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Abstract
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VioLit summary:
OBJECTIVE:
The intent of this article by Crabtree was to describe a treatment for hospitalized adolescents who acted-out, with the dual goal of maximizing their treatability and minimizing their destructive impact on the treatment center and other hospitalized adolescents.
METHODOLOGY:
The author employed a non-experimental design by describing the different elements of a successful treatment program for dealing with adolescents who acted-out (i.e., who engaged in antisocial and rebellious behavior). The treatment was initiated on an intermediate-term, inpatient adolescent unit in a general psychiatric hospital, Horsham Clinic's Young Adult Program. 20 male and female patients in their teens to early 20s resided in the unit for an average of 3 months. One-fourth were diagnosed as psychotic, one-fourth as behaviorally disturbed with relation to their families, schools, or the law, and one-half were suicidal or self-destructive in some way. The author identified five components among this and other programs for effectively treating adolescents who act-out: 1) Control of behavior, which entailed an immediate, simple, and consistent response to good and bad behavior and avoided inconsistencies or bureaucratic lags. The Horsham Clinic program employed a tiered Level System in which privileges and responsibilities were closely linked to freedoms, expectations and responsibilities. 2) Communication, which entailed cooperation with families to ensure a similar structure when patients were at home or on excursions. This communication also included family feedback on the dilemmas which surfaced while the patient was at home. 3) Implicit in the previous two components were incentives, which allowed patients to link behaviors with tangible outcomes and provided greater clarity on role expectations. 4) Confrontation, which involved moving beyond the identification of good and bad behavior to include confrontation of allegedly good behavior which was, through the intentions of the patient, ultimately causing him or her to sacrifice opportunities for engagement, participation and belonging. In other words, attitudes as well as behaviors were addressed. 5) The author turned to therapeutic dismissal as the final component in the program, noting that the previous approaches were successful in most cases, but that with severe disorders of narcissism and sociopathy, some patients remained unresponsive. The lack of response often turned staff members into callous, cynical wardens due to the cycle of recurrent ward tension created by the outlaw leader. This final component included diagnosing the periods during which the community had been negatively transformed, confronting the transformation at the community level, and directing community energies toward constructive goals. When this protocol failed to provide an effective intervention, the patient was removed from the unit with the intent to prepare him or her for future incarceration or hospitalization. The stages identified by the author in this fifth and final component were: A) The Initial Stage in which the acting out patient was treated like any other patient. B) The Reevaluation Stage in which the patient was identified as being in jeopardy of expulsion and entered a two-week probation period. C) The Cue Card in which the a clear statement was made to all participants that the staff found the patient untreatable. D) Finally, the Termination Stage, in which the temptation to rescue the patient was resisted in order to maximize the patient's awareness of the implications of his or her behavior.
AUTHOR'S RECOMMENDATIONS:
Programs with an emphasis on the elements described above should be implemented with greater regularity because, argued the author, they reduce turbulence and vulnerability to collective disturbance and impasse. He also added that within these programs staff were operating in a heightened sense of mastery, control, and effectiveness, and patients were more likely to learn from the experience.
(CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
Language: en |