Therapeutic Planning: Trends from 2023 & Predictions for 2024

2023 Trends: What We Saw in Schools & Colleges

Like boarding and independent day schools, the therapeutic field of private behavioral health schools and programs saw a large surge of students seeking their services during the early COVID period. While the student mental health crisis has since returned to pre-COVID years’ levels, 2023 continued to see historically high numbers of student mental health and developmental struggles disrupting the typical, healthy course of education and growth for our children, adolescents, and young adults. The increasing demand on independent schools and colleges to support and work with students with emotional and behavioral struggles required increased support programming and greater accommodation of mental health leaves of absence and re-entries of students seeking therapeutic interventions away from school in 2023.

This increase of students with higher needs continued to stretch both specialized and mainstream faculty, affected the positive peer culture schools strive to build and maintain, and created additional challenges to schools’ enrollment goals and practices due to increased attrition. While some schools stretched their missions and tried to serve needier students in order to meet enrollment goals, others intentionally worked to vet students with high needs during the admission process and found themselves, despite their best efforts, reacting to unanticipated student struggles. Both scenarios placed significant stress on school systems and personnel.

In the college realm, while student mental health services have increased exponentially across higher education, data published from Higher Education (2023) showed that only three in ten undergraduate students who identified as needing help chose to use the services provided and 70% of undergraduates considered dropping out of college for mental health reasons. These data are more important for independent schools than ever as a majority of students are leaving high school underprepared for the challenges of young adult life and undergraduate academics.


2023 Trends: What We Saw in Therapeutic Schools and Programs

Despite the fact that student needs for higher levels of support continued at epidemic levels in 2023, last year was a particularly brutal year for our colleagues and partners in private therapeutic schools and programs who have so successfully addressed young people’s mental health crises for the past two decades. As we predicted last year, multiple factors combined to result in a significant drop in students using these excellent resources that have been repeatedly proven to restore personal well-being and educational success for a significant population of students struggling with a wide range of mental health and developmental challenges. Additionally, numerous excellent owner-operated programs closed their doors in 2023 in the face of troubling market and economic factors that continue to combine to push a large percentage of the struggling student population that schools are seeing enter their admission process in less effective treatment directions. 

Additionally, similar to independent schools, therapeutic programs and schools saw significant staff attrition due to the intense stresses of COVID work conditions. This staffing challenge occurred at the time media coverage of high profile individuals grabbed onto sensationalized stories (the sources of which are questionable) of abusive treatment occurring in a handful of similar types of programs last century. The internet then caught fire with negative reviews of the entire field, fueled by disinformation and unverified sources. We have seen the unfairly skewed coverage of this treatment field  resulting in intense parental fear of and resistance to these highly effective treatment options. 

Finally, the last decade’s intensive research and related buy-out strategies of this private therapeutic field by venture capitalists and large corporations culminated in a rapid corporate “takeover” of a significant portion of high quality, owner-operated therapeutic schools and programs in 2023. The corporate buy-outs, coupled with program closures, largely led to a change, or rather a reversal, of youth mental health treatment models, exchanging the integrative, clinically sophisticated practices of small owner-operated programs for a medical model of mental health delivery that has proven inadequate to address mental health needs and places profit over student outcomes. Meanwhile, parents have shown they prefer the medical model because of its familiarity.

How have these factors impacted students? We saw a high number of students cycle through mental health leaves from school only to need future leaves or a new school to address lingering challenges treatment was unable to resolve. We also saw a higher rate of school refusal, and a more acute student presentation, resulting often in multiple hospitalizations for suicidality. 

How did these factors impact parents? We saw many parents reach out with a fundamental misunderstanding of what independent and boarding schools offer and what colleges are capable of doing for the student. More parents reached out to us hoping that a change to a (new) independent school would alleviate the stress their children were experiencing, seeing independent schools or school change as an alternative to more intensive residential treatment. As a result, we worked hard in 2023 to educate parents of students struggling with emotional and behavioral challenges about the missions and programs of independent schools and colleges, while compassionately guiding their children to more realistic and better treatment and educational options and outcomes.


2023 Trends: What We Saw in Students 

Despite increased parental resistance to specialized therapeutic programming, we continued to see a high need for specialized treatment among children, adolescents, and young adults in 2023. We were heartbroken to see a strong uptick in elementary-aged children in crisis, many facing significant emotional and behavioral dysregulation associated with ADHD and spectrum or neurodivergent profiles. We worked hard to provide ongoing advising, greater community resources, and a wider repertoire of residential options for very young children. 

We continued to see an increase in neurodivergent and gender questioning students in crisis and needing a higher level of therapeutic intervention than outpatient or intensive outpatient services were able to provide. We began to see a resurgence of students struggling with substance abuse in 2023, most in the realm of THC (with vaping as the common denominator) and alcohol use. 

Young adults were struggling emotionally in higher numbers in college, causing parents to seek us out initially for college transfer work, but then recognizing that the path back to a typical educational continuum would first require everything from updated neuropsychological testing to more intensive, often residential, therapeutic work and rebuilding of the student’s transcript. We also saw much more complex and acute mental illness among young adults experiencing young adult onset of adult mental illness and among students with complex autism spectrum presentations. The common denominator among our most distressed students was a high level of emotional and behavioral dysregulation.


2024 Predictions: What We Expect

Despite last year’s trends, we predict some bright spots ahead. 

  • Schools are showing an even stronger commitment to understanding how to identify and assess mission and program-appropriate students as the best key to retention. We have enjoyed partnering with schools in conference presentations on related topics and have been heartened by the growing interest at the Board level for greater understanding and education around current student profiles and schools’ future and strategic planning. We predict that school boards, admission office practices, and school programming will continue to better connect around the realities of the current and future school-aged demographic of boarding and independent school-bound students, resulting in better institutional and student outcomes.
  • We are already seeing the recognition by some parents and programs of the limited efficacy of the corporate medical model of mental health care provision that has laid siege to private therapeutic schools and programs, which have helped so many young people find a way back to healthy growth. We predict a slight uptick in families returning to the quality private behavioral, owner-operated programming options that have weathered the COVID-media scandal-corporate takeover storm of the past two years and will continue to enhance student outcomes.
  • New leadership in the field of therapeutic schools and programs promises for clearer messaging, the publishing of the field’s robust research outcomes, and effective answering to false, sensationalized claims about their field. We predict these efforts will enable us to give parents greater access to accurate, verifiable information and data, ultimately allowing them to choose among more and higher quality options for their children’s mental health and developmental needs.


Some Less Positive Predictions for 2024

  • This generation of college students will continue to show higher rates of struggle with emotional and behavioral challenges and academic failure, resulting in college withdrawal or medical leaves. We predict that we will continue to need to be creative and adaptive in addressing the multiple needs of these students who require a “longer runway” and interim therapeutic and life skills development interventions to become college ready. As always, we will combine our expert knowledge of college and transfer planning with our extensive clinical training to help these young adults find renewed hope and a path forward.
  • In the short term, schools will continue to see too many students entering the admission process who require more significant assessment to determine mission and program match. We also predict that schools will continue to see a higher number of medical leaves for mental health struggles and a higher rate of attrition among students with emotional and behavioral challenges while they more completely align enrollment goals, admission practices, strategic planning, and programming development.
  • We predict that there will be more therapeutic school and program closures in 2024 at the same time the remaining, healthier arm of the field begins to gain momentum in the face of its multiple and significant economic and messaging challenges.
  • Sadly, we predict that some schools will confront significant student and staff attrition, as well as potential liability, in 2024 as too many parents continue to see independent schools as “treatment” options for their children who are in need of a higher level of care.

We are especially appreciative of our therapeutic, independent and boarding school partners who work so closely with us during the admission process to ensure our more complex students are mission and program appropriate. Thank you! And here’s to a healthy and successful 2024!

Carolyn Nelson and Rachel Leja traveled to Georgia, South Carolina, and North Carolina to visit Brightstone Transitions, Cherokee Creek Boys School, Black Mountain Academy, Equinox RTC, Asheville Academy for Girls, and Foundations Asheville.


Kelly McAdams and Samantha McMillan New visited several therapeutic programs in Central Utah this past year.

About The Author

Sarah McMillan, Ed.D.