Understanding the Pediatric Mental Health System

What is a residential mental health treatment facility?

Residential treatment programs are for kids who continue experiencing mental health challenges even after participating in most other levels of treatment. This is the most intensive level of mental health care, and kids who take part live at a facility where they can get around-the-clock care. Every residential program has a different length of stay, but most last for around 90 days.

In Colorado, there are two main types of residential programs: a qualified residential treatment program (QRTP) and psychiatric residential treatment facility (PRTF). PRTFs are designed for kids with more acute needs, as they have more coverage from psychiatrists, nurses and physicians. QRTPs, meanwhile, typically treat kids with serious emotional or behavior disorders that may be less behaviorally complex. Both use trauma-informed care, where clinicians adapt their approach based on the child’s experiences, rather than only treating the mental health symptoms.

It is important to know that residential programs often have long waitlists that could last up to several months. That’s why insurance providers and state requirements often ask that kids and families try all other types of mental health care, including intensive outpatient, partial hospitalization and in-home care, before thinking about residential treatment. 

Does insurance cover residential mental health treatment?

Families who use Medicaid usually can get residential care covered. You will work with your care manager to get help coordinating residential care. The care manager will do an assessment to understand what level of care your child needs and will then send referrals to residential facilities. This can be a lengthy process, but your care manager is there to help. 

If you have private insurance, the process looks a bit different, and coverage depends on your insurance plan. Some insurance companies offer care managers, so it’s always a good idea to check whether that’s an option. If not, you can work with your child’s doctor to get a list of programs that may be a good fit. You can then reach out to those programs to get on waitlists, learn what information you need to collect and more. If your insurance does not cover residential care, you may be able to get funding through the Children and Youth Mental Health Treatment Act in Colorado. This program can provide funding if your child is eligible and you don’t have another way to pay for treatment.

Residential care and education

While your child is in a residential program, they will get some type of schooling to help them keep up with their studies. Each program handles this a bit differently, so it’s useful to ask how a facility you’re considering plans to approach education.

When your child is ready to leave a residential program, it’s common for their care team to meet with you and your child’s school to create a re-entry plan. That’s part of the reason it is very helpful to have a release of information (ROI) form signed. This gives your child’s care team permission to coordinate and collaborate with the school about your child’s needs so they have the best chance of success when they go back to school.

What is my primary care physician’s role during residential mental health care?

During treatment, your child likely won’t be visiting their primary care physician (PCP), but it is still valuable to let them know what’s going on. This allows your PCP to help transition your child from residential care. When your child starts their treatment in a residential facility, they may get a physical. Additionally, your child will still receive important routine medical care, including any vaccines they might get annually, dental care, vision care and any urgent/emergency issues that arise. This is often done through doctors that the residential facility works with. Of course, along the way, this team will work closely with parents and caregivers.

What can I do at home to support my family?

Residential treatment programs often ask family members to participate in some parts of treatment, such as family therapy. You’ll also have dedicated time to visit your child while they are in treatment.

While your child is in a residential treatment facility, your child’s care team may recommend that parents and siblings find mental health care for themselves if they need it. This is also a good time to connect with the people in your life who can provide support and to find time for self-care.

What is the next step in care?

After residential treatment, most kids continue on with some type of mental health care. When they are ready to leave their residential program, your child’s care team will work with you to ensure a smooth transition. If needed, you might get a referral for your child to move to a lower level of care, such as outpatient visits, partial hospitalization or intensive outpatient care.