Therapeutic Boarding Schools

Understanding therapeutic boarding schools

Therapeutic boarding schools are residential educational institutions specifically designed for adolescents who are struggling with a range of psychological challenges. ^[1] This could include young people struggling with substance use, emotional challenges, or behavioral problems. ^[1] While traditional boarding schools focus primarily on academic achievement, therapeutic boarding schools integrate mental health support, such as behavioral therapies or counselling, alongside educational work. ^[1]

Who may benefit from therapeutic boarding schools?

Any adolescent or young adult struggling with mental health, behavioral, or emotional challenges that are beyond what a traditional school can manage might benefit from a therapeutic boarding school. However, these boarding schools are not set up to manage severe psychiatric conditions or provide more intensive treatment, such as medically assisted detox or other acute mental health concerns. It’s also worth noting that therapeutic boarding schools often have very structured daily schedules with strict rules, which may not suit everyone.

How therapeutic boarding schools work

Once a student is enrolled in a therapeutic boarding school, they will follow a structured timetable that integrates education with therapeutic mental health support. ^[1] A typical day may include educational activities, therapy sessions, physical activity, and supervised free time. ^[3]

Many of these schools promote small class sizes that help cater to different learning needs. ^[3] Therapists are often available to provide evidence-based therapies, including Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). ^[3][4] Physical activity, outdoor experiences, and mindfulness practices can all contribute to providing an integrated and holistic approach.

Therapeutic boarding schools and substance use treatment

Therapeutic boarding schools can provide useful support and structure to assist with Substance Use Disorder (SUD) treatment. While they generally cannot accommodate more intensive treatments, such as medical detox, they can provide evidence-based therapies that are known to be effective in treating SUDs, such as CBT and DBT. ^[4][5] Having a structured timetable with 24/7 supervision can also create an environment that promotes sobriety and reduces access to substances.

Potential benefits of therapeutic boarding schools

Therapeutic boarding schools can offer several benefits for adolescents who have not responded well to outpatient treatment or traditional schooling. Firstly, the structured environment with a consistent daily routine and 24/7 supervision can provide stability that can be difficult to replicate at home. The integration of education and therapeutic interventions can allow the students to have regular mental health treatment without their education being impacted.

Therapeutic boarding schools can also remove adolescents from a potentially harmful home environment that may be contributing to their ongoing substance use or mental health difficulties. Additionally, these boarding schools can provide a supportive peer community, which can be beneficial, particularly for individuals who may feel more isolated in their normal home environment.

Risks, limitations, and controversies

Despite their potential benefits, therapeutic boarding schools do have limitations and have received significant criticism. Firstly, there is no federal legislation specifically relating to therapeutic boarding schools, meaning they are largely unregulated. ^[1] Subsequently, the quality of care, qualifications of staff, and therapeutic approaches can vary considerably between facilities. ^[1] There have also been some serious reports of harmful practices and poor living conditions, which have even resulted in some therapeutic boarding schools being shut down due to allegations of abuse and human rights violations. ^[1]

Additionally, adolescents are often placed in therapeutic boarding schools without their consent, and are sometimes transported there involuntarily. ^[1] This lack of informed consent can impact the therapeutic benefit of the boarding school, potentially leading to more distress or trauma for the individual. Therapeutic boarding schools can also be very expensive, with annual fees often ranging between $30,000 and over $100,000, which makes them out of budget for many families. ^[1]

Costs and insurance considerations

As mentioned, therapeutic boarding schools are a very expensive treatment option, with annual costs often ranging from $30,000 to over $100,000 depending on the facility, location, and level of care provided. ^[1] Therapeutic boarding schools are generally not covered by most standard insurance plans, and therefore are often not affordable for many families. ^[9] This is because the schools are deemed mostly educational rather than medical for insurance purposes. ^[9] However, it’s recommended to contact the insurance provider directly to clarify if any parts of a therapeutic boarding school program may be covered.

Therapeutic boarding schools vs. Other treatment options

Below is a table comparing therapeutic boarding schools to other treatment options.

How to evaluate a therapeutic boarding school

Given the lack of regulation, there can be a huge variation in the quality of different therapeutic boarding schools. When choosing a therapeutic boarding school, families should consider the following:

• Accreditation. Look for schools that hold accreditation from bodies such as the Commission on Accreditation of Rehabilitation Facilities (CARF). Accredited schools will meet certain standards for clinical care, safety, and staffing.
• Staff qualifications. It’s important to inquire about the school’s staff, including their education and experience, alongside ensuring that any therapists are licensed.
• Daily structure and therapeutic approach. Find out what the daily schedules look like, which evidence-based therapies are offered, and how these are integrated into daily life at the school.
• Family involvement. Some schools will welcome input from families, whereas others only facilitate limited family contact to protect students from potentially negative influences.
• Independent reviews and alumni. Finding references or reviews from families who have used the school, or first-hand accounts from school alumni, can provide valuable insight into the school.

It’s important not to rush any decision about using a therapeutic boarding school; if the school is not a good fit for the individual, it could have a significant negative impact.

Choosing the appropriate level of care for your teen

Selecting the right level of care that is required for an adolescent can be challenging and is dependent on several factors. This includes the severity of any mental health issues or substance abuse, and the level of risk to the young person. A mental health professional can help guide what level of care they deem to be appropriate after they have assessed your teen.

Where possible, involve the young person in discussions about their treatment, as having their approval can help improve engagement. If you’re uncertain where to begin, speaking with your teenager's primary care physician, school counselor, or a mental health professional is a good first step.