Insider’s Guide: How to Pay for Therapeutic Boarding School (2017 UPDATE)

Before we dive into understanding the options for paying for a Therapeutic Boarding School, let’s quickly review what they are.

The Rise of Therapeutic Boarding Schools

Image result for boarding schoolAs public schools across the country have slowly been pruned back by state legislatures, funding for behavioral, emotional and academic support within schools have nearly dried up while public money is increasingly being used for private charter schools. Therefore, it’s not surprising private institutions that offer therapeutic (or quasi-therapeutic) environments like boarding schools and private schools have exploded. One of the fastest growing kinds of boarding schools is what’s called a Therapeutic Boarding School. 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).

While this all may sound great, there are definitely some risks and downsides (beyond the financial cost) of sending a kiddo off to therapeutic boarding school. I address those issues in great detail in another blog post. For now, let’s revisit the financial aspects…

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

Image result for therapeutic boarding school

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

1.   Hire a Consultant: Say what? More money? Yes, but trust me, this really will have super high ROI. Also referred to as case managers, therapeutic placement consultants or educational consultants, a good one is worth their weight in gold (a bad one is expensive and makes bad treatment recommendations). 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. A good therapeutic placement consultant/educational consultant will save you thousands of dollars by negotiating these discounts.

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.

Program Tour: Day 3-4 Oxbow Academy and Discovery Ranch

Here is the second of two part series of my visit to Redcliff Ascent and their sister programs in January 2013.

Day 3 – Oxbow Academy and Discovery Ranch

From Redcliff we went North East. Next was a long, weaving drive through mountain valleys towards  Oxbow Academy which specializes in working with adolescent boys with sexually-inappropriate behaviors. Their two campuses provide the ability to support kids with unique needs rather than having just one big facility. It’s a deeply clinical program with the feel of a safe home-away-from-home. Erin Nester, Admission Director, drove me between the programs so we could talk clinical details about the program. Basically, these folks know what they’re doing and clearly help families that feel hopeless.

After meeting with some extraordinary young men from around the world with the backdrop of snow-crusted mountains behind them, Steve and I slid out the icy driveway and continued our trek North towards Mapleton, UT where, on the sprawling campus of Discovery Ranch, I presented to all the Redcliff sister programs on working with affluent individuals and families. From the moment I went through the front gate to the final good-byes with staff – I felt I had experienced a truly thoroughly-designed and supported residential program. Every detail had been thought of to fully engage adolescents in realigning themselves.

Day 4 – Discovery Academy

I was not prepared for the detail the owners took to preserve the church they refurbished into a cutting-edge therapeutic boarding school. The staff at Discovery Academy maintain important history for the surrounding town while providing cutting-edge therapeutic academic support. The academic professionals, the clinicians, the administrators – all of them, they all show a level of personal commitment to the kids and program at large. The kids that go here are clearly good kids that need a bit of structure, a bit of nurturing, and a whole lot of encouragement to transcend unhealthy patterns.

Summary

I can not recommend any dining options anywhere near Redcliff programs for those of you that appreciate a good meal. Options between some of the programs often pitted us between awkward Chinese food restaurants and the snack aisle in the strangely empty WalMart. And please, do not ask for Starbucks or good coffee. If you can’t bring your own, start adapting to Earl Grey for your morning fix since you’ll either be drinking the brown hotel swill or hot black tar at one of the prolific truck stops. But let’s be real, you’re not looking at a Redcliff program because of the food or drink choices. You’re here because you’ve got a child or adolescent that’s been acting out and needs help. If you’re considering a Redcliff program, you’ll do a bit of traveling … but the investment of time, money and energy will be well worth it. Redcliff and all their programs are full of passionate, thoughtful staff with a full array of behavioral and academic services for teens and their families. They are not perfect and struggle with similar issues effecting other programs. The big difference is their curiosity and sincere interest in being a truly learning organization.

Here is the full list of Redcliff programs: Redcliff Ascent, Discovery Ranch, Discovery Academy, Medicine Wheel, Oxbow Academy, Discovery Connections

Program Tour: Day 1-2 New Friends from Redcliff Ascent

There is a stark contrast flying into Las Vegas. The rugged, jagged contours of the surrounding mountains and scorched earth of the encroaching desert seem so alien compared with the steel and concrete and activity that bombards one in Sin City. This was how my visit with Redcliff Ascent programs started.

 

Day 1 – Las Vegas

 

I grabbed my suitcase from the conveyor belt and made our way to the car. Steve Schultz, my guide for the week and program expert, wove his way through the hustle of the Las Vegas strip, searching for someplace to grab a bite to eat and prep me for the upcoming program visits. We stopped at New York, New York and had a satisfying meal which evolved into a fantastic conversation about our families and backgrounds. The day was getting away from us and we needed to head North to position us for the start of the many tours and events they had lined up for me.

 

Day 2 – Redcliff Ascent

We pulled up to a desolot, wind-swept stretch of Utah valley in Enterprise, UT and pulled into the non-descript parking lot flanked by the Redcliff Ascent offices and gear shed. Within minutes we were deep in another engaging conversation about program philosophy, professional backgrounds and personal views on wilderness work. Nice furniture, nice office, super nice people. I could see this being a comfortable place for parents to meet the professionals responsible for helping their kids change.

We hurried across the icy, stone lot and secured the heavy metal door behind us. Those of you with wilderness and outdoor experience would appreciate the attention to detail Milton, Warehouse Manager, has chosen the safest, most durable gear. The shelves are lined with your typical boxes and containers, but the contents is so different than many other programs. Milton clearly has a passion for organization. Each shelf and box is well labeled and the quality of the gear is outstanding. He is certainly not cutting corners with cheap boots, socks or anything else I dug through. They also have an amazing system of self-review with an internal committee that reviews all incidents and makes recommendations for change.

For example, this cup was the industry standard they used for years until through their own research, they found the microscopic cracks harbored bacteria even after cleaning. They ditched it for a more expensive but safer and reliable stainless steel solution.

After a thorough tour of the gear and offices, we loaded up and hit the road in the crisp air. At the end of the long, straight road flanked by fields and scrub brush, we took a sharp left turn over railroad tracks and headed for the mountains. Within an hour we were in low-tree, scrubby wilderness high up a pass. We quickly met up with some amazing kids from across the world clearly being pushed to regain respect for adults and themselves. We happened to catch the nurse doing her rounds checking each group. Once again, nothing but sincere quality and well-thought support.

With the sun dipping down, we took the long mushy road out of the pass, back to the valley for our final good-byes at base camp.

Check back soon for the second installment of the visit to Redcliff and their sister programs throughout Utah.

Cheat Sheet from NATSAP Southeast Regional Conference Presentation

Below is the full, cranked-up cheat sheet from Rob Danzman’s presentation (Understanding and Working with Affluent Clients: Surprising Findings, Best Practices and Effective Strategies) given on October 18 at the NATSAP Southeast Regional Conference in Asheville. We added some juicy bonus information and links to spice it up a wee bit. Don’t hesitate to contact us with any questions.

Current Research and Findings

1. Substance Abuse

Children of wealthy parents tend to have higher rates of alcohol and marijuana use than their poorer counterparts.  Researchers believe this is due to multiple factors:

a. Money: Increased access to money without having to earn it or pay it back.

b. Supervision: Lack of adult supervision especially after school creates an environment of boredom and poor reinforcement of rules and boundaries.

c. Self-Medication: Increased use of substances to relieve anxiety and stress associated with achievement pressures.

2. Mental Health

Some of the major issues include entitlement, anxiety, depression, eating disorders (male/female are both at risk), and narcissism. Here’s where many of these issues originate:

a. Over-scheduled: They work hard on academics and generally feel over scheduled. There is significant pressure for achieving public success.

b. Only Children: They have fewer siblings and often were not raised with the need to share and have limits the way other children are.

c. Parental Critique: One of the most significant issues found in most of the research highlighted parental criticism. Having high standards is important for kids, but research showed that affluent parents will often push and push for greater and greater test scores, athletic success and social placement. Parents see a correlation between childhood success (grades, soccer, violin, etc.) with college success and, ultimately, career success. We could go one step further and say that the ultimate success parents are looking for is that of how the child contributes to the family’s legacy. Going to Harvard and becoming a respected attorney entrenches and builds the family’s prestige.  Unfortunately, this pressure overwhelms many kids and adult children.

3. Access

For many reasons, mental health and substance abuse services can often be easier to get for poor families due to a significant safety net system created by Medicaid, Medicare, HealthChoice as well as churches and local schools. Fonthill started out as a medicaid provider to families and, ironically, the same service we provided initially were not available to wealthier counterparts due to income limits. Poorer families can move up and down levels of care (outpatient up to hospitalization), get medication, therapy, family therapy, case management, etc. with little difficulty. The family see’s virtually no bills and no paperwork.

Another phenomenon is that, though in their financial best interest, many therapists report they do not like working with wealthier clients. There is a perception that a wealthy client does not appreciate the great life they have. This is addressed in further detail below.

4. Quality of Service

You would think that more money = more and better service. Not in mental health and substance abuse care. Many families’ first connection with services is through an outpatient therapist. Interesting research has found that a high percentage of therapists experience what is called schadenfreude – The enjoyment obtained from the troubles of others. If we were talking about not wanting to work with Black people or Chinese people, we would be branded as racists. Yet, when therapists make fun of or diminish the pain wealthy individuals feel, it’s socially acceptable. Pain is pain and it’s unprofessional and just bad business to ridicule those we serve.

There certainly are high quality programs with commendable outcomes but, as a percentage, wealthier families have a much harder time finding high quality service. One reason is the significant gap between services which, for their lower Socioeconomic Status (SES) counterparts, is less of an issue due to continuums of care being mandated in many states for Medicaid clients.

Best Practices

This refers to what clinical staff as well as non-clinical staff (and management) can do from a clinical or ‘quasi-clinical’ perspective to support and promote progress among affluent clients.

1. Structure

Affluent parents thrive in their professional life while their personal life comes undone. They want and need us to be directive and not waver from what we know is the effective approach to treatment and services. They want to know that your program or service is tight and runs seamlessly. Being firm, direct and clear with your expectations for the parents as well as the children is essential. It will actually relax them to know that you do not compromise or waver on any issue.

2. Curiosity

Express interest and concern for the individual (yes, the parents as well as the acting-out teen sitting in your admissions office). Many of us assume that these people are constantly being supported or, if not, they can easily ask for support or share their thoughts and feelings. Just not true. Ask open-ended questions, even during intake or admissions when your primary job is to get client information or give them instructions. These open-ended questions can go a long way. What has it been like for you Mr. Johnson to try and balance a successful business while also trying to keep your daughter sober?

3. Nurture

Parents often feel the need to create or perpetuate the myth that ‘everything is ok.’ Let them know you are listening loudly and everything is not ok, that’s why they are in your office or on the phone with you. What is ok is them trusting you. Trust has been in short supply in their lives. Let them know things are not ok and that, over the coming months with the team’s help, things will become more and more ok. “Seems like you’ve been caught between doing what is best for the whole family and not wanting your son to feel like you are singling him out. This must be an incredibly challenging time for you.”

4. Treatment Models

Fonthill recommends that professionals (clinical, support or management) use the following treatment models due to their evidence of the effectiveness.

a. Family Systems: Here are the 8 concepts Dr. Bowen discusses as influence within a family system – Triangles, Differentiation of Self, Nuclear Family Emotional System, Family Projection Process, Multigenerational Transmission Process, Emotional Cutoff, Sibling Position, Societal Emotional Process. Having staff do a basic in-service on this would catapult their understanding of why families act the way they do.

b. Cognitive Behavior Therapy: Developed by Dr. Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems. Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behavior, and emotional responses. Cognitive therapy has been found to be effective in more than 1000 outcome studies for a myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others, and it is currently being tested for personality disorders.

c. Dialectical Behavior Therapy: Dialectical Behavior Therapy (DBT) is a treatment designed specifically for individuals with self-harm behaviors, such as self-cutting, suicide thoughts, urges to suicide, and suicide attempts. Many clients with these behaviors meet criteria for a disorder called borderline personality disorder (BPD). Recent research shows that DBT is also effective in treating substance abuse, depression, anxiety and numerous other issues. DBT is  great for staff to use in their professional as well as personal lives. DBT is more like an instruction manual for life rather than a cold, scripted way to solve or process a problem.

Effective Strategies

Professionals and programs are not just made up of clinical programming and require some tailored approaches that come from the world of consumer psychology and marketing specifically regarding the affluent community. Ignore the following section at your own peril.

1. Identify the Boss

This may not be the parents calling on the phone or sitting in your office. Sometimes, grandparents have the power, write the checks and have veto power over what services are allowed. Sometimes there is a Special Needs Trust with several trustees that must sign-off on everything. Get curious about ALL of the stakeholders in the family. Fontill staff do this within the first few meetings/sessions/contact in the form of a genogram (family tree).

2. Target Wants vs. Needs

What you about to read is heretical within therapeutic circles. It disrupts the stogy, dusty, old philosophy that mental, behavioral health and substance abuse interventions should be treatment-focused and marketed on their interventions and outcomes. Fair enough. But we live in an age when we know more about how people make decisions and the rules for how to communicate about products and services are being constantly rewritten one industry at a time. Enough of ranting, let’s get you some solid advice…

Most programs target and sell their services to needs of the families (ie. Length of program, therapy sessions, what type of evidence-based model is used) instead of speaking to their wants (ie. Hope, safety, progress, return on investment). Seems counterintuitive but these parents can’t be expected to really tell the difference between all the great (and not so great) programs. They look the same on the websites, brochures and even on site. The main difference can come when program staff speak on an emotional level to families – connect at their core rather than rattling off program features – tell how the program features eleviate pain, fear, and instill hope and change and investment in the families’ future.

Staff should learn about the lifestyles of wealthy families (ie. Visit lateral websites like BMW, PelligrinoCoachWhole FoodsUmstead Hotel). Each of these examples is selling a promise of what you will experience and feeling when you buy their stuff.

3. Customer vs. Client

Families would prefer to be treated like valued customers rather than parents of clients. They want to be informed, but they also want to be treated like the substantial amount of money they are paying you grants them exclusive, members-only access. You and your staff are consultants, concierges and customer service reps rather than LCSWs, LPCs, and LCASs. Differentiate between clinical info and customer service. This ties nicely into our little piece above about speaking to their wants more than to their needs. 

4. Use Better Language

Use correct, effective, and positive terminology. Here are some sample word make-overs

Investment  vs. Cost

Exclusive  vs.  Availability

Concierge Service  vs. Instructions

Orchestrated  vs. Planned

Artisan  vs.  High Quality

Summary

Want More Detailed Information? There is much more we could cover but this list should get you and your staff headed in the right direction. For a comprehensive list of most of the research published over the last 20 years, contact us here and ask for Affluent Studies Research List. We’ll send you a PDF of what we’ve got. 

Want Your Staff Trained? For more information on working with the unique needs of affluent families, contact us here and ask for more information about having Rob Danzman come and speak or train your staff. He is available for half and whole day staff training and management consultation to make sure that your resources are used in the most effective ways.