by Sloan Nova, Psy.D.

2024

As expressed in Twice Removed: Adoptees and Residential Treatment Care, it is critical for adoptive parents to take cautious, compassionate steps before considering residential treatment for their child. Start by seeking adoption-sensitive therapy for your child, assessing your family dynamics, and engaging in your own therapeutic journey. By exploring these pathways and fully utilizing in-home and community supports, you may uncover new avenues for connection and healing.

Should residential treatment ultimately prove necessary, it is vital to select a program that honors your child’s complex history and provides the attuned, skilled care essential to address the deeper needs underlying their behavior. To prevent further trauma, parents must commit to visiting programs firsthand, asking probing questions, and working with therapists who truly understand the distinct impacts of adoption and the pain of repeated removal from the home. Finally, parents invested in a meaningful lifelong connection with their child should fully invest in their own individual and/or couples therapy throughout the duration of their child’s stay in residential treatment.

Informed by my interviews with adult adoptees who experienced lockdown residential treatment in their adolescence, I offer here a comprehensive list of questions for parents to pose when considering residential care for their teens. These questions arise directly from adoptees’ lived experiences, reflecting their needs and their hopes for care that truly honors their journey.

Treatment Approach & Philosophy

• What is the treatment philosophy of the program?
  • Ensure that it aligns with your values and that it takes a holistic approach, considering the specific needs of adoptees and/or trauma survivors.
• Is the program trauma-informed and adoption-competent?
  • Ask if staff have specialized training in adoption-related issues.
  • If so, ask how treatment is individualized and tailored to meet the needs of adoptees and adoptive families.
• What types of therapy are offered (individual, family, group)?
  • A mix of therapies is often necessary, especially if family dynamics are contributing to the issues.
• How are treatment plans individualized for each child?
  • Personalized plans are essential to ensure the teen’s unique emotional and psychological needs are met.
• How often will my child see a licensed therapist?
  • Regular one-on-one time with a licensed therapist is critical for effective care.

Staff Qualifications & Ratios

• What are the qualifications and licensing of the clinical staff?
  • Confirm that therapists are licensed and experienced in adolescent mental health, trauma, and adoption-related issues.
• What is the staff-to-student ratio?
  • A lower ratio allows for more individualized attention, especially in crisis situations.
• Is there 24/7 medical and psychiatric support?
  • Check that qualified professionals are always available, especially if your child has significant mental health needs.
• What training does the staff receive in crisis de-escalation and trauma-informed care?
  • Staff should be trained to handle emotional and behavioral outbursts without resorting to punitive measures.

Safety Protocols

• What are the policies on physical restraints and isolation?
  • Ensure the program minimizes or avoids these methods and has clear, humane protocols for crisis management.
• How are emergencies handled?
  • Understand the protocols for medical, psychological, and safety emergencies, including how and when parents are notified.
• How is bullying or peer conflict managed?
  • Ask about policies to protect teens from emotional harm, both from staff and peers.
• What is the policy on communication with parents?
  • You should have regular, open communication with your child and the staff during their stay.

Environment & Daily Life

• Can I tour the facility and meet staff?
  • A transparent program should allow in-person visits and interviews with staff before enrollment.
• What does a typical day look like for the residents?
  • Look for a balanced schedule that includes therapy, education, recreational activities, and downtime.
• What are the living arrangements like?
  • Check for cleanliness, safety, and comfort in the sleeping, eating, and recreational areas.
• How does the program handle transitions or crises?
  • Ask how the program supports teens during difficult times and whether they are allowed contact with family.

Educational Services

• How does the program address educational needs?
  • Is there an accredited academic program on-site?
  • How are learning differences or special education needs accommodated?
  • How is academic progress monitored and communicated to parents?

Medication Management

• How are medications managed within the program?
  • Is there a licensed psychiatrist on staff?
  • How often are medication regimens reviewed?

Aftercare & Long-Term Support

• What aftercare support is provided once my child leaves the program?
  • Effective programs offer transition plans and continued support for both the teen and the family after treatment.
  • Are there alumni networks or mentorship programs?
  • How does the program prepare residents for reintegration into their home and community?
• How does the program involve families in the treatment process?
  • Family involvement is key for long-term success, so ask about family therapy sessions and ongoing parental education.
  • Does the program offer training or workshops for parents?
• What is the success rate of the program, and how is it measured?
  • Ask for data on outcomes and how success is tracked after the child completes the program.

Accreditation & Oversight

• Is the program licensed and accredited by reputable organizations?
  • Accreditation from organizations like the Joint Commission or CARF (Commission on Accreditation of Rehabilitation Facilities) ensures the program meets quality standards.

• Does the program comply with all state and federal regulations?
  • Are staff background checks and clearances up to date?
  • Has the program faced any legal actions or violations recently?

• Has the program ever been investigated or had complaints?
  • Look into any past allegations or investigations to gauge the program’s integrity and safety record.

Cultural Responsiveness & Staff Training*

• Questions of cultural responsiveness are especially crucial, as many residential treatment programs are situated in predominantly white, often deeply religious regions of the country. These settings may lack the breadth of perspectives and multicultural sensitivity essential for supporting adoptees from diverse backgrounds.

• What training do staff receive on cultural awareness, sensitivity, and humility, particularly in relation to adoption and transracial adoption?
  • Ensure staff understand the complexities of cultural identity for adoptees, especially those from transracial or international backgrounds.
• How often is cultural competency training updated or reinforced for staff?
  • Look for ongoing education rather than a one-time training, to ensure cultural awareness is current and evolving.
• Are there staff members from diverse cultural backgrounds who can offer perspectives that align with my child’s cultural needs?
  • A diverse staff can provide a broader range of understanding and support for adoptees from various backgrounds.
• How does the program work to address implicit bias among staff and within the community?
  • It’s important that the facility actively works on reducing implicit bias within its staff and the residential environment.

Cultural Responsiveness in Treatment

• How are cultural values considered in family therapy sessions?
  • Some families may have cultural values around respect, hierarchy, or communication styles that should be recognized during therapy.
• How are culturally relevant therapies or practices integrated into treatment plans?
  • Cultural healing practices, language considerations, and other relevant cultural elements should be factored into the therapy offered.
• Can you share examples of how the program has successfully supported teens from diverse cultural backgrounds?
  • Asking for examples will give you insight into how well the program actually integrates cultural sensitivity into practice.
• What opportunities are there for my child to learn about or explore their cultural identity while in treatment?
  • For adoptees, especially in transracial or international adoptions, maintaining a connection to their cultural heritage can be critical for their sense of identity.

Sloan Nova (she/they), Psy.D., is a licensed clinical psychologist and assistant clinical professor at the University of California, San Francisco, Department of Psychiatry and Behavioral Sciences. At UCSF Benioff Children’s Hospital Oakland, Sloan is developing a trauma-informed family therapy model and program designed to support families impacted by trauma. They completed their pre- and postdoctoral fellowships at UCSF, where they specialized in the treatment of acute and complex trauma across diverse family systems involving children and adolescents. Sloan brings her unique perspectives as a clinician, researcher, activist, parent, and transracial, transnational adoptee devoted to her work, with a deep commitment to enhancing care for system-involved youth and families.