Frequently Asked Questions
· How will my child be assessed and matched for treatment services?
· How does the program take a comprehensive, integrated approach to treating adolescents?
· How is the family involved in the treatment process?
· How are the program's services developmentally appropriate to treat adolescents as opposed to adults?
· Is the content designed to engage and retain youth?
· How are staff trained?
· What is the ratio of staff to clients?
· How does the program deal with gender and cultural competence?
· What continuing care services will my child receive?
· How can I contribute to Turn About?
How will my child be assessed and matched for treatment services?
Many clients are referred through schools, where counselors have on-site communication with adolescents. The school has a referral form, which notes grades, attendance report, conduct and behavior, and teachers' comments. Counselors obtain permission from parents to refer adolescents to the program. At this point, the adolescent comes to the facility for an assessment. Assessment typically consists of interviews with the family and adolescent, Beck Depression Inventory, Substance Abuse Subtle Screening Inventory (SASSI), and the Family Environment Scale. The Minnesota Multi-phasic Personality Inventory (MMPI) will be used as appropriate. Staff will use the MMPI with Adolescent specialties for those 18 years and under. The adult MMPI will be used for those over 18 years of age. Clients in the intensive outpatient program may be reassessed 3-6 months after the initial assessment.
The assessment includes 2 in-depth psychosocial inventories, one completed by the parents, one by the client. In addition, a through current and historical physical health questionnaire developed by Turn About's medical director is completed by the client and parents. Readiness and motivation for treatment is assessed. For adolescents, we have found the most important persons to be ready and motivated toward treatment are the parents. With consistent structure provided by Turn About and the parents, we can often create motivation and readiness in the client.
Counselors with master's degrees and/or higher qualifications conduct the assessments.
Staff create an initial treatment plan to reach the goal of abstinence within 3 days of the client's arrival. This plan includes concrete objectives and exercises in getting honest, not using drugs or alcohol, journal and paperwork, feelings, facts about drugs, expectations by parents and program, and dates for completion. Staff also look at DSM IV issues including substance abuse, conduct disorder, oppositional defiant disorder, ADHD, depression, bi-polar disorder, anxiety disorders, developing personality disorders, abuse issues, and/or behavioral problems.
A contract accompanies the treatment plan that is behavioral and very specific. The contract outlines consequences that the program asks parents to apply consistently.
How is the family assessed?
The program will asses family dynamics using information gathered from the client, the parents, family conferences, direct staff observation of family functioning. The Family Environment Scale may be used. All family members are included in the assessment at some point during the client's program. Family contracts may be a result of such assessment, structured much like the client's treatment plan.
How does the program take a comprehensive, integrated approach to treating adolescents?
The program addresses various issues in the client's life, including:
- Schools: The program receives most of its referrals from schools. Turn About has master's and PhD level counselors present in the home schools of our clients for a number of hours each week. Close contact is kept with the school personnel involved with Turn About clients. Attendance records, disciplinary records, teacher/administrator concerns, grades, and teacher/parents/counselor conferences are all used to note improvement by the client in the school environment.
- Juvenile Justice: The program receives referrals from juvenile justice.
- Mental Health: Master's and PhD level counselors work with clients with co-occurring mental health disorders. They attend meetings with the psychiatrist, family and client. Some psychiatrists solicit joint working with Turn About.
- Community: The program has a state grant that allows 2 counselors to give chemical education training to professionals in the community, including teachers, counselors, mental health professionals, school resource officers and social workers.
- Physical Health: Concerns about a client's physical health, including sexual health are discussed with the client. If a client is under age 18, these concerns may be addressed with the parents. A referral to a physician or Public Health Department will be made given unresolved concerns or certain criteria endorsed by the client on an HIV/AIDS risk assessment.
How is the family involved in the treatment process?
The program provides parent training and support groups every Monday night from 5:30 – 6:30. Supervision for the adolescents or a chemical education class for the adolescents is provided during this time. The parent training includes how to communicate with the child, how to recognize signs and symptoms of drug use, how to deal with adolescent behavior, and how to provide structure and consistency. These sessions also address co-dependency and enabling issues. Staff provide support, teaching parents not to be ashamed, that they are not bad parents, they can ask for help, and that there are other people in the same situation. The length of services depends on the child's progress. Former parents of the Turn About program sometimes provide additional support and guidance in these meetings. Parents must attend these Monday night meetings and biweekly family conferences. Parents sign a contract stating that they will follow the rules and procedures of the program.
The program requires parents to be sober, and staff will confront parents about their use of illegal substances or abuse of legal substances. The idea is to help parents understand how their use is affecting their child's sobriety.
The program stays connected to families through the Monday night meetings, a minimum of biweekly family conferences, telephone contacts, notes/journals left for the primary counselor by the parent and brief meetings at drop-off or pick-up. Turn About is working on having a medical information secure e-mail provider with fire-wall protection for parent/client/counselor contact.
How are the program's services developmentally appropriate to treat adolescents as opposed to adults?
The program distinguishes between different developmental needs of middle school, high school and college age clients. Materials such as workbooks are age appropriate. Experiential/hands-on therapeutic activities are utilized. Roles-plays are essential for changing behaviors and training clients to cope differently. Having the client explore life activities (renting an apartment, having a baby, buying a car, buying groceries) can often interrupt “magical thinking.” Art and music therapy are another outlet for expression of feelings and looking at self. Looking at where the individual client is developmentally determines how much of their treatment is focused on concrete concepts rather than abstract thinking. Parents are trained to understand the need for concrete contracts and consequences for their child. Issues of dependence on parents are addressed, as well as working toward independence.
Turn About does not provide treatment for independent adult clients.
Is the content designed to engage and retain youth?
To engage adolescents in treatment, the program utilizes motivational enhancement therapy, in which motivational interviewing is used to help the client understand the risks associated with continued use. Additionally, the program focuses on hiring creative counselors. Staff attempt to frame topics in a way that is relevant to clients. Treatment includes different activities, music and art to appeal to youth. The peers helping peers approach is used in group. Adolescents are encouraged to encourage and confront, as needed, their peers in their similar quest to be sober and functional in their path toward independence and reaching their personal goals.
The program uses a point system that determines whether clients advance in treatment and gain privileges. They can also earn field trips and special treats. Clients lose points for being rude or disruptive.
Within the treatment groups, the program addresses eating disorders, anger management, relapse prevention, concerns regarding sexual orientation, dual diagnosis issues, authority issues, rights vs. privileges, responsibilities vs. privileges, nicotine, alcohol and drug/abuse addiction, self-mutilation, being the victim or the perpetrator of abuse, identifying and dealing with feelings of any kind, forming a sense of self that is healthy and satisfying, how to recreate without drugs, etc.
Staff emphasize urge control, which helps clients recognize and change thoughts, feelings and plans that lead to drug use or other destructive behavior; social control which involves family members and other people important in helping clients avoid drugs; and stimulus control which helps clients avoid situations associated with alcohol, tobacco and other drug use and learn to spend more time in activities incompatible with drug use.
Family members are required to be an active participant in their child/adolescent/young adult college student's treatment. Any parent not attending parent meetings or not making themselves available for the minimum of family conferences, who are reported to not be enforcing the Turn About rules, or who are abusing drugs/alcohol themselves, are contacted by the primary counselor and are required to come in for a conference to address these concerns. If the parent refuses to satisfactorily correct the above treatment needs, an outside referral not requiring family participation may be made.
How are staff trained?
All direct service staff have a master's degree or higher (PhD) in counseling, human services, social work or psychology. Graduate work also requires an internship. Staff have required readings and continuing education 16 hours per year. Staff lacking experience with adolescents are "shadowed" by more experienced counselors for 30 days.
Clinical supervisors have worked with the agency 20 years, 17 years, 10 years, 3 years, and 2 years. Staff turnover is low. These counselors include a licensed clinical social worker, a master's level certified addiction professional, a doctoral candidate, 2 masters of science, one with an additional Educational Specialist degree. All counselors are license eligible and are working toward licensing. On staff are 2 additional doctoral candidates and additional certified addiction professional. Supervision of staff is frequent with daily feedback available. There is a weekly staff meeting, and supervisors observe counselors in group therapy once every couple of weeks.
What is the ratio of staff to clients?
One staff member to 5 clients.
How does the program deal with gender and cultural competence?
Boys and girls are offered the same treatment services. The clinical staff is culturally diverse and we are working to be more diverse in gender. Staff receives training in cultural diversity.
To ensure safety, clients are supervised at all times while present at the Turn About facility.
The program works with clients who are questioning their sexuality.
What continuing care services will my child receive?
Relapse prevention and peer influences are discussed consistently throughout the program. Staff focus on how the peer group has affected clients' lives, noting negative as well as positive influences and emphasizing the negative consequences of substance use.
The program has a 3-month aftercare component built into the program. The structure gradually decreases as the client advances. Clients must complete the requirements of the contract before being released from program. Families are encouraged to stay in touch with the primary counselor and the aftercare counselor during this time. Family conferences may be held as needed.
Adolescents are also linked to Twelve Step meetings as part of their aftercare.
Adolescents are encouraged to attend aftercare even after the formal contract has been met. With this attendance, the program continues to work with the family as well. Periodic phone contacts are made with the client and/or the parents regarding progress after leaving the program. The frequency of this contact often depends on the willingness of the client/parents to participate. Given permission, Turn About counselors will maintain contact with the client's home school to note any relapse behaviors and to initiate intervention.
Clients are encouraged to get involved in extracurricular activities that interest them. Turn About counselors may facilitate the initial contacts toward this end. Any ongoing unresolved issue, such as an academic difficulty or mental health issue, is addressed with a referral to the appropriate agency.
How can I contribute to Turn About?
To find out more on contributing to Turn About, click here.
Turn About, Inc. provides services without regard to race, color, sex, creed, religion, national origin or handicapping conditions.
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