Coming Home from Treatment: A Game Plan for Your Teen

September 20, 2021

Episode Transcript

Selina
Hello, and welcome to On Air with Elk River Treatment Program for Teens, the residential program of Pinnacle Behavioral Health. I'm Selina Mason, the Director of Marketing and Outreach. Today, we welcome Amy Moor, Clinical Coordinator for Elk River Treatment Program. Thank you Amy, for taking time out of your busy schedule to talk with us today. Thank you for having me. So can you talk to me, or rather talk to parents out there that are listening, about how they know when it's time to consider a residential placement or an intervention like residential?

Amy
That's a great question. I think that's a parent's hardest decision - having to decide that they really need some bigger outside help. Definitely when a kid is starting to show signs of not managing life in a productive way, you want to reach out to those basic resources. Not ‘basic,’ but ‘first-level’ resources: an outpatient therapist, or an outpatient psychiatrist (depending on what the behaviors are or the intensity). Or you may need to look at perhaps an intensive outpatient program where they're going to group a few times a week. When kids really start to become unsafe - when those behaviors continue to increase despite the attempts - or maybe even when you try to get them into those first level of defense, so to speak, of outpatient care, and they refuse to participate. Those would all be instances where it is time to go to a higher level, where they're going to be surrounded by therapy and have staff available to them who are going to be able to keep them safe and keep them supervised. They're going to have regular access to treatment to start working on those issues and figure out what's going on underneath all that.

Selina
So they don’t need to be looking for something like a summer camp, right? It needs to be therapeutic.

Amy
Yes. You definitely want to have the therapeutic aspect to it. No, it is not a time to be looking for camp and fun and games. You want a program that focuses on the therapy, focuses on the behavior, and there's different varieties of doing that. We take a very minimalistic approach in that we don't have a lot of distractions out at the program. Everything that they do out there is focused on the therapy. Every part of their day has some therapeutic component to it. We don't have a lot of distractions like TV or things of that nature because we want kids to come in, get to work, figure things out, and get back to their family because that's where they're supposed to be. Residential can be a longer-term thing and some kids may need a longer time to be able to work through everything. But ideally we want kids to come in and get to work so they can go back to having more productive lives in a safe manner.

Selina
I have a question about returning home. Let’s say they go to the campus or they get to a facility and into a program and they make great progress. The parents make good progress as well. How can they solidify those gains once they get home?

Amy
Yeah, discharge planning is probably one of the most vital parts of a client's treatment. Yes, the work that they do in the program with us is the foundation. But if you don't continue to build on that foundation, when they get home, then things can start to fall apart. And so, and it's just as vital with what the parents do as what you know the child does. And so we actually have our parents start discharge planning from the beginning. Our clients move through different stages of the program and they have different assignments that they work on at those different stages. The parents have assignments too; they have their own homework and with each one it's fine-tuning that discharge plan. So first and foremost, we should look at who's going to be their individual therapist. Our recommendation is that every child continues with individual therapy when they go home. And so who's going to be that individual therapist? You typically want someone who has a background in family systems and has a background in trauma as well. We at the program view trauma in a broad spectrum. And so having someone that is experienced in that is beneficial.

Selina
Okay. Family systems. Can you explain that?

Amy
They just do that family work, so they know how families interact with each other, and that it's not just one person's problem to be fixed, but that it's everybody working together for the betterment of the family. So they know how to work with the family as a whole. They also know how to work with clients individually, but then they know how to bring it together and address everything within the family. Depending on your child's behaviors, being able to find someone that maybe has more of a background with substance use is always a good thing. And so you can tailor it from there, but having an individual therapist with a basic background in family and trauma work is a good start. If your child is on any kind of medication, you want to make sure you have a Child and Adolescent Psychiatrist. It's really important that they are Child and Adolescent, because meds interact differently in kids than they do in adults.

It’s not that a psychiatrist that works with adults couldn't do it, but the Child and Adolescent Psychiatrist is going to be more up-to-date on the research. And what is best addressed for kids in regards to medication? Well, that's why we have pediatricians. It's the same thing, their bodies and their brains just function differently, especially as they're continuing to develop. So we want to make sure we're addressing that appropriately. Sometimes also a client needs to step down slowly from residential and step down into something called a Partial Hospitalization Program (PHP). And that's typically a day-long treatment where they would go and they'd be there from about eight to four. And then they spend the night at home.

With certain insurance policies, we do have a PHP portion of our program. We can look at doing that with some of our families and, they would remain boarding with us. We address that with each parent on an individualized family basis. But if for some reason they can't do it with us, then finding a PHP program close to them is beneficial - looking at a PHP program or sometimes just going to what's called an Intensive Outpatient Program or an ‘IOP’ program. That’s typically a group therapy session, a few hours a day, a few days a week. For some of our local families we have an IOP program. So we would look to see if that continuity of care would be beneficial in support of those families. Those are the basic therapeutic aspects that we want to look at when doing discharge planning,

Selina
I would assume structure is important.

Amy
Structure is very important. Part of the kids' assignments when they're working through the program is creating a ‘home safety plan.’ And in that home safety plan they create a daily schedule and work with their family to create implement it. Part of what we do at the program is reconfigure a client's day. Most kids when they get to us have their days and nights mixed up: they're sleeping all day and they're up all night. And so we get them up at the same time. Every single day, they have breakfast the same time every day, they have lunch at the same time every day, dinner, they get their meds, so on and so forth, and they go to bed basically the same time each night. And so they're getting a certain amount of sleep each night, they're having structure throughout the day.

That helps with having a more productive day, but also a more productive sleep. They are physically active during the day and they are ready for bedtime. And so their sleep is going to be much more productive because we've got that structure and we've got that preparation for bedtime. It also prepares the body for sleep too, but prior to coming to us, their sleep and their days are all kinds of mixed up. That's just not healthy for our bodies’ and our brains’ development and our brains’ healing. So being able to get them on a regular eating schedule, getting good calories in, and good healthy fats and carbs, and all the things that their bodies need to function. We have three meals a day and two snacks a day as scheduled eating.

Obviously, at home, families can't be as strict and as structured as we are, but you can still have that regular time up and time to bed. Limiting access to social media is really important. Even just screen time - as a whole, screen time is kind of the “it” saying when you're talking about little kids, but it's just as vital for adolescents as well. If you have a ‘trauma brain’ or an ‘ADHD brain’ and you put it in front of a screen that's moving, it keeps that brain stimulated. And so it's hard for them to calm down at night and be able to relax at night. And so you know, having the agreement that an hour before bedtime, we're going to shut off, at the very least, looking at the phone, and maybe just sit as a family and watch TV, but not having that screen close to their eyes and allowing that brain to start to calm down is important. Having time at the dinner table that is not necessarily a thing of the past, but doesn't happen as much families are on the go. But that regular family time (even if you don't do it every night) perhaps a couple meals a week having dinner time together is just so important. Having that communication check-in with each other, seeing how everybody's doing. Using the structure of your daily schedule can help build all those things in.

Selina
Is that part of creating boundaries, as well? Does that tie in to boundaries?

Amy
It can, definitely. What are the boundaries in our home as far as: when is family time, when is quiet, personal time? Being able to set those limits is going to be really important. And again, for each family, it's going to look different, and we work with our families to figure that out because the important part with boundaries or any expectation is: can you follow through with it? We may have a nice idea what we're going to do, but maybe in reality, that's just not going to work. So let's be realistic about how you guys can set up communication, have healthy boundaries with each other and just build more positive skills moving forward.

Selina
So you have a plan, or the child comes up with a plan, and I'm assuming the parents agree, or they modify it?

Amy
Yep. They work together on it.

Selina
And then, say something's not really working out. Do you have family meetings once a week? I mean, is it important to do that - to reevaluate? I'm not saying to negotiate. That's not my point. As a parent, I know that I have flown off the handle and established a boundary way too strict that even I couldn't adhere to. But then it's hard to back down because, like I said, that's what I was going to do now. What do I do there? Is there a day or once a week or every other day or a check-in recommended?

Amy
Yeah. So having a quick family meeting once a week, I think, is beneficial, whether it's at the start of the week or the end of the week. I always like the idea of it doing it at the start of the week. Because you can plan your week ahead, look back on what just happened and “How'd that last week go for us? What changes do we need to make and what are we looking forward to in the week ahead?” and again, with scheduling or building in that family time, following through with consequences and being able to have those conversations, but also looking at that family plan and seeing what's working for us and what's not working. Hopefully what's happening is that when your child first comes home, it's going to be really strict and tight boundaries because they've got to come back and build that trust.

And so hopefully as they build that trust up, which is about being able to take a risk with your child. We like to associate trust with love, but has nothing to do with love, but everything with me being willing to take a risk with you. And so as I'm more willing to take a risk with my child, hopefully I can ease up on those boundaries a little bit, give them a little bit more space and a little bit more freedom. So yeah, you want to be assessing that on a regular basis in regards to what you were saying. Sometimes you come in a little too hot with the consequences. It’s okay to be able to come back and say that to your kid, but I would recommend having a plan of maybe what the change is going to be.

So it's not just, “Yeah, I messed up on that. That was too much. We're going to ignore it,” but “This is what I've decided is more natural and logical. This is what we're going to do instead.” I think that actually really builds communication up; that builds that relationship. I've learned when working with the teenagers that they can smell if I'm not being honest, they know it.

Selina
Like a horse.

Amy
Yeah, exactly. They've just got that sense. And so they really appreciate, and there've been times I've had to come back and say, “You know what, I didn't approach that right. I didn't say that the right way,” or, “You know, what I thought in my head was a really good plan and that was gonna work, didn’t, so let's reconfigure it, let's figure this out.” If you think about it, anybody respects that - it's not just teenagers, but we as humans respect when someone owns their behaviors, makes amends on it, and figures out how to move forward with it. I think it's important that we live as an example of that to our kids.

Selina
You're definitely the mentors on the campus. Now you mentioned natural and logical consequences. I think I hear that a lot. It does make sense, but I don't know, as a parent in crisis, if I would know what the heck you were talking about. So you want to maybe give me an example of that?

Amy
Sure. So yeah, ‘natural and logical consequences.’ You want to make sure that a consequence matches whatever it is that you're trying to address. We have to really work through this with families, because often families want us to simply provide a list of consequences that they get to go home with.

Selina
Just give me a list or a book; a book would be great!

Amy
Exactly. And I wish I could do that, but it's not that easy. Again, going back to the boundaries, I don't know what's feasible for you to be able to maintain. If a kid's grounded, that typically means the family's grounded, right? So if a kid can't watch TV, that means no one's watching TV in the living room while said grounded child is present. So you've got to be able to follow through on whatever you put out there. If you say “no car,” that means you've got to drive your child around, or you got to have a way to get them to their places that they're going. Again, is that a punishment or not? We don't want “punishment” because “punishment” comes out of anger, but is that a consequence you're willing to take on too? You must be able to look at the situation and ask “What am I trying to teach them? What do they need to learn?”

In our day and age, we want to go right to hurting them back, so to speak, by taking away that phone, taking away that social media, just saying “give me that,” which in some instances may be natural and logical. If you asked your child to take the trash out, and the reason they never took the trash out was because they were playing on their phone too much, then yeah, they may get to lose the privilege of their phone, but they may also need to clean all the trash cans because now they're going to be stinky before trash day comes again. So you have to figure those pieces out. If the behavior had nothing to do with the phone, then you're not really sending the right message just by taking that away. At that point, you're just trying to kind of get them in their feelings and hurt them where it hurts, versus being able to teach them whatever it is that they need to learn in the moment.

And so you have to slow down and look at what do they need to learn. The first and foremost thing, when looking at consequences is: are they safe? If they're safe, you've got time, so you can get creative and you can think of what is going to be the best way. If you have a partner that you are raising your child with, you want to make sure you consult with the partner too. So you guys are on the same page and coming as a unified front. It’s important to have all those pieces in play.

Selina
So if a child doesn't wash their clothes, you don't run and wash them for them and have them ready the next morning?

Amy
I wouldn't recommend it.

Selina
What is it that they're learning if you wash their clothes?

Amy
Exactly. Then they're just going to have to wear whatever they've got that's clean. If they come to you late and say “By the way, I have this project due tomorrow and I need X, Y, and Z,” and they’re telling it to you at seven o'clock the night before, it's a consequence of that they may not get a good grade on that project or they may get in trouble for it. That starts to teach a lesson. I'm taking responsibility thinking ahead, being proactive, and planning. And so yeah, if they were supposed to wash something and they didn't ask for help or say, “Hey, I'm having trouble getting this done,” or wherever the case may be, it's not my responsibility, it was yours, you know? So you have to be able to learn what's age appropriate for expectations, that’s important too.

Selina
So what we've discussed so far is that when a child comes home from a treatment program like Elk River they should have a solid aftercare plan for them. I mean, they should have a solid aftercare plan.

Amy
Yes.

Selina
Structure is really important.

Amy
Yes. Boundaries, yes.

Selina
Natural and logical consequences.

Amy
Yes.

Selina
Is there anything else you can think of? I'm sure there are plenty of other things.

Amy
Yeah there’s all sorts of things we can add. Going back to what the structure and the schedule is, it is important to make sure that they've got positive activities and that they can build positive peer relationships. That's gonna add to keeping them busy, getting some of that energy out. One of the things our clients address in their home safety plan is what's called A, B and C peers. Their A peers are the peers that are good for them to be around. Those are the peers that everybody's okay with. They're safe. They’re productive and positive people for them to be around. A B peer is one that for the most part is a good relationship, but maybe they make some negative choices too. And it's just something to be mindful of. Maybe they've gotten in trouble together, something like that. But they have the potential to be an A peer. C peers: those are the peers that we've got to end relationships with because it hasn't been productive. It hasn't been safe. It's added to the problem instead of improving the problem. So you have to make sure that you've got positive activities to help them build and find new peer relationships. That is going to be really important.

Selina
Because when they come home, they may not have a peers left.

Amy
Correct.

Selina
Those parents may say, “No, he's a C and you're not hanging out with him.”

Amy
Correct. Exactly. You've got to build up trust with the community as well, and that should be expected. That's a consequence.

Selina
Well, these are some great ideas for families. I really appreciate your time, Amy. I know you're busy and can't wait to get back to the campus and see those kiddos.

Amy
Oh yeah. Looking forward to continuing to work with them.

Selina
Now you did say that you were kind of frightened of working with kids that age. I mean, have you overcome that?

Amy
I love working with teenagers now. My own personal counseling style is a little bit more assertive, not quite the stereotype of what you think: laying back on a couch and just talking like they always depict in the cartoons. I just love that you can be really honest and assertive with teenagers cause that's how they are. They don't want us beating around the bush. And as I said in the beginning, we want to make this as productive and efficient a process as possible. So I like that I get to be a little bit more assertive with the clients and jus get to work and figure out the solution.

Selina
Wow, they're really lucky to have you. I'm glad you are there. And I'm glad you took the time to come to the home office today. I also want to thank everybody else for listening to On Air with Elk River Treatment Program. To learn more about a residential program for teens, you can visit ElkRiverTreatment.com or you can always email [email protected]. You can also call directly at (866) 906-8336. Thanks again, and we hope you'll join us next time, on air.