• Learn about behaviors that high-risk adolescents exhibit.
• Explore causes of emotionally troubled behaviors.
• Learn about how medication is an important component in treatment for adolescents.
• Examine interventions used to reduce symptomatic behavior.
• Use a case study to identify methods to help an adolescent.
• Learn about the programmatic approaches for adolescents from outpatient to residential care.

1. Sharon L. Foster, Patricia A. Brennan: Helping Adolescents at Risk; Prevention of Multiple Problem Behaviors.
   ISBN #: 1572309733

2. Rachel Simmons: Odd Girl Out: The Hidden Culture of Aggression in Girls.
   Hardcover ISBN #: 0151006040
   Paperback ISBN #: 0156027348
   (Note: Paperback page numbers may not match hardcover page numbers.)

3. J. Jeffries McWhirter, Benedict T. McWhirter, Ellen Hawley McWhirter, Robert J. McWhirter: At-Risk Youth: A Comprehensive Response.
   ISBN #: 0534548717

1. Causes of behavior problems- possible factors that are barriers to adolescent mental health.

1. Internal

1. Biochemical - imbalance in brain chemistry

2. Hormonal -normal changes that occur in puberty

3. Substance abuse - adolescent's intake of mood altering chemicals such as alcohol, marijuana, cocaine, inhaling of glue or paint type of chemicals, designer drugs (ecstasy)

2. External

1. Family - parents with their own history of psychological/substance abuse, have alcohol/ substance abuse problems, history of physical or sexual abuse of adolescent

2. Peers - to achieve identity, find group to belong to, such as "nerds", "socies", "Goth", gangs, drug crowd, etc.

3. Environment - families with their own set of problems such as:

1. Financial problems due to layoffs or low skills

2. Legal -parents who have been incarcerated or have had adolescent removed from home due to neglect or abuse.

2. Disorders - from Diagnostic Statistical Manual (DSM-IV) of American Psychiatric Association

1. Mood (Bipolar or Depressive)

2. Anxiety

3. Thought (Schizophrenia)

4. Eating

5. Attention-Deficit

6. Developmental Disorder (Autism)

7. Alcohol or Substance Abuse

3. Functional impairments-results or consequences of adolescent behaviors and disorder if untreated.

1. Home -

1. Arguments

2. Runaway

3. Destruction of property

4. Abuse of self and others/suicide attempt

2. School -

1. Fights

2. Truancy, absenteeism

3. Grades, lack of participation

3. Community

1. Sexual acting out

2. Gang involvement

3. Arrests/drug behavior

1. Psychotropic medications are used in conjunction with behavior treatment and counseling to help the adolescent improve his/her ability to function in daily life.
2. Some psychiatric problems are caused by chemical imbalances in the brain, which medications help to counteract.
3. Types of medications

1. Antipsychotic - to prevent hallucinations and delusions.

2. Bipolar meds - to control mood swings.

3. Antidepressants - to prevent mood fluctuations.

4. Stimulants - used for attention deficit to stimulate brain functioning.

4. Benefits of medications - helps to reduce biochemical effects of disorder, and makes aggressive behavior more controllable, and helps other treatments be successful.
5. Drawbacks of medications - side effects may make adolescent not want to take possibility of multiple medications making adolescent more "zombies"; parental lack of cooperation makes it difficult for compliance.

1. Group psychotherapy - used for helping adolescent to learn ways to handle social and group situations. Allows adolescent to either participate or be quiet in group, to learn vicariously while listening to others, less threatening. Treatment of choice for substance abuse, because it helps to confront others who may be denying their use, and helps to reinforce social skills in positive manner. Two options

1. Process group - more of a traditional group therapy, process group, helping adolescents learn to express feelings in safe and positive environment.

2. Leisure skills - may be less threatening way to express emotions while doing activities, such as playing board games, doing therapy, dance or art therapy, etc.

2. Behavior modification - two different types of usage -

1. Point systems - used in institutional settings to help reinforce positive behavior and give consequences for negative behavior. Adolescent or resident earns points for behaviors - self-care behaviors, school behaviors, and participation in groups, appropriate responses to staff.

2. Behavior reinforcement - 1 on 1 observation and specific reinforcement of behavior. Used in TBS (Therapeutic Behavior Service) programs, to specifically focus on behavior, make contracts to stop or start behavior, then to monitor a adolescent's behavior in his/her environment. Adolescent is observed and either reinforced with praise when engaging in behavior that creates positive outcomes or redirected when engaging in behavior that would otherwise create negative outcome.

3. Individual psychotherapy - 1 on 1 therapy within private setting designed to go over adolescent's behavior. Example might be CBT (Cognitive behavior therapy) - use of techniques to allow adolescent to use thoughts and behaviors in productive manner to change behavior patterns.
4. Family therapy - meeting with adolescent and one family member, most likely parent, sibling, and other guardian to work on helping others change in conjunction with adolescent. Based upon principles that adolescent's family inadvertently help to keep adolescent from changing, so having family participate stimulates change from others as well.
5. Case management - Monitoring the total care of the adolescent, not only his/her psychological needs, but educational, vocational, medical, legal, financial needs that affect the adolescent as well as those of the family. This approach helps to improve the socioeconomic factors that affect the adolescent's functioning at home.

1. Program models available for adolescent

1. Outpatient counseling, where the adolescent still is living at home, consists of following:

1. Traditional psychotherapy, where adolescent can go to office alone or with family to discuss problems. Not as successful with adolescents, because they don't want to be “labeled patient” or seen as different or crazy.

2. In-home model, used in public sectors and known with Medi-Cal Early Periodic Screening Detection and Treatment (EPSDT) funding. Model allows for case manager to go into school, home and community to intervene with adolescent. Funding allows for these interventions and is highly successful because it does not rely on parental transportation, can go to adolescent to reduce resistance to care, and involves parents, educators, and others in treatment.

2. Outpatient programs such as day treatment or rehabilitation. From 3 to 6 hours per day, this is more intensive program and is done in conjunction with school programs. Designed to help adolescents avoid hospitalization.

3. Residential programs - for long-term care for adolescents that cannot be placed at homes. Could be in foster care setting (temporary legal guardian), group home setting (long term setting where parental rights might have been terminated and adolescent is part of social service system), or residential setting. Depends upon the ability of the adolescent to maintain behavior in less supervised setting. Designed for long-term care until adolescent is emancipated.

4. Inpatient psychiatric facility - short term care designed for adolescents in danger of hurting him/herself or others. Usually lasts between 72 hours to 1 month, then adolescent is returned to previous setting, at home or new setting.