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Leaving Residential Treatment

by Dore Frances, IEC, MA, founder of Horizon Family Solutions, LLC
How we deal with youth who are leaving residential treatment has a powerful effect on post-placement adjustment for the teen and their entire family.

Any adolescent / teen in residential care is, by definition, in a time limited and temporary living situation, and usually in a very structured daily living controlled environment. Staff come into the lives of young people with the goal of assisting / helping them to eventually leave them.

Ideally, discharge begins the day they arrive. The purpose of these workshops, both for parents and program staff, is to relate and promote an understanding of the departing / graduation process that relates to the experiences of the young people in residential therapeutic care and provide program staff and parental guidelines for at-home intervention.

Leaving Residential is Difficult

Graduating from residential treatment is not just an ending, it is a critical, distinct phase of the entire treatment process. It begins on day one when young people and the staff working with them begin to anticipate the end of the placement.

For some, this lasts weeks (wilderness or shor-term placement) months or years, while others may only become aware of their impending departure within days or even hours before it truely takes place.

This phase of their program / treatment is not to be taken for granted.

This beginning has its own unique challenges and requirements.

Under ideal circumstances, placement ends when the young person, the staff, and the family acknowledge the progress that has been made and feel ready. Often, however, youth do not leave residential placement under these optimal conditions. While a common tendency on the part of parents and residential staff is to frame a discharge/graduation as a positive event, most adolescents / teens leave residential placement with mixed feelings. Leaving a residential treatment setting provokes powerful and often unpleasant (although in most cases) temporary feelings of anxiousness.

This reaction is influenced both by previous experiences with separation or other placements and the meaning which they give to the experience of being in constant residential care. The end of placement stimulates a rethinking of the reasons for coming into residential care in the first place by both the teen and their parents and, although, unintentional, forces a young person and their parents to relive the past in memory and thought.

For many young people, this is a painful and at times angry-making experience. The anticipation of discharge/graduation is disorganizing in many ways for both the teen and the parents / family. Young people often fear giving up the protection of a residential setting. They may feel extremely apprehensive about their capacity to function 'on the outside,' especially in light of past failures. The longer a young person has been in residential care, and depending on the type of care they have been receiving, the more severe this anxiety may be. Leaving residential treatment may also bring up multiple new losses.

Discharge/graduation represents the giving up of valued relationships with peers, staff, therapists and newly made friendships. In some situations it may also result in the loss of improved living conditions and access to enriched schooling and activities. The result of all this is an uncomfortable mixture of anger, confusion, excitement, fear and loss. Because of the complex emotions it elicits, discharge/graduation frequently stimulates renewed behavioural difficulties in young people in placement, even those who have made remarkable long-term and progressive progress.

Acting out and difficult behavior that emerge when a young person is leaving residential care are really attempts to cope. Some possible motivators for behavioural regression in response to an upcoming discharge/graduation which we cover in depth during the workshop are:

  • Youth are afraid of rejection by family, friends, neighbors and school personnel. The quality of the relationships the teen has in residential is usually at a healthier level that those they left behind.
  • Even when it is fantasy about how things may be in the future, the teen may make those things happen now.
  • When a youth encounters an experience which generates anxiety, then they are likely to deal with it in ways that were successful for them in the past, even when they have new tools they have learned from their program.
  • Provoking the parents into responding in a familiar manner, even when it is a negative response, as it is familiar, and therefore they know how to handle those old familiar responses.
  • Teens who return to their families, while usually thrilled, have fantasized through-out their residential placement about this return and have particular anxieties about failure. Age, cognitive capacity and maturity level are always factors.

There Must Be a Process

Because leaving residential care provokes a complex array of feelings no matter what the circumstances, adequate preparation is critical.

Unskilled/unprepared parents or poor preparation on the part of a residential program may lead to even more dramatic relapses in behavior and the development of new problems after the teen returns home.

A skilfully well-planned discharge/graduation can assist a young person to: begin to rework past losses; achieve a degree of closure in relation to placement; and to enter the next phase of life with more realistic expectations and awareness of available supports. There are three vital aspects of working with youth who are leaving care:

  • Helping the young person manage the present separation experience
  • Helping the young person prepare for future separations
  • Helping the young person resolve previously unfinished separation experiences
  • These three major tasks need to be accomplished through a careful sequencing of pre-planned interventions.

Plan. To begin with, it is vital that discharge/graduation from residential therapeutic care be planned far enough in advance to allow for some working through of the issues, yet not so far as to cause more anxiety than a young person can tolerate.

Process feelings about the past. A common tendency of staff at residential placement centers is to begin their discussion of discharge with a future focus. An important part of this work is to anticipate the ending and what comes next.

Help youth to review their experience. The next step in this work is to participate with youth in evaluating their time in residential placement.

Encourage a future orientation. Anticipation and exploration of the future is a third element in a well-managed situation. This means a thorough exploration of the young persons' expectations, as well as any concerns that they may have.

The last step in a discharge/graduation is the actual goodbye. For some young people, this is the most anxiety-provoking piece of the process, and their emotionality will escalate until their last day, no matter what the quality of the preparation. It is those youth whose departure is imminent who may test the skills and patience of the staff the most. It often happens that, despite much planning, some youth act out so much that they arrange to be discharged/ejected so as not to face saying goodbye.

Intervention strategies are summarized below and are explored in much more detail during the workshop:

  • Plan a discharge as far as possible in advance. Start talking about leaving/graduationg when youth first enter the door, so that it comes as a predicted process.
  • Provide emotional support of an accepting nature while still offering daily encouragement.
  • Offer relevant education about what they might experience while going through the process of separation. Be as concrete as possible about how it will feel and how events around them will unfold.
  • Help the person to realize what they are grieving about - we don't always know.
  • Help youth to talk about self and their own experience.
  • Explore the feelings about feelings.
  • Give large reinforcements for small steps in expressing themselves appropriately.
  • Help the youth get connected to support structures.
  • Create a future orientation. Help them explore the possible positive value of leaving and what they might look forward to in the future.
  • Use separation rituals. This is especially useful in residential group care situations and wilderness.
  • Use transitional objects.
Show them how you will stay connected and for what period of time.

Feelings of Staff in Residential is Very Relevant

Supporting a young person through leaving residential placement can be a draining and emotional process. Not only is it painful to share the turmoil; it elicits a person's own feelings about separation and loss.

All staff who participate in discharges/graduations from residential placement need to become aware of their own issues about saying goodbye. An important component is that we acknowledge and express our (their) own feelings of loss in order to be accepting of similar feelings of the children in our (their) care. Inability of staff to face separation may block the capacity of the students to express similar feelings.

Residential staff has a critical role to play in modeling self-expression and ownerships, and they need to acknowledge their own emotions in relation to a young person's upcoming departure. Aside from their own history of losses and their readiness to acknowledge their lasting effects, the experience of saying goodbye to a student has a very real and present impact on a child. Staff, too, are letting go of a valued relationship, sometimes one that may have met many of their own needs.

They may have been dependent on a young person for their sense of accomplishment and professional self-esteem. This is very common in residential care settings and is a procees of growth and learning. They are often more important to a young person than they will ever know, so as they say goodbye, they are often unsure of what their influence has been.

A residential staff person may experience relief at the same time, because a challenging young person is no longer demanding their attention. They may have concerns about a student's capacity to function outside of placement and even wonder if the gains they perceived were real, leaving them with nagging questions about whether they have done enough. At times, residential staff are not in agreement with a specific discharge plan. At other times, they may experience the process as so rocky that they doubt the wisdom of letting the young person go. Like the young people who are leaving residential placement, residential staff need to acknowledge their own unresolved feelings. Facing and expressing these feelings can free up their energies for the challenges ahead.

For more information about these workshops, please contact Dore Frances, M.A. at (541) 312-4422.

Dore Frances, IEC, MA, is an educcational consultant, childs right advocate, parent coach, specializing in working with troubled teens and their families in the United States, Canda, and abroad. See her site at: www.guidingteens.com or contact her by phone at:(541) 312-4422, or email at:Dore@DoreFrances.com.
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