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 

Getting Insurance to Pay for Residential Treatment

imagesSince paying for therapeutic treatments like residential treatment, intensive outpatient program and therapeutic boarding school with insurance is a big topic we’ve broken this into a few different posts. Today, we’re starting with the basics of the health care act that tightens up the requirements for insurers. Historically, insurance paid for outpatient services and residential treatment was only for more affluent families. But thanks to the mental health parity act, insurers are not more responsible than ever for paying for higher levels of care. 

What’s the Mental Health Parity Act?

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires many insurance plans that cover mental health or substance use disorders to pay for coverage for those services that are no more restrictive than the coverage for medical/surgical conditions. Basically, if they pay for medical stuff, they have to pay for mental health and substance abuse stuff – that’s the ‘parity’ part. 

What Does it Cover?

  • Copays, coinsurance, and out-of-pocket maximums
  • Limitations on services utilization, such as limits on the number of inpatient days or outpatient visits covered
  • Coverage for out-of-network providers
  • Criteria for medical necessity determinations

MHPAEA does not require insurance plans to offer coverage for mental illnesses or substance use disorders in general, or for any specific mental illness or substance use disorder. It also does not require plans to offer coverage for specific treatments or services for mental illness and substance use disorders. However, coverage that insurance plans do offer for mental and substance use disorders must be provided at parity (the same) with coverage for medical/surgical health conditions.

The original MHPAEA was enacted in October of 2008. The main purpose of MHPAEA was to fill the loopholes left by the previous Mental Health Parity Act was legislation signed into law on September 26, 1996 that requires that annual or lifetime dollar limits on mental health benefits be no lower than any such dollar limits for medical benefits offered by a group health plan.

What if My Plan is Not in Compliance?

Before escalating things and contacting state or federal officials, contact Fonthill to see how to ‘encourage’ the insurers to provide appropriate coverage (look for future blog posts on how to communicate and educate your insurers for coverage). If you still have concerns about your plan’s compliance with MHPAEA, you can contact the Feds or your State Department of Insurance. You can contact the Department of Labor at 1-866-444-3272 or http://www.dol.gov/ebsa/contactEBSA/consumerassistance.html. You can also contact the Department of HHS at 1-877-267-2323 ext 61565 or at phig@cms.hhs.gov or your State Department of Insurance at http://naic.org/.

Check back next time when we explore some tricks to getting insurance to pay for treatment – it’s what the insurance companies don’t want you to know. 

 

 

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. 

Fonthill Response to Vice Article: AMERICAN TEENS ARE BEING TRAPPED IN ABUSIVE ‘DRUG REHAB CENTRES’

To those outside our field of therapeutic schools and programs, it makes sense that Matt Shea‘s article from May 2013 in Vice titled American Teens are Being Trapped in ‘Abusive Drug Rehab Centres’ is alarming.

To those of us in the field it’s a joke. You can read the whole article here: http://goo.gl/zW43F and judge for yourself. It’s a joke not because it’s inaccurate and not because there are no failures within the industry. It’s a joke because, just like so many other ‘journalists’ he paints a picture with such broad strokes that Mr. Shea fails to really understand the pressures, the people and, as cliche as it may sound, the passion with which so many in this field work. Mr. Shea fails to sort out the fiction from fact.

But how else can a budding journalist get retweeted and get his name out there without this version of quicky-journalism? Had Mr. Shea visited programs like many of us in the mental health and educational consulting world do, he would quickly meet and have experiences  which deepen his 2 dimensional paradigm. He would have been driven out into the remote and hot Utah desert to meet with small groups of teens guided by thoughtful and well-trained staff working on individual enrichment projects. He would leave thankful he never had to endure a Spring or Summer like they do yet, somehow, understands that this programming is providing a level of nurturing and structure significantly lacking in their home lives.

Let’s address the reference and correlation Mr. Shea makes between the therapeutic industry and Josh Shipp of MTV fame. Let’s revisit part of Mr. Shea’s article now…

Shipp is your classic Jerry Springer brand of therapist – no real qualifications, a huge ego and a penchant for money and entertaining TV over science and genuine psychology. “I’m a teen behaviour specialist,” he says in the intro. “My approach is gritty, gutsy and in your face.”

If he had actually spent time with Josh Shipp AND real mental/behavioral health and substance abuse professionals – he would very quickly understand that Mr. Shipp (…Mr. is used loosely here) does not represent the values of folks in this industry, an industry that is run by licensed clinicians and professionals. Mr. Shipp is nothing more than a court jester providing entertainment. He’s a monkey with two cymbals making noise and no signal for his ‘edgy’ reality-TV pushers at MTV (MTV is still around?). Occasionally, I’m sure there are teens and even parents (and maybe the rare delusion clinician) that hear the Shipp-Clown-message and it connects with them – changing their lives forever. But an overwhelming majority spend no more energy than a giggle or slight frown. Mr. Shipp does not have a degree, license or any sort of evidence-based training. He graduated from “Life Experience College” which sounds ‘super cool’ to the teens and teen parents he markets his wares to but there is no depth. He’s a can of soda full of empty calories. The therapeutic industry and Mr. Shipp are as polar-opposite as a Kardashian and Bill Moyers. And yes, we recognize as cold as it may sound, it’s an industry.  Just like cancer treatment, just like teaching, and just like daycare. If it were not an industry and did not have the same oversight as other industries, there would be little oversight. Trust me, you want therapy to be part of an industry. Industrialization provides codes of conduct, ethical guidelines, evidence-based treatment standards, inter-disciplinary work and research. NATSAP is an example of this type of self-imposed quality control.

FYI – Therapeutic wilderness programs are not boot camps. Therapeutic boarding schools are not military schools. There may have been some greedy, old-school meat-heads that sold parents on boot camps decades ago, but in the therapeutic world, those non-clinical programs as a laughable as Josh Shipp which may be why he talks about them in his MTV show. Boot camps and military schools are dying out and, thankfully, being replaced by sophisticated, evidence-based programs with transparency and clinical integrity. Not every program is awesome but, neither is every physician or dentist.

Mr. Shea, I make a challenge to you. Join me on a tour to visit 5 therapeutic programs. Together, you and I will kick the tires, dig through the closets and truly get to the bottom of whether this universe of programs is as detrimental as you propose. We’ll spend 2 days out in the back-country, in storage rooms with gear, and circled up in treatment centers. After that, I challenge you to write the same article blasting this world that has helped so many families. Not likely to happen.

Blogs of Note: The Interpreted Rock by Steve Schultz

The Interpreted Rock is a blog written by our good friend Steve Schultz from Oxbow Academy in Utah. Steve was born and raised in Eugene, Oregon. He graduated from the University of Utah with a degree in psychology and received formal training as an addictions counselor. He spent several years working with health care facilities in clinical services, operations and marketing. With over twenty five years assisting families to navigate the rough waters of addiction, mental illness and the various struggles produced by wayward teens, Steve has a unique perspective and compassionate demeanor. He joined the RedCliff Ascent family in 2002. His clinical insights and customer service emphasis help him give parents a better understanding of the unique services provided by RedCliff Ascent and its sister programs.

Here’s an excerpt from a friend’s blog we thought you all may enjoy…

Monday, May 13, 2013

I was recently in Tucson Arizona meeting with the family of a student who graduated from Oxbow Academy. www.oxbowacademy.net I was traveling with the clinical director of Oxbow, Todd Spaulding LCSW.  We also had the opportunity to meet with allied health professionals in the area who work with troubled teens and their families.

As we met with folks in Tucson, I just wanted to make a brief introduction to Oxbow Academy. I shared with them that Oxbow works with families that are struggling with a son who is burdened with sexual behavioral concerns. Often this is excessive use of pornography, inappropriately touching a sibling, friend or neighbor or other compulsive sexual behaviors. About half of our students come to us with some type of Learning Disability (LD) and 60% are adopted…80 and above IQ, but socially awkward…..
For more on struggling families, Steve, Oxbow Academy or any of the other Redcliff Ascent programs, check out Steve’s blog or check out Redcliff Ascent’s list of programs.

5 Things Your Education Consultant/Case Manager Should Be Doing Right Now

This is our raw, irreverent guide on what in our humble opinion education consultants and case managers should be doing right now to provide the highest quality service to you. This list is valid regardless of the type of mental, behavioral health or substance abuse treatment you or your loved one is receiving (eg. therapeutic wilderness program, therapeutic boarding school, individual outpatient therapy, psychological assessment). If you go through the list and your well-compensated professional is providing you with anything less than what we discuss below, copy and paste this into an email and let them know you’ll keep them hired only if they get on board.

1. Consistent Contact

When we first started Fonthill, we were so focused on accomplishing all the goals and objectives we developed with parents and families that we failed to keep everyone informed and on the same page. We learned from our mistakes that weekly contact (at a minimum) is essential. Your education consultant / case manager should be providing you (and the whole team) with regular email or text updates. These are not updates you should need to respond to, just information letting you know an application was submitted, insurance claim was accepted or that the psychologist doing your son’s assessment will be available about 30 minutes earlier if that works for you. Parents count on us to keep them informed.

2. Proactive Planning

Here is another mistake we made. Our teams are experts on working with behavioral acting out, crisis, intervention, parenting, and families but what we quickly learned we needed to do just as well was developing a treatment plan that included more than just what the parents thought was the issue. We expanded our planning WAY beyond what we estimated our involvement to be so that after we had worked ourselves out of a job (…another hallmark of good work) the family had a set of instructions, a road map, a guide if you will on who should be doing what and by when. Make sure that your education consultant / case manager is developing a plan that considers the big picture since treatment and life do not stop when the professional’s final payment is received. Seriously, they should be mapping out way far into the future to mitigate obstacles and pot-holes you are not even thinking of (eg. Financial literacy for your son entering substance abuse treatment).

3. Saying ‘No’

A really good way to determine if your education consultant / case manager is worth their weight in gold (…or Rhodium) is how often they say ‘no’ to 1. New Clients, 2. Current Clients and 3. Professionals on your team.

Let me explain. New clients – We make it very clear to perspective clients that not everyone that contacts us becomes a client. We could become the Wal-Mart of family services but quality would go WAY down. Education consulting, case management, family counseling and our parent education and consulting would become commodities. Many desperate professionals say ‘yes’ when leads are low and expenses are high (…McMansions are cheap ya know). Current clients – A really valuable and important education consultant and case manager is hired to set a course, develop a plan and make sure the heading if followed. Parents often, with the best intentions, attempt to deviate from the course when kids get unruly or their own fears start to percolate. Professionals – One of  our most important jobs as case managers is working out issues behind the scenes (eg. Setting a limit on the ‘add-ons’ a program may want to push on parents). Being able to effectively and respectfully say ‘no’ to other professionals is an essential skill that should be in your case manager’s repertoire.

4. Billing Fairly

Have you ever lost your mind when you looked over your hospital bill from the Cedars-Sinai Medical Center that showed that the Aspirin they gave you cost $1000? Yeah, we don’t like that either. We think billing should be fair and transparent. There are many, many families that we work with that make a bazillion dollars. There are also just as many families that are have very modest incomes. We charge the same for them all and we are upfront with our costs. We also don’t think it’s appropriate to gouge our clients with ridiculous initial consultation fees ($5,000 for an initial meeting? Get real.) We also don’t like contracts for X number of months. Life happens and we know families sometimes need to make drastic changes. Being on the hook for a service that’s supposed to solve problems and not create new ones is important to consider when signing up with an education consultant  or case manager. We recommend the shortest term necessary with flexibility built in. For instance, rather than expecting payment everytime we meet, we invoice clients monthly for the work completed (…not for the upcoming month like a landlord). Make sure you understand your bill and that all the expenses are for things you agreed to.

5. Maintaining Boundaries

Oh this one really gets us frustrated. To be able to have the healthiest working relationship with your education consultant and case manager they should constantly maintain professional boundaries similar to Licensed Professional Counselors – No dual roles (eg. Your professional is not also your CPA) and No merging of personal/professional relationships (eg. Your professional is not discussing non-work related issues). This may seem like small stuff but, think about it this way. You hired this person to provide objective analysis and recommendations to advance your family through some obstacle. This creates what in mental health parlance is referred to as a power differential. A power differential is when one party has greater power than the other (eg. Judge vs. defendant). In this case, the professional has power over the parents because the parents are in a vulnerable position, meaning they are counting on advice, but also relying on the professional to protect their confidential information, reputation as well as their emotional and psychological health. If your education consultant has crossed any line that’s not clearly stated in their scope of service, consider talking with them directly and asking them to respect the professional relationship you want with them by limiting the personal sharing and interaction. It may feel uncomfortable, but consider this – what happens if you are not happy with something they did? What happens if the treatment program they recommended turns out to be crap? It’s much easier to confront someone who has maintained professional boundaries throughout the process.

This list is not exhaustive but a starting point to ensure you have some reasonable expectations of what to expect in your relationship with an education consultant/case manager. Contact us at Fonthill if you need more help or if you’re not sure how to best use your current professional support.

Boot Camp and Therapeutic Wilderness Programs: Part 1: History, Myths and Reality

Ahhh, the boot camp. Good ‘ole fashioned behavior modification through discipline, intimidation and fear. It was the era of Tough Love. The boot camp’s sordid history stems from our collective belief that all kids need when they’re acting out is an experience more like what the military provided (past tense is key here since the military no longer uses ‘boot camp’ tactics in basic training – They found it to be counterproductive). What may come as no surprise is that these bastions of verbal ballistics just were not (…and continue not to be) effective.

Once associated almost exclusively with the initial weeks of military indoctrination, the term “boot camp” has, in recent years, come to be adopted by programs that want to emphasize the rapidity and intensity of their experience.

From computer boot camps (become a certified systems engineer in one week!) to fitness boot camps (10 sessions to a Bigger, Stronger you!) to weight loss boot camps (shed those pounds in a fraction of the time!), the boot camp phenomenon seems to be particularly appropriate for the members of today’s overscheduled, not-a-moment-to-waste society that need their butt kicked.

But while many so-called boot camps are actually little more than sped-up seminars, the intense, intimidating, and “in your face” philosophy (think the first hour of the film “Full Metal Jacket”) still permeates at least one type of non-military boot camp: the juvenile boot camp for troubled teens.

A Rigorous Road to Redemption?

The boot camp approach began to cross over from the military world to the civilian population in the early 1980s, when boot camp programs were created as alternatives to incarceration for certain adult and juvenile offenders.

According to the Office of Juvenile Justice and Delinquency Prevention, the first boot camp for adult offenders was established in Georgia in 1983. Two years later, Orleans Parish, Louisiana, became home to the first juvenile boot camp.

According to information on the OJJDP website, most juvenile boot camps (and the majority of boot camps for adult offenders) feature the following components:

• Boot camps almost always include rigorous physical conditioning and other forms of physical labor.
• An emphasis is placed upon discipline, which is usually enforced through a military-like code of rules and regulations.
• Teen boot camp participants usually have been convicted of nonviolent crimes, or have been referred to the boot camp by parents in an effort to curb unhealthy and illegal behaviors.
• Teen boot camps are usually intense short-term experiences (rarely lasting longer than six months) after which the troubled teen is returned to the community.
• Depending upon the nature of the boot camp, the teen may be required (or encouraged) to submit to a post-camp supervision program or enroll in an aftercare program.

More Boot Camps for Teens in Trouble

In the early part of the 1990s, OJJDP provided funding for a pilot program consisting of three juvenile boot camps – one each in Cleveland, Ohio; Mobile, Alabama; and Denver, Colorado. Information provided by the National Criminal Justice Reverence Service (NCJRS) indicates that these three OJJDP-funded teen boot camps were “designed to address the special needs and circumstances of the adolescent offender.”

The NCJRS website provided the following details about these three juvenile boot camps:

• The OJJDP’s juvenile boot camps were designed for a target population of adjudicated, nonviolent offenders under the age of 18.
• The pilot boot camps for teens included highly structured, three-month residential programs that were followed by six to nine months of community-based aftercare.
• During the aftercare period, youth who had completed the juvenile boot camps were to pursue academic and vocational training or employment while under intensive, but progressively diminishing, supervision.

Though the juveniles who completed these pilot program boot camps were found to have improved in certain academic areas, an OJJDP “Lessons Learned” document reports that the teen boot camps had no impact on reducing recidivism rates (that is, decreasing the odds that a juvenile would re-offend after completing the boot camp):

The pilot programs, however, did not demonstrate a reduction in recidivism. … In Cleveland pilot program participants evidenced a higher recidivism rate than juvenile offenders confined in traditional juvenile correctional facilities.

It should be noted that none of the sites fully implemented OJJDP’s model juvenile boot camp guidelines, and that some critical aftercare support services were not provided.

This observation was echoed in a 1996 report (Boot Camps for Juvenile Offenders: An Implementation Evaluation of Three Demonstration Programs) that was prepared for the National Institute of Justice:

What appeared to be a promising prognosis at the conclusion of boot camp disintegrated during aftercare. All three programs were plagued by high attrition rates for noncompliance, absenteeism, and new arrests during the aftercare period. …

In all fairness to the programs, aftercare was particularly affected by unexpected cuts in Federal support. … However, at this juncture it does not appear that the demonstration programs solved the problem that typically plagues residential correctional programs: inmates who appear to thrive in the institutional environment but falter when they return home.

‘Therapeutic’ Boot Camps for Troubled Teens?

Though the boot camp model appears to have been less than successful in its efforts to effect long-term positive change among adjudicated young people, this failure has not stopped the concept from spreading. For example, a number of private programs continue to market teen boot camp services to parents who are concerned about their children’s behavior.

Why do boot camps remain an attractive option for some parents? The National Institute of Justice’s 1996 Boot Camps for Juvenile Offenders report indicates that this popularity may be due in large part to certain media-fueled attitudes about the power of “getting tough” with troubled teens:

• In addition to their considerable popularity within the correctional system, boot camps have demonstrated extraordinary appeal to the general public.
• Experts on boot camp programming nationwide note that boot camps are a “natural” for media coverage, which tends to focus on the programs’ disciplinary aspects and appeals to “get tough” sentiments.
• In a culture where many people view military service as a formative experience, the public also seems to intuitively grasp the rehabilitative rationale for the programs.

An alternative to the juvenile boot camp approach can be found in therapeutic wilderness programs for troubled teens, which emphasize non-abusive techniques while still providing a series of challenging opportunities through which struggling teens can develop valuable skills, communication strategies, and self-esteem.

Emphasizing responsibility to oneself and one’s family and community, and providing a significant therapeutic component, strong family involvement, and considerable aftercare support services, wilderness programs for troubled teens are founded upon the philosophy that teen mental health challenges are not “quick fix” problems.

Unlike the top-down control that is a hallmark of the juvenile boot camp approach, wilderness programs for troubled teens help participants identify their own problems, take responsibility for their past failures and frustrations, and decide that they want to make healthy changes.

New Generation Using Wilderness – Not Brutality

Thanks to visionaries that saw the benefits of using wilderness and adventure as a context, strategy, metaphor and intervention for behavioral, mental health and substance abuse issues, we have seen a significant move away from the Boot Camp to the Therapeutic Wilderness Program. Some of the big names in the field started with Kurt Hahn (1886-1974) who started Outward Bound, then decades later we saw the influence of Larry D. Olsen and Ezekiel C. Sanchez at Brigham Young University; Nelson Chase, Steven Bacon, and others at the Colorado Outward Bound School; Rocky Kimball at Santa Fe Mountain Center.

This pivot away from Boot Camp and towards therapeutic intervention led many programs to adopt the very successful recipe of a series of tasks that are increasingly difficult in order to challenge the patients; teamwork activities for working together; the presence of therapist as a group leader; and the use of an evidence-based (eg. CBT) therapeutic process such as a journal or self-reflection.

Next Time: A look at some of the types of therapeutic wilderness programming being offered and what the research says.

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