LEVELS OF CARE
PROGRAM OBJECTIVES
To structure and maintain an environment in which the following will occur:
- Cessation of self-destructive behavior patterns.
- Provide an immediate alternative for the adolescent in a drug and smoke free environment which is healthy and supportive.
- Promotion of the willingness to explore those problematic areas of personal and interpersonal relationships which have resulted in the isolation, alienation and loneliness often present in adolescents.
- Activities which allow adolescents to develop a sense of self-worth, and an ability to solve basic problems as a result of an enhanced sense of self-esteem.
- Emphasize honesty, responsibility for self, and productivity for all adolescents.
INTERVIEW / ADMISSION
An adolescent and family system interview will be conducted by a multidisciplinary team (2-3 hours). It is essential to include requested members of the family system in the initial interview. We request the opportunity to review the Family Intake Questionnaire and records of previous treatment experiences in preparation for our interview. The adolescent and family will be interviewed to determine the presence of emotional, behavioral, psychological, academic and/or social problems. The professional staff will interview and then present to the adolescent and family a perspective for treatment with a specific recommendation for the level of care. This interview is not a treatment component but intended as an educational process for appropriateness of care with our Institute or a referral elsewhere.
The severity and duration of emotional symptoms or reckless, destructive, dysfunctional behavior must be of such intensity to require immediate treatment beyond the continuum of "normal", troublesome adolescent behavior. Previous treatment failures either on an outpatient, inpatient, or partial care basis may indicate the need for admission and treatment. Our intensive family therapy focused format is usually not found in previous treatment endeavors and therefore represents a more vigorous and vital treatment experience for all family members. It is this process of family members' participation in treatment that is the basis of family connectedness and is reflective of the philosophy of the Institute.
As you give us permission for treatment, a new frame of reference will probably emerge. We introduce new concepts, terminology, procedure and its purpose, including the risks and possible complications of treatment, and the alternatives and possible consequences of no treatment. We cannot give an outcome assurance or guarantee. Our performance of procedures is of the highest quality with favorable outcomes.
The immediate risk and possible complication for parents may include feelings of guilt, ambivalence (anger versus caring) failure, and loss. "Will my child ever forgive me for admitting him/her to AFIC?" Your first visit, the family interview, may be difficult yet informative in that a better understanding of the problems experienced by all family members may surface. Many families actually report a sense of relief, hope, satisfaction and positive attitude about their future after the initial interview.
Those adolescents who are skilled at manipulation and believe that their parents only want to scare them for a few days, or who believe that their parents will "rescue" them because of guilt or fear may possibly threaten to run-a-way. In those few cases when adolescents actually do run, they run back home or to a friend's house. They usually try to contact the parent whom they feel can be manipulated the easiest. They promise that parent a complete reversal of behavior and attitude, if only they can come home! "Give me another chance" is the initial plea from the adolescent. "If you put me back there, I'll hate you!" etc., is the alternate plea which may include a threat of drastic behavior or consequences directed toward the parent(s).
This of course is difficult to cope with but it clearly addresses who is in control and what steps are required to restore reasonable order in the family system. You will be given very specific directions by our staff as to how to return your adolescent to AFIC - if that is the message you want to convey to your son/daughter, i.e., "we are serious and are going to follow-through with treatment". Or your message can be, "we will let you off the hook again and give in to you".
The unique family focused model utilized by the multidisciplinary treatment team is essentially a blended family focused approach which integrates principles from but is not limited to: Strategic and Structural family therapy, the MRI brief therapy approach, Problem-Centered family therapy, the Milan approach / and use of paradoxical and encounter group interventions.
Our techniques are designed to be clear, frank, direct and accurate, though at times you may feel uncomfortable with them. You may find some of the focused language to be explicit, and possibly unpleasant. Please keep in mind that change is at times temporarily uncomfortable. This is why we have our Parents Survival and Educational Group to help you through this transition period. Your colleagues, other parents, can provide you with the support and direction needed for this transition.
Please try to keep in focus: treatment means change, and no treatment may result in no change and may actually make the condition worse.
24-HOUR CARE
Adolescents in need of this level of treatment are typically in a crisis interval, reckless or endangering behavior to themselves or others. These adolescents require immediate interruption and stabilization.
Inpatient care requires intense psychiatric, nursing, medication management, direct 1 to1 care and is intended to interrupt the crisis interval. This facilitates a willingness for a more adaptive level of functioning. A therapeutic treatment environment, to decrease reckless and lethal tactics while engaging and establishing a paradigm of connected relationships with care-givers and family members, is the critical focus of inpatient care. The developmental stage of the adolescent (emotional and behavioral) and the ability of parents to demonstrate the skill of mentalization and reflective functioning are necessary to step down to the residential level of care.
Adolescents presenting with "externalizing disorders", such as disruptive or defiant disorders, conduct disorders, substance use disorders, impulse disorders, with or without concurrent attention-deficit or hyperactivity; or dual diagnoses typically require intensive residential care. Adolescents presenting with "internalizing disorders" such as adjustment disorders, mood disorders, depression and affect disorders typically respond to short term residential care.
At each of these levels of care, family system intervention is mandatory and punctuates all five axis of psychiatric treatment. Intensive residential care is intended to reduce a career of patienthood, while enhancing the paradigm of how to use ‘curious-critical-creative’ thinking patterns in interrupting cognitive and behavioral distortions. Engaging parents, with education and therapeutic techniques to be responsive to their own needs, their adolescent’s needs and to emerge as executives in the family system, is a concurrent treatment component of intensive residential care.
Our distinct intensive level of treatment provides for adolescents and parents a 24-hour shared group living and learning environment with individualized therapeutic interventions. We utilize a totally monitored and supervised milieu where the environment is maintained to allow normalization for adolescents. In this phase of treatment, adolescents and family members receive comprehensive 24-hour services by a team of experienced professionals in the psychiatric-medical, nursing, mental health, counseling and educational fields, in a shared group living campus environment. The assigned Primary Therapist will be the managing therapist for the entire length of treatment at all levels of care for the adolescent and for the family. This process assures continuity of care for the entire family system and allows our professional team the unique opportunity to structure an individualized treatment plan and program for each family.
PARTIAL CARE / INTENSIVE OUT PATIENT
Treatment (day or night care) is utilized for adolescents who have received 24 hour care and progress to a less than severe condition, or those defined as transient reactive disorders with moderate disruptive impact on the adolescent's family, school, or social functioning. Partial care is extremely useful and appropriate in situations where an adolescent's ability to maintain and sustain productive and stable behavior is emerging; or where more intensive 24-hour treatment is no longer needed, yet a brief transitional phase of vigorous treatment is merited. Partial Care treatment is usually five to seven days a week eight to ten hours a day.
The partial care treatment plan emphasizes self-esteem, strengths, improved cognitive functioning and continuity of life skill development of each adolescent. It is a progressive and challenging program individualized for each adolescent.
Intensive outpatient care is designed to facilitate the transition to family, school, home setting while still under the guidance and respite of the milieu and Primary Therapist. This phase typically follows the Partial Care level of treatment and consists of three days or less a week three to six hours a day as needed.
OUTPATIENT AFTERCARE
Outpatient and aftercare services are the necessary continuity of care components designed to monitor and maintain the strengths and skills learned by the adolescent and the family system. Emphasis on the process of “challenging, confronting, consequences and confirmation “ is maintained as the basis for success in the family system. The ADOLESCENT AND PARENT AFTERCARE GROUP affords each adolescent the opportunity to address unfinished work, confront and support their peers, and to engage each other in a more productive and healthy manner. This group encourages parents to discuss difficulties they are having in their family relationships. This group is facilitated by Primary Therapists who continue to function as advisor and consultant to the family and provides individual and family sessions. Adolescents who are in need of individual and/or family outpatient sessions schedule these with their Primary Therapist as needed.
