What Are the Levels of Care for Children’s Mental Health?

Navigating the mental health system for children can be confusing for parents of teens who struggle. We know that our child needs support, but how much help is needed and appropriate for their behaviors? 

Often, kids might not enter mental health treatment until an emergency occurs. We might not be aware of issues going on, such as suicidal ideation or drug and alcohol addiction—until our child engages in risky behavior requiring a stay at the acute care unit (inpatient care). These moments can be challenging for families. They might not have known that their child struggled. Suddenly, they are handling a life-threatening situation of a suicide attempt or an overdose.

Parents now need to navigate the next levels of their child’s care, and several questions can arise, like:

  • What diagnosis does my kid have?
  • How long will they receive care in the acute unit?
  • Will a stay at an acute care unit be enough to cure my child?
  • Will they engage in these behaviors again when they return home?
  • What are additional services that can help my child after the hospital?
  • How will we pay for additional services?
  • What are the next steps?

What Is Acute Care?

Understanding specifically what an acute care unit is—and is not—can help parents identify the next steps for their child. An acute care unit is:

  • Generally run by a hospital under a corporate-run health network
  • Also referred to as a “psychiatric unit” or a “crisis unit”
  • A safe and restrictive environment
  • Focused on stabilization
  • Short-term (usually three days to approximately two weeks)
  • Usually reimbursed by insurance

Parents might assume that acute care units offer the same services as treatment facilities. However, these units do NOT focus on treatment and recovery. While kids might attend therapy and group sessions at an acute unit, the primary focus is stabilization. Acute care units primarily address the immediate safety concern; however, they do not dive deeply into the real work of identifying underlying causes, developing coping skills, or preventing recurrent issues.

What Comes Next?

Acute care units often refer a child to the next level of care (or a “step-down” from crisis services). If a psychiatrist or other qualified person at the acute care unit recommends this next level of care, insurance is likely to cover the costs. Most of the time, acute care staff will recommend a step-down owned by their company.

The next steps are either an Intensive Outpatient Program (IOP) or a Partial Hospitalization Program (PHP). Both programs offer intensive therapy and treatment services that do not require overnight stays. Participation in these programs is usually four to eight hours per day, three to five days per week for several weeks. IOP and PHP are staffed by therapists, psychiatrists, social workers, doctors, and other mental health staff. While these units can have dedicated and caring staff members, they are often overloaded with clients. Some therapists and psychiatrists in these units can have 20 or more individuals under their care at one time.

What If This Step-Down Is Not Enough?

IOP and PHP rely on a child having a healing environment at home to prevent relapse or other issues when not in the program. Sometimes, however, these services are not enough for kids with severe mental health concerns or addictions. They might still be at risk of imminent harm and not stable enough to safely return home without 24-hour supervision.

In these instances, the acute care unit might recommend residential treatment following stabilization. Again, these programs might be covered by insurance when recommended by a qualified medical practitioner. However, residential treatment facilities often require out-of-pocket expenses and can be expensive due to the staff and facility costs. If residential care is recommended, parents should do the following:

  • Research residential programs online or ask for recommendations from trusted individuals (family doctors, therapists, friends who have kids in treatment, or even family members in the treatment field).
  • Look for a licensed program, as unlicensed programs will not be covered by insurance, even if residential care is recommended.
  • Call these programs and be honest about finances. Ask questions about paying for these programs, like: 
    • Do they offer scholarships and financial assistance?
    • Do they offer add-on policies for insurance?
  • Many of these programs will claim that they offer specific evidence-based services because these services are covered by insurance. Find out if they do offer services like:
    • Eye Movement Desensitization and Reprogramming (EMDR)
    • Dialectical Behavioral Therapy (DBT)
    • Cognitive Behavioral Therapy (CBT)
  • Research the therapeutic modalities offered by these programs, and ask questions about the specifics of these modalities (i.e., “How many hours per day does my child have a therapy session?”, “How long does EMDR last at your program?”, “What are the ratios of staff to clients?” etc.)

Navigating the levels of care for children’s mental health services can confuse parents of teens who struggle. We might worry about treatment costs and hope that a stay in an acute care unit will be enough to help our child. Unfortunately, a stay at an acute unit will only focus on stabilization. While these units can get our child out of immediate harm, they will not address the underlying issues at the root of our child’s recent crisis. Our child did not develop these issues overnight, and an acute care stay of three to ten days will not be enough to make a full recovery. If you have questions or feel lost about where to go next, visit Fire Mountain Residential Treatment Center’s Facebook group “Parenting Teens That Struggle.” Here, you can resource and share tips with other parents who have been there before. For more information, call (303) 443-3343.

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