Teens-at-risk: what parents can do/ or/ teens at risk: the parent process
When kids act out
Parents are often overwhelmed by emotions when their kids start using drugs, act out, or lose interest in school. Feelings of anger, shame or inadequacy may cloud their ability to respond. They need to know they are not alone in the fight for their child’s mental, emotional and behavioral health. They need to know there are programs out there that have worked, have turned kids around and have healed them.
It’s important to be able to talk about difficult issues that our teens and young adults face in our community in an open forum, and I’m glad that the Daniel Island News helps foster a safe space in which to discuss this. Daniel Island is a close-knit community with many great kids but also kids who are at risk. The teen years are marked by raging hormones, conflict and mood changes. The teen brain still needs to develop and mature. It’s why teens have a harder time inhibiting their responses, delaying gratification and controlling their behavior.
According to Dr. Joseph Lee* some teens are more at risk than others because of the way they are wired. According to Dr. Lee, author of Recovering My Kid: Parenting Young Adults in Treatment and Beyond, there are specific genetic markers that make some children more susceptible to becoming addicted. Their DNA is different. You never know if this child who needs oxycodone after surgery will become addicted. It’s hard to tell if an oppositional teen showing signs of depression and anxiety will go on to harm himself. Who knows if a teen smoking pot or drinking for the first time will grow into an adult who uses substances on a regular basis?
It leads me to believe that teens do well for their own internal reasons connected to the wiring. Some teens receive lousy parenting and still make it. Others have most loving parents and yet suffer crippling anxiety and depression. The environment triggers deeper reactions in them. An everyday event for one teen could traumatize another. One thing we can do to keep kids away from drugs and alcohol, especially while their brain is in the plasticity stage of neural development, is to educate them about their fantastic elastic brain. We’d need to make classes such as physiological psychology a core requirement.
Parents need to act early in the child’s life
The prognosis for a successful outcome depends on the onset of symptoms, type of disorder, and intellectual ability among other variables. Therapeutic programs start with assessments, because addiction is often just a manifestation of underlying issues. Once parents become aware of programs, they often ask: where could we get an accurate diagnosis? What would be best for our child? Among the hundreds of programs on the Internet, which one would be best?
Shopping for a therapeutic program for your child is more complicated than shopping for a school or college. It helps if a teen has a psychoeducational evaluation that describes their cognitive performance, though it’s no substitute for a neurological assessment. Most wilderness programs will assess teens and conduct psycho-social and psychoeducational evaluations after the teen is free of drugs. In more acute cases residential or hospital programs assess teens in one to two weeks.
Programs that save teens
Wilderness programs offer an immediate way to remove teens from situations dangerous to themselves or others. It’s like a wake-up call that stops teens from using. Oppositional teens can be transported by specialized agencies to programs. However, I prefer to coach parents into taking their teen to programs themselves. This shows that parents are serious about treatment, are in control, refuse to be manipulated, and have enough courage to take charge.
Occasionally a teen has to appear in court and I’ve seen a favorable court response when parents have been proactive and sent their kid to a residential program for therapeutic treatment. Undoubtedly, the natural setting itself in the wilderness has proven highly beneficial (http://bit.ly/2cnoYn7).
Living among trees on mountains or on the mesas of Utah disconnects kids from all electronic gadgets and allows them to slow down and find their natural rhythm. Kids learn self-efficacy through mastering difficult tasks like busting a coal in order to start a fire, so that a hot meal can be prepared jointly with others. This task alone can teach impulsive and impatient teens to deal efficiently with unexpected events, develop coping skills and build self-confidence.
Unlike other outdoor expedition programs that focus on environmental stewardship, wilderness programs are intentionally therapeutic. Mother Nature offers a laboratory where kids learn to problem-solve alongside other peers. For the first time they may get enough sleep, exercise and natural foods. They journal their experiences and write to their parents. Therapists help uncover issues that may have hindered the family from growing together. In this setting, he/she can be tested and clinically evaluated accurately. The relationship with their therapist and peers teaches them responsibility, accountability and resilience.
Residential Treatment Centers (RTCs) focus on kids who need more intense or acute clinical treatment and medication management. Some offer short term assessment (2-4 weeks), while others provide longer term therapeutic intervention, stabilization, and behavioral support (6-9 months). Depending on individual State licensure, specialty RTCs offer medical monitoring just like a hospital would, if they are accredited by CARF (Commission on Accreditation of Rehabilitation Facilities) or JCAHO (Joint Commission on Accreditation of Healthcare Organizations).
Emotional Growth Boarding Schools offer therapeutic treatment and education, along with support and nurture. These boarding schools typically work well for teens with varied learning styles, ADD/ADHD, anxiety, depression, peer conflict, school refusal, low self-esteem, grief and trauma, difficulties with parents, body image and gender issues. Do not confuse these boarding schools with military schools – which can use negative reinforcement to shape behavior. Do not confuse these schools with boarding “preparatory” schools that enroll healthy teens, from very high achieving students to teens who may have some learning disabilities. If caught smoking or drinking students are expelled, often on a first strike.
Transitional Independent Living for Young Adults are designed for 18-22 year olds who need training and practice to “launch” into adulthood. They get help as they recover sobriety, find work, may take college classes, volunteer at community centers and participate in the running of the group home. There are specific components to each program though a common denominator is life-skills training, 12-step meetings, group and individual therapy.
Bunnies and Ferrets
Parents often worry about their teen being placed in a therapeutic group with “worse kids” than theirs. In plain language (of for the lack thereof) I compare kids to “bunnies” or “ferrets” classification. Bunnies tend to turn their anger and emotions toward themselves. They may cut, starve or overfeed themselves. They may use drugs as a way to escape. They may be unable to learn even though they are smart enough.
Ferrets on the other hand, act out outwardly, blame and attack others, become street smart and gang leaders. They tend to become socially maladjusted. Teens may exhibit signs of both but looking at the onset of symptoms, their intellectual functioning, academic achievement among other indications, one is more dominant. I would never refer a bunny to a program that is geared for ferrets. For example, ferrets can benefit from military school, but not bunnies!
When I visit programs I talk with teens to assess how the program is working out for them. In my mind I figure out if they are bunnies or ferrets. I evaluate the direct care staff, licensing and accreditation, therapeutic modality and clinical approach. As a professional member of IECA and Certified Educational Planner, I maintain knowledge of any significant programmatic or staff changes. I like to examine programs from a safety perspective as well. When kids are placed in wilderness there is always an amount of risk. Day and night staff members are trained as first-responders and are able to react on a dime. Therapists have masters’ degrees with years of experience with teens. It is costly to oversee teens in such settings, which is why these programs are expensive. Some families just can’t afford these programs, so I end up referring to DSS, local hospitals and mental health professionals. If parents tell me their budget however, I can help them invest their limited resources in the most productive program, one that will have the most impact and benefit on their teen.
Message for Parents
It takes a good deal of courage for parents to turn over the care of their teen to a wilderness and residential treatment program. It may be the most difficult decision we as parents will ever make. Some hope that it’s just a stage. It’s hard to tease out what is typical teen behavior and what is more than that. However, parents have that gut feeling and know their kid. Wilderness camp offers unique growth experiences that benefit every teen, whether mentally ill or not.
Some teens need more deliberate approaches with interventions not possible at home. Parents may worry about their teen falling behind in school, when the therapeutic treatment may be far more important for now. Once kids stabilize, they can recover credits in many ways. To help parents feel more persuaded that it’s the right thing to do I send them out to visit appropriate programs, so they can get to know the people who run them and feel more comfortable.
The benefit of positive peers
Adolescents grow in groups. Some families ask me to find their child a program that gives them individual therapy. But in group therapy these teens become a family and exhibit the same behaviors as at home, treating peers as they would siblings and parents. Parents often get worried when their kid acts out at a program and fear that the program isn’t working. However, the program needs to witness those behaviors and address them in a very direct manner. This helps the staff and therapists observe the teen as he resolves his/her issues and builds better coping skills. It’s how teens can practice building productive relationships which they will have in place once they return home. Oftentimes it’s not just the teen who benefits. The entire family heals.
*Lee, Joseph, M.D. ABAM, Recovering My kid: Parenting Young Adults in Treatment and Beyond (for parents who already know their child has a problem with drugs or alcohol. Explains how addiction and mental health issues operate in young people)
JoAnn Deak, Ph.D. Your Fantastic Elastic Brain – Stretch it, Shape it.
C. Claire Law, M.S. is an IECA Consultant on Daniel Island. She is certified in placing students in college, boarding schools, wilderness and residential treatment programs. She spends 20% of her time visiting therapeutic schools throughout the US and matching students’ needs to specific program. Claire is a certified NAMI Family-to-Family teacher.