A couple key aspects of an adolescent transport…

The approach of an adolescent transport can either facilitate or obstruct the therapeutic or treatment process. Adolescent/teen transport techniques that employ respect and empathy tend to be conducive towards treatment whereas those tactics which include low levels of respect and reduced empathy tend to obstruct the overall therapeutic process.

Equally, the benefit of an adolescent transport for a troubled teen/adolescent and his or her family is contingent on the treatment program being both clinically appropriate for the adolescent and his or her specific issues and being reputable…

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Adolescent Transport Services also support community-based treatment programs

Although adolescent transport services are often associated with out-of-home therapeutic contexts, such as residential or wilderness therapy settings, adolescent transport services can also collaborate and work closely with community treatment resources and programs as well.  New Start Transports works with both community-based and residential treatment programs.

 

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An Adolescent Transport Should Better Prepare the Adolescent/Teen for Treatment

If an Adolescent is transported into a treatment settings, such as a wilderness program, therapeutic boarding school, or residential treatment center, he/she should arrive better prepared than when the transport first commenced.  In essence, even if an adolescent and his/her parents are in conflict regarding treatment, by the time the adolescent arrives at the treatment program–e.g., wilderness therapy, residential, or therapeutic boarding school or program–they should be better prepared and hopefully more open to the treatment process.   Most importantly, the adolescent/teen should feel that they were treated with respect during the entire transport process!  How the adolescent perceives they were treated during the admission process, which includes the transport, is essential to their subjective experience of the admission/transport process and likely their cooperativeness and openness to the treatment program…

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Differentiating Adolescent Transport Approaches from false stigmas

Per the advice and assessment of a licensed and experienced mental health clinician, such as a psychologist, youth advocate, or educational consultant, an adolescent transport can facilitate a safe and therapeutically conducive context for transitioning, between the home and treatment program–e.g., wilderness program, residential treatment center, therapeutic boarding school.  If the transport staff or mediators use a therapeutic approach, an adolescent transport can in many cases help to alleviate the anxiety and even perceptions of coercion and negative emotions that are embedded in the family context, both during and before the transport.  It is important to recognize that the parent-child or adolescent dynamic is already volatile and escalated well-before the transport begins or is even arranged.  Therefore, in many cases and under the proper advice of a qualified mental health professional or consultant an adolescent transport service arrives to intervene and mediate in a family context that is already extremely volatile or even in crisis.  By taking a therapeutic approach, properly trained and experienced staff can facilitate a safer and more therapeutically conducive transition to the program.

In essence, whether or not an adolescent transport is appropriate for a troubled teen or teen being placed in a treatment program should be determined by the mental health professional who is working directly with the family–parents and teen–and preferably residing in the same community or nearby.  If an adolescent transport is deemed appropriate for the teen, then the transport service should implement crisis intervention and therapeutic techniques that (according to research) are most conducive to the therapeutic process…

Please feel free to express your thoughts–positive or negative.

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The Coercive Myth of Adolescent Transports and Teen Treatment

In reality almost all adolescent treatment entails some degree of coercion—meaning adolescent is not choosing it on his/her own volition. The developmental research supports this and in fact has underscored that adolescence is a period where teens may overtly resist parental and other authority, even when they know or believe their parents may be right, or in the case of treatment that help is necessary. In sum, it may not be practical to expect adolescents, especially those beleaguered with behavioral and psychological problems, to enter treatment on their own or without outside sources of pressure, such as parents or other family members. Therefore, the issue isn’t so much of whether or not adolescents should be coerced into treatment but what approaches and tactics are ethical and conducive to the treatment process.

Perhaps of more importance, is a process of thorough assessment and evaluation, which can help to ensure the best approach and modalities are used for the particular adolescent and his/her presenting issues…

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Research Awareness Among Adolescent Transport & Youth Treatment Services is Essential

It is essential that any adolescent treatment service, especially an adolescent or youth transport service, to be aware of the research that pertains to the populations of adolescents, teens, and in some cases adults, they are providing therapeutic services. Transport and treatment services should also be familiar with the research as it pertains directly to the modality or approach they use during the admission process. For example, different approaches engender different emotional and perceptual reactions from those being coerced into treatment. If an adolescent perceives the process as fair and respectful they are much less likely to perceive coercion and experience negative emotions, even if the adolescent is entering the program involuntarily…

Please respond with any questions or comments.

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Adolescent Transport: The issue of mistrust between parents and adolescent/teen

This video responds to a website comment that adolescent/teen transports can adversely impact an adolescent’s trust for their parents.  In essence, trust is an important consideration, especially considering the inherent structure of a transport.  It is important for transport services to incorporate procedures that are sensitive to this.  Techniques of aggressive force or threat are not appropriate techniques and are likely to aggravate (vs. improve) the situation.  Additionally, parents can also seek advice from consultants and therapists on what should or should not be disclosed before a transport occurs for their adolescent child.

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Description of Therapeutic Adolescent/Teen Transport (video)

It is essential for the transport of an adolescent to be therapeutic–conducive towards treatment…

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Dispelling The Accusations & Myths Associated With NATSAP Adolescent Treatment Programs Through Research

As previously discussed by Hardy (2011) in the Journal of Therapeutic Schools and Programs (JTSP), private treatment programs for adolescents (PTPs)—those providing 24-hour supervised residential or outdoor care to non-adjudicated “at-risk” adolescent populations—have encountered increased levels of scrutiny in recent years.  The American Bar Association (ABA, 2007) and United States Government Accountability Office (GAO, 2008), among others (e.g., ASTART), are two organizations that have questioned certain PTP practices.  As an extreme example, the ABA (2007) purported that the following concerns were associated with the practices of some PTPs:

  • Limiting the ability to contact parents over extended periods of time
  • Overusing medication to control behaviors
  • Confiscating children’s and youths’ shoes to prevent them from running away
  • Employing physical restraint techniques, lasting for hours at a time.  (The overuse of restraints has been causally linked to the death of some children and youth)
  • Sexual abuse from program staff… (p. 416)

While the pervasiveness and plausibility of these issues vary across treatment contexts, and conceivably do not exist in all PTP milieus, the very suggestion of these grievances can arouse hesitation and concern among parents and professionals unfamiliar to the PTP industry.  In particular to the National Association of Therapeutic Schools and Programs (NATSAP), it seems reasonable (from an insider’s perspective) to presume that the majority, if not all, of NATSAP’s member PTPs operate according to the highest ethical standards of treatment, thereby, precluding its members from any association to these grave infractions.  Equally, the state of Utah—the home to many NATSAP and other  PTPs—has been recognized (by both the ABA and GAO) for its exemplary oversight and licensing procedures for PTPs, suggesting Utah licensing as an additional assurance of ethical treatment practices to parents and professionals (ABA, 2007; GAO, 2008).

Notwithstanding, some organizations (e.g., GAO, ASTART) still propose that several PTPs, including NATSAP programs and those licensed in Utah and other States where oversight exists, still engage in unethical adolescent treatment practices.  While a thorough analysis of these accusations is beyond the scope of this post, it is proposed that these purported concerns, or perhaps myths in some instances, can be dispelled and avoided through the increase of research.  That is, as more PTPs invest and participate in research, a more accurate and evidenced based perspective of the industry can ensue.  In turn, parents and professionals less familiar with the PTP industry may not only find greater confidence (or less reluctance) in considering PTP approaches, but the effectiveness of treatment can also be advanced—improving long-term outcomes and establishing PTP approaches as empirically valid alternatives.  Therefore, research may be the crux to the future success of the private adolescent treatment industry, especially for those that lack a current empirical foundation or that have experienced increased scrutiny.

As this is a blog post, comments are always welcomed and appreciated!

 

References

American Bar Association (ABA) policy requiring licensure, regulation and monitoring of privately operated residential treatment facilities for at-risk children and youth. (2007). Family Court Review. 45 (3), 414-420.

Hardy, C. J. (2011). Adolescent Treatment Coercion. Journal of Therapeutic Schools & Programs, 5:1, 88-95.

United States Government Accountability Office (GAO). (2008). Residential programs: selected cases of death, abuse, and deceptive marketing. Retrieved from http://www.gao.gov/new.items/d08713t.pdf

 

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2012 Study Suggests An Adolescent’s Readiness to Change When Entering Wilderness Treatment May Not Impact Long-term Outcomes

In their 2012 publication, Bettmann, Russell, & Parry discussed that adolescent treatment coercion can sometimes involve an adolescent literally being escorted by a third-party service (e.g., youth transport service) into treatment via physical force or implied intimidation.  In reasoning that entering treatment unwillingly or coercively (perhaps third-party escort/transport) might impact an adolescent’s readiness (motivation) to change, Bettmann and colleagues suggested that their findings–adolescent readiness to change when entering wilderness treatment did not relate to post-treatment outcomes at 6 months and 12 months–may be applicable to coerced adolescents as well.  More explicitly, Bettmann and colleagues’ central finding was that an adolescent’s (initial) readiness to change was not related to the post treatment outcomes of the adolescents in their study.  From this, they surmised that parents admitting their adolescent teens into wilderness treatment coercively (i.e., against adolescent’s own volition) might not impair post treatment outcomes.  Thus, coercing an adolescent into wilderness treatment (e.g., via a third-part youth escort/transport service) may not obstruct the therapeutic process.  Rather they may stand to benefit from wilderness treatment as much as those entering non-coercively or with greater treatment motivation.

Notwithstanding this suggestion—especially considering coercive admission practices for adolescents—this study was limited in scope and more robust data is essential before drawing any absolute conclusions.  Specifically, the population of investigation was limited to one wilderness program of privately placed (middleclass) adolescents.  Also the first author of this article (although highly reputable) is directly affiliated (with ownership) in this particular wilderness program, indicating a potential bias in both the design and data interpretation.  Importantly, wilderness treatment is distinct from traditional residential treatments (e.g., therapeutic board schools, residential treatment centers):  Wilderness programs are relatively shorter in their duration and treatment occurs in an open outdoor setting, which may lessen an adolescent’s perception of coercive pressures during treatment per se.  Therefore, these findings should not be extended to traditional residential treatment contexts until supporting data is collected.

Despite the mentioned (and likely other) limitations, Bettmann and colleague’s (2012) study has offered sound evidence that more research is essential to understanding the practices of private wilderness programs and their long-term implications (e.g., post-treatment outcomes) for adolescent participants in particular.  Furthermore, there is a pronounced need to better understand the perceptions and responses of adolescents to treatment contexts that enroll adolescents unwillingly (or coercively).  Although this discussion is far from conclusive, at this point (according to this publication) it seems plausible that some adolescents can experience positive results from participating in wilderness treatment, even if they are not ready (or perhaps willing) to change at the onset of (wilderness) treatment.

I look forward to future research contributing to these issues.  The reference of this article is enclosed below.

Bettmann, J. E., Russell, K. C., & Parry, K. J. (2012). How substance abuse recovery skills, readiness to change and symptom reduction impact change in wilderness therapy participants. Journal of Child Family Studies. doi: 10.1007/s10826-012-9665-2

 

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