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.

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. 

How to Lose a Fortune: The Stroh Family Tale

I posted the article below to highlight a typical evolution within family wealth. It’s part cautionary tale and part voyeuristic experience for those of us that will never be billionaires. It’s a tale of rise and greed and fall. The important lesson here is that the tale of this once prominent family doesn’t end just because the money did. Lives are changed and rebuilt. 

The once proud and lucrative Stroh brewery in Detriot.

The once proud and lucrative Stroh brewery in Detriot.

The original version of this article is from 7/8/2014 on www.forbes.com and was written by Kerry A. Dolan who specializes in writing about the world’s wealthiest people and philanthropy. 

AS WITH MANY OF AMERICA’S GREAT FORTUNES, the Stroh family’s story starts with an immigrant: Bernhard Stroh, who arrived in Detroit from Germany in 1850 with $150 and a coveted family recipe for beer. He sold his brews door-to-door in a wheelbarrow. By 1890 his sons, Julius and Bernhard Jr., were shipping beer around the Great Lakes. Julius got the family through Prohibition by switching the brewery to ice cream and malt syrup production. And in the 1980s Stroh’s surged, emerging as one of America’s fastest-growing companies and the country’s third-largest brewing empire, behind only public behemoths Anheuser-Busch and Miller. The Stroh family owned it all, a fortune that FORBES then calculated was worth at least $700 million. Just by matching the S&P 500, the family would currently be worth about $9 billion.

Yet today the Strohs, as a family business or even a collective financial entity, have ceased to exist. The company has been sold for parts. The trust funds have doled out their last pennies to shareholders. While there was enough cash flowing for enough years that the fifth generation Strohs still seem pretty comfortable, the family looks destined to go shirtsleeves-to-shirtsleeves in six.

“We made the decision to go national without having the budget,” sighs Greg Stroh, a fifth generation family member and former Stroh Brewery employee. “It was like going to a gunfight with a knife. We didn’t have a chance.” His analysis comes tinged with inevitability. It wasn’t. A handful of family-owned regional brewers such as Yuengling and Schell’s continue to thrive, while others, like Olympia and Hamm’s, sold out. And the Strohs’ largest rivals during the 1980s and 1990s, the Coors, who also aspired to turn their no-frills, regional suds into a national powerhouse, remain in the top 100 on the FORBES America’s Richest Families list.

The Strohs chose a different path, a saga that serves as a powerful reminder: Hard as it is to build a family business designed to last in perpetuity, it’s shockingly easy for any successor to tank it.

FOR ITS FIRST CENTURY the Stroh beer business, based in Detroit, grew by following the basics: respect your customers; respect your employees. The former meant catering to Midwest working-class tastes at working-class prices (the family watered down Bernhard Stroh’s precious recipe, after hops and wheat shortages in World War II left Americans accustomed to weaker brews). The latter by treating every employee like an honorary member of the clan. John Stroh, who oversaw a dramatic sales surge in the Eisenhower years, “was known for walking the brewery and knew everyone’s first name,” his grandnephew Greg remembers. “Employees would run through walls for the family.” As if to connect the customers and the business, the Stroh signature was emblazoned on every bottle, topped by a family crest with a lion. Sales surged in lockstep with postwar Detroit, from 500,000 barrels in 1950 to 2.7 million barrels in 1956.

The Stroh Family Management - Not as clever or frugal as they needed to be.

The Stroh Family Management – Not as clever or frugal as they needed to be.

The mammoth changes came in the early 1980s. John Stroh had moved into the chairman’s role in 1967 and handed control of the brewery to his nephew, Peter, who became CEO in 1980. Like John, he had a plan to grow, but not incrementally: He would do it by acquisition. In 1981 Stroh bought New York-based brewer F&M Schaefer, which, like Stroh, was founded by a German immigrant in the mid-1800s and also offered low-priced suds to its regional fans (famous marketing line: “The one beer to have when you’re having more than one”). The next year, in what family members describe as “the minnow swallowing the whale,” Peter Stroh bet the family business, borrowing $500 million (the book value of the Stroh business was $100 million at the time) to buy Joseph Schlitz Brewing of Milwaukee.

Suddenly Stroh was the third-largest brewer in the U.S., with seven plants and a national footprint. On paper there was synergy. FORBES valued the company at $700 million in 1988, listing the Strohs with one of the largest family fortunes in the U.S. at the time, shared by 30 relatives.

But Peter Stroh’s grand vision of a thriving U.S.-wide brewer failed to materialize. It largely missed the boat on the biggest industry trend in a generation: light beer. And Stroh’s core product–cheap, watery, full-calorie beer–was a commodity. But saddled with debt, Stroh couldn’t afford to match the ad spending of its bigger rivals, Anheuser-Busch and Miller. Unable to spur demand through marketing, Stroh turned to price, introducing a 15-pack for the price of 12 cans and a 30-pack for the price of a case of 24. While the latter had legs, it wasn’t enough to outrun the shrinking margins.

Meanwhile, an ambitious family from Colorado began moving into the Stroh markets. “It became a competition between Stroh and Coors,” says Scott Rozek, a former director-level employee who spent 12 years at Stroh. “At that time there were four big breweries in a three-brewery industry–there was really only room for three.” By the end of the 1980s Coors overtook Stroh as the country’s third-largest brewer.

In August 1989 the Stroh Brewery Co. was in retreat. The company that had treated employees like family laid off 300 people, one-fifth of its white-collar workforce. “I had to let go four of the five people in the marketing research department. It was heartbreaking,” remembers Ed Benfield, former director of market research at Stroh.

The next month Peter Stroh, who died in 2002, agreed to sell the family business to Coors for $425 million. But Coors got cold feet and pulled out of the deal a few months later. “It had something to do with due diligence, and Bill Coors,” says Benjamin Steinman, longtime editor of newsletter Beer Marketer’s Insights. “There were lots of stories.”

Desperate, Peter Stroh brought in renowned adman Hal Riney to give the Stroh’s brand a more upscale look and position. The cherished Stroh signature gave way to block print, prices were raised, and the 15- and 30-packs were nixed. It could not have been a worse decision. But since the product hadn’t changed, customers could do the math: Sales of Stroh’s-brand beer fell more than 40% in one year, “the biggest drop in sales in the history of beer,” says Benfield.

Market share for Stroh’s, as well as for its acquired brands like Schaefer, Schlitz and Old Milwaukee, fell from 13% in 1983 to 7.6% in 1991. Even CEO Peter Stroh admitted the troubles. “We’ve been through a very difficult period,” he told FORBES in 1992. “We tried to do too much.”

And yet it tried to do more. In 1996 Stroh repeated his mistake, borrowing yet more money for the $300 million acquisition of struggling brewer G. Heileman. The purchase fell flat. Heileman had breweries in cities like Seattle and Portland, where Stroh didn’t, but it lacked a big stable of strong brands. One industry analyst remembers the deal described as “two sick chickens–they were both declining.”

It got worse. Peter Stroh had tried to diversify the business, with investments in biotech and Detroit real estate. Both were far from the family’s core competencies and lost them millions more. By 1998 cousin John Stroh III had taken charge at Stroh Cos., the brewery parent. And while the company had turned to contract brewing for others, including Sam Adams, as a way to make up for plummeting sales, Stroh took a mortal hit in 1998 when it lost a contract with Pabst.

By 1999 there was internal concern about whether they could even make their interest payments on the debt incurred, says one former executive. And so Bernhard Stroh’s legacy was sold for scraps: Miller Brewing, owned at the time by Philip Morris, bought Stroh’s Henry Weinhard’s and Mickeys brands, while Pabst bought the rest of the brands owned by Stroh’s as well as its brewery near Allentown, Pa., for a price several sources peg at around $350 million–about $250 million of which was used to pay down debt incurred with the Heileman purchase. Some of the remaining $100 million or so was transferred to a fund to pay employee pension liabilities, which Stroh had retained in the sale. The rest went into a fund for the family that dribbled out checks until 2008, when it was completely tapped.

FOR GENERATIONS, GROWING UP STROH meant a life of comfort. “My life with my father felt like being inside a gilded bubble,” says Frances Stroh, whose father, Eric, quit the company after a fight with his brother Peter in 1985. An artist at heart, Eric spent millions buying hundreds of antiques–guns, cameras, guitars–to fill the big house that Frances grew up in. Saving, Frances says, was not a priority.

And why would it have been when the checks rolled in? In the 1980s the seven members of the fourth generation got $800,000 a year. (There were another 20 or so shareholders from the third and fifth generations as well, who received differing amounts.) That enabled several Stroh families to live in stately homes on gated Provencal Road in the tony Detroit suburb of Grosse Point Farms, with maids, cooks, country club memberships, boarding school tuition and no need for 9-to-5 jobs. “A lot of people were living off the family business,” says Greg Stroh, who’s now 47.

As with too many families with more money than direction, drugs and alcohol followed. Frances Stroh was kicked out of boarding school at Taft after she was caught drinking. Her three brothers also got kicked out of different prep schools. In an excerpt from a memoir about the family that Frances is writing, she describes one incident during her college years when she was snorting cocaine with her brothers while the rest of the family was downstairs having Christmas dinner at their Grosse Point Farms home.

One of her brothers, Charlie, narrowly avoided going to prison for dealing cocaine in college in the early 1980s. His parents forced him to join the Marines, and good behavior in the service was the key to evading a prison sentence. Yet the demon of addiction reappeared two decades later, in 2003, when he fell to his death from a tenth-floor hotel balcony in Texas, as the sheets he tied together to form a rope failed to hold. He was 43. One report quoted police saying he called the front desk at the hotel “to report a bank robbery and other nonsensical things.”

There have been other tragedies throughout the years. Nick Stroh, a fourth-generation member of the family and a freelance journalist in Africa, was bludgeoned to death by Ugandan troops in 1971 after he investigated reports of an army massacre. Peter’s brother Gari Stroh Jr., who ran the Stroh Ice Cream division, became a quadriplegic after a fall from a horse on his farm in 1982. And so on.

All of which served to make 1989–the year of the failed sale to Coors–something of a shock to the family. For the first time the company couldn’t come up with dividend payments. “My generation probably grew up with the illusion that things were going to be pretty good,” says Greg Stroh. “We had to make adjustments.”

Eric Stroh was hit particularly hard. His first wife had to briefly loan him money to help him make ends meet. In 2009, a few months after the checks stopped for good, the overweight and diabetic Eric collapsed, alone, after letting a leg wound go untreated–most of his estate went into trusts to pay liabilities to his two former wives (the second one had gone to high school with Frances).

Frances and her two surviving brothers each inherited $400,000 from a trust. She also inherited her dad’s collections of antique cameras, guns and guitars–some of which turned out to be fakes, and others, fittingly, worth pennies on the dollar of what her father had paid for them.

To learn more about how to insulate your family from the unintended consequences of wealth, contact Fonthill Counseling for a fee consultation. 

Is CRAFT the Best Unused Substance Abuse Treatment?

Community Reinforcement Approach and Family Training

Today I’d like to introduce you to one of the most effective treatments/interventions for substance abuse that is rarely used and even-more rarely discussed. It’s called CRAFT and is a behavior therapy approach designed primarily for those with substance abuse issues. Developed by Nate Azrin in the 1970s, his technique focused on operant conditioning to help people learn to reduce the power of their addictions and enjoy healthy lifestyle. CRA was later combined with the FT (…family training), which equips family and friends with supportive techniques to encourage their loved ones to begin and continue treatment, and provides defenses against addiction’s damaging effects on loved ones.

The first part of this acronym – Community Reinforcement Approach (CRA) was originally created for individuals with alcohol issues. Clinicians later went on to apply it to a variety of substance use disorders for more than 35 years. The clinical premise is based on operant conditioning (…type of learning in which an individual’s behavior is modified by its antecedents and consequences), basically, CRA helps rearrange the client’s life so that healthy, drug-free living becomes more interesting/stimulating and thereby competes with substance use.

CRA is designed to be a time-limited intervention. The time limit is decided upon between the clinician and client. For example, a set number of sessions (for example, 16 sessions) or time limit (for example, one year) may be decided upon either at the very beginning of therapy or within the early stages of therapy.

One major goal of CRAFT is to increase the odds of the substance user who is refusing treatment to enter treatment through close support of family members, as well as improve the lives of the concerned family members. CRAFT clinician and participants teach and reinforce the use of healthy rewards to encourage positive behaviors. Additionally,  it focuses on helping both the substance user and the family strengthen their relationships which is often torn apart.

In the model, the following terms are used:

  • Identified Patient (IP) – the individual with the substance abuse issues that is refusing treatment
  • Concerned Significant Others (CSOs) – the relevant family and friends of the IP.

Three goals

When a loved one is abusing substances and refusing to get help, CRAFT is designed to help families learn practical and effective ways to accomplish these three goals:

  1. Move their loved one toward treatment
  2. Reduce their loved one’s substance use
  3. Improve their own lives

This comprehensive behavioral program accomplishes these objectives while avoiding both the detachment espoused by Al-Anon and the confrontational style taught to families by the Johnson Institute Intervention.

CRAFT and these traditional approaches all have been found to improve CSO functioning and increase CSO-IP relationship satisfaction. However, CRAFT has proven to be significantly more effective in engaging treatment-resistant substance users in comparison to the Johnson Institute Intervention and Al-Anon (or Nar-Anon) facilitation therapy. 

CRA Breakdown of Treatment

The following CRA procedures and descriptions are typical recommended clinical content areas for the substance user:

  1. Functional Analysis of Substance
    • explore the antecedents of a client’s substance use
    • explore the positive and negative consequences of a client’s substance use
  2. Sobriety Sampling
    • a gentle movement toward long-term abstinence that begins with a client’s agreement to sample a time-limited period of abstinence
  3. CRA Treatment Plan
    • establish meaningful, objective goals in client-selected areas
    • establish highly specified methods for obtaining those goals
    • tools: Happiness Scale, and Goals of Counseling form
  4. Behavior Skills Training
    • teach three basic skills through instruction and role-playing:
    1. Problem-solving
      • break overwhelming problems into smaller ones
      • address smaller problems
    2. Communication skills
      • a positive interaction style
    3. Drink/drug refusal training
      • identify high-risk situations
      • teach assertiveness
  5. Job Skills Training
    • provide basic steps for obtaining and keeping a valued job
  6. Social and Recreational Counseling
    • provide opportunities to sample new social and recreational activities
  7. Relapse Prevention
    • teach clients how to identify high-risk situations
    • teach clients how to anticipate and cope with a relapse
  8. Relationship Counseling
    • improve the interaction between the client and his or her partner

Communication 

With CRAFT, CSOs are trained in various strategies, including positive reinforcement, various communication skills and natural consequences. One of the big pieces that has a lot of influence over all the other strategies is positive communication. 

Here are the seven steps in the CRAFT model for implementing positive communication strategies.

  1. Be Brief
  2. Be Positive
  3. Refer to Specific Behaviors
  4. Label your Feelings
  5. Offer an Understanding Statement – For example, “I appreciate that you have these concerns, … [or] I understand that you really want to talk right now, and that this feels urgent, … [or] I would love to be there for you.”
  6. Accept Partial Responsibility – This step “is really designed to decrease defensiveness on the part of your loved one. … It’s not about accepting responsibility for things you are not responsible for. … [Rather, it’s to] direct you towards the piece that you can own for yourself. … [For example, ] what you can take responsibility for are the ways that you communicate,” etc.
  7. Offer to help

Take home message – Help decrease defensiveness on the part of the loved one that you are speaking to, and increase the chances that your message is really going to be heard—so, increasing the ability that you have to really get across the message that you want. 

Consequences with specific limits/expectations being in place is essential in terms of communicating your message, but it’s also really important, maybe even more so, to be consistent in following through with those consequences and rewards.

Al-Anon 

As an organization, Al-Anon does not currently adopt, hold, or promote the view that CSOs can make a positive, direct, and active contribution to arrest compulsive drinking, which is the opposite premise of CRAFT. Al-Anon is a fellowship with a focus on helping families and friends, themselves, without promoting a direct intervention process for alcoholics. Because “no one ever graduates” from Al-Anon, it can be viewed as an open-ended program, not time-limited.

Al-Anon view

Regarding the CSO’s relationship to alcoholism and sobriety, the view from the Al-Anon organization can be summarized:

  1. PowerlessnessAl-Anon‘s First Step promotes a powerless view for families and friends, “We admitted we were powerless over alcohol—that our lives had become unmanageable.”
  2. Disease viewAl-Anon writes, “As the American Medical Association will attest, alcoholism is a disease.” Al-Anon also states, “Although it can be arrested, alcoholism has no known cure.”
  3. Three C’sAl-Anon has a dictum called “the Three C’s—I didn’t cause alcoholism; I can’t control it; and I can’t cure it.”
  4. Loving detachment. Al-Anon “advocates ‘loving detachment’ from the substance abuser.”
  5. Family illnessAl-Anon writes, “Alcoholism is a family disease,” and “we believe alcoholism is a family illness and that changed attitudes can aid recovery.”

Summary

CRAFT is not perfect and is not easy to implement partially due to lack of clinician training and also because of having multiple people involved (ie. IP, concerned others, and clinician). Programs, agencies and clinicians may not even be aware of CRAFT if you ask so if you or a loved one are in need of a non-residential approach that’s well researched and effective, find a substance abuse therapist able and willing to use it. 

Program Review: Veritas Collaborative

In April 2014, Dr. Marino and I visited Veritas Collaborative in Durham, NC, a 2 year old for profit eating disorder treatment program specializing in children and adolescents. Don’t let the age of this program fool you – they clearly know what they’re doing and have some clinical and business heavy-weights in their corner.VC dining pic

 

Below is a write-up of our experiences, thoughts and additional info we gathered together just for you. As always, our perspective as clinicians may be uniquely different from those of perspective clients or their parents. We highly encourage you to do your own research before committing to any program.  

What They Do

Veritas provides Inpatient, Residential Treatment and Partial Hospitalization for adolescents and children with eating disorders. What is key in our description is what is not listed. This means, during a time when other programs do everything for anyone, Veritas has committed to specializing. They have 26 inpatient/acute residential beds and 12 partial hospitalization beds. Below is a description of the three different levels of care (directly from the Veritas Collaborative site).

Inpatient hospitalization is the most intensive level of treatment available. Inpatient treatment is necessary for those who need frequent nursing care or are medically unstable (as determined by vital signs, lab abnormalities, or general physical and psychological condition). Patients who are severely entrenched in their disorders are depressed, suicidal, or are a danger to themselves or others, are also appropriate for this level of care. These patients see a medical doctor daily.

Acute Residential Treatment is a 24-hour monitored, structured treatment program for medically stable patients who still need constant supervision. Nursing care is still provided around the clock, but patients see doctors less frequently. Some individuals are admitted directly to residential treatment while others first go through inpatient treatment and them move to the residential program.VC bdrm pic

The Partial Hospitalization level of care is appropriate for patients who need structured programming but do not need 24-hour supervision. Patients participate in individual and group therapy, structured activities, and programming around meals similar to what is offered in the inpatient and residential programs. Some patients admit directly to this level of care, but many “step down” from the residential or inpatient levels, as partial programming still provides a high amount of structure and support. These patients are medically stable, and can move more readily while maintaining appropriate, non-disordered behaviors without direct supervision.

Another key feature to the Veritas program is the pervasive use of Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), both of which are evidence-based treatments for eating disorders and co-occurring mental health issues.

Who They Serve

Veritas serves children and adolescents (both male/female) 10-19 years old from around the country experiencing eating disorders. It’s rare for an eating disorder program to serve younger adolescents and children which is a huge plus. It’s also less common for a program to work with male clients. VC pic

Location

Veritas is located at 615 Douglas St #500, Durham, NC 27705. They sit right next to Duke University. They are 20 minutes from the Raleigh-Durham International Airport (super, super easy airport to travel through) and 2 hours from the Charlotte airport. The parking deck is easily accessed from the road. The building is nondescript but that’s works nicely for those seeking a more discrete treatment experience. 

Fees + Insurance + Financing 

Yes, they accept insurance and will work with you to figure out what is covered.

As with most treatment centers, there are many outside financing agencies that specifically work with mental, behavioral and substance abuse programs.

A quick word about their fees – they wouldn’t say. Not a peep about daily or monthly rates which, in our humble opinion is no bueno. See below in the Reviews section for commentary on this. It’s not unusual for programs to defer questions about cost but they eventually give us an idea (normally as a monthly rate). But not Veritas. 

Reviews

It’s really disappointing and feels a bit awkward when we have a hard time finding negative reviews of a program. Either they’ve done a good job of scrubbing the internet of nasty feedback or…. they actually provide great service. From all around the intertubes we scoured parent blogs, professional review sites as well as the more general review sites. So what’s out there? What’s the overall judgement of this fledgling treatment center? Mostly just really nice praise for the staff, treatment and program as a whole. The thing that kept on coming up over and over was Veritas’s involvement of the whole family – which happens to be another key feature they told us about on our tour. Family work is at the core of how they impact the client’s treatment. 

One negative in our view is discussion of cost. We really, really like programs to be up front about what the estimated costs for service will be. It’s not that we expect a solid dollar amount since we know as well as the next professional that expenses can go up or down depending on loads of variables. But what we do want to see is an effort towards transparency, especially with pricing. When asked for pricing we were told ‘it depends‘ but would not commit to a daily or monthly rate and nothing is listed on their site. 

Other than the cost issue we experienced, there’s not much else for us to complain about. We’ll definitely continue looking for bad reviews and update this post. 

Contact Information

Reach out to Kelly Robinson at krobinson@veritascollaborative.com or 919.698.8574 to learn more or take a tour. You can also schedule a tour directly from their site here: Schedule a Tour.

Final Thoughts

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. 

The Maudsley Method for Eating Disorder Treatment

imagesThe Maudsley Approach (aka Maudsley Family Therapy) is a family therapy specifically designed for the treatment of anorexia nervosa (but now used for many other eating disorders) devised by Christopher Dare and colleagues at the Maudsley Hospital in London.

The Maudsley approach can mostly be construed as an intensive outpatient treatment where parents play an active and positive role in order to: Help restore their child’s weight to normal levels expected given their adolescent’s age and height; hand the control over eating back to the adolescent, and; encourage normal adolescent development through an in-depth discussion of these crucial developmental issues as they pertain to their child.

More ‘traditional’ treatment of AN suggests that the clinician’s efforts should be individually based. Strict adherents to the perspective ofonly individual treatment will insist that the participation of parents, whatever the format, is at best unnecessary, but worse still interference in the recovery process. In fact, many proponents of this approach would consider ‘family problems’ as part of the etiology of the AN. No doubt, this view might contribute to parents feeling themselves to blame for their child’s illness. The Maudsley Approach opposes the notion that families are pathological or should be blamed for the development of AN. On the contrary, the Maudsley Approach considers the parents as a resource and essential in successful treatment for AN.

Phase I: Weight Restoration

The Maudsley Approach proceeds through three clearly defined phases, and is usually conducted within 15-20 treatment sessions over a period of about 12 months. In Phase I, also referred to as the weight restoration phase, the therapist focuses on the dangers of severe malnutrition associated with AN, such as hypothermia, growth hormone changes, cardiac dysfunction, and cognitive and emotional changes to name but a few, assessing the family’s typical interaction pattern and eating habits, and assisting parents in re-feeding their daughter or son. The therapist will make every effort to help the parents in their joint attempt to restore their adolescent’s weight. At the same time, the therapist will endeavor to align the patient with her/his siblings. A family meal is typically conducted during this phase, which serves at least two functions:

It allows the therapist to observe the family’s typical interaction patterns around eating, and it provides the therapist with an opportunity to assist the parents in their endeavor to encourage their adolescent to eat a little more than she was prepared to.

The way in which the parents go about this difficult but delicate task does not differ much in terms of the key principles and steps that a competent inpatient nursing team would follow. That is, an expression of sympathy and understanding by the parents with their adolescent’s predicament of being ambivalent about this debilitating eating disorder, while at the same time being verbally persistent in their expectation that starvation is not an option. Most of this first phase of treatment is taken up by coaching the parents toward success in the weight restoration of their offspring, expressing support and empathy toward the adolescent given her dire predicament of entanglement with the illness, and realigning her with her siblings and peers. Realignment with one’s siblings or peers means helping the adolescent to form stronger and more age appropriate relationships as opposed to being ‘taken up’ into a parental relationship.

Throughout, the role of the therapist is to model to the parents an uncritical stance toward the adolescent – the Maudsley Approach adheres to the tenet that the adolescent is not to blame for the challenging eating disorder behaviors, but rather that these symptoms are mostly outside of the adolescent’s control (externalizing the illness). At no point should this phase of treatment be interpreted as a ‘green light’ for parents to be critical of their child. Quite the contrary, the therapist will work hard to address any parental criticism or hostility toward the adolescent.

Phase II: Returning Control over Eating to the Teen

The patient’s acceptance of parental demand for increased food intake, steady weight gain, as well as a change in the mood of the family (i.e., relief at having taken charge of the eating disorder), all signal the start of Phase II of treatment.

This phase of treatment focuses on encouraging the parents to help their child to take more control over eating once again. The therapist advises the parents to accept that the main task here is the return of their child to physical health, and that this now happens mostly in a way that is in keeping with their child’s age and their parenting style. Although symptoms remain central in the discussions between the therapist and the family, weight gain with minimum tension is encouraged. In addition, all other general family relationship issues or difficulties in terms of day-to-day adolescent or parenting concerns that the family has had to postpone can now be brought forward for review. This, however, occurs only in relationship to the effect these issues have on the parents in their task of assuring steady weight gain. For example, the patient may want to go out with her friends to have dinner and a movie. However, while the parents are still unsure whether their child would eat entirely on her own accord, she might be required to have dinner with her parents and then be allowed to join friends for a movie.

Phase III: Establishing Healthy Teen Identity

Phase III is initiated when the adolescent is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has abated.

Treatment focus starts to shift to the impact AN has had on the individual establishing a healthy adolescent identity. This entails a review of central issues of adolescence and includes supporting increased personal autonomy for the adolescent, the development of appropriate parental boundaries, as well as the need for the parents to reorganize their life together after their children’s prospective departure.

Maudsley Approach Sites

In addition to the Maudsley Hospital and other centers in London, this family-based approach to treatment is implemented by programs in the United States, including Columbia University and Mt. Sinai School of Medicine, New York, NY, Duke University, Durham, NC, The University of Chicago, Chicago, IL, Stanford University, Stanford, CA, the University of California at San Diego, CA and the Eating and Weight Disorders Center of Seattle (part of the Evidence Based Treatment Centers of Seattle), Seattle, WA. Dissemination of the Maudsley Approach has also been successful in Canada, e.g., Eastern Ontario Children’s Hospital in Ottawa, North York General Hospital and the Hospital for Sick Children in Toronto, and McMaster University in Hamilton, ON. The adolescent eating disorders program at the Westmead Children’s Hospital in Sydney, and the eating disorders program at the Royal Children’s Hospital in Melbourne, Australia, have well established FBT programs. 

Conclusion

In summary, the Maudsley Approach holds great promise for most teens who have been ill for less than 3 years. This family-based treatment can prevent hospitalization and assist the adolescent in her/his recovery, provided that parents are seen as a resource and that they are allowed to play an active role in treatment. For a program or clinician to effictively offer the Maudsley Approach they should be certified through The Training Institute for Child and Adolescent Eating Disorders. Certification training requires workshop participation and 25 hours of supervised training on 3 cases during three treatment phases. 

 

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. 

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: