When stepping down from an inpatient psychiatric admission or being at imminent risk for hospitalization, there are 4 levels of care you can consider to help increase support and services for your struggling child. These levels of care are selected based on various factors, such as health severity, environmental support, disruption to every-day-life, insurance, and more. They are:

1. Residential Treatment Centers (RTC)
2. Partial Hospitalization Programs (PHP)
3. Intensive Outpatient Programs (IOP)
4. Outpatient Care Programs 

Deciding if the residential treatment level of care is right for your teenager is stressful and requires a lot of research. Sometimes it’s hard to tell what is right and what is wrong. In this article, we will provide the information you need about each of the four levels of care. We broke up each level of care into four primary considerations—the medical criteria for insurance coverage, the treatment components, the advantages and disadvantages of services, and scenarios in which each level of care is appropriate. But your biggest, most pressing question is probably the first one.

As a Parent, How Do I Know I’m Doing The Right Thing?

Deciding which treatment is suitable for your teenager may feel overwhelming, but it’s not a decision you have to make alone. While having a hand in the decision-making process is important, it’s also essential to listen to mental health professionals trained to determine the right fit for the sake of yourself and your child’s health and safety. It’s important to remember that there is no one-size-fits-all solution, and it’s common for a teenager to jump around the levels of care when needed.

Your child’s mental health professional can comprehensively evaluate their needs, the severity of their condition, and available support systems. As the parent, your input will also help determine the required level of care. A few considerations that you may want to take into account when speaking with a mental health professional include:

• The impact treatment will have on your child’s daily life and routines
• The amount of support that is available in your family and community
• Your financial considerations and options

It’s essential to weigh the benefits of an immersive and structured environment provided by the residential treatment level of care vs. outpatient care’s flexibility and familiarity. Prioritize your child’s well-being and long-term recovery, and consider their readiness for a specific treatment setting and the potential impact on their overall growth and development. Remember, you are not alone; seeking professional guidance and support can provide invaluable insight and perspective.

Comparing the Residential Treatment Level of Care to Other Options 

It is essential to identify the difference between the residential treatment level of care and other options for your teenager or adolescent when they are struggling with mental health issues. Before going into further details, we’ve provided a broken-down, simplified version of each level of care for additional comprehension.

We’ve described the difference between the residential treatment level of care and other options—now, let’s explore the main components of each.

Partial Hospitalization Programs (PHP)

Partial hospitalization programs are recommended for teenagers who require intensive mental health or substance abuse care but do not require 24-hour supervision in an inpatient setting. It provides structured programming and support while allowing patients to return home at the end of the day. Partial hospitalization programs can benefit teenagers transitioning from IOP or RTC and require more structure than outpatient care.

PHP Treatment Components

1. 1. Intensity and Frequency of Services: 3-5 days a week, 5 hours a day
   2. Nursing: None
   3. Milieu Counseling: Supervision, skills coaching, and behavior modification are offered during programming hours.
   4. School: Optional component
   5. Psychiatry: Once weekly
   6. Group Therapy: 5 hours a day
   7. Family Therapy: 1-3 hours a week 
   8. Individual Therapy: 1-3 hours a week

When Is It Appropriate to Select a Partial Hospitalization Program?

1. PHP is a good “step-down” choice from either inpatient or residential when your child is still at a high risk of suicide, serious self-harm, or other high-risk behaviors.
2. If your child’s functioning is low due to high avoidance, like school refusal, paralyzing social anxiety, or debilitating depression
3. If your child’s mental health is so acute that school must be a secondary consideration
4. If your child needs a high degree of structure and skills training that a lower level of care cannot provide

Medical Criteria For PHP Coverage

To admit your teen into a partial hospitalization program (PHP) with insurance coverage, the insurance company will assess specific medical criteria. Insurance companies will cover PHP if your teen possesses the following criteria. 

• Significant Risk of Harm: 
  • Significant suicide thoughts are present.
  • The patient or family can commit to and carry out a safety plan.
• Moderate Functional Impairment: 
  • Has high relationship conflict and significant avoidance (school and socially)
  • Has less than normal habits for hygiene, sleeping, or eating
  • Has recently gained or stabilized some functioning while participating in structured, protected, or enriched services
• Significant Co-Occurrence: 
  • The patient presently has conditions, signs, or symptoms that may adversely affect the presenting problem or require significant alteration of services for the presenting problem, are present and persist without stress, and are moderately debilitating. Examples include:
    • Developmental disabilities
    • Medical conditions
    • Substance use issues
• Moderate Stressful Home Environment: 
  • Moderate disruption of family or social support due to illness, death, divorce, sustained harassment by peers, exposure to substance abuse, or separation of parent and child or adolescent
• Limited Environmental Support: 
  • The family/primary caretaker is limited in the ability or is ambivalent about providing for the patient’s needs or problems and demonstrates only a partial ability to make necessary changes during treatment. 
  • There are community resources for support, but they only partially compensate for unmet needs.
• Moderate Resiliency: 
  • The patient has demonstrated an inconsistent ability to deal with stress and maintain normal development. 
  • Previous services are at low-intensity levels and have not successfully relieved or controlled symptoms.  
  • Attempts to maintain the gains attained with intensive services have moderate success for a limited period, but only with strong support or in structured settings. 
  • Developmental pressures and life changes create temporary distress. 
  • Change and transition require moderate support. 
• Limited Involvement in Services: 
  • Unsuccessful at IOP level of care
  • The patient is ambivalent, avoidant, or distrustful of their relationship with clinicians and other care providers. 
  • While acknowledging the problem, they still have trouble accepting limited age-appropriate responsibility for the development, perpetuation, or consequences of the problem. 
  • Minimizes or rationalizes problem behaviors and consequences and cannot accept others’ definition of the problem and its consequences
  • Frequently misses or is late for appointments or does not follow the service plan

Intensive Outpatient Programs (IOP)

Intensive outpatient programs are typically recommended for teenagers in various situations where more structured and intensive treatment is necessary but does not require inpatient care. Intensive outpatient programs can benefit teenagers transitioning from PHP or RTC or need more structure and support than outpatient care can provide.

RTC Treatment Components

It’s suggested to select an IOP that offers 1-2 individual sessions a week and has a minimum of 1 family therapy session a week.

1. Intensity and Frequency of Services: 2-3 hours daily, 3-5 days a week
2. Nursing: None
3. Milieu Counseling: Supervision, skills coaching, behavior modification during programming hours only
4. School: None
5. Psychiatry: Typically NOT included
6. Group Therapy: 2-3 hours a day
7. Family Therapy: 0-1 hour(s) a week
8. Individual Therapy: 0-2 hours a week

When Is It Appropriate to Select an Intensive Outpatient Program?

1. If your child can contract for safety (agree to no self-harm) and is engaged in treatment, intensive outpatient care is an ideal level of care because it does not disrupt school. Skills can be generalized to home, peers, and school.

Intensive Outpatient Programs (IOP)

Intensive outpatient programs are typically recommended for teenagers in various situations where more structured and intensive treatment is necessary but does not require inpatient care. Intensive outpatient programs can benefit teenagers transitioning from PHP or RTC or need more structure and support than outpatient care can provide.

Medical Criteria For IOP Coverage

To admit your teen into an intensive outpatient program (IOP) with insurance coverage, the insurance company will assess specific medical criteria. Insurance companies will cover IOP if your teen possesses the following criteria. 

• Some Risk of Harm: 
  • History of suicidal thoughts with no intent, plan, or significant distress
  • Brief lapses in the ability to care for self or use environment for safety 
• Mild Functional Impairment: 
  • Has minor deterioration in relationships (school and socially)
  • Has minor disruption of habits in hygiene, sleeping, and eating
• Minor Co-Occurrence: 
  • The patient has minimal developmental delays or disorders, limited medical conditions, and occasional substance use is present with no impact on the presenting problem. Transient, occasional, stress-related psychiatric symptoms are present but have no impact on the presenting problem.
• Mild Stressful Home Environment: 
  • Normative transitions occur, and the patient has minor interpersonal conflict. Death or loss has a minor impact on the child and family. Illnesses are transient, there are inadequate resources or the threat of losing resources, performance expectations create discomfort, and the potential for exposure to substance use exists.
• Supportive Environmental Support: 
  • The family/primary caretaker is only occasionally disrupted or only occasionally inconsistent. 
  • The family/primary caretakers are willing and able to participate in treatment if requested and have the capacity to effect needed changes. 
  • Special needs are addressed through successful involvement in systems of care.
  • Community resources are sufficient to address the child’s needs.
• Significant Resiliency: 
  • Patient has demonstrated an average ability to deal with stressors and maintain developmental progress. 
  • Prior experience with services has successfully controlled symptoms, but more lengthy intervention is needed. 
  • Can sustain recovery for extended periods but needs a structured setting, ongoing care, and support. 
  • Recovery has been managed for short periods with limited support or structure. 
  • Can adapt to changes with minimal support.
• Adequate Involvement in Services: 
  • Unsuccessful at an outpatient level of care. 
  • The patient can develop a trusting, positive relationship with clinicians and other care providers. 
  • Patient is unable to define the problem as developmentally appropriate. Still, they accept others’ definitions of the problem and its consequences while accepting limited age-appropriate responsibility for behavior and passively cooperating in services.

Outpatient Care Programs

Outpatient treatment is well-suited for teenagers with moderate mental health concerns who can effectively manage their symptoms while residing at home. It is suitable for adolescents who do not require round-the-clock supervision or intensive intervention but still benefit from regular therapy sessions and ongoing support. Outpatient programs can benefit teenagers with a strong support system at home and in their social networks, as outpatient care often relies on active family involvement and existing community resources. 

Outpatient Treatment Components

Dialectical behavioral therapy (DBT) was designed to treat chronic suicide behaviors at this level of care. However, to increase the likelihood of obtaining treatment gains, work with a DBT-LBC Certified Program™ or DBT-LBC Certified Clinician™. 

1. Intensity and Frequency of Services: 1-2 sessions per week
2. Nursing: None
3. Milieu Counseling: None 
4. School: None
5. Psychiatry: None or a separate service
6. Group Therapy: 0-2 hours a week
7. Family Therapy: 0-1 hour(s) a week
8. Individual Therapy: 1-2 hours a week

When Is It Appropriate to Select an Outpatient Program?

1. If your child’s mental health would decline by removing them from school and extracurriculars, outpatient care may be appropriate. 
2. If your child needs solutions for mitigating problems, but the problems are not life-threatening
3. Outpatient care can work for life-threatening behaviors if your child can contract for safety (agree to no self-harm), engage in a supportive relationship with a parent, monitor their safety, and stay motivated to get better by staying engaged in treatment. 

Outpatient Care Programs

Outpatient treatment is well-suited for teenagers with moderate mental health concerns who can effectively manage their symptoms while residing at home. It is suitable for adolescents who do not require round-the-clock supervision or intensive intervention but still benefit from regular therapy sessions and ongoing support. Outpatient programs can benefit teenagers with a strong support system at home and in their social networks, as outpatient care often relies on active family involvement and existing community resources. 

Medical Criteria For Outpatient Coverage

• Low Risk of Harm: 
  • No suicidal thoughts
  • No high-risk impulsive behaviors
• Minimal Functional Impairment: 
  • Developmentally appropriate behaviors in relationships, school, and self-care
  • No more than temporary, stress-related deterioration
• No Co-Occurrence: 
  • Consistent functioning appropriate to age and developmental level 
  • No more than transient impairment in functioning following exposure to an identifiable stressor
• Minimal Stressful Home Environment: 
  • Absence of significant or enduring difficulties in their environment, and life circumstances are stable
  • The living environment is conducive to normative growth, development, and recovery.
• Highly Supportive Environmental Support: 
  • The family/primary caretaker and ordinary community resources are adequate to address the developmental and material needs. 
  • With at least one caretaker, there is a continuity of active engagement in a warm and caring relationship. 
• Full Resiliency: 
  • The patient has no previous experience with services and has demonstrated the ability to maintain development in the face of everyday challenges. 
  • Prior experience indicates that most services have helped control the presenting problem in a short time. There has been successful management and extended recovery with few periods of relapse, even in unstructured environments or without frequent services. 
  • The patient can transition successfully and accept changes in routine without support.
• Optimal Involvement in Services: 
  • The patient quickly forms a trusting and respectful positive therapeutic relationship with clinicians and other care providers.
  • The patient can define a problem as developmentally appropriate and accept others’ definitions of it and its consequences. The patient also accepts age-appropriate responsibility for behavior that causes or exacerbates the primary problem while cooperating and actively participating in services.

Whether the residential treatment level of care is appropriate for your child is about more than medical criteria and objective measures. This crucial decision is best arrived at through a collaborative effort between you and a qualified, compassionate medical team.

At Compass Behavioral Health, we treat depressed and anxious children and young adults with gold-standard, evidence-based treatments that create mastery, a sense of belonging, and a purpose-focused life. Our residential program is overseen by clinicians certified by the DBT -Linehan Board of Certification™, meaning only the most experienced therapists and medical staff will provide your child with individualized treatment at our employee-owned facility. We also teach valuable dialectical behavior therapy (DBT) skills for parents to use at home to help their children understand and respond to their emotions. 

Schedule your free consultation today to learn more about our teen residential treatment vs. outpatient programs.