Live-in treatments: frequently asked questions (FAQs)

LT occurs when individuals receive intensive mental health and/or addiction (MHA) treatment and support in a supervised therapeutic environment. Some LT programs offer a short-term stay (e.g. 4 weeks) and others, a long-term stay, where patients live in residence at a program site full-time for a designated amount of time (e.g. this can range from one month to a year or more.

When youth enter LT, they are often removed from the daily stressors of their usual environment. This creates an opportunity and space for young people to focus on their own recovery, and receive specialized and comprehensive support to help stabilize their conditions. It can also serve as a starting point to gain experience with independent living and to learn positive coping skills. Typically, youth who are motivated and engaged with the treatment plan usually have better functioning, reduced clinical symptoms, and can return to their community to receive less intensive MHA support after completion of the program.

Other live-in facilities, such as group homes and halfway houses are not considered therapeutic live-in treatment. These programs involve less intensive staff supervision, specialized treatment, and focus more on independent living and achieving personal goals (e.g., secure housing, education and/or employment, learn life skills), than recovery. In some situations, these kinds of group homes or halfway house are part of transitional care after discharge from LT.

Given the intensity, cost, and time commitment of LT, young people typically try other programs as a first step before LT (please see question number 5 for information about wilderness programs).

Some youth attend LT because their MHA issues are affecting their ability to manage life at home or school, or they are coping with traumatic events and/or behaving in ways that can be dangerous to themselves or others. Consulting with your service providers can help to evaluate youth and family’s needs and determine whether LT is a suitable next step. Most LT options offer free consultation and site visits for interested youth and families.

Yes. The key differences between live-in treatment and inpatient hospitalization are highlighted in the table below:

LT involves a diverse range of services to address all aspects of a resident’s health and recovery. Some of the common services offered are:

• Psychiatric and psychological assessment and consultations
• Medical care and support
• Mental health treatment
• Addiction support (e.g., AA, SMART Recovery)
• Safe environment – the LT and its surroundings are designed to ensure a safe and supportive environment for residents. Some LT programs are lockdown facilities, where residents are required to stay at the facility for the full duration of the program
• Structured daily programming
• Therapeutic recreational activities (e.g., yoga, meditation, horseback riding)
• Family support
• Life skills training
• Food and nutritional support

LT is considered part of the recovery journey, rather than a final destination. There are a variety of options that can assist young people with their of MHA needs. LTs have different structures, treatment approaches and environments. In North America, there are three main options for live-in treatment programs:

1. Wilderness programs
   • First step to live-in treatment
   • Helps families and healthcare professionals understand the youth’s needs and decide whether a more formal live-in treatment program is the suitable next step.
   • Helpful for getting youth ready for the next phase of treatment.
   • Length of time: Nine to 12 weeks, depending on youth’s needs and the program.
   • Staff use nature and the outdoor environment as a tool to help youth reflect and learn adaptive skills and behaviours.
   • Highly structured and sometimes isolated environment with no access to substances, technology, or activities that may be problematic for youth.
   • Emphasize a positive peer system with structure and boundaries that promote a safe environment for youth to build positive relationships.
2. Live-in treatment program
   • Specialized treatment programs for young people with specific and high level MHA needs who are not in an inpatient setting, but whose behaviour or symptoms cannot be managed in outpatient settings.
   • Evidence-based and intensive MHA treatment to stabilize client needs and help with transition to less intensive MHA programs.
   • Often considered as a 'next step' after wilderness programs.
   • Length of time: Approximately one to twelve months, depending on youth’s needs and the program.
   • Staff use daily experiences within the environment as opportunities to foster youth learning and well-being.
   • Programs for school-aged children offer academic programming.
3. Therapeutic boarding school
   • Combined educational and therapeutic programs for students with moderate to severe MHA concerns and/or those who have difficulties in a traditional school setting
   • Focus is on academic achievement while receiving comprehensive MHA support within a therapeutic environment.
   • Length of time: Support for junior kindergarten to Grade 12.
   • Fosters transition to traditional school settings as treatment and a full academic program are provided to support academic performance, physical health, and mental well-being.

Many youth complete wilderness programs and a live-ln treatment program before attending a therapeutic boarding school.

In Ontario, these three types of LT are typically targeted to youth 12 and older with addictions or concurrent disorders. Other provinces, such as British Columbia, also have a few LT options for young people with mental health issues only and/or other specific MHA needs. There are very few wilderness programs and therapeutic boarding schools in Canada; however, there are substantial programs in the United States.

Day Treatment (DT) programs are another type of intensive MHA treatment. Young people attend treatment during the day and return to their family home or community, at night. Many DT programs for youth offer educational components to keep youth on track with academic needs. The table below highlights the key differences between DT and LT:

It can feel overwhelming when choosing an LT option that is appropriate for youth and their families. In order to make an informed decision, there are many factors to consider to ensure youth and their families feel confident and comfortable with an LT facility. Some factors include:

• Population served (e.g., gender, ages and typical profile of clients)
• Treatment style and/or approach (e.g., cognitive behavioural therapy, dialectical behaviour therapy, acceptance and commitment therapy)
• Detox requirement and active addiction support
• Level of clinical and medical support
• Location (i.e. urban or rural and distance from home)
• Cost
• Insurance coverage
• Length of stay
• Size of the LT facility (e.g., number of beds)
• Available services

Take your time and gather as much information as you can to find programs with evidence-based practices that match youth and family’s needs. Talk to your family, health-care professionals, school staff and community to explore different LT options. Connect with youth and their families who have been through the process, if possible. Contact the LT programs that you are interested in and consider arranging site visits to see the facility first-hand.

Please see ‘Questions to ask a live-in treatment centre’ for more information »

Most programs have a structured and consistent daily schedule designed specifically to address their residents’ needs. Staff also work closely with residents to engage them in therapeutic activities and motivate them to work towards their goals.

Some typical activities in the daily program are:

• Scheduled meals
• Set wake-up and bed time
• Academic program
• Individual and group therapy
• Family therapy (with and/or without the youth)
• Physical/recreational activities
• Family visits
• Chores/ daily life activities
• Free time

Interested youth and their families can request a copy of the daily schedule from the LT agency to decide whether the activities address the youth’s and family’s needs.

The intake process varies among LT options that are publicly-funded or privately-owned in Canada.

For live-in treatment in Canada:

Step 1: Intake

Applications for LT, may require a healthcare professional to complete a referral, which is then directed to an LT facility. Youth, ages 16 years and older, can also complete a self-referral with the assistance of a health professional or apply directly to the LT facility. Across Canada, some MHA agencies can assist with the application process. For example, in Ontario, regional agencies coordinate referrals to publicly-funded LT options for youth under the age of 18 in their local areas. LT agencies’ websites provide information about the referral process. You can also contact the agencies directly, for more details.

Step 2: Interview

Once the LT agency receives and reviews your application, the intake coordinator will contact the youth and/or the family to arrange an interview (i.e telephone and/or in-person) to determine eligibility and fit for the program. This is the perfect opportunity for youth and their families to find out more about the program and ask questions.

Step 3: Admission

The admission committee of the LT agency will review the youth’s file and fit with the program. If the youth is a good fit the program, youth and/or their families will be notified of the approval and an admission date will be arranged, depending available space. There may be a waiting list and it is important to inquire about the length of the waiting list and to seek support as your family goes through the application process.

For live-in treatment in the United States:

Provincial health plans may provide coverage to certain LT facilities in the United States. It is important to check your province’s plan.

In Ontario, OHIP funding is provided to a very limited number of approved treatment facilities in the U.S. The formal application process is lengthy and requires that all service options within Canada have been exhausted. If you would like to learn more, please visit the OHIP Out of Country Services webpage.

Privately-funded treatment centers in Canada and the U.S. offer a fee-for-service. Youth and their families can research these facilities online, speak with other families, or, for a fee, enlist the help of a therapeutic placement specialist or educational consultant, who can help identify appropriate LTs in the U.S., assist with the application, and coordinate and communicate with the LTs. It is important to note that the cost of private treatment is significant and youth and their families may wish to consult with their healthcare providers before considering any out-of-country treatment options. There are also no centralized services that monitor or evaluate providers. Families may also want to seek support from specialized law firms on the legal aspect of the application process for any out-of-country treatment options.

There are both ‘no-fee – publicly funded’ and fee-for-service (private) LT. Cost can range from no-fee to upwards of $800/day for private LT and is based on many factors such as the location of the LT facility, length of stay, condition being treated, insurance coverage or services provided. It is important to clarify what services are included in the treatment fees, and identify costs associated with any additional services. Some programs also offer financial assistance and different payment options for families. Other costs to consider include; travel to and from the LT facility as well as accommodation for family members during visits.

Youth often return to their family home or to transitional or step-down housing after they complete LT. It is important to discuss any concerns about discharge with the LT staff and request any family services, aftercare programs and support to help with the transition. Caregivers may also wish to speak to your youth to find out how they feel about the transition and identify support to aid with the discharge process.

If accessing out of region LT, the LT can help identify and arrange support in your home region.

While the youth is in LT, a discharge/aftercare plan is created by the youth, caregivers, and the care team to address continued need for MHA support and to avoid gaps in treatment and medication after completion of the program.

Having a discharge plan and attending to the aftercare is critical to maintain youth’s recovery. When reviewing the discharge/aftercare plan with the youth and care team, make sure the following are in place:

• Assessment of risk factors and concerns
• Crisis plan
• Living arrangement
• Mental health and/or addiction support
• Family support
• Regular check-ins from LT facility and/or other healthcare professionals
• Community-based services
• Social and recreational activities
• Enrollment in the aftercare program at the LT when possible
• Medication monitoring (when necessary or relevant)

Success is different for every individual and family. It can be affected by many factors and is best defined on an individual basis through achieving individual goals and involvement with LT medical and mental health support teams throughout the recovery process.

Although LT facilities use different treatment approaches and target different populations, factors related to better outcomes in youth in live-in treatment include:

• Youth motivation to get better
• Family involvement in the program when appropriate
• Aftercare support in place after the youth has been discharged
• LT facility has extensive and specialized experience in running the treatment program

LT facility has ongoing program evaluation and research to examine outcomes and ensure program quality

No. The goal of LT is long-term recovery. Attending LT may help to address youth’s presenting issues and provide a foundation for a young person to build on their competencies and strengths. Ongoing MHA services and support after discharge and during the transition periods are particularly important to help youth to sustain their gains during treatment and improve their functioning.

Families are often encouraged to be involved in the youth’s treatment and aftercare process as much as possible. Caregivers can stay in contact with most LT agencies through in-person visits, phone calls, and/or emails. However, there may be limitations to your communication with the youth, as well as the information that the LT facility can share with you about the youth’s recovery. This is because youth has the right to determine who has access to their personal health information and they may feel more comfortable to keep the information that they share in treatment private. LT staff can provide further details about the process for individual facilities and discuss with youth and their families about how youth would like their information shared and with whom.

No. Attending LT is only a part of the recovery process. Although youth and their families who pursue LT have often tried other less intensive and community-based treatment and have not found success, LT should not be considered the 'last resort' for youth with complex MHA needs. In LT, youth are offered a safe and supportive environment to focus on their recovery and receive the specialized and intense care that they need for their issues. This change of location can help youth and their families learn new ways to communicate, help families build skills to best support their youth.

Family involvement is an integral part of the therapeutic process in LT and is determined prior to admission. The LT agency will let you know what level of involvement they expect from families. In some programs, family involvement is mandatory and families should carefully consider whether involvement will be agreed on by themselves and the youth. LT can involve families in many ways, for example, some LT agencies invite families to have regular meetings to discuss the youth’s progress and arrange visits for the youth to see their families at home during weekends. Support for the families and siblings is also often available, such as family therapy, parents support groups, and workshops and these support may continue even after discharge.

Youth readiness for live-in treatment may vary due to individual and systemic factors. It can also be hard for the youth to leave home and live in a new place with unfamiliar people. Continued communication, information, and encouragement over time may help youth consider this option.
If the youth is not ready to access live-in treatment, you can review alternatives with your health care providers and explore other support options that would be suitable for your youth’s condition. Caregivers can connect with LT agencies for more information about supporting youth in accessing services.

When considering LT, review the information with youth as much as possible and invite them to visit LT websites. If possible, bring youth along to visit LT agencies to give them an opportunity to see the facilities, meet the staff and residents, learn more about the treatment program, and ask questions. Caregivers can also involve service providers who have a good relationship with the youth, such as a family doctor, social worker, peer support, or case manager, to encourage and prepare youth for treatment.

Although caregivers, families, friends, or health care professionals can refer young people to LT, admission is often voluntary in Canada. It is important to consult with the youth when deciding and choosing different LT options.

As caregivers continue to support and encourage youth to seek treatment, it is important for caregivers to receive support as well. Family support services may include:

• Family support workers – help families acquire skills and build capacity to better address youth’s MHA needs at home and motivate youth to participate in their own treatment planning.
• Parent coaches – help families to acquire the right language to communicate with their youth and support families with effective parenting skills.
• Individual peer support/peer-run groups – connect with caregivers who have previously engaged with the MHA system or LT to share tips on how to manage youth issues, receive support on parenting skills and self-care strategies and learn about resources that may be relevant to the youth’s issues.

Speak to your family doctor or service provider about how to access any of the above services.