Programs for Struggling Teens: Ideal Features- Part I

Parents of struggling teens often feel desperate to find the “right” program or school for their child.  Parents typically feel a sense of urgency, particularly when the teen and family are in a crisis situation.

Parents should avoid making decisions quickly; as the adage goes, haste makes waste.  Too often I get phone calls from desperate parents who feel as if they’ve run out of options.  They may have spent hours on the Internet trying to find a “good” program or school.  Parents may ask around, hoping they can find someone who has heard of a “good” program or school.  Nearly always, this haphazard approach is unproductive, and sometimes disastrous.

As hard as it is to be patient in a crisis situation, parents would do well to slow down the pace and take a hard look at the features and qualities of schools and programs that seem appealing.  The professional literature on adolescent development and programs for struggling teens suggests that, ideally, programs should have a number of key features.  These principles should underpin any efforts to help struggling teens and their families along every point in the continuum of care, including initial assessment, crisis intervention, home-based services, community-based counseling, alternative community-based education, mentoring, drug and truancy courts, wilderness therapy programs, emotional growth boarding schools, therapeutic boarding schools, and residential psychiatric treatment.  Parents of struggling teens, and the professionals who work with them, should seek to identify programs that embrace these principles.

Principle 1.  Above all else, do no harm. Programs for struggling teens must adopt this core principle of the Hippocratic Oath. Noble intentions do not always produce good outcomes.  Verbal, emotional, and physical abuse are unacceptable; the ends never justify these means.

Principle 2. Schools and programs should focus on strengths, resilience, and a developmental perspective.  These points of view are compatible with, and can be incorporated into, multiple educational and therapeutic modalities.  They help professionals avoid destructive and harmful interventions.

Schools and programs should use the language and concepts of strengths, resilience, and developmental perspectives in their written descriptions of their program, policies, procedures, and day-to-day practices. This translates into daily staff-teen interactions that hold great helping potential. When the teen makes unwise choices, is noncompliant, withdraws, misbehaves, breaks rules, or is otherwise unresponsive to direction, these mishaps are viewed and addressed as learning opportunities, not as character flaws. Staffers recognize that obnoxious behaviors that appear to be willful disobedience could perhaps simply reflect a teen’s slowly maturing brain or mental health issues stemming from insufficient brain development, dopamine, serotonin, or norepinephrine and other neurotransmitters.

While willful disobedience most certainly does occur, it is best to apply firm, consistent consequences and manipulate antecedent conditions in a nonpunitive manner. Administrators and staffers take the stance of, “She needed to behave that way at this time. Our job is to clearly state the rules and consequences, have high expectations and standards, believe in her ability to grow and mature over time, provide constructive discipline, structure, and compassion as she moves through adolescence in her unique way and at her own pace. We trust that when the time is right, she will come along.”  This nonjudgmental, firm stance is deeply rooted in the strengths, resilience, and developmental perspectives.

Principle 3. Avoid coercion. Coercion can be traumatic and cause more harm than good. It is easily misused, with lasting consequences.

At times a teen may need to be restrained or transported against his or her will. A suicidal teen must be prevented from killing herself or himself.  A violent teen must not be allowed to hurt others.  A relentlessly defiant teen who repeatedly disappears to use harmful drugs, commit crimes, and engage in risky sex, and who refuses to accept help and treatment, may need to be escorted to a program equipped to help him deal with these behaviors and the reasons for them. In these extreme circumstances only ethical, skilled, and properly trained transportation services should be used.

When a transportation service, program, or school needs to apply physical restraint, staffers must adhere to written policies and protocols that comply with widely accepted national standards.  Physical coercion and restraint lie on a slippery slope; while they may be needed in extreme circumstances to prevent harm, they must be used in ways that do no harm, emotionally or physically.

[to be continued]

Frederic Reamer Ph.D. Bio

Dr. Reamer is a professor in the Graduate Social Work Program at Rhode Island College.

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