Presentation on theme: "Adolescent Externalizing Behaviors"— Presentation transcript:
1Adolescent Externalizing Behaviors Joshua Leblang, Ed.S., LMHCDivision of Public Behavioral Health and Justice Policy
2Our youth now love luxury Our youth now love luxury. They have bad manners, contempt for authority, they show disrespect for their elders … they contradict their parents…and tyrannize their teachers."Socrates (c BC)
3The number of boy burglars, boy robbers and boy murderers is so astoundingly large as to alarm all good men."New York Times editorial in 1857
4Disruptive disorders, such as oppositional defiant disorder and conduct disorder, are characterized by antisocial behavior.It presents as collection of behaviors rather than a coherent pattern of mental dysfunction. As such, there is no “magic bullet” to fix the problem.
5Normal Adolescent Development (AACAP, 2005) Movement towards independenceMore cohesive sense of identityAbility to think ideas throughConflict with parents begins to decreaseIncreased ability for delayed gratification and compromiseIncreased concern for othersPeer relationships important and take an appropriate place among other interests
6Morals, Values, and Self-Direction Greater capacity for setting goalsInterest in moral reasoningCapacity to use insightIncreased emphasis on personal dignity and self-esteemSocial and cultural traditions regain some of their previous importance
7For adolescents that you may encounter It is rare that an adolescent self-refers themselves to counseling.Externalizing youth are rarely interested in “insight”Engagement with the youth is important, but equally important is parent/caregiver—Ensure attendance at sessions.Reinforcing any new behaviorsProvider of “reliable” information about behaviors.
9Why do we need to know what works? First, many programs, despite their good intentions, are either ineffective or actually do more harm than good.Second, ineffective or harmful programs are a waste of scarce resources.Blueprints for ViolencePrevention
10Biases against Evidence-based Practices “They are too rigid and cookbook”“Doesn’t apply to real world kids with real world, multi-problem histories”“Developed in some lab”“Overly simplistic”“Too difficult to implement in community setting”“Just a band-aid and doesn’t address underlying issues and concerns”“Another passing fad”“My training and expertise are not valued”10
11Why use EBT’sInterventions showing beneficial effects in outcome research should be taught and used in preference to interventions that have not been tested and shown to be effective.National Institute of Mental Health (National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention and Deployment, 2001),Office of the Surgeon General (1999, 2004),President’s New Freedom Commission on Mental Health (2003)
12Rationale for Using Evidence-based Practices Programs that are integrative in nature (practice, research, theory) and use systematic clinical protocols ”clinical maps”Manual drivenModel congruent assessment proceduresFocus on adherence and treatment fidelityClinically responsive and individualized to unique “outcome” needs of the client/familyModels that have strong science/research support12
13Family Factors that Promote Resiliency (National Resilience Resource Center) Parent and family connectedness Parent/Adolescent activities Parental presence Parental school expectations Parents involvement and awareness of sexual behaviors Limit access to substances and weapons Seek help for parental and familial problems/concerns Seek support from other parents Know community resources
14Program characteristics that support positive youth development 1. Comprehensive, time-intensive2. Earliest possible intervention3. Timing is important4. High structure is better5. Fidelity to model is key to effectiveness
15Positive Youth Development (con’t) 6. Need adult involvement7. Active, skills-oriented programs are more effective8. Programs that target multiple systems are most effective9. Programs that are sensitive to the individual’s community and culture are best10. Programs based on strong theoretical constructs and proven effective by evidence are bestConnecticut Center for Effective Practice (From meta-analysis published in 2005)
163 Treatments top the list for adolescents ALL focus on family/ caregiversFunctional Family TherapyMultidimensional Treatment Foster CareMultisystemic Therapy
17What is Functional Family Therapy? Focus is to improve family communication and supportiveness while decreasing the intense negativity so often characteristic of these families.Many of the targeted interventions, therefore, emphasize communication skills, family interaction, problem-solving and promoting constructive behaviorsIntervention ranges from, on average, 8 to 12 one-hour sessions up to 30 sessions of direct service for more difficult situations
18What is Functional Family Therapy? Conducted both in clinic settings as an outpatient therapy and as a home-based modelA treatment technique that is appealing because of its clear identification of specific phases, which organize intervention in a coherent manner, thereby allowing clinicians to maintain focus in the context of considerable family and individual disruptionEach phase includes specific goals, assessment foci, specific techniques of intervention, and therapist skills necessary for success
19Functional Family Therapy A treatment technique Functional Family Therapy A treatment technique
20Multidimensional Treatment Foster Care (MTFC) Program Overview:The goal of the MTFC program is to decrease problem behavior and to increase developmentally appropriate normative and pro-social behavior in children and adolescents who are in need of out-of-home placement.20
21MTFC MTFC treatment goals are accomplished by providing: Close supervision; fair and consistent limits ; predictable consequences for rule breaking ; a supportive relationship with at least one mentoring adult; and reduced exposure to peers with similar problems.The intervention is multifaceted and occurs in multiple settings. The intervention components include:Behavioral parent training and support for MTFC foster parents;skills training for youth;supportive therapy for youth;school-based behavioral interventions and academic support;and psychiatric consultation and medication management, when needed.
22MULTISYSTEMIC THERAPY Youths’ behaviors are influenced by their families, friends, and communities (and vice versa).Families are the key to success, so all aspects of treatment are designed with full collaboration from the family.Change can happen quickly, but it demands daily and weekly efforts from the youth and all the important people in his/her life.Families can live successfully without involvement in social service agencies.
23How is MST Different?Discipline: Offers a combination of “best practice” treatments within a disciplined structureAccountability: At all levels, providers are held accountable for outcomes through MST’s rigorous quality assurance systemEcological validity: Working in the youth’s natural environment with existing family supports, thereby ensuring cultural sensitivityFocus on long-term outcomes: Empowerment of caregivers to manage future difficulties; focus on sustainability
24How Does MST “Work?”Intervention strategies: MST draws from research-based treatment techniquesBehavior therapyParent management trainingCognitive behavior therapyPragmatic family therapiesStructural Family TherapyStrategic Family TherapyPharmacological interventions (e.g., for ADHD)
25Why is MST Successful?Treatment targets known causes of delinquency: family relations, peer relations, school performance, community factorsTreatment is family driven and occurs in the youths’ natural environmentProviders are accountable for outcomesStaff are well trained and supportedSignificant energies are devoted to developing positive interagency relations
269 Principles of MST Finding the Fit Positive & Strength Based Increasing ResponsibilityPresent focused, Action-orientatedTargeting SequencesDevelopmentally/ Culturally AppropriateContinuous EffortEvaluation & AccountabilityGeneralization
27An ecological approach Work with the entire ecology. By addressing the multiple systems, it is possible to make longer lasting changes for families.CommunitySchoolPeersFamilyYouthBronfenbrenner, 1979
28Condensed Longitudinal Model of Youth Antisocial Behavior FamilyPrior antisocialbehaviorLow MonitoringLow AffectionHigh ConflictAntisocialPeersAntisocialbehaviorSchoolExplaining delinquency and drug use, by D.S. Elliott, D. Huizinga and S.S. Ageton. Beverly Hills, CA: Sage Publications, 1985, 176 ppLow School InvolvementPoor Academic Performance
29Individual Factors Antisocial behavior Mental health problems Low social conformity
30FAMILY Poor monitoring Ineffective discipline Low warmth High conflict Parental drug use/abuse
31PEER Association with drug-using peers, Low association with prosocial peers
32SCHOOLLow achievementTruancyLow commitment to school
33Neighbors who use drugs COMMUNITY FACTORSHigh crimeNeighbors who use drugsTransience
34What usually happens to youth? Youth gets in troubleSent to treatmentMeets other anti-social peersNo changes at homeCYCLE CONTINUESReturns home
35What usually happens to youth? Sent to treatment / groupYouth uses drugsMeets other drug-using peersCYCLE CONTINUESNow has greater access to negative peers, people to buy from
36Case Example 16 year old male Hx of truancy (missing school 2-3 days/week)Runaway (usually 1-2 nights but as long as a week)Defiant/oppositional –refuses to follow household rules
37Case Example 2 14 year old female Involved with negative peers Reportedly gang-involvedAlcohol/marijuana usageStealing/shoplifting charges
38How can we best use this??? House Bill 1373 …up to twenty outpatient therapy hours per calendar year, including family therapy visits integral to a child's treatmentHow can we best use this???