Multidimensional Family Therapy for Adolescent Drug Abuse - PowerPoint PPT Presentation

1 / 114
About This Presentation
Title:

Multidimensional Family Therapy for Adolescent Drug Abuse

Description:

Multidimensional Family Therapy. Promising approach for ... Skill in family therapy facilitates development. Knowledge of social systems and systems of care ... – PowerPoint PPT presentation

Number of Views:129
Avg rating:3.0/5.0
Slides: 115
Provided by: UM19
Category:

less

Transcript and Presenter's Notes

Title: Multidimensional Family Therapy for Adolescent Drug Abuse


1
Multidimensional Family Therapy for Adolescent
Drug Abuse DelinquencyReclaiming
FuturesTreatment Improvement Institute28
January 2005
  • Howard A. Liddle, Ed.D., ABPP
  • Professor, Epidemiology Public Health and
    Psychology,
  • and Director, Center for Treatment Research on
    Adolescent Drug Abuse
  • University of Miami School of Medicine
  • www.miami.edu/ctrada

2
Miami, FloridaDowntown Brickell
3
Miami, FloridaDowntown Harbor
4
Miami, FloridaSouth Beach
5
(No Transcript)
6
(No Transcript)
7
University of MiamiCoral Gables Campus
8
University of MiamiMedical Campus
9
University of MiamiMedical Campus
10
University of MiamiMedical Campus Quad
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
MDFT for Adolescent Drug Abuse and Delinquency
  • Multidimensional Family Therapy
  • Adolescent substance abuse specialty
  • Related problems
  • Family-based treatment system
  • Diversity of studies
  • Sample findings
  • Clinical thinking features

15
MDFT Fact Sheet
  • Background
  • Variety of studies
  • Sample findings
  • Website
  • Contact information

16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
(No Transcript)
21
Developmental Stage
  • Renaissance of adolescent treatment
  • New treatments and methods exist
  • Feasibility and efficacy has been established
  • Mechanisms are being investigated
  • Generalizability has been addressed
  • Treatment manuals are available
  • Training models and materials exist
  • Full generalizability has not been established

22
New Generation of Interventions
  • Integrative
  • Connected to basic research on development
    and dysfunction
  • Diverse approaches
  • Expanded in scope Multiple systems of
    assessment intervention
  • Brief interventions as well
  • Context of service delivery
  • Well specified protocols

23
Features and Themes of the MDFT Research Program
  • Research-based knowledge about development and
    dysfunction
  • Therapeutic ingredients and processes
  • Therapist competence and development
  • Efficacy Rigorous treatment evaluation under
    controlled conditions
  • Effectiveness Rigorous treatment evaluation in
    regular clinical settings

24
Research Program (2)
  • Transporting and disseminating
  • Training studies
  • Refining and adapting
  • Defining and testing different versions
  • Continued exploration of key components and
    processes

25
Diverse Client Populations
  • Urban and inner-city ethnic minority youth and
    families - many with serious economic
    disadvantage
  • Co-occurring mental health problems
  • Juvenile justice involved teens
  • Parents with mental health, criminal justice, or
    substance abuse problems

26
Completed Treatment Outcome Studies
  • MDFT, Group, Multi-Family Clinical Trial
  • MDFT - Individual CBT Clinical Trial
  • MDFP Prevention Trial
  • MDFT-I Treatment Development
  • CYT Multisite Clinical Trial
  • MDFT - Group Early Adolescent Clinical Trial

27
Current Treatment Development and Outcome Studies
  • Alternative to Residential Treatment (NIDA)
  • Transporting MDFT to Day Treatment (NIDA)
  • Brief Version of MDFT (NIDA)
  • Training Outcomes (NIDA)
  • Long Term Follow Up (NIDA)
  • Cost Outcomes (NIDA)
  • Juvenile Drug Court (NIDA)
  • Dependency Drug Court (NIDA)
  • CJ-DATS Research Center (NIDA)
  • International Studies
  • (NIDA, 6 European Health Ministries)

28
Treatment Development
  • ASUD multidimensional phenomenon
  • Multidimensional clinical phenomena require
    parallel understanding, intervention and research
  • Clinical Model MDFT as a treatment system
  • Research strategy is multidimensional
  • Variety of variables and dimensions of research
    interest
  • Study variety Outcome and process studies
  • Focus on setting issues
  • Treatment development strategy is multidimensional

29
Multidimensional Family Therapy
  • Promising approach for transportation or
    adaptation
  • Superior outcomes in comparison to several
    state-of-the-art, widely used treatments
  • Capacity to impact a wide array of risk factors
    associated with adolescent drug abuse
  • Capacity to engage teens and families in
    treatment and motivate them to complete the
    program

30
  • Lower cost than standard outpatient or
    residential treatment
  • Demonstrated success in treating a range of teens
    and families (e.g., different ethnicities,
    genders, ages, severity of problems)
  • Empirically based knowledge about mechanisms of
    action
  • Flexibility in adapting to existing program
    factors and providers resources and needs
  • Success in improving client, therapist, and
    program outcomes in community-based
    transportation studies

31
Substance Use Outcomes
  • MDFT has demonstrated better results than several
    state-of-the-art treatments
  • Family group therapy, peer group treatment,
    individual cognitive behavioral therapy, and
    residential treatment
  • Substance use is significantly reduced in MDFT to
    a greater extent than all comparison treatments
    previously tested
  • 41 to 66 reduction from intake to discharge

32
Substance Use Outcomes
  • Effect sizes have consistently been in the
    medium-large (d.6 Liddle, 2002 Liddle, Dakof,
    Henderson, 2002) to large range (d.7 Liddle
    et al., 2001, 2004)
  • Treatment gains are enhanced in MDFT after
    treatment discharge
  • Youth continue to decrease drug use up to 1 year
    following treatment entry
  • Comparison treatments have increased drug use

33
Change in Substance Use Frequency
43 Reduction from Intake to 6-Month Follow-Up
41 Reduction from Intake to 12-Month Follow-Up
Reductions at 12 Month Follow-Up maintained
through 30 months
34
Change in Number of Substance Use Related Problems
Reductions at 12 Month Follow-Up maintained
through 30 months
35
Reduction in Average Cost to Society
Cost savings to society continue to decrease
through 30 months
36
Outcomes on Associated Risk Factors
  • MH symptoms show greater reductions during
    treatment in MDFT
  • Range of 35 to 80 within treatment reduction
  • MDFT clients continue to improve following
    discharge
  • Affiliation with delinquent peers decreases more
    rapidly in MDFT

37
Impact on Associated Risk Factors
  • School functioning improves more dramatically in
    MDFT
  • Youth return to school, receive passing grades at
    higher rates, and are less disruptive in the
    classroom
  • Family functioning improves to a greater extent
    in MDFT

38
Process Studies IlluminateTreatment Mechanisms
  • Outlined within-treatment process of improving
    family interactions
  • Demonstrated how therapists successfully build
    therapeutic relationships with teens (Diamond
    Liddle, 1996)
  • Parenting practices are systematically improved
    during therapy and that these changes are linked
    to reductions in adolescents symptoms (Schmidt,
    Liddle, Dakof, 1996)

39
Process Studies
  • Specified the links between exploring important
    cultural themes and increasing teens
    participation in treatment (Jackson-Gilfort et
    al., 2001)
  • Identified parent and adolescent factors critical
    to treatment engagement (Dakof, Tejeda, Liddle,
    2001)

40
Change in Parenting and Change in Adolescent
Drug Use
Schmidt, Liddle Dakof, J. Family Psychology,
1996
60 Tandem change 20 Adolescent only change 10
Parent only change 10 Neither parent or
adolescent change
41
Family Functioning Before, During, and After the
Therapeutic Impasse Diamond Liddle, 1996, J
Consulting Clinical Psychology
After successfully addressing impasse, family
functioning improves
Family functioning remains poor after
unsuccessful impasse resolution attempt
42
Three WorldsM. C. Escher 1955
43
MDFT Part of a New Generation of Interventions
  • Connected to basic research on development and
    dysfunction
  • Expanded in scope
  • Multisystemic assessment intervention
  • Context of service delivery
  • Clinician contributions to outcomes
  • Treatment development emphasis

44
Conceptual FrameworkCurrent Key Elements
  • Risk and protective factors
  • Normative development
  • Developmental psychopathology
  • Ecological perspective

45
Intervention Targets
  • Adolescent Self, son/daughter, peer system
  • Parent Self and parenting
  • Family Interaction and Family Relationships
  • Extrafamilial

46
Adolescent development
Community connection
School / academic
Treatment Foci
Family relations
Job/vocational
Cultural identity
Peer network
Drug use / drug taking contexts
Liddle, H. (2002). Multidimensional Family
Therapy for Adolescent Substance Abuse. CSAT CYT
Manual Series.
47
Outcome
Treatment Parameters
Process
Multiple Dimensions of MDFT
Family Therapy
Development
Psychotherapy
Problem Behaviors
Ecology
48
Key Features and Processes
  • Facilitation of development
  • Working the four corners
  • Therapeutic alliances
  • Concrete alternatives for a better life
  • Adolescent self, school, peers, family
  • Parent self, stress, parental subsystem
    conflict, parenting practices
  • Changing family environment
  • Therapist attitude and behavior

49
Principles of Multidimensional Family Therapy
  • Current symptoms of adolescent or other family
    members as assessment intervention opportunities

2) Change is multidetermined and multifaceted
3) Motivation to change is not assumed to be
present with adolescents or their parent(s)
50
Principles of Multidimensional Family Therapy
  • Practically-oriented , outcome-focused working
    relationships between therapist and family
    members/extrafamilial influences
  • Failure crises are intervention opportunities
  • Planning and flexibility are critical components
  • 8) Therapists think in terms of stages of work
    and modules

51
Principles of Multidimensional Family Therapy
  • Therapist attitude is fundamental to success
  • Believer in Change
  • Optimistic
  • Respect and Admire Parent and Teen
  • See Parent and Teen Better Than They See
    Themselves
  • Systems thinking - seeing the case through a
    complex lens
  • Knowledge of social systems and systems of care
  • Navigation ability -- The Loop
    functioning-dysfunction-change processes-intervent
    ions-read feedback-track outcomes-recalibrate
  • Practical, outcome orientation
  • Comfortable working in close proximity. Not
    afraid to challenge.
  • Do what it takes attitude.

52
MDFT Theory of Change
  • The family/parents are the key change agents
  • Peer influence operates in relation to the
    buffering effects of families
  • Adolescents need to develop an interdependent
    relationship with parents

53
MDFT Theory of Change
  • Symptom reduction and enhancement of prosocial
    and normative developmental functions occur by
  • Targeting the family
  • Facilitating curative processes in several
    domains of functioning across different systemic
    levels

54
MDFT Theory of Change
  • Targets adolescent functioning in six
    health-related domains
  • Drug use
  • Adolescent identity development and autonomy
  • Peers and peer influence
  • Bonding to prosocial institutions
  • Racial and cultural issues
  • Health and sexuality

55
MDFT Theory of Change
  • Attempt to stop the cascading momentum
    established by the interacting risk and
    development-derailing process

56
MDFT Theory of Change
  • Problem behavior can desist when meaningful,
    concrete alternatives are created, accepted,
    attempted and adopted
  • If it has been multiple risk factors and a
    network of influences that have created and
    maintained adolescent drug abuse, then the same
    complex of interrelated influences must be
    systematically assessed and targeted for change

57
MDFT Site Requirements
  • At least one MDFT Team
  • 2 therapists (masters level)
  • 1 therapist assistant
  • Supervision with a family therapy orientation
  • Cell phones for all team members
  • Urine test kits
  • Reimbursement for team member travel
  • Transportation for clients
  • Camcorders to record sessions
  • Discretionary funds for meals, movie tickets,
    books, movie rentals
  • Caseload of 5-7 cases / therapist
  • Treatment length 3-8 months

58
MDFT Required Forms
  • Case Conceptualization
  • Therapist Session Planning and Implementation Log
  • Supervision Weekly Contact Log

59
Assessment Intervention Sequence
60
Pieces of MDFT Approach
Developmental Psychopathology
Development
MDFT
Ecology
Risk and Protection
61
Pieces of MDFT Approach
Developmental Psychopathology
Development
MDFT
Ecology
Risk and Protection
62
Components and Logic of MDFT Approach
  • Problems
  • are multidimensional
  • Multidimensional problems
  • require multidimensional
  • conceptualizations

Parent(s)
MDFT
Adolescent
Family
Extrafamilial
  • Multidimensional
  • conceptualizations yield
  • multi-systems interventions
  • MDFT assesses and intervenes
  • into multiple systems of
  • development and influence

63
Pieces of MDFT Approach
  • Self
  • Family
  • Peers

64
Pieces of MDFT Approach
  • Self
  • Overall functioning
  • Stress and burden
  • Parent
  • Love and commitment
  • Guidance and limit setting

65
Pieces of MDFT Approach
  • Transactional
  • patterns

Family
66
Pieces of MDFT Approach
  • School
  • Neighborhood
  • Legal (Juvenile Justice)
  • Social
  • Medical

67
Pieces of MDFT Approach
Therapist - Parent
Therapist - Family
Therapist
Therapist - Adolescent
Therapist -Extrafamilial
68
MDFT Case P05
  • Mothers abstinence from alcohol
  • Improve mothers parenting skills
  • Engage and motivate mother to seek treatment for
    traumatic history and drug use
  • Motivate parents to believe they are the medicine
  • Abstinence from all drugs
  • Improve adolescents anger management skills
  • Build hope with adolescent
  • Decrease involvement with negative peer
  • Facilitate self-examination

4. Therapist - Family
  • Improve adolescent and mothers relationship
  • Help adolescent and mother communicate about past
    hurts

5. TherapistFamily-Extrafamilial
  • Help the family to have successful
    interactions with agencies
  • Contact the school to set-up a meeting
  • Help Mom get assistance from court to stabilize
    adolescent

69
Learning Complexity Components, Sequence,
Interrelationships, Staging
  • Darins Keys

MDFT
2. Parent(s)
1. Dribbling
1. Adolescent
4. Defense
3. Family
4. Extrafamilial
  • Foul Shots
  • Jump Shots

5. Moving Without the Ball
6. Game Strategy
5. Stages
6. Orchestration
70
Clinical Features
  • Treatment protocol capable of being adapted and
    tested in different forms
  • To date - outpatient and intensive outpatient
    variations
  • Masters level therapists
  • Initial training and ongoing supervision
  • Use knowledge about known causes and correlates
    to assess and target dysfunction

71
Clinical Features (cont.)
  • Use knowledge about known buffers and protectors
    to assess and target strengths
  • Principle-driven
  • Flexible adaptation
  • Multiple, simultaneous targets and activities in
    several realms of functioning
  • Sequenced, multi-level, multi-person change
  • Organization, planning and orchestration

72
Clinician Characteristics
  • Systems thinking - seeing the case through a
    complex lens
  • Skill in family therapy facilitates development
  • Knowledge of social systems and systems of care
  • Comparable relationship and intervention skill
    with parent, adolescent, and extrafamilial
  • Navigation ability -- The Loop
    functioning-dysfunction-change processes-intervent
    ions-read feedback-track outcomes-recalibrate
  • Practical, outcome orientation
  • Motivation - Wanting to work in this way
  • Do what it takes attitude

73
Practice Guidelines 1
  • Complex conceptualization
  • Think in terms of interaction and synergy
    among various social systems
  • Dangers in too narrow or too broad a
    conceptualization
  • Clinical phenomenon is multidimensional and
    involves multiple systems
  • These systems vary in nature, process, role
    and function, access, malleability, and change
    difficulty

74
Practice Guidelines 2
  • Standardization and flexibility
  • Treatment stages
  • Stages within stages
  • Core treatment components
  • Core treatment processes

75
Practice Guidelines 3
  • Integration of drug and psychotherapy foci
  • Integration of treatment and casework
  • Integration of different service delivery
    orientations - clinic, home, community,
    school, court
  • Flexibility of dose
  • Focus on the research derived determinants
  • Facilitate growth of the known protectors
    and buffers

76
Practice Guidelines 4
  • Need to acquire knowledge and skill in
    several areas- drugs, jj, schools, families,
    individuals, peer networks, residential care
  • Orchestration and organization skills
  • Mobilizing individual and social context
    forces to sustain gains

77
Center for Treatment Research on Adolescent Drug
Abuse University of Miami School of
Medicine www.miami.edu/ctrada hliddle_at_med.miami
.edu
78
Overview of Treatment Model/Intervention
79
3 Stages of Treatment
  • Stage 1 Build the Foundation/ Engagement
  • Stage 2 Work the Themes /Request Change
  • Stage 3 Seal the Changes and Exit

80
Modules are intervention targets
  • Four focal areas (primary developmental arenas)
  • Adolescent
  • Parent(s) and Parenting
  • Family Relationships Interaction
  • Extrafamilial systems of influence

81
MDFT Interventions That Are Not Stage Specific
  • Check in that client understands what therapist
    is talking about (Do you know what I mean? Do
    you know what it means?)
  • Gently ask leading questions. Questions that you
    know the answer to for the point of making the
    point palpable to client. Can be simple
    questions. Therapist asks questions not to get
    information but to help client realize something
    important.
  • Help youth and parents talk about (stay with, go
    to) emotions of sadness, pain, sensitivity.
    Instead of anger and acting out.
  • Constantly check in about behavior in home and
    school, etc. How is it going? Is the change
    keeping? Are there problems?
  • Encourage experience and expression of affect.
  • Prepare participants individually for upcoming
    in-session interactions.

82
MDFT Interventions That Are Not Stage Specific
  • Arrange, coach, process multiparticipant
    interactions in sessions.
  • Use the phone between sessions with both parent
    and youth.
  • Use current crisis to mobilize action and create
    focus.
  • Read client feedback and shifts focus, when
    necessary, to respond to clients needs and
    concerns.
  • Be supportive, non judgmental (I understand what
    you are going through.) Communicate
    unconditional positive regard.

83
MDFT Interventions That Are Not Stage Specific
  • Look for most accessible area to make a change.
    It does not have to be the most important area.
    You just want the adolescent and parent to see
    you as an ally.
  • Create positive expectations. They must believe
    that all this hard work and pain is worth it.
  • Reinforce small steps, small changes, small
    accomplishments.

84
Stage 1 Build the Foundation
  • Treatment creates a new system
  • Welcome the adolescent and family to a new life
    space
  • Explain and orient to the program
  • Develop a temporal orientation
  • Intensive involvement

85
Stage 1 Build the Foundation
  • Use current crisis to mobilize positive forces
    and create focus. Distress is used to facilitate
    motivation
  • Conduct family and individual sessions
  • Create expectations
  • Elicit and shape the stories

86
Stage 1 Build the Foundation
  • Work multisystemically
  • Meet or talk with everybody familial and
    extrafamilial
  • Build alliances
  • Think development
  • Work the phone

87
Stage 1 Build the Foundation
  • Craft themes Plant Seeds
  • Visit the school and neighborhood
  • Test different pathways and kinds of change


88
Stage 2 Work the Themes
  • Theme work launches from the foundation
  • Increase action and change orientation
  • Requires commitment, communication, belief, and
    consistent orientation

  • Think successive approximations
  • Work with the most accessible areas first

89
Stage 2 Work the Themes
  • Make theme development more rich
  • Think and work in all modules
  • Storyboard it out Thinking in stages. Session
    planning sheets.
  • Crises, slips, and detours are opportunities

90
Stage 2 Work the Themes
  • Family enactment Dont be afraid, or Thats
    why theyre there
  • Work the core sessions

91
Stage 3 Seal the changes and exit
  • Time is an important treatment dimension
  • Honest appraisal of current status
  • Accept rough around the edges outcomes
  • Emphasize and make overt the changed in any and
    all domains our exit is their new beginning
  • Assess next steps, future needs. Expect bumps in
    the road.

92
Stage 1
Stage 1- Building the foundation (Engagement)
Adolescent Module
Adolescent Module
  • Motivating the adolescent to engage in
    therapeutic process
  • There is something in this for you.
  • Articulating how the therapist and therapy will
    help adolescent get what he/she wants.
  • But dont make false promises.
  • Discuss with youth what they want to see changed
    in their family, with their parents.
  • Discuss with youth what he/she wants to see
    changed in themselves, in their life.
  • Communicate that you are their ally and advocate
    (I will help you get what you want.). This is a
    chance for therapist to show adolescent they care
    and will help.

93
Stage 1- Building the foundation (Engagement)
Adolescent Module
Stage 1
Adolescent Module
  • Encouraging a collaborative Process We are
    going to work together to formulate goals. What
    we do here is
  • Communicating interest in knowing about youth and
    who he/she is. Getting to know them and their
    world His/her interests, what they like, music,
    sports, anything that is important to the
    adolescent. Therapist is very positive and
    encouraging. Completely nonjudgmental. No
    attempts are made to change youth. The point is
    to just get to know youth and to express that you
    like him/her, are interested in their thoughts,
    etc.

94
Adolescent Module
Stage 1
  • Get details of their life, day to day. How they
    spend their time. Peers. Girlfriends/boyfriends.
    Thoughts, feelings. So that their life is
    palpable to therapist
  • Allow youth to voice their concerns, complaints
    about anything and everything.
  • Encourage expression of hopes, dreams,
    competencies, strengths. Highlight these
    expressions, enlarge upon them. Discuss with
    youth who he/she wants to be.
  • Assess for co-morbidity (depressions, anxiety).
    Refer to psychiatrists for psychiatric
    evaluations and medications if necessary.

95
Stage 1- Building the foundation (Engagement)
Stage 1
Parent and Parenting Module
  • Assess current and past stress and burden (I
    know this is hard on you. You have been through
    a lot.)
  • Encourage parents to talk about all efforts in
    the past including treatment failures and
    success, parenting efforts, etc. Seek out
    competences and strengths in parent.
  • Highlight how well they have done given difficult
    circumstances.
  • Explore their childhoods- what type of parenting
    did they receive? Look for strengths to build
    upon. Look for accomplishments in this realm
    given poor role models.
  • Enhance and strengthen feelings of love and
    commitment. (PRI- look at photo albums, help them
    go back to a time when they remember loving their
    adolescent when things were good between them.)

96
Parent and Parenting Module
Stage 1
  • Communicate to parents that this program is for
    them too. (I will be here to help you.)
    Therapist is an ally and advocate for parent.
  • Motivating parents You are the medicine,
    parental influence. Help them state (put on the
    table for all to hear) that they will do whatever
    it takes to help their child.
  • Motivating Parents No Regrets

97
Stage 1- Building the foundation (Engagement)
Stage 1
Parent Relationship/Family Interaction Module
  • Assess family interactions. What happened in the
    past? What went wrong up to now? (Is there
    conflict? How do they problem solve? How do
    they talk to each other? Is it superficial or do
    they talk about important issues? Who talks to
    who? How often do they talk to each other? How
    and how often do they communicate warmth and
    love?)
  • Assess family history, family story. Look for
    themes of strength as well as past betrayals,
    neglect, abuse that will need to be talked about
    in Stage 2.
  • Focus on the affective component of their
    relationship. Move to a level of love,
    commitment, connectedness, relationship and
    compassion.

98
Stage 2- Work the Themes
Stage 2
Adolescent Module Remember Stage 1 interventions
are carried through and administered as necessary
in Stages 2 and 3.
  • Prepare adolescent to tell his/her story to their
    parents. (Have adolescent tell parents about
    their world).
  • Facilitate self examination. Help them examine
    the positives and negatives about their drug use,
    selling, high risk sexual behaviors, etc. If
    adolescent is still using and engaging in
    delinquent behaviors, help them talk about the
    positives (pleasure, esteem, money, etc) as well
    as the negatives (getting arrested, failing in
    school, never to get a decent job, disappointing
    parents, etc). If the adolescent is clean, this
    is a chance to allow the adolescent to talk about
    how they miss the drugs or the lifestyle, money,
    etc.

99
Adolescent Module
Stage 2
  • Examine barriers to change (youth may want to
    change but cant do it alone) and explore
    ambivalence about change.
  • Help adolescent to articulate hopes and dreams
    for the immediate and long term. Create
    alternatives to current life (both short term and
    long term). Who you were, who you are, and who
    you want to become.
  • Discuss with adolescent how they are going to get
    to where they want to be. Help them make a plan
    and take steps to realize the plan. This is a
    very problem-focused, behavioral intervention.
  • Directly address drug abuse and other
    externalizing problems. (delinquency, high risk
    sex, school failure). Help adolescent deal with
    the truth about their behaviors and their
    thoughts about it. Help them explore
    consequences, risks, etc. (Your actions hurt
    others, hurt people you care about. -- What was
    going on with you when you did _______?

100
Adolescent Module
Stage 2
  • If depressed, work with psychiatrist if on meds.
    Regardless of medication, launch depression
    module.
  • 7a. Education to parent and teen about depression
  • 7b. Have youth keep daily activity log. Use in
    therapy sessions.
  • 7c. Have youth keep automatic thought log. Use in
    therapy sessions.
  • 7d. Regular consultation with psychiatrist if
    youth on meds.
  • Refer teen to sex education and HIV prevention
    programs to address their high risk behavior.
    Discuss experience in therapy sessions.
  • Use the drug screen in treatment. Use both
    positive and negative results in the session.
    Allow them to talk about all the details about
    their relapse or their abstinence.

101
Adolescent Module
Stages 2
  • Help youth form a new and more effective way of
    communicating with parents, teachers, other
    adults. Help them to see the negative
    consequences of certain types of communications
    (e.g., disrespectful and/or angry).
  • Improve functioning in areas that get them into
    trouble anger management, impulse control,
    negative thoughts, self-esteem, hopelessness. (If
    the adolescent needs extra assistance with anger
    management and impulse control, refer them to
    anger management classes. If referred to anger
    management class, discuss experience in therapy)

102
Stage 2- Work the Themes
Stage 2
Parent and Parenting Module Remember Stage 1
interventions are carried through and
administered as necessary in Stages 2 and 3.
  • Help parent look at their own life and what they
    want for themselves. (Assess level of support- do
    they need any extra psychiatric services? If yes,
    make appropriate referral and follow up)
  • Emphasize self-love, self care. You need to take
    care of yourself. Cant be good parent if you
    dont take care of self. Focus on parents needs.
    Who they are and who they want to be.
  • Instill hope in parent (things can change, he/she
    can change, power of parental influence, etc).
    Create positive expectations.

103
Parent and Parenting Module
Stage 2
  • Address inter-parent conflict. Inspirational
    Help parents work as a team. Teamwork very
    important in parenting. Help them to realize that
    they must put aside their differences and come
    together for their child. Be very positive (you
    can do it).
  • Address inter-parent conflicts. Behavioral Help
    parents work out a plan for how they will work as
    a team to parent child. Problem solve,
    collaborate with parents. Take an experimental
    framework (We will try it, and if it doesnt work
    we will try something else.)
  • Prepare parent to hear the adolescent tell
    his/her story. If you want to have influence on
    your adolescent you have to know him/her. You
    may hear some things that are difficult and that
    you may not like. It is very important that you
    are able to hear about his/her world. Also,
    help parent not to flip out.

104
Parent and Parenting Module
Stage 2
  • Help parents examine their own behaviors,
    including drug use or other high risk behaviors.
    Encourage change in relevant areas.
  • Encourage strong anti-drug stance and strong
    pro-school stance (Even if parent uses
    themselves, their stance to the adolescent is
    crucial).
  • Psychoeducation about parenting adolescent
    development. (Sometimes you just need to tell
    them what to do. Some parents need more
    assistance than others with their parenting
    practices)
  • Empower parents. Help them to be parental. Help
    them have influence and authority.

105
Parent and Parenting Module
Stage 2
  • Encourage age appropriate parenting skills
  • Monitoring
  • Limit setting
  • Consequences (positive and negative)
  • Follow through

106
Parent and Parenting Module
Stage 2
  • Assist parents in establishing extra support that
    will help them be successful with parenting their
    adolescent.
  • Help parents to be emotionally available to
    child.
  • Examine barriers to change (I cant. I
    wont.), and explore ambivalence about changing.

107
Stage 2- Work the Themes
Stage 2
Parent Relationship/Family Interaction
Module Remember Stage 1 interventions are
carried through and administered as necessary in
Stages 2 and 3. All the items below will be
addressed through enactments with the family.
Sometimes you will be meeting with adolescent
alone parents alone to prepare for these
enactments.
  • Bring the conflict out in the open. Put it on the
    table so family can begin dealing with it.
  • Help family resolve conflicts. Help them
    establish effective ways to problem solve.
    Improve conflict resolution skills. Help them
    learn to express self without fighting and
    blaming.
  • Encourage age appropriate negotiation between
    adolescent and parent. Work together to set
    certain limits and consequences.

108
Parent Relationship/ Family Interaction Module
Stage 2
  • Help family find ways to have positive
    interactions.
  • Help adolescent to tell his/her story to their
    parents. (Have adolescent tell parents about
    their world). Keeping the parents from
    interrupting, disagreeing, or judging. Help
    parents respond in a constructive way, including
    apologizing if appropriate and explaining their
    stress and burden. Dialogue is the key.

109
Parent Relationship/ Family Interaction Module
Stage 2
  • Help family talk about important issues.
    Increase communication between family members.
    Have them start with something small so that they
    can experience positive interactions. Have them
    work towards more important issues that are
    impacting their relationships (Through family
    interactions is where the adolescent will learn
    how to be healthy in the world. They will be able
    to have good communication with important adults,
    such as teachers, judges, police, employers, etc.)

110
Parent Relationship/ Family Interaction Module
Stage 2
  • Focus on affective component of their
    relationship. Support and enhance family
    communication of warmth and love. Help them to
    recognize how important they are to each other.
    Their positive qualities, etc.
  • Help family understand how important it is for
    them to establish positive supportive
    relationship. (parents need to show their love
    and warmth at the same time that they are making
    demands on the adolescent)
  • Facilitate parent-adolescent discussion about the
    love, worry and concern behind parents limiting
    setting and discipline practices.
  • If youth experienced past hurt, betrayals,
    neglect or abuse, facilitate discussion about the
    past. Dialogue is the key.

111
Stage 3- All Modules
Stage 3
  • Seal changes- make all changes overt. Acknowledge
    the progress and changes. Acknowledge what is
    good.
  • Assess progress make a plan to focus on workable
    goals during the last 6 weeks of treatment.
    Examine what you have accomplished, what is left
    to accomplish, and set priorities. Accept rough
    around the edges outcomes, if necessary.
  • Talk about ending treatment. Explore clients
    thoughts and feelings. Seal changes- make all
    changes made overt.
  • Discuss future potential, bumps in the road.

112
Extrafamilial ModuleTherapist will deal with
most accessible areas first. This will help
therapist engage with the family. All this work
is done throughout the three stages.
  • School
  • Get records
  • Assess adolescent needs. Are they in appropriate
    placement?
  • Schedule school meeting- introduce program and
    establish collaborative relationship.
  • Facilitate placement is best possible
    school/educational situation.
  • Closely monitor school/educational situation, and
    make adjustments as necessary.
  • Teach parents how to assess school problems, and
    interact with systems to get the best for their
    child.
  • At end of treatment, have youth stable in best
    possible educational situation.

113
Extrafamilial Module
  • Court
  • Get records.
  • Attend court appearances.
  • Advocate for adolescents.
  • Establish good working relationship with
    probation officer and other juvenile justice and
    court officials.
  • Closely monitor judicial situation, and make
    adjustments as necessary.
  • Teach parents how to advocate for their child in
    court/juvenile system.
  • Recreational Services for Youth
  • Help adolescent get involved with prosocial,
    recreational activity (sports, art, music,
    community service, etc)

114
Extrafamilial Module
  • Social Services for Family
  • Assess needs and obtain services
  • Financial assistance (DCF)
  • Immigration
  • Housing
  • Food
  • Health Care
  • Mental Health Care (psychiatric or more intensive
    services for any family member.)
  • Disability
  • Social support for family
Write a Comment
User Comments (0)
About PowerShow.com