1) Determine whether a change in the environment is needed. Youth tend to create an external environment that both complements and reflects their current attitudes and behaviors. That environment consists of the social relationships they maintain (friends), the places they spend their free time, the media they choose to consume (television, music, books, magazines, favorite internet sites, etc.), and the activities they choose to participate in. Every adolescent creates his or her environment and is heavily influenced by that environment. If the environment your child has created poses a serious risk with respect to their health, safety, or emotional/psychological well-being, a residential program should be a strong consideration for you. If a child has not surrounded themselves with a negative environment, but is having problems primarily at home, family counseling may be a better alternative since families can alter their home environment by changing themselves. Parents often have little or no control over an adolescent's environment outside the home, especially when the child learns that many consequences are essentially unenforceable. If a child is making poor choices about what or whom they surround themselves with, it is usually necessary to introduce a new and positive environment to bring about change. This allows the child to clear their head of the constant negative stimulus they have invited into their lives and to stop and re-evaluate their lives while experimenting with a new set of choices. In order for adolescents to gain a desire to change, they must experience the consequences of different choices and learn that there are alternative ways of conducting themselves that bring more desirable results into their lives.

2) Evaluate your own effectiveness in resolving the problem at home. If you have reached your "wit's end" in dealing with your child's behavior, or if your child's behavior is destroying your family life, it is probably time for an out-of-home placement. It is important for parents to consider the impact a defiant or angry teenager may be having on family connectedness and peace as well as younger siblings. The last thing you need is for your younger children to learn from or be affected by an older sibling that is out of control. Younger children idealize older siblings and often follow in their footsteps, for better or for worse. If your child's behavior has reached a level that is intolerable for you or other family members to deal with, more often than not, the situation is already beyond resolution without removing the child from the home for at least a few months in a residential setting.

3) Evaluate the effectiveness of other interventions you have experimented with. Many parents reading this article may have already attempted to use several interventions such as drug rehabilitation, professional counseling or therapy, private schools, day treatment programs, or even short-term residential programs. Each of these interventions can be effective in certain circumstances. However, note that none of these options remove a child from their environment (at least not for very long). If you have tried one or more of these interventions with limited or no success, it's important to recognize that continuing the same strategy will virtually always get similar results. Counseling is rarely effective with adolescents who have no motivation to change. Teenagers are usually more intelligent than we give them credit for and quickly learn how to "work the system." They discover that the best way to get everyone off their back is to say what counselors and parents want to hear. They also employ a number of other manipulative tactics such as guilt or getting counselors to focus on artificial problems. Some teens simply refuse to talk or when they do talk, they avoid dealing with anything that could lead to discomfort. Many short-term programs make big promises, but when teens come home, they rarely have experienced a change at a fundamental level. A smart teen knows how to bluff by showing superficial change after being in a drug-treatment program, day-treatment program, or short-term treatment program. The fa?ade usually only lasts long enough to regain the trust of parents. After returning from such a program, many teens simply make greater efforts to keep their inappropriate activities covert but have made no real commitment to change. If you find yourself in these circumstances, your child probably needs a long-term residential program such as a specialized boarding school or residential treatment center. These programs allow adolescents the time to develop and internalize a new approach to life. They also are able to practice applying new skills, attitudes, and behaviors in a supportive and controlled setting. A long-term residential setting also can humble teens in such a way that they become teachable. Residential placements exert additional pressure for teens to change because they greatly limit the teen's options: 1) Wait until I turn 18 and be miserable in the meantime; 2) Work on my problems. If a child has a year or longer to go until they reach age 18, working on their problems is usually the option they choose. In short, if you have "tried everything" and nothing has worked, it's time to enlist the help of a long-term residential program.

4) Determine whether a less restrictive intervention such as those discussed in #3 above might be effective. Parents who have not tried other interventions can usually determine quite easily whether a given intervention is likely to work by asking themselves the following questions: 1) Is my teen willing to work on his/her problems? 2) Is the influence of the non-residential intervention I am considering likely to outweigh the negative impact of my teen's current environment? If you can honestly answer "yes" to both of these questions, go ahead and try the intervention. If your answer to either question is "no" you are probably wasting your time and money. A teen who has no interest in working on his/her problems is not going to put the effort into outpatient therapy, a day-treatment program, or drug-rehabilitation program to make a significant change. They will probably just go through the motions to appease parents and professionals while continuing to act out or abuse drugs.

5) Assess whether your child is involved in a risky behavior that presents an immediate threat. If your teen has used serious drugs such as heroin, crack, cocaine, methamphetamine, inhalants, ecstasy, LSD, etc. you need to remove them from their environment immediately to prevent possible overdose. An addiction to any of these substances is almost certainly beyond your teen's power to overcome on their own regardless of their desire to change. In some cases, you may want to utilize a detoxification facility or short-term (30 days or less) drug treatment center prior to admission to a long-term residential treatment center or specialized boarding school. Other problem behaviors that warrant an immediate out-of-home placement include but are not limited to prostitution, attempted suicide or serious self-harming behavior, use of intense anger, verbal abuse, and intimidation to manipulate others, explosive physical aggression or angry violent episodes. Residential placement is also recommended if a teen has been diagnosed with major depressive disorder, severe reactive attachment disorder, oppositional defiance disorder, or bi-polar disorder when medication and other interventions have failed.