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News & Views - Feb, 1995 Issue #32 

by: Elaine Bruce
Boise, Idaho

As an established medical model residential treatment center, we receive calls of interest for possible admission into our distinct program for adolescents. The initial call is the beginning of a comprehensive clinical screening process designed to appropriately assess the adolescent's effectual need for a locked residential treatment program vs. Other options the family will need to thoughtfully consider before any decisions are made. 

The alternatives to placement must be first explored and exhausted. Criteria being evaluated are behavioral, medical and/or psychiatric problems, history of previous treatment, including all outpatient and hospital stays, therapeutic group homes, schools and any other past approaches that have been tried for the adolescent. If the adolescent has not yet tried therapy on an outpatient basis and can still be managed successfully within his home or school, this disposition must be explored if there are signs that psychiatric symptomatology are evident. If the information we receive from the family or other referral source indicates moderate behavioral problems and all psychiatric criteria has been ruled out, our residential program would not be the correct course of placement in such a case. A better alternative often may be a referral to a qualified family therapist, placement to a well-structured school, or merely a parenting class for the parents. Thorough and conscientious qualification is crucial to the needs and future of the adolescent and is also indicative of the professionalism and ethical philosophy of any of the several adolescent programs now available throughout the U.S. and abroad. 

If the adolescent truly needs medically based residential treatment, a typical hypothetical profile would include: a DSM-IV diagnosis indicating moderate to severe mental disorder, stabilization on a pharmacologic regime, all acute symptomatology also stabilized (actively suicidal behavior would not be appropriate), a demonstrated need for continuous skilled psychiatric observation, supervision, structure, high dose medication or therapeutic milieu, recent IQ testing of 75 or above, and behavioral problems which severely impact social, familial, occupational or educational functioning. 

Other criteria for admission must still be considered before the residential treatment team accepts the adolescent. The impact upon the whole milieu of patients in the program must also be a factor of the acceptance. Any history of sexual perpetration and other symptoms such as fire setting need to be examined and in the recentness and severity of each incident. Differentials need to be established between a continuum of sexual experimentation considered still within normal boundaries to that of a well-established pattern of aggressive sexual assaultive behavior. Careful examination of fire starting is also clarified as is the difference between early age experimentation and signs of certain arsonist conduct. The extreme behaviors of perpetration and fire setting need a specialized treatment and must have the long-term programs designed for behavior modification in a secure setting. Acceptance of either of the two behaviors in a positive peer program with many victims of abuse is not conducive for either the adolescent needing treatment and the other adolescents in the program. 

Family involvement is essential due to the severity of the problems that the adolescent is exhibiting. Teleconference family therapy sessions are mandatory for families coming from out-of-state and are surprisingly effective, though long- distance. Every effort is made by the treatment team to facilitate this process. In closing, the key to success from this type of selective screening is that the family is very clear on what the expectations of the treatment plan are, and the likelihood for good outcomes become high at the onset. 

Copyright 1995, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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