One of the consistent challenges that we face with when working with youth and their families is the lack of hope that many have when they come to our residential treatment center (RTC) program at KidsPeace. Often they have already participated in a myriad of behavioral health/mental health services, and unfortunately many of them have not had positive experiences that allow for the creation and fostering of hope.
I was assigned such a case several months ago, involving a youth whose family is covered by TRICARE. This young woman had been transferred from another RTC program; her parents reported that they were not satisfied with the level and type of care she had been receiving and wanted something different.
The youth had been referred for a higher level of care due to significant issues with physical aggression towards family members and peers. There were also concerns related to her ability to interact appropriately with same-age peers, as well as her lack of understanding of boundaries with others – particularly strangers. She and her parents stated she had been involved in multiple services since a very young age, and they were apprehensive about engaging with another provider, given their experiences. I acknowledged their concerns and assured them that we would do our best to provide them with what they needed to be successful, facilitate healing, and instill hope.
Many of our initial sessions were focused on developing an understanding of the impact their involvement with service providers had on the youth and her family. Sessions then shifted to identifying the strengths and barriers the family felt they possessed, and how both could be utilized in order to facilitate genuine positive change. This positive change, if recognized and embraced, would be a way for the youth and her parents to be successful and experience the hope they all had been lacking.
Initially there was much resistance, as the youth focused much on how things had not worked in the past, and that our sessions would not make a difference. In family therapy sessions her parents were guarded and spoke frequently to what did not work for their daughter. They were concerned about if things would change for the better and if their daughter would have to remain in placements for the rest of her life.
The approach I had to take within these sessions was one of optimism. I made it a point to highlight the “little victories” that the youth and her family were able to accomplish throughout their lives, as well as during her stay at the RTC. I engaged in evidence-based strategies designed to help identify how her negative/positive thoughts and feelings affect her behaviors and interactions. I also reiterated the importance of using the past as a guide, not an indicator of how the future will turn out.
With time, the youth and her family began presenting as more amenable to the idea of things being better. All began to speak more positively about their situation and identified a renewed sense of hope for the youth and for their family. The weekly meetings became an environment where all could communicate more freely and plan for the eventual return of the youth to the home. Scheduled home passes went on without any significant issues. The family continued to remain focused on the prospect of improvement and positive change.
There were still challenges, of course; long-standing struggles, particularly those related to behavioral/mental health, are not resolved overnight. However, once she and her family were able to recognize the possibility of change, success, and hope, things did progress in a more positive direction. Ultimately, the youth was discharged back home to her family, with less restrictive aftercare services in place.
Zachary Venable is a senior clinician at KidsPeace.
TRICARE is the health care program for uniformed service members, retirees, and their families. KidsPeace’s adolescent hospital and residential treatment programs at the Orchard Hills Campus in Pennsylvania are TRICARE certified.
