Kids Shouldn’t Have to Leave the State to Get Critical Residential Treatment

Youth in Starr Commonwealth’s residential treatment program based in Albion, Michigan, learning about animals during a trip to the zoo. Photo courtesy of Starr Commonwealth.

By the time Skylar was a teenager, his mother was serving a life sentence for manslaughter. His biological father was homeless, addicted to drugs and completely uninvolved in his life. As a result, Skylar began to spiral into destructive behaviors, such as theft, assault and defiance toward authority.

With the help and support of residential behavioral health treatment provided by Sequel Youth and Family Services, he was able to stabilize and put his life on a productive path. He learned independent living skills, earned his high school diploma and completed a Certified Nursing Assistant program – which is how Skylar is employed today. Skylar’s story is just one success story among thousands of young people who have accessed care at a residential treatment center.

Residential behavioral health treatment facilities are an important component in the continuum of care for the small percentage of youth with intensive to severe behavioral health needs. Often times these youth are placed in this setting by county and state child welfare, juvenile justice, education and mental health systems. Residential treatment facilities offer the evidenced-based treatment these youth need, preferably close to home, giving them the best opportunity to reach their fullest potential and eventually transition back to their families, schools and communities.

Sadly though, there are thousands of other youth in our nation who are like Skylar, but don’t get a second chance to put themselves on a path for success because their community doesn’t provide access to residential treatment facilities designed to support their intensive mental and behavioral health needs.

All stakeholders in our behavioral health system – Congress, state legislators, federal and state agencies, providers and more — must understand the important role that residential treatment plays in the child welfare system. As a nation, we must commit to reallocating the funds and establishing the resources that enable youth to have access to quality residential treatment services closer to home and community.

Youth in Starr Commonwealth’s residential treatment program based in Albion, Michigan, participating in a drumming circle. Photo courtesy of Starr Commonwealth.

It is in everyone’s best interest for this type of stabilization and treatment to be provided in close proximity to a child’s home. Chances for success are much greater with a youth’s own school, friends and community resources nearby. Too often though, this type of treatment simply does not exist in these children’s communities or even within their own states.

Cuts in funding or flawed rate setting regulations at the state level for residential treatment centers mean some states are increasingly forced to send youth with complex behavioral health needs out of state. In Wisconsin, for example, the Department of Children and Families reported that about two dozen children were sent out of state for care in 2014. By 2018, the number of placements had skyrocketed to more than 100. In Oregon, 82 children were placed out of state in 2018 as compared to one in 2014.

In the current system, many states do not determine funding based on the intensive acuity level of these youths’ conditions. Furthermore, they often don’t fund high acuity residential providers in-state at the same level they will fund them out of state. This leads to inequities in access to care based on the child’s geographic location.

As leaders of nonprofit organizations with missions to enable all people, including youth, to reach their fullest potential, we recognize the importance of building capacity that includes residential treatment for youth living with significant behavioral health challenges.

Because our current behavioral health delivery system fails to provide effective earlier interventions and treatment, too many youth ‘fail up’ to the point where they need intensive residential treatment to address these adverse childhood experiences that lead to a myriad of issues, including significant psychiatric needs, intense psycho-social issues, substance use disorder, post-traumatic stress disorder, suicide ideation and high levels of anxiety and depression.

Residential treatment centers are an important component in the child welfare ecosystem to meet the particular needs of children with complex mental health and behavioral health issues.

We must all collaborate in a deep and serious manner to address the real issues plaguing our children’s behavioral health delivery system.

Let’s all come to the table to create solutions that ensure that, like Skylar, all of our country’s children with serious behavioral health conditions have the opportunity to live healthy and productive lives.


Elizabeth Carey is president and CEO of Starr Commonwealth, a national leader in trauma-informed and resilience-focused services for children, youth and communities for over 100 years who partners with Sequel Youth and Family Services, a behavioral health provider across the nation.

 Susan N. Dreyfus is president and CEO of the Alliance for Strong Families and Communities, a strategic action network of thousands of committed social sector leaders working in communities nationwide to achieve a healthy and equitable society.

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