What are the key questions to consider
when assessing a residential placement for your child?
Raymond W. DuCharme, Ph.D.
Founder – Director of the Learning Clinic Day and
Residential Programs, Brooklyn, CT
More parents of children diagnosed along the Autism continuum
are seeking services. In California, the number of cases
of autism nearly doubled over the past four years to more
than twenty thousand. The cause is unknown, but clearly
not related to population increase. The study that identified
the increase was conducted by the California Department
of Developmental Services. The researchers tracked the number
of identified cases to twenty-one regional centers where
autistic children and their parents receive government-funded
services. The report showed that the caseload increased
by 97 percent, from 10,360 in December 1998 to 20,337 four
years later.
The most difficult choice for many parents is the option
of residential school and treatment. Parents have learned
that they are often alone as advocates for their children
and are reluctant to transfer “parenting” roles
to others who may be less informed about what their children
need.
The complexity of needs of each individual child or adolescent
requires careful consideration when choosing services. Education,
cognitive and social assessment, clinical treatment such
as individual, group, family counseling, social skills activities,
pragmatic language programs and other related services need
to be available. Each residential program must be suited
to the individual child and his or her residential needs.
Consideration of the “whole child’s”
needs and the family’s ability to meet those needs
at home often results in a decision to seek a residential
placement. As a precondition for starting the process of
evaluation and review of the residential options, site visits
are important. But decisions need to be made as part of
a sequence of steps:
FIRST:
Access consultation to determine a reliable diagnosis of
your child and obtain recommendations about how to best
meet the child’s needs.
A precise diagnosis and functional analysis of your child’s
present behavior and psychiatric, neuropsychological, educational
and medical needs are of critical importance. A comprehensive
baseline of the child’s individual program needs is
the foundation for decisions about residential program strengths
and weaknesses in relation to what your child requires.
The purpose of residential, comprehensive services is to
enhance appropriate levels of achievement and independence
and by doing so compete with counter productive past behaviors.
SECOND:
Allow yourself the “option” of a residential
school - treatment placement. Decide to research residential
programs with an open mind.
The correct choice of a residential school, if made by
you alone or in conjunction with an educational consultant,
will provide a complete and beneficial experience to the
entire family. Most importantly it will provide a direction
and the necessary supports to obtain future independence
for your most important concern: the future well-being and
independence of your child. Planning for a life post-high
school must begin early and comprehensively.
The pressures associated with a child’s struggle
in their current placement often obscure the cost implications
of services. Financial responsibilities may create a new
set of unintended or unexpected burdens. Professional financial
guidance for the family is also an important component to
help make a selection from among the available realistic
education and treatment options.
A cautionary note is in order. Residential schools that
are comprehensive are also costly. Parents should carefully
consider the financial implications of assuming the costs
personally, or sharing cost with an LEA, as part of a cost
sharing agreement for placement. Residential care often
provides impressive results that cannot be duplicated by
less comprehensive services. Also, residential programs
are often a long-term commitment.
THIRD:
Research the options for help. This may include an ombudsman,
professional educational and treatment consultant, or attorney
specialist, and the resources for assistance available through
your local education agency (LEA) and State Department of
Education. Become informed of your child’s and family’s
rights and protections under state and federal law.
Reliance on the local education agency (LEA) and on federal
guidelines for identification of need and referral are critical
issues. You must follow state and federal guidelines for
special education eligibility for services, and obtain approval
from your LEA for services to be provided. Funding and support
for residential education and related services are dependent
on specific criteria. If you do not follow the correct process
you may forfeit your entitlement to LEA assistance and IDEA
protection.
A knowledgeable advocate and/or attorney with an “education”
placement specialty may be very helpful. An objective person
to assist you may provide some barrier to the emotional
stress and complexity of the placement process that can
overwhelm parents.
FOURTH:
Use the processes provided by the federal statutes and
guidelines described by IDEA (Individuals with Disabilities
Education Act) to include
appropriate agencies in the decision process.
FIFTH:
Research the specific residential school options that are
suited to your child’s particular needs.
Initial questions to ask and evaluate when considering
a residential placement are:
Who are the children and adolescent students served by
the program?
What is the range of their diagnoses?
What are the levels of student intellectual functioning?
What teaching methods are used to provide instruction?
What related services are offered?
What are the qualifications of the staff?
Children learn as much, or more, from their environment
and peers than from their classroom teacher and therapist.
It is important to observe the residential school milieu,
the routines, schedules, and levels of staff supervision
during activities.
Careful consideration of your child’s peer group
is needed to ensure an appropriate intellectual and social
match. Also, certain clinical diagnoses do not fit with
other children. Aggressiveness, “street-wise”
behaviors, delinquency issues, conduct disorders, sexual
aggression and exploitiveness are some of the major contraindicated
peer-matches for the Asperger Syndrome child.
SIXTH:
Identify a list of suggested school and treatment programs
and prioritize
your options.
Be an informed consumer of residential treatment and educational
services. Program brochures and online web site information
are only a start in evaluation of the program quality and
appropriateness. The way in which the residential program
environment is described often defines how staff will perform
their roles. The way in which the residential living setting
is described and staffed will influence the nature of interaction
between staff and child and child and peers. If, for example,
the child will reside in a dormitory of 20 with same sex
peers of different ages, their interaction, supervision
and staffing schedules will be different from smaller, co-ed
settings.
The way in which the instructional setting and facilities
and resources are made available to children and adolescents
is also an important consideration.
Determine how large the classrooms are, how many students
in each class, the student-teacher ratio, instructional
approaches (is computer-assisted instruction available?).
Keep in mind that smaller is generally better when evaluating
classroom size and number of students in the class.
Effective programs can demonstrate the degree of cohesiveness
between each part of the program. Cohesiveness means the
sharing of goals and objectives by all staff, across all
settings. When there is cohesiveness teachers, residential
living staff, clinicians, medical staff and administrators
will share philosophy, treatment aims, educational goals
and independent living aims. Staff will be able to illustrate
how practices relate to program and individual child goals.
Another very important consideration is how well the residential
services provide preparation for independent living, community
involvement and transition to work and additional education.
The residential curriculum should illustrate pragmatic strategies
for practical daily living skills. The curriculum should
lead to evidence of self-regulation and behavioral repertoires
that demonstrate increasing student independence and community
involvement. The program should provide you a written description
of the structure of the daily routines and activities, e.g.,
clarity of objectives, resources, setting description, and
student-staff ratio.
The effective residential program will require a “cohesive”
approach to education and treatment. Education and treatment
goals need to be shared by all staff in each part of the
total program. Assessment of objectives is best considered
across settings, e.g. in each classroom and other school
and residential settings used by each student. Clinicians
and related services staff need to be integrated into the
systems of care and education in a “seamless”
way. All staff require a schedule that allows frequent planning
sessions. Staff are better able to support student gains
when they share clear, precise objectives and strategies.
It is preferred that all staff that are employees of the
school retain a coherent, consistent approach to your child’s
needs.
Medication management, psychological services are best
provided in conjunction with observational data from each
staff member providing services to the child. You may wish
to see how data is collected and reported to children and
parents. Certainly the more systematic are the collection
of performance data of children, the better the decision
making will be about what and when to change aspects of
the program.
The collaboration between staff members requires that all
staff be employees of the program. Independent consultants
providing services may be an indication of “fractured”
services and lack of coordination and consistency in service
delivery.
Residential programs should be able to provide staffing
schedules to illustrate level of staffing throughout a twenty-four
hour, three hundred and sixty-five day period.
Ask to see staffing schedules that indicate levels of supervision
during the course of a twenty-four hour day, procedure manuals,
and schedules of staff training sessions.
It is important that the program can ensure adequate reliable
twenty-four hour awake supervision is available to your
child. Students need supervision during sleeping hours –
not all children sleep during the schedule they require.
Also, establish that all staff have state and federal background
checks, and that the program has a “staff drug and
alcohol use” monitoring policy to ensure the absence
of drugs and alcohol.
Other factors related to selecting a residential program
require research and systematic investigation. Internet
searches are informative and time saving. On-line descriptions
of programs will provide basic information such as geographic
location, costs, philosophy, staffing and students served
by age and diagnosis. The program web site will outline
admission criteria and the steps to follow in the admission
process. Contact persons are usually identified at the web
site.
SEVENTH:
Visit the school without your child after records or information
summaries are reviewed by school admissions staff.
Visit the program several times. Visit first without your
child. And then, if you observe aspects of the program,
speak to students, staff and other parents, then bring your
child for an interview. If you include your child in school
visits before you screen out inappropriate options the child
may become confused and anxious by their perceived differences
in program options.
The admission process should begin with a review of past
education and treatment, past services provided, recommended
services and performance histories. After the review, you
should assess the program’s philosophy, offerings,
and structure during a site visit without your child’s
presence. If you are considering a co-ed program, be sure
that male and female students are present in equal proportion.
The age range needs to reflect both younger, same age, and
older students in relation to your child’s age.
Same-sex program, all boy or all girl, have advantages
and disadvantages. Are there options for same-sex or heterosexual
classes? Consider both in relation to your child’s
age.
Ask to speak with parents who have a child in the program
who is about the same age as your child. Ask questions about
their experiences and what they perceive program strengths
and weaknesses to be.
Determine the openness of the campus to your visits and
the criteria and conditions for your child to visit you
at home. Ask if you are expected to follow program procedures
during the child’s home visits.
Ask if the program is open to your visits, visits by your
designees and what are the conditions placed on students
in order for them to visit home. How frequently are parent
visits permitted? How frequently does school staff contact
parents to discuss progress and prepare for home visits?
After you review the program, visit its classrooms, see
its students, speak to staff and students then follow-up
with a visit by your child for an interview.
EIGHTH:
If the decision is to proceed with admission, bring your
child for an interview and site visit after the parent visit
is made.
Prepare your child for their visit to the school and the
interview. A few days prior to your visit rehearse your
child about what they will see and who they will meet.
The residential school option is often best presented by
the child’s counselor, therapist or evaluator in collaboration
with the family prior to the site visit. Educational consultants
are of significant assistance to families in ways to discuss
residential options as a family.
The age of the child will help determine the degree of
choice and decision- making in the process the child will
have. The child needs to know that he or she will participate
in, but not control, the decision-making process of choosing
a program.
Children are advised to prepare a list of questions they
want to discuss, but only after they review written and
website materials that describe the school to be visited.
Students often want to know about dress codes, discipline
policy and procedure, roommates, home visit schedules, and
other personal concerns. Help them articulate their concerns.
Assist the child to formulate criteria for assessing a residential
program that relates to their concerns.
It is helpful if the child visits classrooms, speaks with
several staff and receives a “tour” by a student
at the school.
The ways in which a child’s performance is assessed
and reported to you is an important consideration. Read
examples of progress reports and ask about the frequency
of written reports to be sent to you.
A book I recently co-edited Asperger Syndrome: A Guide
for Professionals and Families will provide more detail
about types of services and optimal considerations.
Sufficient time to be able to see facilities and ask questions
of school personnel are important in order to have the child
form an impression of students, staff, and milieu.
It is often very helpful for your child to have an overnight
stay for several days prior to finalizing the admission.
An assessment based on the actual experience of your child
may save a missed step and inappropriate placement. Visitation
will be more reliable and authentic for the child if they
actually walk through the program expectations rather than
being “told” about them.
Assure the child that a visit is not the same as an admission
into the program and that they will not be left at the
school after their visit is complete.
The residential program director will be able to provide
you with the licenses and certifications required by each
state agency in order for the program to operate, e.g. State
Board of Education and State Child Care Agency licenses
appropriate to the program. You may check with licensing
agencies to determine if there is a history of causes for
action against the program.
The distance of the school from your home and state is
less significant than the “fit” of the program
to your child’s needs and family values.
If your research indicates, and you believe the school
is a possible placement, then arrange for a brief stay for
your child of three to seven days duration. The first thirty
days usually provides important additional information about
the experience you and your child will have over the long
term.
A quality residential program will articulate all aspects
of its program and where those program aspects will lead
your child.
Residential programs, comprehensively designed, provide
a great deal more than education of traditional academic
skill. Preparation for a future life that includes additional
post high school education, independent living, vocational
preparation through career exploration and sufficient social
awareness and skill to navigate a social life are the equally
significant provisions.
ADDITIONAL POINTS TO CONSIDER:
Your child’s program needs to be clearly planned
al be it in outline form, at the time of admission. Clear
steps need to be described that will increase your child’s
achievement, self-reliance and independence.
Is a work ethic valued and supported? Are opportunities
for authentic application of skills both academic, social
and pre-vocational available to each student?
Residential programs will be able to provide staffing schedules
to illustrate level of staffing throughout a twenty-four,
three hundred and sixty-five day period.
The structure of the daily routines and activities e.g.,
clarity of objectives, resources, setting description, student-staff
ratio should be able to be provided to you.
The ways in which child performance is assessed and reported
to you is an important consideration. Read examples of progress
reports and establish the frequency of written reports to
be sent to you.
The pressures associated with a child’s struggle
in their current placement often obscure the cost implications
of services. Financial responsibilities may create a new
set of unintended or unexpected burdens.
Professional financial guidance for the family is also
a component of selecting from among realistic education
and treatment options.
