Jan./Feb. 2007

Finding Help for Struggling Teens
By Frederic G. Reamer, PhD, and Deborah H. Siegel, PhD, LICSW, DCSW, ACSW
Social Work Today
Vol. 7 No. 1 P. 32

One size does not fit all. Get some guidance on how to help parents make the right treatment choice for their struggling teen.

Maria Hernandez, a licensed social worker with 30 years of experience working in family service agencies, is perplexed about one of her cases. She’s been working with the Almeida family off and on for several years, ever since their now 13-year-old son, Tony, was a preschooler. Tony’s parents had first reached out for help when Tony was in preschool because his behaviors at school and home were hard to manage, and he didn’t respond to typical behavior management strategies. Over the years, Tony’s parents had been to several social workers, psychologists, and psychiatrists and had dutifully followed their advice about medication and behavior modification programs in the home. He was diagnosed with attention-deficit/hyperactivity disorder, anxiety, and depression, had an individualized educational program (IEP), and had been in individual and family therapy for years.

Despite his struggles, and thanks to the carefully coordinated efforts of Tony’s parents and various professionals, Tony made it through grade school and most of middle school. But now his life is spinning out of control. He is skipping school, failing several subjects, experimenting with marijuana and other substances, engaging in unprotected sex, and defying rules at home. His parents are frantic. Clearly, Tony is at risk. Outpatient psychotherapy, family therapy, medication, special education services, home-school coordination, and behavior management programs aren’t working. What to do next? Maria is unsure. Maria and the family have tried every clinical strategy included in her social work education and training.

Maria, a competent clinical social worker, isn’t unusual. Social workers often encounter exasperated parents at their wit’s end in dealing with their struggling teen. Too often, there is no coordinated, carefully articulated system of care for struggling teens and their families; a welter of disconnected programs and services leaves many teens falling through the cracks. Instead of getting what they need, many teens and families get whatever services are available and affordable. Fortunately, there is a framework, described later in this article, to help social workers conceptualize the continuum of options so they can help guide families grappling with struggling teens.

Social workers are in a key position to help struggling teens and their parents.* Although the road can be long and hard, struggling teens can make great progress. Knowing where to turn in times of crisis is a challenge. When crises emerge, most parents scramble frantically, grasping for information and help that, too often, turns out to be minimally useful, fragmented, and incomplete. If they are familiar with the wide range of available services, programs, and specialty schools, social workers can guide parents and teens through the complex maze of options. Unfortunately, not all social workers are adequately informed about the full range of options because programs and services vary considerably from community to community, change over time, and often reflect funding source preferences, rather than a coherently conceptualized and well-articulated continuum of care.

Options for Struggling Teens
Struggling teens usually show signs of distress, such as low self-esteem; school failure and truancy; social isolation; depression and anxiety; substance abuse; defiance toward authority (parents, teachers, police); running away from home; choosing the “wrong” friends; impulsive behavior (such as speeding); getting in trouble with the law (for example, shoplifting or driving without a license); eating disorders (overeating, not eating, self-induced vomiting); and self injury (such as cutting).

Social workers can help families with struggling teens by providing the following:
• information about important warning signs of teens who are on a downward spiral, so parents can intervene;

• crisis intervention counseling to help stabilize the situation;

• ongoing counseling for the teen, the parents, and the family as a whole to provide emotional support, change counterproductive family dynamics and parenting strategies, and teach problem solving and coping skills;

• comprehensive assessment of the teenager’s and family’s needs and strengths so parents can search for services that truly fit their child’s circumstances;

• information about and referral to needed programs and services, both locally and nationally;

• information about financial resources to pay for needed services (for example, getting subsidies from the local school district or child welfare agency or exploring educational loans designed for families with struggling teens);

• information about legal assistance from educational advocates who are specially trained to pursue funding and services from local school districts;

• case management (helping staff from multiple agencies coordinate and communicate on behalf of the teen, and advocating for the family with these providers); and

• guidance in recognizing and avoiding common mistakes made by parents who are desperate for help and want to stop their teen’s freefall. For example, parents, in their urgency, may want to pick a program quickly and impulsively without sufficient exploration; select a program or school based primarily on cost rather than its suitability to meet the teen’s needs; select a program or school whose methods and approach are not grounded in sound published theory and research; shun out-of-home placement when it is, in fact, the best way to meet the teen’s needs; or select a program or school primarily because it is close to home, not because it fits the teen.

To help parents navigate the disconnected jumble of programs and services, social workers can provide parents with the names of competent educational advocates and consultants who may be able to help parents and teens obtain needed services.

Educational advocates—often attorneys—help people obtain specialized educational services from the public school system. Educational advocates charge parents a fee and work with local, state, and federal education officials to ensure that students receive the services and special accommodations to which they are entitled by law. Advocates may file claims in court to force school districts to provide or pay for special needs services and programs outside the school district. Also, in collaboration with social workers, advocates may attend meetings at school to represent the parents’ and teen’s points of view, when school personnel meet to develop an IEP that addresses the struggling teen’s special education needs.

Educational consultants help parents locate programs, services, and specialty schools designed to meet their child’s needs. Educational consultants charge parents a fee, assess each teen’s unique strengths and needs, and help the family find the most appropriate services, schools, or programs for their teen. Many educational consultants work closely with social workers and monitor students’ progress in the new program or school; when necessary, educational consultants and social workers advocate for the teen with that program or school when challenging issues arise.

When parents don’t have the money to purchase services from an educational advocate or consultant, social workers in public or private child welfare agencies may step in to perform the educational advocate or educational consultant function. For example, a social worker in a private family service agency, where the family is receiving counseling, may be willing to go with the parents to a child’s IEP meeting at school to help the parents assert their points of view. Perhaps this private agency uses a sliding-fee scale or has a grant that provides this service free of charge. A social worker in a state public child welfare agency may be able to share with parents their professional experiences with specialty schools and programs for struggling teens. In some communities, social workers can help clients find tax- or grant-funded programs that provide educational advocates who work with low-income parents needing support negotiating with schools to get their children’s needs met. Social workers can also link parents with other parents who can support them at IEP meetings and other negotiations with schools.

It is important for social workers to help parents understand that, for financial reasons, school systems and agencies may be reluctant to provide the services a child needs. Hence, parents and their advocates must be relentlessly dogged in their insistence that needed services be provided. Parents, very understandably, may become disheartened and angry when schools and agencies claim the child does not need a service that is, in fact, needed. A social worker can help parents manage their anger to more effectively argue their case and maneuver through bureaucratic obstacles.

Selecting the Right Program or School: Questions to Ask
In addition to offering traditional counseling and clinical services, social workers can acquaint parents with a wide variety of community-based options, alternative and therapeutic schools, and treatment programs that serve teens who struggle with significant behavioral, emotional, mental health, and substance abuse issues. Some programs, such as local alternative high schools, focus primarily on education, while being sensitive to students’ mental health and behavioral challenges. Sometimes, however, the type and level of care the teen needs are only available outside the home community. Residential treatment programs, therapeutic boarding schools, and wilderness therapy programs focus primarily on mental health, emotional, and behavioral issues, while including an educational component. Emotional growth boarding schools address mental health, emotional, behavioral, and educational issues simultaneously. Other boarding schools focus on specific learning disabilities, while also paying attention to the whole student. In short, different programs give different degrees of emphasis to personal and academic issues. It is important for social workers to understand and be aware of this conceptual continuum of programs and services so they can plan interventions tailored to each family’s unique needs. Social workers, like parents, must resist the urge to plunge into programs and services because they are easily available, conveniently located, and relatively low cost.

Parents of struggling teens—particularly teens who are oppositional and defiant—are naturally tempted to place the child in a school or program that promises to impose needed discipline and structure. These schools and programs—such as some military boarding schools and those that advertise their mission as “character education”—often do not provide the mental health services many struggling teens need. These schools and programs may use shame-and-blame methods that cause more harm than good for struggling teens who have personal and mental health issues contributing to their challenges.

Generally, it makes sense first to consider home- and community-based programs and schools. Thus, the following list starts with the least restrictive home- and community-based options and progresses toward different kinds of residential schools and treatment settings. Prominent services, program, and school options include the following:

• Mentoring programs provide struggling teens with an adult who gives support, guidance, advice, and friendship. Mentoring programs encourage teens to stay focused on their education; provide support during crises; offer constructive ways to spend free time; and expose teens to career paths and options. Mentors seek to enhance, but not replace the roles of parents, guardians, and teachers.

• Youth diversion programs help teens who have had contact with the police avoid further involvement in the juvenile justice system. Typical youth diversion programs offer first-time offenders individual and family counseling and links to other important social and educational services.

• Substance abuse and truancy courts use a supportive and nurturing approach rather than a punitive one to help struggling teens. Using case management, counseling, tutoring, mentoring, and parent education, the courts’ goal is to prevent future problems and more formal involvement with the juvenile justice system.

• Alternative high schools provide education, including special education services, to teens who have floundered academically or socially in traditional high schools. These schools may be freestanding or sponsored by a community mental health center, family service agency, school district, or a collaborative composed of several social service and educational programs.

• Emergency shelters and foster care provide short-term care and sometimes an opportunity for assessment, diagnosis, and stabilization to facilitate plans for longer-term care.

• Day treatment and partial hospitalization programs provide teens with nonresidential services to help them address mental health and substance abuse issues. Typical programs require youths to participate in individual, group, and, when feasible, family counseling. Educational services may be included to help teens stay on track academically.

• Group homes provide teens with structured, supervised out-of-home care. Teens are placed in a group home when living with their family is not realistic or in the teen’s best interest. Group homes typically provide shelter and a wide range of mental health, educational, and recreational services.

• Independent living programs are residential programs designed to help adolescents develop the skills they need to live independently. These programs primarily serve teens who do not have stable families and are in the state’s custody. Some independent living programs also serve teens whose families are able to pay for these services privately. Typical services include practice in daily living skills, money management, career and educational planning, mental health services, rental assistance, recreational and social activities, and case management.

• Wilderness therapy programs offer highly structured intensive short-term (five to eight weeks) therapy in remote locations that remove adolescents from toxic distractions available in their home communities (such as television, music, cell phones, Internet, instant messaging, cars, drugs and alcohol, and high-risk peer groups). The challenges of living full-time outdoors and developing wilderness survival skills help teens develop self-confidence and prosocial behaviors. Often, families are advised to send their struggling teen to a wilderness therapy program, and then to a therapeutic or emotional growth boarding school rather than return the teen to their home community environment; returning directly to the home community often means returning to the lure of problematic peer groups. Wilderness therapy programs focus the teen’s attention on his or her struggles, promote insights, and prepare the youngster for success in the next out-of-home placement, where the teen receives continued structure and support. Ideally, this new placement continues until the teen is mature enough to function safely in the home community.

• Boarding schools for teens with significant learning disabilities offer structured academic programs that focus on education and learning, while addressing emotional and behavioral issues.

• Emotional growth boarding schools offer structured academic programs and focus on emotional development and personal growth but do not provide the intensive treatment services offered by therapeutic boarding schools.

• Therapeutic boarding schools focus intensively on students’ mental health, substance abuse, and behavioral needs, while also providing an academic educational program.

• Residential treatment centers offer highly structured treatment addressing substance abuse, family, and other mental health issues. In contrast with therapeutic boarding schools, residential treatment centers are more like a psychiatric hospital than a school, although they may have an academic/educational component in their program.

Helping Parents Cope
Understandably, parents of struggling teens are often preoccupied with immediate crises. When their efforts to help their child fail to protect the teen, feelings of fear, frustration, anger, and despair grow. Social workers can help parents manage these feelings by teaching them some coping guidelines:

• Stand firm and be compassionate. Struggling teens do not do well with laissez-faire parenting. They need respectful supervision and clear, fair rules consistently backed up with consequences. Punitive, controlling, and shaming parenting may provoke more misbehavior.

• Form a united front. The teen’s parents must be on the same page, asserting the same rules, expectations, and consequences. Teenagers who hear inconsistent or contradictory messages from parents are freer to follow their own destructive instincts.

• Let go and hold on. This may seem like a contradiction, but it is not. The challenge for parents of struggling teens is finding the right balance. Allowing a struggling teen too much freedom is fraught with risk, but hanging on too tightly can backfire with teenagers who have rebellious instincts. Social workers can help parents figure out how to find this tenuous balance.

• Accept painful truths. Parents of struggling teens may need to abandon fantasies of the “ideal child” and learn how to accept and celebrate the real child they have. Social workers can help parents grieve the loss of the fantasy child and appreciate their actual child’s charms and gifts, while addressing the child’s challenges.

• Learn ways to cope with shame and isolation. Parents of struggling teens may feel shame, disappointment, sadness, frustration, fear, and anger. They may find it difficult to socialize with other parents whose children seem so successful. Parents of struggling teens often find it helpful to acknowledge their challenges with social workers and a few trustworthy, nonjudgmental friends. Storing up and holding in one’s pain and frustration can be debilitating. All parents need support; parents of struggling teens need extra support.

• Do self care. Social workers can help parents develop a self-care plan. The parenting journey is a marathon, not a sprint. Parents must pace themselves and find ways to replenish their spirits.

• Take the long view. Parents of struggling teens often live with frequent crises. Parents need to understand that a teen’s frontal lobe—which is responsible for one’s ability to control impulses, use good judgment, learn from consequences, and engage in meaningful problem solving—takes time to grow. Patience is an antidote to despair.

Parents of struggling teens have their hands full. Fortunately, an impressive array of help is available. Social workers can help parents provide the right kind of scaffolding and support and find compassionate, competent services and settings that meet teens’ needs.

* Not all struggling teens live with their parents. Some parents struggle with their own mental health, substance abuse, financial, legal, and other problems. In such cases, the teen might live with grandparents, friends, other relatives, or in foster or group homes. To avoid cumbersome terminology, throughout this article, the term parents also includes other guardians of struggling teens.

— Frederic G. Reamer, PhD, and Deborah H. Siegel, PhD, LICSW, DCSW, ACSW, are professors at the School of Social Work, Rhode Island College in Providence. They are the authors of Finding Help for Struggling Teens: A Guide for Parents and the Professionals Who Work with Them.

Resources
Frederic G. Reamer, & Deborah H. Siegel, Finding Help for Struggling Teens: A Guide for Parents and the Professionals Who Work with Them (Washington, DC: NASW Press, 2006):
naswpress.org/publications/books/children/strugglingTeens/3736.html

Independent Educational Consultants Association: www.educationalconsulting.org

National Association of Therapeutic Schools and Programs: www.natsap.org

National Mentoring Partnership: www.mentoring.org

The Association of Boarding Schools: www.schools.com

Woodbury Reports (Web site on programs and schools for struggling teens): www.strugglingteens.com