If your child may be in immediate danger, call 911 or go to the nearest ER. To reach a trained counselor at any hour, call or text 988 (988 Suicide & Crisis Lifeline).
Part of our guide: A Parent’s Guide to Child and Teen Mental Health
A teen may need more than weekly therapy when symptoms keep worsening despite treatment, when safety concerns come up, or when school and daily life are falling apart. Options include an intensive outpatient program (IOP), which is often 9 to 19 hours a week while the teen lives at home, a partial hospital program (PHP), and residential treatment, where a teen temporarily lives at the facility.
Child psychiatrists aim to provide treatment in the least restrictive setting possible, and that depends on each teen's needs. A current clinician or a new evaluation can help you find the right level. Start by asking, "Is the current plan strong enough for how my child is doing right now?"
The levels of care, side by side
| Level | Typical intensity | Lives at | Often used for |
|---|---|---|---|
| Outpatient | Scheduled visits, commonly weekly | Home | Most ongoing care |
| IOP | 9 to 19 hours a week, 2 to 4 days a week, usually 8 to 12 weeks | Home | Teens who need more than weekly treatment but can keep up with daily tasks, or as a step down from PHP |
| PHP | At least 20 hours a week, 5 days a week, usually 2 to 8 weeks | Home | Worsening symptoms or after psychiatric hospitalization |
| Residential | Around the clock, with supervision and treatment on site | Facility | Teens whose health is at risk in the community, or who have not responded to outpatient care |
| Inpatient hospital | Around the clock, medical setting | Hospital | Immediate safety concerns or acute stabilization |
The IOP and PHP figures come from AACAP's guide, and programs vary. These are descriptions, not rules, and some teens move up and down over time.
Signs weekly therapy may not be enough
Bring these up with your teen's clinician soon:
- Symptoms have kept getting worse over weeks despite consistent treatment
- Thoughts of suicide or self-harm, or a recent crisis or ER visit
- Your teen has recently come home from a psychiatric hospital
- Missing a lot of school, or being unable to get through the day
- Substance use that is growing or hard to control
- An eating disorder with weight or health concerns
- Family safety is being affected, or the household cannot manage what is happening
Any of these can also call for a medical or urgent evaluation. If you see warning signs of suicide, follow this guide on teen suicide warning signs. Self-harm has its own guide, on what to do if your teen is self-harming. Before stepping up, your clinician may also consider changes such as more frequent sessions, a different kind of therapy or a medication review.
What IOP and PHP are like
Both let a teen sleep at home. AACAP says treatment commonly includes individualized plans, group, individual and family therapy, psychiatric medication management, and safety planning. IOP is often after school or part-time during the day. A PHP often overlaps school hours, so ask how schoolwork is handled. AACAP lists school support and communication as a PHP service.
IOP can suit a teen who is stable enough to keep up with daily tasks. Family therapy is a common part of treatment, so ask how much time parents are expected to give.
When residential care comes up
AACAP describes residential programs as intensive help for youth with serious emotional and behavior problems, for teens whose health is at risk in their community, who have not responded to outpatient care, whose education needs can't be met in less restrictive settings, or who need more treatment after a hospital stay.
It is a major step, and it is usually considered after other options have been tried or ruled out. It isn't a punishment, and it shouldn't be presented to a teen as one.
How to vet a program
Programs differ, and AACAP told a 2024 Senate hearing that federal licensing standards must address the issue of institutional child abuse. Look carefully.
Questions for any program
- Is the program licensed and accredited? Licensing rules vary by state
- What evidence-based therapies do you offer for my teen's specific issue?
- How will progress and outcomes be measured?
- Is there psychiatric oversight, and how often does my teen see a prescriber?
- How are families involved? How often can we talk and visit?
- How is school handled, and how will credits transfer?
- What is the safety and crisis plan, including nights and weekends?
- What happens after discharge, and who arranges follow-up?
- What will it cost, and how does insurance work?
Things AACAP says to look for in residential care
- A comprehensive evaluation of emotional, behavioral, medical, educational and social needs, plus an individualized treatment plan
- Individual and group therapy, and psychiatric oversight
- Family therapy and regular contact, with a concrete plan if the program is far from home
- Nonviolent, predictable behavior management
Red flags
- Programs that withhold family contact. AACAP says to be wary of these
- Any use of physical punishment, manipulation or intimidation, which should not occur in any program
- Staff who cannot explain the program's approach or point you to someone who can
- Past reports to state authorities without a clear explanation. AACAP suggests checking whether a program has been reported and what happened
AACAP also suggests asking your teen's therapist or psychiatrist for their opinion, and speaking with families whose children completed the program if possible. This site's residential treatment centers resource list is one starting point. Check each program yourself using the questions above, since age ranges, locations and specialties differ.
How this works in New York
New York has a specific type of program called a Residential Treatment Facility (RTF). According to information for caregivers from the state Office of Mental Health (OMH):
- RTFs are voluntary and serve youth under 18, or up to 21 in some cases, with severe symptoms and a Serious Emotional Disturbance who need active psychiatric treatment and 24/7 care.
- Families apply through their county's Children's Single Point of Access (C-SPOA), with a packet of evaluations. OMH decides eligibility, and individual RTFs then decide whether they can meet a youth's needs.
- RTF services are covered only by New York State Medicaid. OMH helps apply for this coverage when a youth is accepted. Admission may affect a youth's SSI or certain other benefits.
Many private programs, including those out of state, work differently. Ask each about licensing and costs, and ask your health plan what it covers before signing anything. Consent rules for older teens are described in this overview of minors and consent in New York.
How to raise it with your teen
Be honest, calm and specific. You might say, "What we're doing isn't giving you enough support, and that's not your fault. We're looking at a program with more help." Include your teen in choices where you can. Keep in mind that a teen may be scared or angry at first, and ask the clinician how to handle that conversation.
Planning for afterward
Stepping back down is part of treatment. Ask early who will provide care afterward, how the program will share information, and how your teen will return to school. A 504 plan or IEP may help with that return. NIMH says staying in touch after a crisis or discharge can make a difference, and that supportive, ongoing contact can play an important role in suicide prevention, so try to have the next appointment booked before leaving.
For help deciding on a level of care or continuing outpatient treatment, see the child and adolescent psychiatry and therapy page, and ask the intake team what is and isn't available here. Fees and insurance has more on costs.
FAQs
Is IOP the same as a hospital stay?
No. In IOP a teen lives at home and attends a set number of hours a week, while a hospital provides 24-hour care. A clinician can advise which level is safe.
How long does residential treatment last?
It varies. AACAP says length of stay should be driven by the patient's needs, and program lengths differ. Ask each program for its typical range and its reasons.
Will insurance pay for IOP or residential care?
It depends on your plan and the program. Call your insurer and ask about prior authorization, in-network programs and out-of-network benefits. In New York, RTF services are covered only by Medicaid, according to OMH.
Can my teen keep their current therapist during a program?
Sometimes, though many programs use their own team while a teen attends. Ask both the therapist and the program how they would coordinate.
