Sometimes a child has very complex emotional needs
and/or issues that must be addressed through intensive types of care.
A child in this situation may have a crisis, where he or she needs immediate
help beyond what his or her parents can give. For example, a child who is
trying to harm himself or herself, or harm others, is probably in crisis.
If your child is in crisis, you will need to get emergency services right
Intensive services may be necessary to stabilize a child who has been
in crisis. These services may also be necessary for a child who is not
in crisis yet, but who has been living with very painful emotional difficulties
for a long time. Intensive services go beyond counseling and therapy, and
may include hospitalization.
Types of emergency and intensive services
These services may include:
• Crisis stabilization
This is a program that helps a child in crisis calm down, either at
home or at a crisis facility. It also helps parents identify and locate
resources they may need. Crisis stabilization is for children who need
immediate short-term intensive care.
This is 24-hour care in a hospital setting. A child will spend the day
there, sleep there, and receive medical care and mental health care there.
Hospitalization is for children who pose a high risk of harm to others or
• Acute residential treatment
This is 24-hour care in a less intensive hospital setting. As with hospitalization,
a child will receive care there during the day, and will stay there at night.
This service is for children who pose some risk of harm to others or to
• Residential services
This is 24-hour care in a community setting, and is less intensive than
acute residential treatment. A child receives care during the day and stays
there at night. Daytime activities may include schoolwork. Residential
services are for children who need longer-term care away from home.
• Day treatment
This is a day program that provides a place for children to go and receive
counseling, medication, and other structured services. Often, they do their
schoolwork in this setting. Day treatment is for children who need structure
during the day, but can be at home in the evenings and at night.
• Home-based treatment/Family stabilization
These services include intensive family and individual counseling services,
provided in the home of the family and/or individual. Often, a counselor
is available 24 hours a day. The length of these services will depend on
the needs of the family.
• Respite/Foster care
This service allows a child to spend the weekend(s) with a foster family.
As a result, the child and his or her family are able to take a break from
the stress and/or structure of the intensive services received during the
A Child in Need of Services petition (CHINS) requires the Juvenile Court
to get involved in a child's situation. This petition can be filed by a
parent or legal guardian, a school administrator, or a member of the police
force. It is intended to address problematic behaviors such as running away,
skipping school, and/or ignoring school regulations. Often, the Department
of Social Services will step in. If you are considering a CHINS petition,
proceed with extreme caution.
In general, a child who needs emotional care does better at home. The
positive influences of family and community often contribute to a child's
overall wellbeing. However, some children with very complex and/or intense
emotional needs are unable to make progress without the kind of intensive
care provided at a hospital. It's important to talk with a mental health
specialist about what kind of treatment would be in your child's best interests.
Who provides these services
• Local emergency rooms
• BEST (Boston Emergency Services Team)or another designated emergency
services team. You can reach BEST at 1-800-981-HELP or 1-800-981-4357.
• Mental health agencies and organizations
How to get these services
It is not easy to obtain emergency and/or intensive services. Most parents
will benefit from contacting an advocate or counselor who is familiar with
these services and can give suggestions and advice. For more information
about advocacy resources, call the Parent/ Professional Advocacy League (1-800-537-0446).
If you and/or your child's health care provider believe that your child
is in crisis, you can take your child to the nearest hospital emergency
room. You may also call 911 or your local police department and request
assistance. If you believe it is not safe to put your child in the car,
the emergency medical technicians will transport your child in an ambulance.
If your child is in crisis and is receiving emergency services, the
health care professional at the emergency room may recommend intensive
services and will arrange for these services.
You may also want to consider intensive services if your child's emotional
difficulties are unusually painful and prolonged. To figure out if intensive
services are necessary, talk with your child's counselor and/or your counselor,
your child's school, and/or your child's primary care physician.
You will then have to contact your insurance company to discuss the
services available to your child. If your child has complex and severe
problems that require care beyond what your insurance company provides,
you will have to contact a state agency.
The insurance companies and state agencies that provide intensive services
will need a lot of information about your child's emotional state. Each
company and agency has its own approach to evaluating the complexity of a
child's needs, and its own criteria for determining which services are appropriate.
The general limitations on confidentiality apply.