What residential treatment means, what a referral involves, and where to find guidance to find the right setting for your child.
What is residential treatment?
Residential treatment is the most intensive form of treatment for children and youth.
Some children and youth can receive mental health support and treatment while still living at home. But others who have serious behaviour problems, or live in homes that are unsafe, will need a residential setting to live in.
Residential treatment is only considered when other, less intense treatment in the community has been tried and either didn’t work, or wasn’t enough to meet the young person’s needs. In other words, residential treatment is the last thing you try when you’ve tried everything else.
Residential treatment is different than psychiatric in-patient care in a hospital. Psychiatric care is usually for people in crisis who need help for a short period of time, whereas residential programs usually involve longer stays.
Making a decision about whether to place a child or youth in a residential facility can be very stressful. Support available for the family varies by region, but may include:
- parent/guardian training groups
- family counselling or therapy
- in-home support to help family and youth practice new strategies during mediated family visits
- support groups run by and for parents and guardians troubled by the behaviours of a teen or young adult
- telephone support
- education around mental health issues
Types of residences
Some programs are designed specifically for young people who have been diagnosed with a mental health problem. Other residences may accept children or youth who simply can’t live in the family home: Many of these young people will have mental health problems, but the kinds of problems they have will vary.
Like many health and social services, there are more residential treatment programs to choose from in large cities than there are in small towns and rural areas.
Choosing the residential treatment program that will be right for your child should be done with the help of a mental health professional who is familiar with your child’s difficulties. This is because no two residential services are exactly the same. Group homes offer different types of services and have different groupings of children with different needs and problems.
Knowing the kinds of services available will help you to find the right program for your child.
The two main types of residential treatment programs for young people with mental health problems involve living in:
- a group home
- an institution or semi-institution
Publicly funded group homes are operated through the Ontario Ministry of Child and Youth Services (www.children.gov.on.ca), at no cost to the family. These group homes are for young people up to the age of 18.
Although there are some group homes that are privately funded, these are mainly for youth who are wards of children’s aid societies, who have taken on the permanent responsibility of caring for a child. Some young people in this type of home may receive counselling or other types of psychological or medical help.
In Ontario, most residential treatment programs are community based. This means that the houses are in residential neighbourhoods and look very similar to other houses in the area.
Group homes where young people work on personal goals to resolve their problems are a form of treatment centre. These group homes are different from ones where children and youth are placed more or less because they have nowhere else to live. The Ministry of Children and Youth Services requires that all children in care have goals that are reviewed every 90 days. Treatment group homes differ from regular group homes in the type of programming, the number of staff and how they are trained.
All residents have responsibilities and chores to carry out in the home, and rules they need to follow. For example, residents may have set times to get up, eat meals as a group, study and do other activities.
Residents are expected to attend school or have a job. Curfew times and levels of supervision will vary depending on the age and abilities of each resident. Many group home residents attend a local school; some residences have special education classrooms.
Some residents are quite independent. These are youth who aren’t able to live with their family but are not quite ready to live on their own. They may have part-time jobs and have the freedom to come and go—for visits to family during the day, and possibly for weekends.
Adolescent homes — Most group homes in Ontario are set up to serve teenagers. There are two types of adolescent homes, treatment- or transition-oriented.
a) Treatment-oriented: The purpose of placement in these homes is to help the teen work through problems, so that they can leave more able to handle their lives. The goal is to help the teen change and grow.
b) Transition-oriented: These homes tend to be for older teenagers who are not able to live in the family home, but are also not quite ready for independent living.
Latency programs — These residential treatment programs are for kids aged 6 to 12. These homes usually have a maximum of seven beds. Because the children are younger, staff are more involved with the children’s families, in hope of reuniting them. Children in latency programs have often been removed from the home because of issues around safety, or because they have behavioural problems or a fetal alcohol spectrum disorder (FASD).
Staff in group homes
Community-based group homes generally have four to ten beds. At least one staff member is always present, and (depending on the needs of the group members) there may be two or three: a residential supervisor; often, a family worker; and a cook and/or housekeeper.
Institutional or semi-institutional residences
Institutional residences, instead of existing in a house in a residential community, tend to be in low-rise buildings. They have higher levels of supervision for young people with more serious mental health problems.
In Ontario, these types of residences are less common than community-based group homes. Instead of being in residential neighbourhoods, some of these residences are set apart on their own campus—a stretch of land where the youth live in “cottages” or units with four to six bedrooms in each. Other semi-institutional residences are in low-rise buildings.
Semi-institutional residences tend to have a higher ratio of staff to residents. They provide more supervision than group homes and sometimes offer other supports such as nursing care. These larger programs are usually designed to serve residents who have more serious mental health problems.
Specialized programs: Some (semi-)institutional programs have a special focus or take place in a unique setting. For example:
- Rural programs — Here adolescents live on a farm or in log cabins, go to school and carry out various activities, such as caring for farm animals or harvesting firewood to heat the cabins.
- Addiction programs — Although residential treatment for youth with addictions does exist in Ontario, there are very few beds available. The many residential services in the United States that treat specific problems such as addictions are usually expensive.
To learn about Ontario’s programs for youth with both mental health and addiction problems, or “concurrent disorders,” go to Finding and Navigating Addiction Services for Children and Youth.
Types of services
Almost all residential treatment programs have private bedrooms, although occasionally residents may need to share a room with one other youth.
Services may include any of the following:
- individual therapy
- family therapy or counselling
- group therapy
- “milieu treatment,” with routines, rules, activities and group meetings in the residence to help residents build self-confidence and develop daily living skills; for example, they may:
- help cook dinner
- clean their rooms
- do chores around the house
- develop self-care routines to help prepare them to live independently
- support to the young person and their family once a resident leaves treatment
Types of problems
- have been diagnosed with one or more mental health problem (for example, depression, anxiety)
- have experienced parental divorce, death of a friend or family member, neglect, sexual abuse or other forms of violence, trauma or family conflict
- be coping with genetic or other inherent conditions (for example, FASD)
- behave in ways that can be dangerous to themselves or others, for example, by:
- setting fires
- violent or aggressive behaviours
- suicidal thoughts and behaviours
- substance use problems
- eating disorders
- running away
These behaviours may affect their ability to manage in the home or school.
Length of time in residence
How long someone lives in a residence really varies. On average, young people will stay 3 to 15 months in a community-based residence. Some youth with very serious mental health problems may be in a residence for many years. Wards of children’s aid societies for whom a family setting cannot be found will spend their entire childhood and adolescence in group homes, until they turn 18.
How to get treatment
Young people may be placed in residential settings by parents or guardians. A judge may also order a residential placement through the courts for youth involved in the justice system.
Youth of 16 years and older can refer themselves. However, referrals are usually made by a social services professional who knows the child or youth well enough to be confident that a residential placement is what is needed.
Although these placements are seen as voluntary, many children may consent to going into a residence without really wanting to be there. A residential placement must be supported by the child’s parent or guardian.
Most regions in Ontario have agencies that coordinate referrals received from mental health professionals.
A region’s programs are normally available only to residents who live in the area. Exceptions are made where a child or youth’s needs cannot be met by a local program.
Many residential programs have a wait list. The wait can be anywhere from a week to several months, depending on the needs of the child or youth, and the mix of kids in the program.
For youth in crisis, emergency admissions can be made through hospital emergency departments.
Publically funded residences are free for the residents, which means that families do not pay a fee.
Privately owned residential services are available but can be very expensive.
For publically funded programs, the local children’s mental health service organization usually determines eligibility.