Medical/Insurance-Based Options

Hospitalization

Margie’s 26 years working at Boston Children’s Hospital, as a Clinical Social Worker (LICSW) in the Department of Psychiatry, has taught her the skills to both identify appropriate points of access and guide her clients through the acute care systems.

Hospitalization is used when a person of any age is of danger to oneself or others. At times when this is a concern, this is the best intervention. Hospitalization is accessed through a visit to the local emergency room and is funded by insurance. Length of stay is from days to weeks and is funded by insurance only until the symptoms that brought the person to the hospital are stabilized. There are times when extending a hospital stay with private funds may be possible, and there are a few hospitals that will accept private funding to offer a longer length of stay. As a clinician with decades of experience working in hospital settings, Margie is able to join with the hospital professionals to help to find the right resources following hospitalization. Following a hospitalization, a return to the previous school or setting with additional supports, or use of any of the types of schools/programs described could be a possibility.

Acute Residential Treatment/Community-Based Intervention Program

These are insurance funded programs that are step-downs from hospitalization in terms of the acute need of the patients served. Note that the name of this resources is specific to the Commonwealth of Massachusetts and other states may or may not offer similar levels of care. There are times when an admission to an ART is used instead of hospitalization, initiated by either an out-patient clinician or an Emergency Room evaluation.. Length of stay is generally longer than hospitalization, up to two weeks, which provides more time for assessment, initiation of treatment, and planning for next steps.

Day Hospital/Day Treatment

These programs are funded by insurance to provide a stepping stone between hospitalization and home. On occasion they are used as a diversion to hospitalization as a response to an Emergency Room evaluation. Length of stay is usually a few days to two weeks. They can provide an opportunity for the family to explore schools/treatment options, but are not usually more than a bridge to aftercare.

Acute Substance Abuse Treatment

For adolescents and young adults, often the initial point of assessment is a hospital Emergency Room and the initial intervention is one of the above interventions, where the goal is to assess the adolescent or young adults’ full situation to determine what additional to the substance abuse is driving the crisis.

There are times when the entry into treatment involves a legal situation and a rehab facility is the first step.

At the end of an initial intervention for substance abuse, the choice becomes whether the situation is seen and treated as dual -diagnosis (substance abuse and mental health concurrently) or as only a case of substance abuse. Margie’s clinical and philosophical background predisposes her to considering the developmental and mental health underpinnings of adolescent and young adult substance abuse problems.

Short term options, particularly those that are insurance based and run only for days or weeks, are not meant to provide full recovery. They can, however, provide the family and the child, adolescent or young adult with a better understanding of the problem and recommendations about how to continue growth and prevent relapse.