Outpatient vs. Inpatient Hospitalization vs. Residential Therapy 

When a child or adolescent has behavioral issues, it can cause several problems in the lives of those around them. More than seven percent of children aged three to 17 have a diagnosed behavioral problem, but only 53.5 percent receive treatment for their disorders. These issues become more difficult to manage if appropriate intervention does not occur. Luckily, there are steps you can take to help your child.

Once you realize that the behavioral issues are serious and escalating, pursuing treatment becomes paramount to your child’s overall health. There are many treatment options to choose from, and choosing the most effective one can be a challenge.

Behavioral health support comes in a variety of forms that assist patients at different levels of care. The level of care your child requires is determined by a variety of factors that may not be immediately obvious to you. Understanding the levels of care available is essential in placing your child in a program that meets their treatment needs.

Levels of Outpatient Care

Outpatient treatment programs provide care while your child continues living at home. Treatment can range from visits to the site of care for a few hours per week to partial hospitalization where the child participates in treatment on-site for the majority of each day. Some of the common types of outpatient care include:

Routine Outpatient Care

Routine outpatient care is the first level of care to consider. It is suitable for adolescents who are struggling with specific problems or circumstances, such as moving to a new city or dealing with grief over the loss of a loved one. Anxiety or depression over specific issues (i.e. school, social relationships, etc.) can often be addressed by routine outpatient therapy or the combination of therapy and psychiatry.

Those who are maintaining their day-to-day activities in school or other settings with minimal interruption by their symptoms are good candidates for routine outpatient care. Outpatient therapy or counseling can help patients gain valuable insights into their emotions and behaviors, as well as strategies and skills to manage their emotions or symptoms, regardless of whether they have a formal mental health diagnosis.

Intensive Outpatient Program (IOP)

For patients with more severe symptoms, the structure of an intensive outpatient program may be beneficial. When children are struggling socially and academically due to their mental health, the symptoms can manifest in behavioral problems such as chronic tardiness, school refusal, disruptive behaviors, social withdrawal. An IOP can give more support on a weekly basis to help clients learn to manage stress and cope with a range of emotional and behavioral issues.

Every IOP is different but treatment usually consists of eight to ten hours per week. An IOP typically ranges from three to five visits per week, with each visit comprised of two to three hours of treatment. Many intensive outpatient programs are structured to allow participants to go to school and perform essential daily routines as they normally would. IOPs take place over a set period of time, usually four to six weeks. This window may be adjusted depending on how the patient responds to treatment, and different programs may have a shorter or longer projected treatment time.

This level of care is primarily done in a group therapy setting. Some programs may include individual therapy, as well as family therapy as clinically appropriate. Patients receive support from the clinicians and also benefit from working alongside others to resolve similar issues.

Intensive In-Home Therapy

In cases where patients can benefit from receiving therapy at home rather than in an office or residential setting, Hillside offers intensive in-home therapy. In-home mental health care can help your child and your family achieve greater stability and promote the type of home environment most conducive to making progress in treatment. This form of intervention can help address:

• Academic difficulties
• Acting out or aggression
• Impulse control
• Conflict resolution
• Social skills
• Anxiety and depression

In-home therapy is an effective way to help reinforce the skills learned in other forms of outpatient treatment. When routine outpatient therapy doesn’t feel like enough support and hospitalizations seems too drastic, Intensive In-Home Therapy program can be the answer. In-home therapy is also an appropriate option for children or teens who are transitioning back home after inpatient hospitalization or completing residential treatment. For local families who may not have the insurance benefit or resources to access in-home therapy, your child may be eligible for the Hillside Community Intervention Program, which offers services through grants specific to Fulton and DeKalb counties.

Partial Hospitalization Program (PHP)

The next level of care in outpatient treatment is a partial hospitalization program. A PHP is appropriate for teens whose behavior is putting them at risk of full hospitalization, or as a step-down for those who are transitioning from hospitalization. PHPs are often recommended for patients who have already participated in lower levels of care without seeing improvement in their emotional and behavioral issues.

A PHP usually involves five to seven days of care per week, with the patient attending the treatment facility for around six hours each day. These programs are highly structured and intensive. Like IOPs and routine outpatient care, therapy plays a central role. PHPs often include an evaluation performed by a psychiatrist, who may find it’s appropriate to prescribe or adjust medication for your child.

The DBT Day Program at Hillside

Hillside’s Experience DBT program is a 6-week treatment for adolescents ages 13 through 17. Hillside’s Day program follows an adherent dialectical behavioral therapy (DBT) model, which includes structured individual DBT therapy, DBT skills training for client and caregivers, coaching calls (for client and family) and clinical consultation team. Social Emotional Ethical Learning (SEE Learning) is also incorporated in the Day program’s curriculum. The program is designed for teens ages 13 through 17 who have struggled with making progress at a regular weekly outpatient level of care.

The day program is an experiential therapeutic milieu. In addition to individual and family therapy, our clients engage in art, recreational therapy, horticulture therapy, as well as therapeutic drumming. Clients participate in field trips and outings to practice their DBT skills in the community. Not only will our clients learn all of the DBT skills in the 6-week time frame, they will also have the opportunity to practice the skills in the real world. Clients attend treatment Monday through Friday, from 8:00 a.m. to 4:30 p.m. for the duration of the program.

The Experience DBT program allows teens to continue living at home while receiving structured care and social interaction with peers. Our clients and their families also benefit from coaching calls with their individual and family therapists after hours and weekends. Medication management and weekly psychiatric consultations are also included for clients in this program.

Inpatient Acute Care or Crisis Stabilization Units (CSU)

When mental health issues escalate to the point of crisis, a person needs immediate intervention in the form of inpatient acute care or crisis stabilization. Inpatient Acute Care or Crisis Stabilization Units are usually short-term hospitalization with average length of stay being around 5-7 day. Short-term inpatient psychiatric hospitals or crisis stabilization units are the appropriate level of care for those who may be an immediate safety risk to well-being of themselves or others. The goals for short term inpatient care are to keep the patient safe and stabilize the crisis.

Patients participate in group therapy and meet with a team of professionals that includes a psychiatrist. Family sessions are conducted before discharge to help create an aftercare plan that frequently includes further treatment which can be a step-down to PHP, IOP, or routine outpatient treatment. However, if the patient has been unsuccessful at maintaining stability at a lower level of care, residential treatment may be recommended.

Residential Treatment Center (RTC) or Psychiatric Residential Treatment Facility (PRTF)

When mental health symptoms are too severe to be treated at lower levels of care or other available treatment approaches have proven ineffective, a person may be an appropriate candidate for intervention at a residential treatment center or psychiatric residential treatment facility. Residential treatment programs can vary from a facilities to facilities and state to state on programming structures, license and requirements, as well as average length of stay. The element that all residential treatment has in common is that the clients will live at the facility with 24/7 supervision. Good residential treatment programs will involve the family in the therapeutic treatment process regularly and help caregivers prepare the home environment for the child’s return.

Hillside’s Residential Program is licensed as a residential mental health facility by the Georgia Department of Community Health. Our residential treatment program specializes in Dialectical Behavior Therapy (DBT) as a modality of treatment in working with clients who struggle with extreme mood dysregulation, self-harming behaviors, and suicidal ideations. Hillside is the first and currently only residential treatment program to be recognized as a DBT-Linehan Board of Certification, Certified Program in the country.

Clients in our residential treatment program engage in individual, group, and family therapy alongside a variety of other unique therapies such as:

• Animal assisted therapy
• Recreational therapy
• Horticulture therapy

Although residential treatment can be highly effective where other interventions were not, it is not a suitable option for every child. If a client can stabilize at a lower level of care, the least level of restriction is generally preferable.

Hillside’s Residential Program – Conant School

Children and teens entering residential programs face a unique challenge: Keeping up with academics. School can be a source of stress for any child, but behavioral problems create additional stress and often prevent children and teens from making adequate progress with their education. Poor performance in school may also exacerbate issues with depression and anxiety. Children with mental and behavioral health problems need a learning environment that supports their treatment and effectively accommodates their individual educational needs.

Hillside addresses this crucial need through our Conant School. The Hillside Conant School is fully accredited through AdvancED. Clients who admit to Hillside for residential treatment can be enrolled in our school. Prior to enrollment you will need to provide Hillside with your child’s:

• School records
• Individualized education plan (IEP)- if applicable
• Eligibility reports
• Psychological testing -if available

The Conant School is a state-of-the-art facility equipped with a variety of specialized teaching tools like our Dorothy Cohen Library, Google Chromebooks and Promethean Boards in our 12 classrooms. Our teachers are highly qualified and understand the value of creative teaching in facilitating behavioral change. They understand that many of the children enrolled in our programs have fallen behind academically due to behavioral issues, and are equipped to take on the challenge of bridging gaps in knowledge and skills. Our small class size and highly supportive environment are instrumental in helping our students to thrive in an academic setting.

Evaluating the Appropriate Level of Care

Determining the appropriate level of care for your child should be done with the input of your child’s doctor or mental health professionals. Your child’s current providers have the familiarity with your child’s clinical presentation and expertise to make the appropriate recommendation. Their assessment will take the following into consideration:

Acute Danger

It is important to assess the level of risk the client poses to self and potentially to others. Is the client engaging in self-harming behavior? What are the risk of a client following through with a suicide ideation? Are there immediate threats to others? If there is clear and present danger to safety of the client or others, the client will likely require crisis stabilization before entering an outpatient or residential treatment program.

Functional Impairment

Children and adolescents who have behavioral or mental health struggles but are still able to participate in school, social activities, and at-home responsibilities are often good candidates for a form of outpatient treatment. Depending on how significantly their problems are affecting their ability to function, they may be able to make progress with routine outpatient care or may need to step up to intensive outpatient or in-home, or even partial hospitalization care.

Other Considerations

Although some children experience behavioral issues without any prior history of mental health diagnosis, it is important to consider that their mental health may be a significant factor in the problematic behaviors. Just over 47 percent of children who have depression also have behavior problems, and more than one in three children with anxiety have concurrent behavior problems. Additionally, more than 36 percent of children with behavior problems have anxiety, and more than 20 percent also struggle with depression.

When mental illness and behavioral issues occur together, it can be challenging to discover the dynamic at work between the two problems. It is important to access the situation accurately in order to set up an effective treatment plan. Clinicians will likely ask about psychosocial factors that relate to the child’s mental health. For example, stress from strained family relations or trouble at school can have a profound effect on a child’s behavior. Socioeconomic status can also affect mental health and behavioral issues, as poverty is a strong predictor of a child’s risk for developing a mental illness.

Before your next appointment with your child’s doctor or mental health professional, consider making a list of symptoms you have noticed. Structuring these notes on a timeline can help the assessing professional form a clearer idea of the severity of the child’s issues, and evaluate the possible trajectory of the symptoms to determine the appropriate level of care.

The Cost of Treatment for Children and Teens

Every treatment center and program has a different cost for treatment. Many programs do not work with insurance and offer services through a fee-for-service or self-pay model only. Some programs or providers will work with some insurance providers and many types of insurance cover behavioral treatment.

Hillside believes that quality treatment should be accessible. We have been intentional about being a quality in-network provider for families. Hillside is an in-network provider for most insurance, including Kaiser and Tricare. In most cases, we can work with your insurance to make accessing treatment possible.

Healing With Hillside

When seeking treatment for your child, you need to know your loved one is in good hands. Hillside, one of Atlanta’s oldest not-for-profit organization, has been committed to providing a support for children and families for over 130 years. Our continuum of care – from Intensive In-Home Therapy to Experience DBT Day Program to Residential Treatment – offer unique treatment and effective care at varying levels to fit the needs of children and teens who are having difficulties with emotional and behavioral issues.

Our treatment team is comprised of experienced professionals who are compassionate and highly skilled. Our commitment to supporting the whole family leads to better treatment and smoother transitions from treatment to home. If you have questions about how Hillside’s variety of programs can help your child, give Hillside’s admissions program a call at (404) 875-4551 or fill out our contact form.