoke about the limitations of many programs that only accept young adults in recovery. Edge is well-prepared and works often with folks struggling with addiction but they don’t think of themselves as a substance abuse program. It is not for those in the very early stages of recovery. It is definitely not for those that do not have basic internal locus of control and responsibility for their behaviors. The heavy lifting of support for each resident is performed by coaches who, for all intents and purposes are therapists as shared with me by their clinical director Jason Wynkoop. They are highly trained and competent to work with young adults struggling with organization, recovery, mental health issues and behavioral support needs.

Our tour and day ended high above Chicago talking about Edge, it’s program and the bright future they have since so many older, more established programs are just not meeting the current needs of students today. To summarize, here are some Pros and Cons to consider. If you need more insight, contact us. We’re happy to share what we know to help you make the best decision.

Pros

Aesthetics: Fantastic common areas (no crappy This-End-Up blocky wood sofas that smell like dog). Mature, hip and nicely appointed apartments with great views . As a side-note, I had no idea This-End-Up was still in business until I researched the link for this review. Wow.

Location: If you are freaked out by silence, if you can’t stand wilderness, and if you prefer the hyper-rhythmic flow of the city, Edge is where you need to be, especially if you are in college and need support.  It’s close to huge parks, museums, great restaurants, entertainment and tons of public transportation. Cars are definitely not needed here.

Independence: For those needing collaborative but not overbearing support from super competent professionals, Edge is your place. There is an expectation you are in school and keeping busy during the day.

Cons

Model: It’s not a bad thing but if you are looking for a super traditional transition program this may not be for you (or your son or daughter). Their collaborative approach rocks for some but may feel overwhelming to those that just want a bed for their head.

Location: If the cacophony of big city life wears you down, this is not the program for you. Edge’s DNA is inseparably tied to the fast-paced hustle of 2.715 million neighbors. Fit is a big deal when looking for support during the already stressful (and fun) time of college and young adulthood.

To be honest, there just aren’t many Cons – nothing here is inherently bad. Quality, in this case, is clearly defined by fit. For those ready for the interdependence of young adulthood we highly recommend visiting Edge for one of their informational meetings/weekends, talking to alum and getting a tour before committing to Edge. Once you know it’s the right place for you, you’ll experience the intense, positive support of this fantastic, innovative community.

 

Definition: Education Consultants, Case Managers, and Therapists oh My!

Those of us in mental, behavioral health and substance abuse fields generally know the difference between all the different professionals that support individuals and families. Unfortunately, we don’t always do a great job of helping clients understand the differences (and similarities). So, without further explanation, we present a humble attempt at defining professionals you may come across.

Educational Consultant: Also known as E.C.s, educational consultants started out decades ago helping families get their kids into college, private school and boarding schools. As family needs changed, so did E.C.’s focus. Nowadays, E.C’s serve families looking for academic advice and placement recommendations. In times of crisis, parents are often overwhelmed by a barrage of emotions, options and information. The confusion and desperation associated with having a struggling teenager or child can be extremely difficult. Parents may not be aware of the choices available, or may not be able to decide on their own which alternative best meets their situation and the needs of their child. Among the questions consultants often hear: How do we know when treatment is necessary? What would be best for our child? Is an intervention needed? Should we find a residential program? Would a wilderness therapy program be a good choice, or would an emotional growth boarding school be better? There is no one certification or academic program for educational consultants. Their quality and experience span a huge continuum.

Case Manager: Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes. Basically they specialize in the organization and treatment planning for families that need finding a treatment program or need help transitioning their child back home. Educational Consulting is often a part of good case management. Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation. The case manager helps identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source. Case management services are best offered in a climate that allows direct communication between the case manager, the client, and appropriate service personnel, in order to optimize the outcome for all concerned. Not unlike E.C.’s, Case Managers do not require certification or specific academic credentials but are often clinicians with at least a Master’s degree in a disciplin like counseling, psychology, social work or marriage and family therapy.

Therapist: A therapist is a general term for counselors, psychologists, psychiatrists, psychotherapists and psychoanalysts. They are trained professionals that treat mental and behavioral health and substance abuse problems through talk, discussion and interaction. A therapist helps clients you learn about conditions and moods, feelings, thoughts and behaviors. Therapy helps the client learn how to take control of one’s life and respond to challenging situations with healthy coping skills. There are many specific types of therapy, each with its own approach. The type of therapy that’s right for a client depends on their individual situation. Therapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

Check back next time when we talk about Counselors, Psychologists, Psychiatrists, Social Workers and Clinicians. Got a clinical term you’re confused about? Contact us and we’ll post info on it. More than likely, you’re not alone in your confusion.