This course is designed for clinical and community-based organization personnel who either treat or are interested in program and clinical treatment approaches for the at-risk adolescent and associated fundamental program modalities. Administrators, managers, clinicians, independent practitioners, educators, community health workers, youth workers, and entrepreneurs will benefit from this course.

Course Title: Department: Instructor: College E-mail: Phone: Fax:

RS505 - Special Populations, At-Risk Youth Rehabilitation Services and Administration Dan Thorne MS, BA   Vita Contact 714.357.6201 (California, USA) 425.790.3919

INSTRUCTOR:

Dan has over twenty years of experience in administrative and clinical functions in healthcare. He started his career as a Marriage and Family Therapist in private practice, and also worked with employee assistance and worker's compensation programs. He then moved into providing clinical supervision at inpatient and outpatient mental health and chemical dependency programs. Over the past 10 years, he has worked as an administrator and director for outpatient programs. Dan has affiliations with many community based agencies and departments that oversee programs for at-risk youth.

COURSE DESCRIPTION:

This course will introduce the graduate student to the special clinical problems that affect the at-risk youth in communities, and current treatment and programmatic approaches to deal with this population.

COURSE OBJECTIVES:

• Learn about behaviors that high-risk adolescents exhibit.
• Explore causes of at-risk behaviors
• Learn about the pros and con's of medications in treatment for adolescents.
• Examine interventions and case studies to reduce symptomatic behavior.
• Investigate the programmatic approaches for adolescents from outpatient to residential care.
• Develop a program model using clinical and administrative approaches

COURSE OVERVIEW:

This course is intended to educate the program administrator, healthcare educator, or clinical manager about the special challenges of the at-risk adolescent. This individual is unique that, because of environmental factors as well as internal factors, has difficulties functioning at home, in the community, or at school. Without proper intervention, this adolescent will eventually have multiple hospitalizations, arrests, be at risk for alcohol or substance abuse, or other behavior that threatens his/her life. Traditional outpatient psychotherapy or hospitalizations are less likely to work with this adolescent because of the chronic nature of the adolescent's behavior, and the lack of supportive resources within his/her home or family.

Treatment of the adolescent is crucial to avoid further problems as an adult so that this individual can become a productive member of society. Special approaches, through the private and public sector, have been successful in reversing the negative spiral of behavior. This course will acquaint the student with these clinical approaches, as well as programs that currently exist and their inner workings, and how these programs are financially and clinical successful.

SUGGESTED TEXTBOOKS: Online Bookstore

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

WEEKS 1 AND 2 OUTLINE:

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

1. Bipolar
2. Depressive

2. Anxiety

1. Phobia
2. Posttraumatic Stress
3. Generalized Anxiety

3. Thought

1. Schizophrenia
2. Schizoaffective

4. Eating

1. Anorexia
2. Bulimia

5. Attention-Deficit

1. Attention-Deficit Hyperactivity
2. Conduct
3. Oppositional

6. Developmental Disorder

1. Autism
2. Asperger
3. Pervasive Developmental Disorder

7. Substance Abuse

1. Alcohol
2. Drug

8. Other

1. Adjustment
2. Impulse-Control

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

WEEKS 1 AND 2 ASSIGNMENTS:

1. Choose one of these disorders and research about the behaviors that the disorder manifests and possible causes of the disorder.
2. Discuss how the problems caused by the disorder are manifested in home, community and school.

WEEKS 3 AND 4 OUTLINE:

Learn about the pros and con's of medications in treatment for adolescents.

1. Types of medications

1. Antipsychotic- to prevent hallucinations and delusions, types include Resperadol, Zyprexa, Haldol, etc.
2. Bipolar meds- to control mood swings, also using anticonvulsant meds as well- Lithium, Depakote, Wellbutrin, Tegretol
3. Antidepressants- include SSRI's and other meds such as MAO's and tricyclics- include Effexor, Paxel, Celexa, Lexapro, Wellbutrin
4. Stimulants-used for ADHD-Adderall, Ritalin, Dexedrine, Cylert, also Strattera

2. Benefits of medications- helps to reduce biochemical effects of disorder, and makes aggressive behavior more controllable, and helps other treatments be successful.

3. 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.

WEEKS 3 AND 4 ASSIGNMENTS:

1. Take the disorder used in Weeks 1 and 2, and determine possible medications that could be used, research effects and side effects and what would be best choices.

2. How a counselor might approach a family in using this medication, how to overcome their resistance that medicine will make adolescent lethargic, or other problems, etc.

WEEKS 5 AND 6 OUTLINE:

Examine interventions and case studies to reduce symptomatic behavior.

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.

WEEKS 5 AND 6 ASSIGNMENTS:

1. Create a case study of an at-risk adolescent who lives at the poverty level in an impoverished area. This adolescent could have the behaviors and disorder that you discussed above in previous assignments or be a new one. Determine whom the adolescent lives with and develop a history of the adolescent, such as problems that occurred in birth, family history and problems that led to adolescent's current problems as an adolescent. Were there traumatic events that occurred to adolescent, such as abuse, or to family, such as deaths or incarcerations, that led to problems? Develop a list of behaviors the adolescent is involved in currently that would lead to a referral for counseling help, at least for now while still living at home.

2. Discuss each of the therapy models and how they might help the adolescent, and what might be some possible interventions or ways that a counselor or case manager might be able to help the adolescent.

WEEKS 7 AND 8 OUTLINE:

1. Program models available for adolescent

1. Outpatient, 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.

2. Design of programs is determined by:

1. Level of care- what is the security and living arrangements necessary to care for adolescent?

2. Funding available-is there a demand based upon market research in your community, or are there RFP's that are asking for these programs?

3. Availability of space-how much space is needed and how quickly can it be purchased, put into use and certified or licensed?

4. Staffing- what are the staffing needs of the program, such as clinical (nursing, therapy, rehabilitation, others), administrative (billing, financial, program), and support (maintenance, dietary, medical records, etc.)

WEEKS 7 AND 8 ASSIGNMENTS:

1. Taking the adolescent used in Weeks 5 and 6, how might the approaches discussed above work or not work for this adolescent and why?

2. If you were a program administrator and you were able to develop a program, which one would you choose? Discuss the program elements you would include and what you would need to do to start up such a program?

Week	Subject	Assignment
1	At risk behaviors	Choose one of these disorders and research about the behaviors that the disorder manifests and possible causes of the disorder.
2	At risk behaviors	Discuss how the problems caused by the disorder are manifested in home, community and school.
3	Medications for adolescents	Take the disorder used in Weeks 1 and 2, and determine possible medications that could be used, research effects and side effects and what would be best choices.
4	Medications for adolescents	How to approach a family in using this medication, how to overcome their resistance that medicine will make adolescent lethargic, or other problems, etc.
5	Individual treatment options	Create a case study of an at-risk adolescent, including behaviors, disorder, type of functional impairments, possible causes.
6	Individual treatment options	Discuss each of the therapy models and how they might help the adolescent, and what might be some possible interventions or ways that a counselor or case manager might be able to help the adolescent.
7	Program options	Taking the adolescent used in Weeks 5 and 6, how might the approaches discussed above work or not work for this adolescent and why?
8	Program options	If you were a program administrator and you were able to develop a program, which one would you choose? Discuss the program elements you would include and what you would need to do to start up such a program?

COURSE POLICIES:

On-Line Participation:

Since this course is offered over the Internet, which allows students to participate at "any time, any where," it is important to plan your time carefully. Students are expected to pace themselves to access assignments, prepare their work and necessary research, and submit assignments to the instructor by the established due dates. Students are expected to make use of local resources as well as required readings.

Course Week and Due Dates:

Generally, Monday is the first of the course week, and Sunday is the last day of the course week. Assignments scheduled for completion during a class week should be sent to the instructor via email or fax by end of the day Sunday, determined by your own time zone. If a student is sending assignments through the postal service, please make prior arrangements with instructor, as there is no postal delivery on Sunday. Given that this is a graduate level course, and that some community contact and independent research is necessary to fulfill assignments, some flexibility regarding due dates may be granted by mutual agreement between student and instructor.

Submitting Assignments - Instructions:

Students may submit work in MSWord (any version) or Excel (any version) or HTML and send as an email note or file attachment. If you use another word processing program (such as Works), please save as an .rtf file. Formats for files received other than those specified here that your instructor cannot open using MSWord or a Word converter program for PC or Macintosh will be returned to you for reprocessing, and will be considered late. Any questions on formatting of your file attachment documents, please Email your instructor with any questions now and we can find a format that will work for your particular needs. Thanks in advance on this matter. Please include name, reply address, title of assignment, title of course, and date submitted on the document itself, in addition to the email text.

Late Assignment Penalties:

Weekly assignments must be received by the instructor not later than Sunday midnight (your time zone) of the week assigned. Students who anticipate that their schedule may cause assignments to be out of compliance are advised to contact instructor at least one week in advance, as an extension may be permitted with prior mutual agreement. Instructor discretion regarding point penalties for any late work will be considered final.

Absentee Policy:

While this course is designed to be completed through independent study, "attendance" is recorded through assignment submissions in a timely manner to the instructor's email address (or via post or fax). However, please note that any student who has not participated (completed assignments) for 14 consecutive days without prior discussion with the instructor regarding such absence shall be recommended for administrative withdrawal. The school shall make recommendations to the instructor as to what action will be taken.

Academic Honesty:

Canyon College policies are in effect. All work must be your own. Presenting as one's own the words, ideas, or expression of another in any form is cheating through plagiarism, and will not be tolerated.
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Grading:

Assignments will be graded based on completeness, correctness and timeliness of submissions. Given that graduate courses are designed to support development of competencies and integration of theory with practical applications, the following criteria will be used by your Instructor to assign both midterm and final letter grades based on assignments in aggregate. Please note that with few exceptions, there are no letter grades for weekly assignments, as the learner's work is assessed in aggregate based on demonstrated achievements toward the course objectives.

Categories for assessment by the instructor of the graduate student's work are as follows:

UNDERSTANDING
Content of readings and other assigned source materials should be reflected by critical analysis and synthesis of ideas in work submitted. Intellectual depth of understanding also applies, by evidence of advancing the course objectives within the student's breadth of knowledge.

APPLICATION
Examples and discussion of course content as assigned to real-life situations, including critique or conclusion.

CLARITY OF EXPRESSION
Written work should be presented in a scholarly manner, with evidence of logic and coherence, including introduction and conclusion as appropriate. Mechanics of writing, such as spelling, grammar, and citations should also be evident.

RESEARCH and SUPPORTING MATERIAL
Examples or evidence as requested should match the level of the assignment, level of inquiry, and depth of investigative endeavor as requested.

Letter grades will be assigned according to the following definitions:

A = Excellent
Work that may be described as superior, excellent, or outstanding. The student demonstrates accuracy, depth of understanding and illustration, and provides original thought and analysis beyond the basic textbook information requested in the assignment.

B = Very Good
Demonstrates high level of competence relative to the assessment criteria, but falls short of the consistent excellence required for A/Excellent category. The B/Very Good category allows for some minor weaknesses in presentation but the content is effectively demonstrated.

C = Satisfactory
Demonstrates the information requested in the assignment, but less completely than B/Very Good work. The major points are expressed, but less complete topic development, and minimal original thought and analysis. Work that contains significant issues with spelling or grammar may fit this category even though development of ideas are of higher levels of synthesis.

D = Flawed
Information digresses and is not adequately focused. Persistent work of D/Flawed level may indicate the student is not ready for graduate level work.

Midterm and Final Weeks.
The Midterm grade is determined by aggregate point performance of work submitted for assignments designated in weeks 1-4.

The Final point allocation is determined through aggregate performance on assignments submitted for all weeks of the course.

Final Letter Grade.
Letter grades will be assigned at the conclusion of the eight weeks based on cumulative points achieved over the entirety of the eight week course. The grading scale based on 100 possible points is as follows:

A A- B+ B B- C+ C C- D F

= 95 - 100% = 90 - 94.5% = 86 - 89.5% = 83 - 85.5% = 80 - 82.5% = 76 - 79.5% = 73 - 75.5% = 70 - 72.5% = 60 - 69.5% = Below 60%

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