Adolescent Treatment Program

Treatment details & clinical protocols

Adolescents frequently come to the program with a history of increasing difficulties in relationships, school, impulse control and substance abuse. Some come following failed outpatient treatment whild others come soon after difficulties emerge to gain an understanding of difficulties as well as an optimum plan for ongoing treatment.

The most frequent primary diagnoses at the time of admission include mood disorders (depression or bipolar disorder), severe personality disorders, behavior disorders and psychotic disorders. Many patients have multiple diagnoses. Drug and alcohol abuse or dependence is often a significant secondary diagnosis.

Treatment approach
The Adolescent Treatment Program combines therapies supported by research, a school program and support from staff into an individualized treatment plan. The program is based on a bio-psycho-social (medical, emotional, social) approach to psychiatric diagnostic understanding and treatment.

This approach is especially applicable because the patients we typically treat may be vulnerable to certain kinds of disorders because of his/her inherited characteristics and life experiences which have contributed to difficulties. Understanding contributing factors is crucial to a diagnostic understanding and the development of treatment plans.

The multifaceted diagnostic and treatment approach is ongoing, reviewed and revised as the patient's team learns about the situation. A part of capturing the diagnostic understanding of an adolescent's difficulties is the identification of one or two core issues that drive the symptomatic behavior. In addition to the formulation of a diagnostic understanding, treatments and interventions specially ordered by the treatment team stress the importance of the development of healthy relationships with family, peers and adults; the acquisition of academic, vocational and social skills and the consolidation of a positive, realistic identity.

Treatment team
Upon admission, patients are assigned a clinical team consisting of a child psychiatrist, psychologist, clinical social worker, rehabilitation specialist and nursing staff. A substance abuse counselor joins this team when needed. A utilization review manager is part of the clinical team, ensuring that needed services are provided and allocated in a manner to effectively improve or eliminate any identified problems.

Assessment
The Adolescent Treatment Program provides an intensive interdisciplinary assessment process accompanied by brief treatment designed to stabilize those symptoms that led to hospitalization and promote optimal ongoing clinical treatment.

More about the assessment process

Core treatment program
All patients participate in the following treatment modalities.

Individual & group therapy
These therapies are central aspects of treatment and are provided by program staff. In order to facilitate an integrated treatment program, the patient's primary clinician serves as his/her individual therapist. A team of primary clinicians, social workers and nursing staff leads each group psychotherapy session.

Individual therapy provides the opportunity for in-depth understanding of a patient's problems and attention to problem solving through the developing relationship between the therapist and patient. It is sometimes the development of this basic trust that allows the patient to address deeper and more difficult issues. The style and focus of individual therapy is directly related to the prioritized goals of treatment. For example, the focus of therapy for an adolescent with psychotic symptoms may be to decrease anxiety related to being in treatment with reality checks coming from the outside regarding distortions. As the patient progresses, the focus of therapy will shift to skill-building and adaptive functioning to manage symptoms. In contrast, a patient with social anxiety, depression, family conflict and role diffusion may work in individual therapy to define a sense of self and family and be encouraged to have authentic experiences and communication.

Group therapy provides an opportunity for patients to share their problems and receive support while providing the same to peers. Every patient's problems are unique, but also overlap with problems of others. Group therapy helps young people achieve a sense of commonality of problems and experiences, and provides the opportunity to help, as well as be helped.

Family therapy
Family support and commitment are crucial to the successful treatment of troubled youth. The goal of family therapy is to provide the best assistance for successful treatment of the patient and smooth reintegration of the patient from the program to home or to another care provider.

Family therapy is provided by the patient's clinical social worker and is an integral part of the patient's comprehensive treatment. Family therapy may be supportive, directive or interpretative. It facilitates a meaningful understanding of the family's needs, roles and boundaries and results in the establishment and/or clarification of family goals.

Parents have at least weekly contact with program social workers. All members of the treatment team are involved in the work on family issues. Patients are expected to address family issues in work with their individual therapist and nursing staff, who will use this support in preparing for family contacts. Psychiatrists and primary clinicians will join family therapy sessions as needed and provide consultation and support to parents during visits.

Medication philosophy & treatment
A child psychiatrist directs treatment and works with patients, parents and other treatment team members in establishing the most effective medication regimen. Medications are used only when necessary and are based upon an appropriate diagnosis.

Upon admission, the patient and parents meet with the psychiatrist for an initial assessment of medication needs. The medication regimen is reassessed through weekly medication rounds. Patients and parents receive education regarding medication, intended effects and side effects so they can participate in monitoring and are prepared to assume responsibility for it after discharge.

Milieu therapy
The milieu is the supportive, therapeutic environment in which the staff work with patients on repairing difficulties in the parent-child relationship that can be applied during treatment and at home. The milieu provides structure, education and support. A consistent routine is maintained, which fosters predictability and trust. Milieu structure assists patients in containing negative behavior and provides opportunities to remediate the behavior through staff and peer feedback and modeling.

A milieu is considered therapeutic when there is a community that provides a sense of membership and belonging and plays a central role in the individual patient's life. In the therapeutic community, staff and patients reflect a sense of responsibility for the welfare of other young people in the community and the community as a whole. The therapeutic community has a set of values and norms for behavior with an expectation that community members will participate in activities, value one another as individuals and learn to care about and trust one another.

The objective of the therapeutic community is to provide a safe, nurturing environment in which patients can develop a sense of trust in staff and other patients in order to share and scrutinize their problems, feelings and beliefs.

Additional objectives are to provide a means for a patient to integrate new and positive experiences; then use these experiences to increase self-esteem and opportunities to practice new, adaptive living skills, social skills and empowerment for experiencing success. Activities that foster these objectives include a weekly community meeting, consisting of all team members and patients, and a nightly agenda meeting for individual and community issues that is attended by patients and nursing staff.

Staff members interact with patients to foster relationships based on mutual trust and respect. All staff serve as role models to assist patients with learning improved social skills, problem solving and relationship skills. Patients are expected to complete assigned talks with nursing staff that are focused on core treatment issues.

Specialized skill-building groups: These groups are part of the core program and focus on:

• Interpersonal relationships and skills required to manage mood fluctuations
• The ability to interrupt problematic behavior
• The identification of triggers and related coping skills
• A better understanding of diagnostic-specific conditions

Therapeutic activities and recreation: Patients meet with the rehabilitation specialist upon admission to begin a functional assessment. The rehabilitation specialist coordinates an active program of recreation and skill-building activities. During school break periods, the activity program is enhanced.

Programs focusing on cultural and spiritual values: Cultural and spiritual needs are assessed at the time of admission. The clinical team uses Menninger and community resources to address these needs. Patients may attend chapel services on the grounds. The hospital chaplain is available for individual consultation as requested by the treatment team.

Individualized treatment
In addition to the core program, patients are prescribed individualized adjunctive programming by their treatment team based on their clinical needs. Most of these adjunctive modalities are provided within the program. Some interventions are accessed through cooperation with other specialized programs at Menninger.

Specialized programming is available for:

Patients with substance abuse issues

• Substance abuse evaluation
• Individual substance abuse counseling
• Substance abuse educational groups
• 12-step group treatment
• Off campus AA and NA groups

Patients with impulsive, anger management & suicidal/self-harm issues

• Anger management group
• Dialectic behavior therapy (DBT) group
• Individualized milieu structure to accommodate behavioral difficulties
• Social skills building through milieu therapy groups

Patients with eating problems or history of trauma

• Body image group
• Eating disorder consultations and nutritional counseling
• Self-harm group, when appropriate and requested by the treatment team

Patients with anxiety disorders or obsessive-compulsive problems

• Cognitive behavioral therapy (individual and group therapy)
• Obsessive-compulsive disorder consultations
• Response prevention (individual and group therapy)

In an effort to help patients master basic social and adaptational skills and to support their return to the community, the Adolescent Treatment Program utilizes community resources when clinically appropriate. These resources include:

• Community Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings
• Community recreational programs

Discharge planning
Discharge planning is an ongoing process that begins at the time of admission. An initial discharge plan and estimated length of stay is established at the diagnostic conference early in the patient’s stay. That information is then communicated to the family. This plan is reviewed and revised in weekly team meetings.

As patients near completion of treatment, therapeutic passes from the hospital to the home may be scheduled to promote the application of skills, behaviors and symptom management techniques within the home setting. Whenever possible, the patient also connects with the outpatient team and school that have been designated in the discharge planning process.