Introduction to Multidimensional Family Therapy (MDFT) A

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Introduction to Multidimensional Family Therapy (MDFT) A Powered By Docstoc
					10 Research-Proven Ways to Improve Adolescent
             Treatment Outcomes
                         Presented at:
           6th Las Vegas Conference on Adolescents
                         April 24, 2008


                Howard A. Liddle, EdD, ABPP
                    Professor & Director
Departments of Epidemiology & Public Health and Psychology,
 and Center for Treatment Research on Adolescent Drug Abuse
          University of Miami School of Medicine
                   www.miami.edu/ctrada
                                                         1
  “We want perfection without practice.”

“The process of learning goes on longer than
           most people know.”



                                Atul Gawande, 2002
                The Learning Curve (The New Yorker)




                                                      2
3
10 Research-Proven Ways to Improve Adolescent
             Treatment Outcomes

     Expectation
     Stimulation
     Specifics
     Outcome
        Bottom line
        Conclusion
        An ending
        Outcome can also be a process

                                                4
                      Goals


 Therapy DVD
    Illustrate ideas-in-action
    Clinical methods
    Therapeutic style
 Instigate a process
 Improve your practice




                                  5
             Why are you here?


   a. I’ve always wanted to come to Las Vegas
   b. The Bellagio was full
   c. In watching the movie Hoax I became captivated
    with the life of Howard Hughes
   d. My teenagers are driving me crazy
   e. I’m interested in adolescents
       working with them
       figuring out why I work with them
       figuring out how to get better at working with
          them
                                                         6
              Common Interests



   Adolescents, adolescent treatment and services,
    adolescent problems, my work setting, my training,
    my clinical work, how to get better
   Focus on teens, their lives, social environments,
    families, peer groups, and institutions




                                                         7
             Basic Questions



 Who are they?
   What are they like?
   How are they alike and different?




                                        8
           Contributions?


 What is my contribution?
     No tabula rasa
     “Objectivity”




                             9
    Range, Scope and Content




 What is the territory of adolescence?




                                          10
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“…everybody should have a chance to do well and they shouldn’t be picked on
because they’re not rich enough to afford stuff.”
                       Stewart McAdams, 16, and Ray Mowrer, 18 of Jolo, W. Va;
   Jeremy Ball, 17, of Bradshaw, W.Va; Mathew Phillips, 17, of Paynesville, W.Va.
                                                                              14
“I guess I always knew I would be a debutante…”
                                            Amy Heldenfels, 19, of Austin, Texas
                                                                            15
“My parents don’t know, but I have a little television.”
                                                         Noami Sue Kramer, 18,
                                 and Marjorie Lynn Kramer, 17, of Jamesport, Mo.
                                                                             16
“I would kill my sister if she was in a gang … I don’t want her following what I
do.”
                                                 Ebony Wilson, 15, of the Bronx, N.Y.
                                                                                 17
"The easiest thing about being a teenager is still having a sort of romantic
perspective or outlook on the world: not being jaded or disillusioned; and
knowing — hoping — that you have time to do what you want and to achieve
what you want.“




"Maybe I was wrong that that's specific to being a teenager. I think you have to
work hard, though, not to let yourself forget that feeling of having dreams and
aspirations and knowing that there's nothing that can stop you."
                                            Patrick Roberts, 19, of Lawrence, Kan.
              Developmental Stage

 Renaissance of adolescent treatment
 New treatments and methods exist
 Feasibility and efficacy has been established
 Mechanisms are being investigated
 Generalizability has been addressed
 Treatment manuals are available
 Training models and materials exist
 Full generalizability – transfer potential - has   not
   been established

                                                           19
      New Generation of Interventions

 Integrative
 Connected to basic research on development      and
   dysfunction
 Diverse approaches
    Expanded in scope: Multiple systems of   assessment
     & intervention
    Brief interventions as well
 Context of service delivery
 Well-specified protocols
 However...

                                                           20
MIND THE GAP
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April 17, 2006
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May 20, 2004
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            MDFT Fact Sheet


 Background
 Variety of studies
 Sample findings
 Website
 Contact information




                              39
Multidimensional Family Therapy (MDFT)

 Recognized as one of the best approaches for
  treating adolescent substance abuse in:
   Numerous scholarly reviews
   International and United States government
     funding agencies
   Private foundations
   Media outlets




                                                 41
MDFT Certified SAMHSA Model Program

 Multidimensional Family Therapy certified as a
  Substance Abuse and Mental Health Services
  Administration [SAMHSA] Model Program, Center for
  Substance Abuse Prevention (2005)
 http://www.modelprograms.samhsa.gov/




                                                      42
    MDFT and the Juvenile Justice System


 “UM Pioneers Teen Drug Abuse Therapy: $3.5 million
  grant recognizes collaboration with Juvenile Justice
  System” (December 2003)
 http://www.miami.edu/scrip/december2003/story05.h
  tml




                                                         44
MDFT Recommended Program by Drug Strategies

     Drug Strategies (2003) “Treating Teens: A Guide to
      Adolescent Drug Programs”
     http://www.npr.org/programs/atc/features/2003/ma
      r/treating_teens/miami_treatment_program.pdf




                                                           46
             MDFT featured in
            National Public Radio
 National Public Radio (2003) Story on Adolescent
  Substance Abuse Profiles MDFT “Treating Substance
  Abuse in Teens: Series Examines the Challenges of
  Getting Effective Help”
 http://www.npr.org/programs/atc/features/2003/ma
  r/treating_teens/index.html




                                                      48
      MDFT certified “Best Practice”


 United States Department of Health and Human
  Services (2002) “Best Practices Initiative” for
  Adolescent Drug Abuse
 http://phs.os.dhhs.gov/ophs/BestPractice/mdft_mia
  mi.htm




                                                      50
     MDFT Manual Published by CSAT


 Center for Substance Abuse Treatment (CSAT
  publishes MDFT Manual used in the Cannabis Youth
  Treatment Multisite Study; order at
 download at:
  http://www.chestnut.org/LI/cyt/products/MDFT_CYT
  _v5.pdf




                                                     52
           MDFT in the Headlines

   MDFT featured by Annie E. Casey Foundation
    magazine. See Mendel, D, A Family Affair,
    AdvoCasey, 4(1): 12-19, Spring
   http://www.aecf.org/publications/advocasey/spring
    2002/familyaffair.htm




                                                        54
           MDFT in the Headlines

   MDFT featured by Annie E. Casey Foundation
    magazine. See Mendel, D, A Family Affair,
    AdvoCasey, 4(1): 12-19, Spring
   http://www.aecf.org/publications/advocasey/spring
    2002/familyaffair.htm




                                                        56
           MDFT in the Headlines

   MDFT featured by Annie E. Casey Foundation
    magazine. See Mendel, D, A Family Affair,
    AdvoCasey, 4(1): 12-19, Spring
   http://www.aecf.org/publications/advocasey/spring
    2002/familyaffair.htm




                                                        58
                  MDFT Recognition


   National Institute on Drug Abuse, NIDA Notes story on
    MDFT (2001) “Family-Based Treatment Programs Can
    Reduce Adolescent Drug Abuse”
       http://www.nida.nih.gov/NIDA_notes/NNVol17N4/Family.ht
        ml
   National Institute on Drug Abuse Principles of Drug
    Addiction Treatment: A Research Based Guide
       http://165.112.78.61/PODAT/PODAT10.html




                                                                 60
                   MDFT Recognition


   MDFT included in University of Maryland based Best
    Practices Project – Maryland Blueprints (manual of
    science-based drug and crime prevention programs)
   Center for Substance Abuse Treatment (1998)
    “Treatment Improvement Protocol Series (TIPS)”
       http://store.health.org/catalog/productDetails.aspx?ProductID
        =15371
   Communities That Care (2004) “Prevention Strategies
    Guide”
       http://www.channing-
        bete.com/positiveyouth/pages/CTC/CTC.html

                                                                        61
MDFT is an Effective and Flexible Clinical Approach

       Superior outcomes in comparison to several state-of-
        the-art, widely used treatments
       Engages teens and families in treatment and
        motivates them to complete the program
       Lower cost than standard outpatient or residential
        treatment




                                                               62
    MDFT is an Effective and Flexible Clinical
                   Approach
   Demonstrated success in treating a range of teens
    and families:
     Different ethnicities

     Genders

     Ages

     Severity of problems




                                                        63
    Treatment Engagement and Retention

   MDFT clients stay in treatment longer:
     95% of clients in intensive outpatient MDFT stayed

      in treatment for 90 days as compared to 59% in
      residential
     88% of clients in intensive outpatient MDFT

      completed treatment (180 days) as compared to
      24% in residential


    (Dakof et al., 2003)




                                                           64
    Treatment Engagement and Retention

   MDFT clients are more likely to complete treatment:
     96% of young teens in MDFT completed treatment (120
      days), as compared to
       78% of youth in group therapy

       58% of adolescent drug abusers stay in standard

        residential for 90 days***
       27% stay in standard outpatient for 90 days***




        *** according to US national statistics

    (Hser, Haikang, Chou, Messer, & Anglin, 2001)




                                                            65
               Impressive Clinical Outcomes in
                     Controlled Studies
   MDFT has demonstrated more favorable outcomes than
    several other state-of-the-art treatments, including:
          family group therapy
          peer group treatment
          individual cognitive-behavioral therapy (CBT)
          comprehensive residential treatment




    (Liddle et al. 2001; Liddle, 2002b; Liddle & Dakof, 2002; Liddle, Rowe, Dakof, Ungaro & Henderson, 2004;
                                                                      Rowe, Liddle, Dakof & Henderson, 2004).




                                                                                                                66
         Impressive Clinical Outcomes in
               Controlled Studies
   MDFT studies have included samples of teens with
    serious drug abuse and delinquency:
       Marijuana (heavy use)
       Alcohol
       Cocaine
       Other drug use; mainly referred from juvenile or drug court.




                                                                       67
           Impressive Clinical Outcomes in
                 Controlled Studies
   MDFT has worked effectively as a community-based
    prevention program *
   Successfully treated younger adolescents who are
    initiating drug use **




    * (Hogue, Liddle, Becker, & Jackson-Leckrone, 2002)
    ** (Liddle et al. 2004; Rowe, et al. 2004a)



                                                          68
        Impressive Clinical Outcomes in
              Controlled Studies
   Substance use is significantly reduced in MDFT to a
    greater extent than all comparison treatments
    investigated in 5 controlled clinical trials
      Between 41% and 82% reduction from intake to

       discharge


    (Liddle et al. 2001; Liddle, 2002b; Liddle et al. 2004a; Liddle et al., 2004b; Rowe et al., 2004a; Rowe,

    Liddle, Dakof, Henderson, Gonzalez, & Mills, 2004).




                                                                                                               69
        Impressive Clinical Outcomes in
              Controlled Studies
   Substance related problems are significantly reduced
    in MDFT to a greater extent than comparison
    treatments.
       Academic failure
       Association with negative peers
       Delinquency
       Family conflict




    (Liddle, 2002b; Rowe et al., 2004a)



                                                           70
          Impressive Clinical Outcomes in
                Controlled Studies
   Treatment gains are enhanced in MDFT after
    treatment discharge;
   MDFT clients continue to decrease substance use
    after discharge up to 12 month follow-up
     58% reduction of marijuana use at 12 months
     56% abstinent of all substances
     64% abstinent or using only once per month

    (Liddle, 2002b; Liddle & Dakof, 2002; Rowe et al., 2004)




                                                               71
          Impressive Clinical Outcomes in
                Controlled Studies
   Youth receiving MDFT often abstain from drug use:
       Youth receiving MDFT report abstinence from all illegal
        substances at 12 months post intake (64% and 93%
        respectively).
       Participants receiving comparison treatments report
        lower abstinence rates (44% for CBT and 67% for peer
        group treatment).

    (Liddle, 2002b; Rowe et al., 2004a)




                                                                  72
                Impressive Clinical Outcomes in
                      Controlled Studies
   Youth receiving MDFT show greater reductions in
    psychiatric symptoms:
     Range of 35% to 80% reduction in MDFT treatment

      group
     MDFT clients also continue to improve following

      discharge while teens in CBT show relapse of
      emotional and behavioral problems after treatment


    (Liddle et al. 2001; Liddle, 2002b; Rowe et al., 2004a; Rowe et al., 2004b)



                                                                                  73
            Impressive Clinical Outcomes in
                  Controlled Studies
   School functioning improves more dramatically in
    MDFT than comparison treatments
       For instance, MDFT clients return to school and receive
        passing grades at higher rates:
           43% in MDFT
           17% in family group therapy
           7% in peer group therapy


    (Liddle et al. 2001; Rowe et al., 2004a)




                                                                  74
                Impressive Clinical Outcomes in
                      Controlled Studies
   Family functioning improves to a greater extent in
    MDFT compared to:
       Family group therapy
       Peer group therapy
   Improvements are maintained up to 12 month follow-
    up




    (Liddle et al., 2001; Liddle et al. 2004a)


                                                         75
                Impressive Clinical Outcomes in
                      Controlled Studies
   Delinquent behavior and association with delinquent
    peers decreases to a greater extent in MDFT than peer
    group treatment
     These changes are maintained through a 12-month

      follow-up
   MDFT transportation studies have also shown that
    association with delinquent peers decreases more
    rapidly after therapists have received training in MDFT
    (Liddle et al., 2004a; Rowe et al., 2004a; Rowe et al., 2004b)




                                                                     76
               Impressive Clinical Outcomes in
                     Controlled Studies
   Arrests, convictions, and probation placements are less
    likely to occur during 12 month follow-up for youth
    receiving MDFT than youth receiving peer group
    treatment




    (Rowe et al., 2004a)




                                                              77
             Impressive Clinical Outcomes in
                   Controlled Studies
   Out of home placements occur less frequently in MDFT
    transportation studies after therapists have received
    training in MDFT




    (Rowe et al., 2004b)




                                                            78
                    Cost Savings of MDFT

   Average weekly costs of treatment are significantly
    less:
      MDFT cost treatment is $164

      Community-based outpatient treatment $365




    (French et al. 2003)


                                                          79
                   Cost Savings of MDFT


   An intensive version of MDFT designed as an
    alternative to residential treatment provides superior
    clinical outcomes at 1/3 the cost
     Average weekly costs of $384 vs. $1,068




(Liddle & Dakof, 2002)


                                                             80
Flexibility in Adapting to Program and Provider Needs

       MDFT is a “treatment system” rather than a “one size
        fits all” approach. Different versions of MDFT have
        been developed and tested according to:
         Study aims

         Client needs

         Treatment setting characteristics




                                                               81
Flexibility in Adapting to Program and Provider Needs

       MDFT developers see “transportation” as a
        collaborative adaptation process in which MDFT
        experts and program staff and administrators
        develop a multifaceted strategy that can address the
        needs of each stakeholder and barriers to
        implementation




                                                               82
Flexibility in Adapting to Program and Provider Needs

       MDFT developers are experienced at:
         Working with complex organizations and systems

          to assess providers’ resources and needs
         Training providers with different levels of expertise

         Adapting and adjusting the model for use within

          existing programs
         Field-testing and the correct approach as

          necessary



                                                                  83
Flexibility in Adapting to Program and Provider
                      Needs
     MDFT training materials and manuals are well
      developed and have been used extensively in:
       Training community-based therapists

       Including specific protocols for procedures and

        techniques




                                                          84
Flexibility in Adapting to Program and Provider Needs

       The MDFT treatment system is amenable to a variety
        of treatment settings:
         Intensive outpatient

         Outpatient

         Day treatment

         Prevention

         And can be adapted to accommodate the

           complexities of these agencies




                                                             85
Flexibility in Adapting to Program and Provider Needs

       MDFT is being adapted and implemented for new
        studies in juvenile drug court and juvenile detention
        settings, and a brief therapy version of MDFT is being
        tested at present as well




                                                                 86
    New International Research Initiatives to
          Implement and Test MDFT

   MDFT is recognized internationally as among the
    most effective treatments for adolescent substance
    misuse
      Brannigan, Schackman, Falco, & Millman, 2004
      DrugScope/ Drug and Alcohol Findings, 2002
      Rigter et al, 2004




                                                         87
    New International Research Initiatives to
          Implement and Test MDFT

   Research funding received from NIDA, and
    generated in the U.K. and Europe to
    implement and test MDFT
       5-country randomized clinical trial of MDFT
        effectiveness in Europe
       2-site implementation study in Glasgow, Scotland




                                                           88
            Ineffective Treatment


“The only thing we have to fear is fear itself.”

                          Franklin D. Roosevelt, 1933
                                  Inaugural Address




                                                        89
“Give me a fruitful error any time, full of seeds,
      bursting with its own corrections.
 You can keep you sterile ‘truth’ for yourself.”

                                    Vilfredo Pareto, 1848
          Italian sociologist, economist, and philosopher




                                                            90
“Errors usually have their good reasons once we
   penetrate their context properly and avoid
judgment according to our current perception of
                     ‘truth’.”
                           Stephen Jay Gould, 1980
                              In The Panda’s Thumb




                                                     91
Failure (noun).
The condition of not achieving the desired end.
One that fails completely.

unsuccess                    default            decline
            delinquency
breakdown              unsuccessfulness                 neglect
              dereliction              deterioration
  outage                    declination                omission

   bust           fiasco         washout               loser

                                                                  92
  “Our traditional American response to failures is
to reject them, to consign them, metaphorically or
    actually to the refuse heap where they are
expected to decay and disappear into our tolerant
 environment like all of our wastes and useless by-
                     products.”
                                  Graziano & Bythell, 1983
                     In Failures in Child Behavior Therapy



                                                        93
               Using Failure

 Recycle our failures
 Process what may be valuable in them
 Examine the conditions under which they
  occur
 Make appropriate adjustments in our
  procedures




                                            94
“Ah, but a man's reach should exceed his grasp,
           Or what's a heaven for?”

                           Robert Browning, 1855




                                                   95
           Mind Set and Goals

 New input
 “Can Do”
 “How To”
 Lists and lists




                                96
       50 Ways to Leave Your Lover




"The problem is all inside your head", she said to me
The answer is easy if you take it logically
I'd like to help you in your struggle to be free
There must be fifty ways to leave your lover…
                         Paul Simon, 1976               97
98
          10 Examples of 10 Ways…
                 (Thanks, Google)

   10 Ways to Improve Your Communication Skills
   10 Ways to Recognize Hearing Loss
   10 Ways to Live Longer
   10 Ways to Prepare for Retirement
   10 Ways to Tell if Someone is Lying to You
   10 Ways to Make Yourself a YouTube Star
   10 Ways to Fight Hate
   10 Ways to End the World
   10 Ways to Marry the Wrong Person
   10 Ways to Save Yourself from Messing Up Your Life


                                                         99
                    Barriers


 Breaking down the difficulty of change
    Program factors
    Method factors
    Therapist factors
    Case factors
    Context factors




                                           100
           Proven Ineffective


 Programs
   Adult-based / “step-down” programs
   Scared Straight
   Boot camps and (most) Wilderness camps
   Lock-step / inflexible
   Acontextual
      Philosophy and methods




                                             101
            Proven Ineffective


 Methods
   Confrontation
   Catharsis
   Resistance oriented/blaming methods
   Waiting for motivation
   Single treatment episodes




                                          102
                 Therapist

 Inadequate preparation
 Handicapping attitudes
   Pessimist about change
   Child saver
   Parent advocate
 Faulty ideas and assumptions
   Wait for them to want to change
 Unsupportive context
 No model
 No map


                                      103
           Adolescent/Family



 Multiple agency involvement
 Severity and duration of problems
 Low expectations for change




                                      104
THERAPY 101
                             PARENTING PRACTICES

   The Ten Basic Principles of Good Parenting
         Laurence Steinberg, PhD, 2000
THERAPY 101                       PARENTING PRACTICES –
                  10 BASIC PRINCIPLES OF GOOD PARENTING

               The Ten Basic Principles of Good Parenting
                   Laurence Steinberg, PhD, 2000
    Developed by Dr. Laurence Steinberg, professor of Psychology
     from Temple University
    What are the qualities that good parenting helps foster?
      -   Empathy
      -   Honesty
      -   Self-reliance
      -   Self-control
      -   Self-reliance
      -   Self-control
      -   Kindness
      -   Cooperation
      -   Cheerfulness
      -   Intellectual curiosity
      -   Motivation
THERAPY 101
                            PARENTING PRACTICES –
            10 BASIC PRINCIPLES OF GOOD PARENTING

 “If you don’t have a good relationship with your child,
    they’re not going to listen to you. Think how you relate
    to other adults. If you have a good relationship with
    them, you tend to trust them more, listen to their
    opinions, and agree with them. If it’s someone we just
    don’t like, we will ignore their opinion.”
THERAPY 101
                     PARENTING PRACTICES –
     10 BASIC PRINCIPLES OF GOOD PARENTING


 #1      Remember, parents matter.
   Make a difference in the life of your teen by providing
    guidance and support. At times, it may seem like your
    teen does not want you around. However, your child
    really does need you and needs to know you care.

    "What you do makes a difference. Your kids are watching
       you. Don't just react on the spur of the moment. Ask
     yourself, 'What do I want to accomplish, and is this likely
                     to produce that result?‘”
THERAPY 101
                         PARENTING PRACTICES –
         10 BASIC PRINCIPLES OF GOOD PARENTING


  #2       Stay warm and close.
   It’s impossible to love your teen too much. Spoil your teen with
     love and support every day. Spend time together at meals, and
     remember to say, “I love you.”




   "What we often think of as the product of spoiling a child is never
       the result of showing a child too much love. It is usually the
      consequence of giving a child things in place of love – things
     like leniency, lowered expectations, or material possessions."
THERAPY 101
                          PARENTING PRACTICES –
          10 BASIC PRINCIPLES OF GOOD PARENTING


  #3     Stay involved with your teen’s life.
   Ask questions about schoolwork and friends, and attend your
    teen’s extracurricular activities. Teens need to know you are
    interested in them just as much now as you were when they
    were younger.




    "Being an involved parent takes time and is hard work, and it
       often means rethinking and rearranging your priorities. It
      frequently means sacrificing what you want to do for what
    your child needs to do. Be there mentally as well as physically."
THERAPY 101
                         PARENTING PRACTICES –
         10 BASIC PRINCIPLES OF GOOD PARENTING


  #4     Set limits and provide structure.
   Clearly communicate your expectations to your teen. Rules and
    expectations should change throughout your child’s life, but
    children of all ages need clear rules.

     “Any time of the day or night, you should always be able to
     answer these three questions: Where is my child? Who is with
       my child? What is my child doing? The rules your child has
      learned from you are going to shape the rules he applies to
                                himself."

   "But you can't micromanage your child. Once they're in middle
     school, you need let the child do their own homework, make
                their own choices, and not intervene."
THERAPY 101
                         PARENTING PRACTICES –
         10 BASIC PRINCIPLES OF GOOD PARENTING

  #5      Enforce rules and consequences.
   Let your teen know what the consequences of breaking rules
     will be ahead of time. Follow through on enforcing
     punishments.

  “Setting limits helps your child develop a sense of self-control.
     Encouraging independence helps her develop a sense of self-
     direction. To be successful in life, she’s going to need both.
     Accepting that it is normal for children to push for autonomy is
     absolutely key to effective parenting. Many parents mistakenly
     equate their child’s independence with rebelliousness or
     disobedience. Children push for independence because it is
     part of human nature to want to feel in control rather than to
     feel controlled by someone else.”
THERAPY 101
                      PARENTING PRACTICES –
      10 BASIC PRINCIPLES OF GOOD PARENTING


  #6      Be consistent.
   Parents should discuss and agree on basic parenting principles
     for guiding their children. Then, be consistent each day and in
     every situation. Mixed messages from parents can lead to
     frustration for both parents and children. Children need
     consistency to help them structure their lives.

  "If your rules vary from day to day in an unpredictable fashion or if
       you enforce them only intermittently, your child's misbehavior
        is your fault, not his. Your most important disciplinary tool is
         consistency. Identify your non-negotiables. The more your
       authority is based on wisdom and not on power, the less your
                             child will challenge it."
THERAPY 101
                     PARENTING PRACTICES –
     10 BASIC PRINCIPLES OF GOOD PARENTING


  #7      Explain yourself and engage your teen
          in decisions and conversations.
   Discuss the reasons for rules and consequences with your teen.
    This does not mean that the rules or consequences will
    change, but it will help your teen understand your reasons and
    respect you. Teens don’t respect authority when it seems
    arbitrary.



        "Generally, parents overexplain to young children and
      underexplain to adolescents. What is obvious to you may not
       be evident to a 12-year-old. He doesn't have the priorities,
                judgment or experience that you have."
THERAPY 101
                     PARENTING PRACTICES –
     10 BASIC PRINCIPLES OF GOOD PARENTING


 #8      Don’t use harsh discipline.

     Harsh discipline, like yelling or slapping, is not an
       effective long-term approach to discipline. Do not
    discipline your teen when you are angry. Instead, make
    arrangements to talk to your teen at a later time when
    wisdom and good judgment, not anger, will guide your
                        discipline choices.

  "Children who are spanked, hit, or slapped are more prone
     to fighting with other children. They are more likely to
       be bullies and more likely to use aggression to solve
                      disputes with others."
THERAPY 101
                     PARENTING PRACTICES –
     10 BASIC PRINCIPLES OF GOOD PARENTING


  #9     Treat your teen with respect.

     Your teen is growing up. Acknowledge your teen’s
    increasing independence and ability to make decisions.
    Guide your teen in making positive choices, but realize
              that he or she will make mistakes.

  "The best way to get respectful treatment from your child
     is to treat him respectfully. You should give your child
      the same courtesies you would give to anyone else.
    Speak to him politely. Respect his opinion. Pay attention
      when he is speaking to you. Treat him kindly. Try to
    please him when you can. Children treat others the way
      their parents treat them. Your relationship with your
    child is the foundation for her relationships with others."
THERAPY 101
                         PARENTING PRACTICES –
         10 BASIC PRINCIPLES OF GOOD PARENTING

  #10      Understand adolescence is a period of
           change – for parents and children.
       As a parent, you are changing as you develop new
    information and skills to help guide your teen. Your teen is
     changing physically, emotionally, and cognitively. Look for
    resources to help you understand the changes your teen is
         going through. Such resources include your local
     Cooperative Extension office, other parents of teens, and
       books. Remember, your relationship with your teen is
                       changing, not ending.

    “Make sure your parenting keeps pace with your child’s
        development. You may wish you could slow down or
     freeze-frame your child’s life, but this is the last thing he
    wants. You may be fighting getting older, but all he wants
                          is to grow up.
        Parents. The Anti-Drug.




 http://www.theantidrug.com
  The Partnership for a Drug-Free America


 http://www.drugfree.org
                      Context


   Fragmentation of services
   Lack of support for effective practice
   Societal bias against teens / parents
   Institutional




                                             130
             Working with Adolescents

   The “Oh no!” response
   Mind set – your expectations
   Challenging, yes; impossible no
   Antidotes
       Why does treatment fail?
       What are the challenges?
       How did things get this way?
       How are these problems understandable?
 Embark on an informed, systematic change plan



                                                  131
       10 Steps to Improving Practice
1. Initiate an inventory
2. Use the buddy system
3. Assess then access resources
4. Study your own work & the work of others
5. Identify what should stay and what should go
6. Target specific knowledge and skills
7. Work multidimensionally
8. Work with families & use enactment
9. Assess/intervene in multiple systems
10. A punch line

                                                  132
               1. Initiate an inventory

   Self study
   Track your career
   Background and training
   Write it down
     Orientation, change ideas, main methods
 Connect your behavior to outcomes
 Logic model of outcomes
 Make a plan


                                                133
           2. Use the buddy system



 Sharing and stimulating motivation
 Improve together
 Change is contextual, interpersonal as well as
  intrapersonal




                                                   134
           3. Access resources


 Books, articles, journals
 Manuals
 Websites




                                 135
4. Study your own work & the work of others


   Case notes
   Case presentations
   Audiotapes/videotapes of sessions
   Expert/experienced therapists




                                              136
5. Identify what should stay and what should go


  Strength-based
  Face the music
  Confirm with the buddy




                                                  137
   6. Target specific knowledge and skills


 New knowledge
 New skills




                                             138
           7. Clarify your principles

 What are the ingredients of engagement, retention,
  and outcome?
 What is outcome?
 What is your logic model of change?




                                                       139
   8. Work with families & use enactment


 What assumptions do I bring?
 What does the literature say?
 Enactment as a method and significant part of the
  change process




                                                      140
   9. Assess/intervene in multiple systems


 Most treatments are too narrow
 Families and therapists get worn down
 Contexts and regulations help therapists work
  ineffectively




                                                  141
10. How do you get to Carnegie Hall?




                                       142
143
144
145
  10. How do you get to Carnegie Hall?


  There's a story about legendary pianist Arthur
Rubinstein who was approached in the street near
     New York's world-famous Carnegie Hall.

              The stranger asked,
 "Pardon me sir, how do I get to Carnegie Hall?"

             Mr. Rubinstein replied,

         “Practice, practice, practice!”

                                                   146
                   10. Practice


   Multiple methods
   Successive approximations
   Specific and systematic feedback
   Interplay of anxiety and relaxation
   Thinking through why I want to improve
   Integrated into a career vs. external motivation




                                                       147
    Center for Treatment Research
      on Adolescent Drug Abuse
University of Miami School of Medicine

    www.med.miami.edu/CTRADA
      (or Google us at CTRADA)

      hliddle@med.miami.edu
                                         148

				
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