Beyond Outpatient: How Residential Programs Provide Comprehensive Autism Support
Feeling like outpatient therapy isn't fully addressing your teen daughter's autism? Discover how residential programs offer comprehensive evaluations and round-the-clock support that can provide deeper understanding and more effective treatment. Learn why this higher level of care might be the missing piece for your family and gain insights into finding the right program.
Getting an accurate autism diagnosis—especially for girls—can be a long, frustrating journey. In this episode, therapist Tiffany Silva Herlin, LCSW, is joined by fellow therapist and Clinical Director at OASIS Ascent, Allison Jenkins, LCSW. They explore how residential treatment programs like OASIS Ascent provide the in-depth evaluations and support that many families struggle to find in outpatient care. Together, they shed light on the unseen challenges of autism in teen girls and the benefits of holistic, round-the-clock observation.
Topics Discussed In This Episode:
- Why outpatient settings often fall short for autism diagnosis and support
- How residential programs offer multi-setting observation and comprehensive evaluations
- Signs a higher level of care may be needed for your teen
- The role of educational consultants in finding the right treatment program
Residential care isn’t the first step for every family—but when outpatient options aren’t enough, programs like OASIS offer essential clarity and support. If you’re wondering whether it’s time to consider something more, this conversation offers both insight and encouragement. Listen in as Tiffany and Allison break down what to look for, what to expect, and how to take that next step with confidence. Call us now at 855-701-2721 to explore how we can help.
Introduction to the Podcast
Tiffany: Welcome back, listeners. This is our fourth and final episode. I'm your host, Tiffany Silva Herlin, a licensed clinical social worker. I'm excited to continue our discussion with Allison Jenkins, also a licensed clinical social worker and the Clinical Director at OASIS Ascent.
Just a quick reminder: this podcast is not a substitute for professional therapy. Please seek support from a licensed mental health professional for your individual situation.
In this episode, we’re talking about the role residential treatment programs play in the evaluation and support of individuals with an autism diagnosis—especially when it comes to knowing if and when a residential program is the right next step. We’ll also look closely at how OASIS Ascent provides comprehensive evaluation, stabilization, and intensive support for neurodivergent teens, particularly females. Let’s dive in and bring visibility to the often unseen parts of the autism spectrum.
So, Allison, what are some of the challenges families face when trying to get a proper autism evaluation in an outpatient setting?
Allison: There are so many. First, there’s the cost. When you go in for a full evaluation, you're looking at a standard battery of tests, and then you have to add autism-specific assessments on top of that. You can’t just go to a psychologist and say, “Hey, I think my child might be on the spectrum—can you run the tests?” It has to involve multiple tools and types of assessments.
And just to clarify, I’m a licensed clinical social worker—I can’t diagnose autism myself. I can advocate, I can refer, I can say, “This is what I’m seeing,” but ultimately it’s the psychologist who gathers all the data and makes the diagnosis.
Another big issue is finding a psychologist in the first place. Here in Utah, most psychologists who do testing are booked out six months in advance. Waitlists are long.
Tiffany: Yeah, those waitlists can be a major roadblock.
Allison: Exactly. And then there's the insurance piece. You have to talk to your insurance to see if they'll even cover the evaluation. If they do, it usually means an even longer wait because so many families are trying to use their insurance benefits.
Another challenge is that many girls don’t present like you’d expect someone on the spectrum to present. They often mask their symptoms well. So schools are hesitant to do testing or offer IEPs, and outpatient providers may miss the signs because they’re only seeing the child for an hour at a time.
Tiffany: Right. They're only catching a tiny glimpse of what’s going on.
Allison: Exactly. So you have a therapist calling the parents saying, “She’s doing great,” while the parents are like, “No, she’s struggling a lot at home—she’s having major outbursts.”
Tiffany: And even the evaluator is only spending a few hours or a day or two with the child, right?
Allison: Yes, ideally, they’re spending a couple of days and collecting data, but it takes a team to do it well. Sometimes, as hard as it is to hear, the best way to get an accurate diagnosis is to remove the child from the home temporarily and observe them in a range of settings—socially, academically, in therapy, and the community.
That’s one of the strengths of a residential assessment center like OASIS. We can see the whole picture.
Tiffany: And OASIS works with insurance, which is huge, because not every residential treatment program can do that.
Allison: Right. We’re about 99% insurance-funded, which makes a big difference for families.
Tiffany: That’s amazing.
Allison: Also, at OASIS, we include psychological evaluations as part of the treatment process. One thing to note is that we don’t cover the cost of the ADOS (Autism Diagnostic Observation Schedule), which is a more specialized test.
Tiffany: But not everyone needs the ADOS, right?
Allison: Exactly. It’s requested when it makes sense—but even without it, we’re still able to gather meaningful data and provide strong clinical insight. And when it is needed, it’s such an important part of the process.
Identifying the Need for Residential Treatment
Allison: Especially if we’re recommending it.
Tiffany: Right. Let’s take a step back for our listeners—what are some signs parents should look for? How do they know it’s time to consider the next step, like a residential program?
Allison: That’s a really good question. I usually look at three key areas. First, how is the child doing socially? Are they failing to connect with peers? Are they withdrawing or struggling to navigate relationships?
Second, how are they functioning in school? Now, this one can be tricky because sometimes we get those “perfect” students—they’re doing everything right academically, but they’re still struggling deeply in other areas.
Tiffany: Yeah, they may be thriving in school on paper but struggling socially or emotionally.
Allison: Exactly. And third, how are things at home? What do the relationships with family members look like? Are there intense conflicts, shutdowns, or isolation?
And of course, we always consider safety. If you find yourself locking up sharp objects, worrying about the safety of your other children during outbursts, or even concerned about your own safety—or your child’s—those are strong indicators that a higher level of care is needed.
Tiffany: That makes a lot of sense. So, if a parent gets to that point, what resources can they use to find a place like OASIS?
Allison: One great resource is educational consultants. I love working with them. They’re incredibly knowledgeable—they’ve toured all these programs, they’ve vetted them, and they know which ones are safe and clinically sound.
They often know the clinicians at these programs and can make thoughtful recommendations about which therapist might be the best fit for your child. Educational consultants are a great guide through what can be a really confusing process.
There are a lot of short-term programs popping up that claim to offer assessment and stabilization, and it can get overwhelming. Especially if there are options close to home, it might feel hard to consider sending your child to a place like Utah. But sometimes, the local programs haven’t been fully vetted, and you’re not sure what level of care they’re offering. That’s where educational consultants can help—they’ll help you cut through the noise and find a program that truly fits your child’s needs.
Tiffany: Absolutely. I’ve worked with so many of them. They serve as advocates for families and as a bridge between the family and the program. It’s such an overwhelming world once you step into it and realize, “Okay, we need help.” Educational consultants have already done that legwork and can make the process so much more manageable.
What Makes OASIS Unique?
Tiffany: So worth your time, and such a great support for families looking for help when they’re in crisis. So what makes OASIS different from other residential evaluation centers?
Allison: That’s a great question. Oh, I love OASIS. It’s a unique model. OASIS is a hybrid—we designed it that way intentionally from the start. The name itself stands for Observation, Assessment, Stabilization, and Intense Support.
A lot of assessment centers just focus on observation. They observe, observe, observe—but there’s not a lot of therapy or treatment happening. At OASIS, we do both. We begin observation and clinical intervention right away.
Tiffany: Yeah, they don’t just need an assessment—they need a hybrid of assessment and therapy at the same time.
Allison: Exactly. And that’s where we see the most progress. We provide intensive clinical services—ten clinical groups a week, sometimes even more. Our clients typically get three to four individual sessions per week. These kids come in struggling, and they need that level of support immediately.
Tiffany: Right, they need to be met where they are, not just evaluated and sent somewhere else later.
Allison: Yes. And we observe them across all areas of life—how are they functioning in school? Are they engaged or easily distracted? What’s their physical health like? Some of these kids are dealing with chronic stomach issues or other medical concerns, and we address those, too.
Then we look at residential life—how are their interpersonal skills? How are they functioning in the milieu, during transitions, and with daily living activities? And at the same time, we’re diving into the clinical side, including family therapy.
Tiffany: Yeah.
Allison: We start family therapy right away. We encourage families to be involved from the beginning. We’re not one of those programs that says, “You can’t talk to your child for the first two weeks.” Quite the opposite—we want you to be involved, to come visit, to participate.
Tiffany: Because it’s a family system.
Allison: Exactly. We need to see how the family interacts so we can support everyone in the system. That’s what makes OASIS different—we’re assessing and treating simultaneously.
Tiffany: You’re taking such a comprehensive look at the whole picture—the whole student and their family. You’re not just focused on mental health; you’re also looking at the physical, educational, and social aspects—everything that makes us human.
Allison: Yes.
Tiffany: And all of that should be integrated. That’s what allows for deeper understanding, more accurate assessment, and real healing.
The Importance of Observation in Evaluation
Allison: Correct.
Tiffany: Yeah, that makes sense. How does observation and assessment help with evaluating one of your female students for autism, especially if she comes in possibly misdiagnosed?
Allison: Yeah. We’re observing 24/7, which means eventually the mask has to come down—and it will come down.
Tiffany: Yeah.
Allison: Especially when it comes to social and interpersonal interactions. Through the milieu, we can observe who they gravitate toward, who they avoid, and what they do during free time. How many shutdowns do they have a day? How many outbursts? We also often see something called an “extinction burst” in some of our students on the spectrum—transitions are hard for them.
Tiffany: Explain that extinction burst, because I love that analogy.
Allison: An extinction burst happens when a child is struggling with the transition into treatment. In the beginning, behaviors can spike—they escalate, and then there’s this “burst”—and after that, things start to settle. So we’re ready for that pattern.
Tiffany: Yeah, so sometimes things get worse before they get better—especially if you're holding boundaries, guiding them in the right direction, and addressing the very things that are hardest for them.
Allison: Exactly. You’re hitting on the hard stuff—like change and transitions. And for families who are nervous about flying their child from California to Utah, yes, that’s a huge transition. But we’re prepared for it at OASIS. We’re expecting those extinction bursts, and honestly, we’re looking for them—they give us useful clinical information.
Tiffany: Yeah, that makes sense. What does a high-quality evaluation process look like in a residential setting like OASIS, especially for a female student who may have been misdiagnosed and has autism?
Allison: A high-quality evaluation is all about being thoughtful, especially about when we do the testing. We don’t want to test a student right in the middle of an extinction burst. That wouldn’t give us reliable data.
As clinicians, we’re constantly collaborating with our team of psychologists to determine when the student is closer to baseline—when they’re more emotionally regulated, safe, and willing to engage. It's a delicate balance, and we work closely with our psychologists to make sure the timing is right, and that we have enough observational data to inform the evaluation process.
Tiffany: Yeah.
Allison: It’s all about getting the most accurate data. So we’re intentional about when that testing window is, and we don’t force it.
Tiffany: And not to force it.
Allison: Exactly. Some of the testing is rigorous. One of the tests has over 400 questions, so we’re mindful of where the student is emotionally and mentally before giving them a testing packet. We also make sure they’re supported during the process and in the right headspace to do it well.
Tailoring Support for Neurodivergent Students
Tiffany: Yeah. So let's talk about providing the right support. How does OASIS tailor therapy and support for the neurodivergent female students you work with?
Allison: The great thing about OASIS is—diagnosis or no diagnosis—we're still treating the symptoms, right? Even if we don’t have an official diagnosis yet, we’re all thinking, “Okay, this is probably what’s going on,” and we start treatment right away.
I’ve mentioned DBT—I love DBT. It includes a lot of interpersonal and social skills work. For example, I might have a girl come right up to me and break personal boundaries, standing inches from my face and saying, “Allison, can I get my packages today?” So we help them understand social norms, what appropriate interactions look like, and how to take their mask down.
Tiffany: Yeah.
Allison: And we help them understand that behind the mask, they’re beautiful. They’re beautiful humans, and they can be themselves. So even if a diagnosis takes 45 days, we’re still treating what we’re seeing right away. We pivot, we support, and we use a strength-based approach—helping them build on what’s already strong in them.
Tiffany: Yeah, I love that.
Allison: And we help the parents learn how to build on their child’s strengths, too. That’s a big part of what we’re always talking about.
Tiffany: And probably helping them love and accept the child they do have, versus holding on to the one they dreamed of or expected, right?
Stabilization and Intensive Support Explained
Tiffany: Helping them come to terms with where things are. What does stabilization and intensive support look like during that process?
Allison: Yeah. We have a three-to-one staff-to-student ratio, so we can provide levels of support that a lot of places can’t. We're also a locked facility.
Some of our spectrum girls are runners—it’s a fight-or-flight response. So, being in a locked building helps keep them safe. But we also do a lot of off-campus activities when the girls are stable and ready.
Tiffany: Okay, so they are allowed off campus?
Allison: Oh yeah. They’re off campus about three times a week. I want them in the community practicing their skill, especially social skills. Sometimes they go to restaurants and practice ordering food. Other times, they do community service. There are a lot of assisted living facilities near our campus, so the girls might go play games or polish nails for residents.
We want them using their skills in real-life situations, then coming back and processing the experience—especially the negative self-talk like, “I didn’t say that right” or “I should’ve done that better.” We help them understand and work through that.
The intensive support also includes weekly clinical staff trainings. We sometimes focus on specific students who need more support. Our clinical and admin teams come together and ask, “Where are we failing this student?” Not, “This student isn’t a good fit—let’s discharge them.” It’s always, “What can we do better?”
Tiffany: I love that. And parents listening—what you’re hearing is that this whole team and community come together to support just one student. It’s not all on you.
If you’ve gotten to the point where you need residential treatment or a more thorough, comprehensive evaluation, it does take a community. You can’t carry all of this alone. And what I love is that your team is constantly asking, “What can we do differently to better meet this child’s needs?”
Allison: And it’s not easy to make the decision that your child can’t live at home anymore. It’s one of the hardest decisions a parent will ever have to make. But at the same time, it can be incredibly beneficial. It can change the trajectory of your child’s life, getting an accurate diagnosis, understanding how her brain works.
We get girls who are very intelligent but have low processing speed. Just understanding that it takes your child longer to process something can make such a difference. Like if you say, “Clean up your room, brush your teeth, and get ready for school,” all at once—it’s too much.
Learning something as simple as giving them one instruction at a time, waiting for them to finish, and then giving the next—that can be a game changer.
Tiffany: I honestly could take a class on that. I’m sure my kids would say I need to get better at that myself! Those are strategies I think any parent could benefit from.
Family Involvement in the Treatment Process
Tiffany: And that leads me to the question of what family involvement looks like, especially for understanding an autistic diagnosis?
Allison: Yeah. Family involvement is about education, psychoeducation, and just coming to OASIS and experiencing your child through a new lens. Right? It’s looking at it through a different lens, and that lens is so beautiful and magical. Embracing that is key. I think it's so important for parents to learn as much as they can, do their research, dig into it, get support, and go to support groups. And at OASIS, we can provide that.
Tiffany: What does OASIS provide? So, do you do family therapy?
Allison: Oh yeah. So, at OASIS, we do family therapy weekly. It’s required. We’ve had parents who want to send their students to us, but if they’re not willing to engage in family therapy, it’s not a good fit for us. We need the whole family system involved. As we’re getting ready to transition the student home, we're bumping up to two family sessions a week. Parent visits are very highly recommended. The more you can come and be involved in person, the better, because that will naturally improve your relationship with your child. We’re not a program where you can just say, “Oh, go to OASIS, and they’ll fix you.” It’s about helping the whole family, and parents need to understand that.
Tiffany: That’s what provides lasting change. Because what happens is if you only fix one individual in the family system and then send them back into the same system, they’re going to fall back into that old role they once carried. If you’re not looking at the whole family system, then you’re not promoting long-lasting change. And, honestly, I can say this as a therapist—we don’t want your child to be at our program forever.
Allison: Yeah.
Tiffany: We don’t want to be your therapist forever. We want you to move forward. We want you to graduate, and we want you to have a second chance at life—as individuals and as a family system—to thrive and move forward and progress.
Allison: And it has happened where we’ve sent kids home to the same family system, and then I get calls three weeks later: “Hey, can she come back?”
Tiffany: Yeah.
Allison: Because it’s just not enough. So the family needs to do their work too.
Challenges and Growth Through Treatment
Allison: And it’s a challenge. Nothing we’re asking you to do is easy at OASIS, and nothing we’re asking your daughter to do is going to be easy. But at the same time, through challenges we grow, and through struggles we grow. At the end, after 75, 85, or 90 days, you’ll see a different child. You will.
Tiffany: Yeah.
Allison: And you’ll have answers that you’ve been wanting your whole life.
Tiffany: Yeah. So, how can a program like OASIS help individuals and families move forward after a diagnosis?
Allison: So, what we do is a lot of community outreach. We help with figuring out what school is going to be the best fit. We work with the teachers to come up with a plan, like, “Okay, you’ve been working with this student for three months, what would be an ideal school? What would be an ideal setting?” We help the parents navigate that. Of course, therapy—what is therapy going to look like? Who is a good therapist? Sometimes the parents say, “Oh, they’ve been seeing this provider for 10 years. We want to go back.” And I’ll say, “We’ve gotta change it up. We’ve gotta mix it up. What we were doing wasn’t working, so what are we going to do moving forward?”
Tiffany: Which is only the definition of crazy—trying to do the same thing over and over again, expecting different results.
Allison: Exactly. They’ll say, “She likes her. And she goes every week and they connect.” And I’ll say, “Let’s try something new.”
Tiffany: Yeah.
Allison: It’s not a dig on anyone who’s been trying to help kids, but sometimes we have to throw everything out that we’ve been doing and start fresh. Especially with treatment. There are a lot of neurodivergent schools with smaller classrooms. But what we do at OASIS is help find wraparound services—what do you need when you go home? Parent coaching. Parent coaching is becoming a big thing. A lot of professionals who’ve been in the field for a long time are turning to parent coaching. Finding good parent coaches.
Tiffany: What does that look like?
Allison: So yeah, parent coaching is something we offer at OASIS. It’s where we get both parents, and then I coach them through different scenarios that could come up, helping them understand how to respond appropriately, reflect, and respond differently to their child.
Tiffany: Yeah, makes sense.
Allison: And how to get along and be on the same page.
Tiffany: So, better communication. Better support. Better connection.
Allison: And for the divorced parents out there, I just—
Tiffany: Oh yeah.
Allison: It’s really hard, especially if they’re divorced parents who aren’t getting along. Those are the ones that benefit from calling together for parent coaching. It’s not easy, but we work hard to get them on the same page.
Tiffany: Co-parenting is so hard. Having to do it myself in a divorced situation, yet it’s essential for your kids. It’s essential to your kids' ability to thrive and function, and move forward into adulthood. So you’ve got to put the past behind you and move forward for your kids.
Allison: Yeah, I’ve worked with parents where maybe one of them even had a restraining order against the other one. I’ll tell them, “We are coming together because this is going to show your child how much you love them.”
Tiffany: Yeah.
Allison: And when I told the student, “I’m doing parent coaching with your parents,” they were blown away. I said, “That’s how much they love you. They are going to come together and talk and get along because they love you.” And the student was like, “I can’t believe it. They’ve never gotten along. I never thought I’d see this.” And I tell them, “I’ll make it work.” And I do.
Tiffany: That’s awesome.
Allison: We do offer parent coaching at OASIS. I run a parent support group every Tuesday. It’s an amazing group. I usually teach a DBT skill, then we discuss a topic I think is relevant, and we open it up for processing or other topics. We cover everything from regression to progress, insurance, and loneliness. Many parents feel guilty when they send their child away, especially when the chaos in the home settles down. They feel like they’re living in a home without their child’s chaos, and we help them process that. There’s so much we cover, and it’s a supportive group. They end up exchanging phone numbers and becoming friends long after leaving OASIS.
Tiffany: And that’s so essential to parents' journey of healing: finding others who are going through similar things. It reminds them they’re not alone, they’re not failures, and that they can form friendships and connections that will be so beneficial for their healing journey.
Allison: Yeah. You are not alone. That’s the theme I hear from parents: “I just felt so alone.”
Tiffany: Yeah, it’s so isolating.
Allison: It is. They see other kids going to prom or applying for colleges, and meanwhile, their child is in treatment.
Tiffany: And on top of it, maybe just got an ASD diagnosis, which adds another layer to work through.
Allison: Exactly.
Tiffany: Allison, to finish up this mini-series, can you leave us with a story of success from a family you’ve worked with?
Allison: Yeah, I’d love to. I had this girl who came in. She was struggling. She would go to school all day and do well, but then come home and just unravel. It got to the point where she was being physically aggressive with her mother.
Understanding Complex Family Dynamics
Allison: And the mother had to move out of the house. They tried to maintain it in the home as long as they could. When the education consultant called me, it was another "question mark" kid. This girl did well in school, she’s bright, she can be social, but she burns through friends, self-harms, and is aggressive toward her mother. She had multiple diagnoses and had been in treatment since she was five, with outpatient therapy, because her mother always felt there was something different. The mother was like, “Yeah, something is going on.”
I talked to the mother, and she said, “This is borderline personality disorder. She has it.” And I said, “Okay, she’s 14.” She started reading me all the behaviors her daughter was exhibiting, and in the back of my mind, I thought, “Oh, I bet she’s on the spectrum. I bet she’s on the spectrum.”
So, the parents finally decided to bring her to us, and we started treatment. I was her therapist, and we started working with the family. Dad was very rigid, which surprised me because she got along well with him, but not with her mom. They were lovely parents, but Dad’s rigidity was tough. We started doing the work and began an evaluation and assessment.
It came out that she was on the spectrum. Mom was so relieved, but also faced with this new autism diagnosis, and didn’t know what to do next. She’d been in neurotypical schools, and the education consultant referred her to a long-term program that specialized in neurodivergence.
She went there, and Mom was still very nervous about having her go home because of the aggression. She did well at the program, graduated, and now she’s at a boarding school, just thriving. Sometimes she’ll call me, which is so funny. She’ll just thank me and give me updates on how she’s doing. Her parents invited me to her graduation at the neurodivergent school, and she’s doing great.
If she hadn’t received that diagnosis and if her mom had leaned into the borderline personality disorder diagnosis, she would’ve ended up at a completely different treatment center and likely would have been kicked out.
Avoiding Misdiagnosis and Its Consequences
Allison: And she would not have thrived.
Tiffany: And probably had even longer treatment.
Allison: And would’ve been in treatment longer.
Tiffany: Yeah.
Allison: If we hadn't gotten that diagnosis, because mom was so sure it was borderline.
Tiffany: Yeah.
Allison: And it presented as borderline.
Tiffany: Yeah.
Allison: And that's the validation, and that's what we're doing at OASIS. It's like that's the validation to the mom of, "Yes, it does look like borderline," and at the same time, autism can look like borderline in females. So helping mom understand that, and then when they went to the next steps, the education consultant could place her in a program where she could thrive, rather than in a program for borderline students with attachment, right? Or one where she would have been eaten alive, wouldn’t have known what to do, and would've blown out.
Tiffany: Yeah. And possibly not get the true help that she needs. And maybe even do more harm than good.
Allison: And be passed around from program to program, right?
Tiffany: Yeah.
Allison: And I’ve seen it like, "Oh, she got kicked out of this program. She got kicked out of this program. She got asked to leave this program," and I'm just like, "She is on the spectrum. She’s in the wrong program."
Tiffany: Yeah.
Allison: And I love that you're sharing this story. You shared a story in our previous episode about a girl who was able to have short-term treatment with you guys and then go straight home.
Tiffany: Yeah.
Allison: And there are some cases where they need further treatment, but at least through OASIS, they’re getting the correct treatment, which does shorten the amount of time they probably would've needed.
Allison: And I just wanna say, our goal at OASIS is always to get the kids home.
Long-Term Goals for Treatment Success
Allison: Always. That’s always our first goal. How do we get the student home? Even if parents are like, "They can never come home again," or "I’m terrified." We’re always looking at, how do we get the kid home, because I think that is what the kids need. I know there are long-term programs that are very helpful. And our goal at OASIS is always to get the child home. If they can’t go home, then we will look at other alternatives.
Tiffany: Awesome. Allison, thank you so much for joining us, and I can tell you're passionate about this topic.
Allison: Oh, yes.
Tiffany: I feel like more people need to hear about it. We need better representation in research for females, especially regarding autism spectrum disorder, and honestly, just more people being aware and educated on this specific topic.
So thanks for coming and talking to me about it today and sharing your wisdom, your knowledge, and your experience behind it.
Allison: You’re so welcome. It’s been a pleasure.