Adolescant Care: a Landscape of Change
Adolescant Care: a Landscape of Change
Twenty years ago, when a young person needed out of home care for behavioral and emotional challenges, it was a pretty good bet that he or she could get help at a nearby psychiatric hospital facility followed by day treatment or sub acute care. Options such as wilderness therapy, community based residential services, emotional growth schools, therapeutic boarding schools, and young adult transition programs were largely unknown, or not in existence.
Times have changed. With the advent of Managed Care in the insurance business coupled with severe cutbacks in the funding of mental health benefits in most insurance plans, the once, booming psychiatric hospital industry has fallen on hard times. At the same time, there has been an explosion of alternative programming to fill the void left when traditional care options became limited.
So what of these alternatives? What are they, and what might come next? In the next few paragraphs I hope to provide you with a brief overview.
Therapeutic Wilderness or Outdoor Behavioral Health
Tracing roots to University based survival courses and wilderness leadership initiatives, the Outdoor Behavioral Health industry has grown rapidly in size and scope over the last ten years. Originally, most wilderness programs provided intense, three-week survival courses for troubled youth utilizing a combination of outdoor skills coupled with brief therapy initiatives, after which the client returned home, or possibly went on to other services. Solo trips by clients near the end of placement, along with a guided reunion with family members capped off the client’s sojourn. Mother Nature’s beauty and imperviousness to mortal manipulations often had high impact on a youth who was otherwise embroiled in addictions and a negative peer culture.
Today professional counselors, utilizing sophisticated testing provided in the field along with involved, intentional psychotherapy that also connects the family via letters and weekly phone contact with therapists, are yielding promising results. The length of stay has become more variable with research indicating that longer stays may significantly improve outcomes. College courses, professional conferences, improved government and industry regulation and formal outcome studies all indicate the effectiveness and importance of this intervention.
Residential Treatment Programs (RTC’s)
Fifty years ago, it was thought by many that a child placed in residential care may need to remain in services for several years. Early pioneers focused much of their work on minimizing outside parental involvement while attempting to manage all phases of a young person’s life. Over time it has become increasingly apparent that care in the more structured and protected confines of a residential program needed to become more permeable. One can now find programs that won’t admit a young person without the promise of full family participation. Residential care often was driven by a doctor/nurse medical model that failed to take into account group dynamics, community living concerns, or other factors. We now see greater attention to milieu therapy, cross training of professional and paraprofessional staff, as well as integration of multi-discipline assessments.
RTC’s, now less restricted by insurance edicts, can provide highly innovative programming. Specialty services not approved for insurance reimbursement such as art therapy, experiential education (ROPES courses, team building exercises, multi-family initiatives, etc.), therapeutic home passes, community service, and specialized therapy for adopted clients or others have emerged. RTC’s now come in more shapes and sizes. Working ranches, combining professional psychotherapy, provide certain interventions; while smaller, gender specific community based programs may serve clients with other needs.
Emotional Growth Schools
Around thirty years ago Emotional Growth Schools came onto the scene. Relying on periodic, high impact, focused workshops related to mastering each phase of human development these schools work to help a youngster master crucial skills. The workshops are under girded by structured scheduling, including formal academics and robust recreational programming as well as a peer culture that takes advantage of the needs for young people to experience healthy rites of passage and group support. In recent years there has been a trend to incorporate more formal psychotherapy into these environments while drawing on past successes. Typically