Residential Treatment Centers - when do they come into play?

I don't know that you can parent a traumatized child and NOT spend time thinking through the question, "When would we need to utilize a Residential Treatment Center?" In a world of lots of alphabet diagnoses, we refer to these as RTC's. I know many of you have needed to use an RTC, or have children currently in a treatment center and I am, in no way, saying they should not be there. This is directed at those who are just now hitting a point with their kids where they realize this may be a possibility one day. I'm just sharing our thought process based on research and close work with our attachment therapist, answering the big question, "When?."

We spent a lot of time on this discussion before our most recent adoption, knowing we would be parenting siblings sharing extreme trauma. We educated ourselves on how this is sometimes one of the rare times it is sometimes best to separate siblings. We weren't sure how much of our kids' issues were attachment-related and how much was abuse-related. We read and read and studied and studied and consulted and consulted and consulted. Then, we just had to start sifting through their behaviors before we could figure it all out (and seriously - you can never actually figure it ALL out).

RTC's should always be your last-ditch effort. We knew that. Our children suffered internally because they lacked the vital attachment process in early childhood. Putting them in an RTC would never, ever, facilitate attachment. Like, never. They would not heal without attaching to US - Mom and Dad. So, our goal was to build a network around us so that we could survive extreme behaviors at home (most which would manifest to try to keep us at a distance), and hopefully avoid any kind of out-of-home placement, albeit temporary.

For us, a Residential Treatment Center would (and will) only come into play if our children became a danger to themselves or others.

Easy to say, but we then had to decide exactly what THAT meant and what THAT looked like. I could have easily made a phone call the first day my life was threatened. Yet, my first question has always had to be: "Can we keep everyone safe and keep them at home?"

Sometimes that has meant alarms on doors. It has always meant extreme limits on who can play with who, who can and cannot wrestle or tickle, who can or cannot ever be unattended with another, more vulnerable child. Deborah Hage has a brilliant article titled "Teaching Self Control to Children Out of Control." We really do have a lot of options in a multitude of situations.

And we have had a few things slip through the cracks.

What a simple sentence to describe something which is usually horrific. *sigh*

Yet, we could figure out where the "breach" was in our boundaries. Each time we have been able to say, "Okay, can this, these particular behaviors, still be managed at home? (*insert hours of consulting with more people, experts, therapists and knowledgeable friends*) Yes, it can. And it won't look like normal parenting, but at least we have found a way to keep them here. They are still at home. This can be done, right now, in this situation."

Now, don't get me wrong. In these times, we have had to stop and grieve heavily. I have had to mourn that things did regress, that things did get worse, that our home does occasionally have to look like an RTC. Yet, it would look like that if they were at an RTC, minus their family, plus a lot of strangers.

This is also when you start to have people openly question your parenting. They would never question what goes on in a Residential Treatment Center - ever. Yet, you take that approach in your home, to make sure they can STAY at home, and oh my ...

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My son, from trauma, has crossed "the line" slightly in the last 21 months. My hurting gal has danced over it with the fanfare of a Mardi Gras parade! I can think of three times I have gone to bed truly believing the very next day would be the day we would have to place her in an RTC. There is a phone conversation forever marred into my memory, as I was recounting the events of the day to our therapist (which involved breaking INTO the house when asked to go outside, and all sorts of other things) and I asked, "What am I missing? What else should I do?" "Christine, you're doing everything right." And all I could think was, "Oh. Holy. Crap."

Yet, when we would re-group and refresh our therapeutic parenting knowledge and keep several people on speed dial (and actually CALL them!), we were able to help her pull out of it. It was still absolutely miserable, but she was no longer putting anyone in immediate danger.

It is a difficult balance. There are times and there are situations when a child must live somewhere else. Some children need very strict separation from bio/adoptive siblings - they must heal first before they can slowly be reintroduced to a family setting with younger children (if ever). A child who does go to their room when asked, and leaves the alarmed door closed and throws, kicks, screams, bashes, destroys, crashes, etc. .... well, that child still is not an immediate danger to anyone. While we experienced MAJOR escalation just after putting our daughter in her own room with an alarm, she now tells us that she needed it and was thankful for it.

When it came to my husand and I - we had to face the way things would look at home. The aggression would be directed toward us, because attaching to us is a terrifying thought. Terrifying. If we could handle that well, and stay regulated, our children would then go after their siblings ... to hurt us and try to guarantee keeping us separated. They may go after pets. So, we have always had to be willing to exhaust every single concept and theory and resource and breathing expert we can access ... to keep our kids at home if at all humanly possible.

We have also had to find ways to keep ourselves refreshed and emotionally healthy (I know, I know - easier said than done!). Our house has often looked like an RTC, yet the "staff" doesn't get to go home when their shift is over. We ARE the staff and we already ARE at home! Sometimes you have to work just as hard at giving yourself a break as you do at therapeutic parenting. I've gotten very good at it over the years, as our family has grown, but it didn't come naturally.

And last, but certainly not least, if we ever do need to utilize an RTC, our goal will be to get them back home as soon as possible, and to make sure we have thoroughly dissected ourselves to make sure there isn't something we're doing which made their escalation happen more quickly.

As I write this post, my daughter has chosen to give me a foot rub (she did something wrong on purpose this morning - and they can come up with something they would like to do to put love back into my heart). We were discussing this post and I was asking her thoughts. I said, "To be completely honest, honey, I think in about two weeks flat I could parent you in such a way that you WOULD escalate and harm someone and end up in an RTC." She responded, "Oh, WAY faster than that."

That's the flip-side of all of this. Our kids live in a heightened state already. We really do have a lot of control over not making it worse. If we keep that at the foundation of these questions and decisions, we can do some preventative maintenance and increase our chances of keeping our kids at home with us, where the real healing happens.

Her timer went off at the five-minute mark and she actually said, "I want to keep rubbing your feet while we talk. Is that okay?"





(photo by Jascha Hoste)