Treatment


It’s an exciting time to be involved in youth violence prevention! Statistics show that youth violence is decreasing and research offers effective ways to stop it. The entire goal of youth violence prevention is just that: preventing it from happening in the first place, or stopping it as fast as possible once it has occurred.
Having a clear picture of how services work makes everyone’s job easier and more successful. Planning for success with families involves a clearly defined and structured approach for both treatment and additional services. Using a research-based approach helps youth and families heal pain.
Knowing what to look for and how to create effective services is vital to a successful community approach to prevention. A collaborative, family-focused and trauma-informed approach for cognitive restructuring, affect regulation, and competency development streamlines efforts and is cost effective. When everyone involved knows what youths need from treatment, violence will stop. Investing in the future of all children in this way is rewarding for everyone!
Current evidence indicates that the most effective treatment is based upon a foundation of non-judgmental attitude, empathy, genuineness, and warmth. Additionally, recent studies indicate that successful outcomes in psychotherapy are based upon four factors: therapeutic technique (15%); creation of hope and expectation for change (15%); the therapeutic relationship between service providers and clients (30%); and client characteristics (40%) including strengths, resources, social support, living environment.
Treatment is based upon these concerns in order to reduce harm, enhance the lives of the children and families we serve, and create safer communities for everyone.

Definitions

Services: Any research-based activities that influence youth violence prevention. This may include therapy, community service, mentoring, physical fitness activities, and expression through art drama, dance, or music.
Treatment/Therapy: Specific, research-based, therapeutic models, or practices that influence youth violence prevention. This may involve evidence-based practices such as Multi-systemic Therapy (MST), or Trauma Focused Cognitive Behavioral Therapy (TF-CBT).
Cognitive restructuring: Changing the way someone thinks.
Competency development: A youth’s ability to increase knowledge and skills in order to become a productive, connected, and law abiding members of their community.
Affect regulation: A person’s ability to manage emotions without causing harm. It is the core of all violence prevention.

Engaging Youth and Families

Engagement is a continuous process of respectful communication that addresses the youth and family’s identified concerns and goals.
Youth and families receive services from a variety of organizations with an interest in a young person’s success but with potentially conflicting agendas. A collaborative, multidisciplinary approach meets the complex needs of youth and families. A youth’s support by, and connection to, the community are critical to successful treatment outcomes.
Establishing, and maintaining relationships with each youth, and pertinent family members, is critical for prevention. Getting someone to change requires offering them compelling reasons to do so. They are more likely to consider change when the person trying to persuade them behaves respectfully and without judgment.
Developing a therapeutic alliance, or collaboration, helps individuals find courage and strength to consider change.

Engaging youth and family members involves:
• Welcoming rituals that promote positive youth development
• Assisting families in identifying strengths and successes in their daily lives
• Clearly defining expectations for participation and change
• Identifying people who can potentially be trusted to make up a social support network and participate in treatment
• Deciding how each social support network member can help
• Initiating contact with social support network members
• Clarifying the role each social support network member will play
• Participating in service activities
• Teaching self-soothing activities to enhance stress reduction and affect regulation
• Demonstrating respectful behavior
• Actively giving and receiving feedback
• Participating in psycho-education that includes but is not limited to: social skills, affect regulation, sexual health and substance abuse (if indicated)
• Monitoring competency development

Facing Up to Harm

Acknowledging harm that brought a youth into treatment provides an opportunity for youth to begin taking responsibility for their behavior. It does not require details of the behavior or admitting responsibility all at once or right away. This part of the process can be scary for a variety of reasons.
Why shouldn’t we expect a youth to admit to the details of the harm they caused all at once? Youth may feel ashamed for behaving violently. They may be afraid of consequences, such as being arrested, or rejected by their family. A thoughtful and sensitive response by all service providers can help youth and families face up to pain caused by violence in their lives. When a youth is able to talk at all about any harm they caused, thoughtful encouragement by a service provider can help the youth continue to address the problem.All adults can help youth face up to harm. People tell lies when they are afraid to tell the truth. When youth behaving violently don’t know what to expect, outright admission of guilt is less likely to happen. Providing clear explanation of what might occur and exploring pros and cons of coming clean about harm helps youth to make informed decisions. When adults offer patient guidance and model truth telling, youth can see that taking responsibility is the best way to proceed.
Slowing down may actually have a paradoxical effect and help youth address the problem sooner. When service providers listen carefully, offer empathy and consideration, youth are more likely to feel safe and talk about the violence. They are more likely to feel disrespected when they are hurried, coerced, or don’t feel like people are really listening to what they have to say. When that happens they are not likely to speak truthfully.
Service delivery, including treatment, does not happen in a step-wise fashion. The process is like weaving. Community activities and therapy are interwoven into each family member’s experience. Many threads are similar and repetitive throughout the fabric of treatment. All services involve affect regulation, cognitive restructuring, and competency development. Practically speaking, this means changing thought processes, expressing emotions in clear and safe ways, and skill building.
The entire experience creates a unique pattern showing the changing tapestry of a youth and family’s life story. The goals are to promote family well being, change social learning, and reduce negative peer influences and antisocial behavior.
Facing up to harm is a type of cognitive restructuring.

Practically speaking, when they don’t face up to it, they are thinking one way (it’s not okay to talk about it, I shouldn’t tell anyone, etc). When they do face up to it, they are considering change (maybe talking about it can help, if I talk about it, maybe things will change, etc.).

Facing up to harm involves:
• Identifying behavior that brought about a need for services
• Acknowledging harmful behavior in therapy
• Continuing to participate in psycho-education that includes but is not limited to: social skills, affect regulation, sexual health and substance abuse (if indicated)
• Demonstrating harm reduction
• Behaving in pro-social ways according to safety and service plans and therapeutic goals

Healing Trauma

Trauma is a deeply distressing or disturbing experience that has lasting effects. Each individual experiences it uniquely. When anyone experiences any type of trauma, healing occurs through the body’s ability to manage the impact both physically and emotionally in ways that promote health and well being.
Taking good care of one’s self is the most important thing anyone does. Developing personal responsibility and accountability for optimum physical and mental health provide a foundation for competency development, self-sufficiency, and personal satisfaction.
Youth and families learn to address painful life experiences that played a part in violence. They may be extremely fearful of facing trauma. Children who have witnessed violence may struggle to learn healthy coping strategies for managing the pain. They may desperately try to put it out of mind, or misbehave in an effort to keep bad memories at bay (Groves, 2002). Intense fear is a normal defense against addressing trauma. People often try to cover up pain in an effort to hide vulnerabilities. Such behavior can be especially challenging.
Services for youth and family should always use evidence-based practices for healing trauma. These include trauma-focused cognitive behavioral therapy, abuse-focused cognitive behavioral therapy, and parent child interaction therapy.
Trauma that takes place within a family can be successfully addressed through evidence-based practices. All family members involved in trauma should participate in trauma-focused therapy. Parents’ abilities to acknowledge children’s feelings and take responsibility for their own actions (whether intended or not) that played a part in the trauma help youth take responsibility for the harm they caused. Practically speaking, when the act of taking responsibility for causing trauma can be demonstrated by an authority figure in the family, youth are more apt to take responsibility for the harm they have caused.
Talking about trauma in a safe therapeutic setting is crucial. Real, or perceived mistreatment or rejection by loved ones greatly affects behavior and relationships. Communication and new understanding produce cognitive restructuring of past events and can stop violence.

Healing trauma involves:
• Learning about, and showing understanding of disturbances of arousal, affect regulation and the trauma outcome process
• Practicing self-soothing activities that promote affect regulation
• Figuring out how previous trauma influences current behavior
• Acknowledging grief and loss, and practicing pro-social self-expression
• Participating in evidence-based therapies when indicated
• Continuing to participate in psycho education curricula as indicated
• Demonstrating improved social skills, moral reasoning, and behavior
• Monitoring competency development

Cognitive restructuring influences affect regulation and competency development.

Practically speaking, when people successfully change their thinking about violence, they stop doing it (affect regulation) and behave in pro-social ways (competency development).

Planning for Success

Each youth, with the guidance of trusted adults, develops a detailed plan for what he or she will do to decrease the likelihood of future harm. This plan becomes the framework for life-long prevention.
Planning for success involves taking full responsibility for violence and making amends to those hurt by a youth’s harmful behavior. Making amends is a process by which people take responsibility for harm they have caused and commit to never doing it again. When youth not only take responsibility and apologize to everyone impacted by the violence, but actually, or symbolically, give back anything that was take away through the violence, restorative justice occurs. Restorative justice is just that: real or symbolic efforts to restore a sense of fairness or justice to crime victims. It is important to note that people other than victims may be deeply traumatized by the harm to self or others youth cause through violence. Acknowledging the impact on everyone helps individuals, families, and communities heal from violence.

Planning for Success involves:
• Maintaining a personal commitment to stop all harm
• Creating a plan for affect regulation
• Practicing affect regulation in all areas of life (home, school and community)
• Creating a plan for restitution and participating in restorative justice victim offender dialogues
• Identify everyone who was hurt by the youth’s harmful behavior
• Decide how they will go about making amends to each of those people
• Participate in community service as a component of restitution (when indicated)
• Apologize to everyone who was in any way hurt by his or her harm
• Conducting social support network meetings to plan for transition out of services
• Presenting a plan for success to a youth’s social support network
• Demonstrating empathy, compassion and moral reasoning
• Consistently displaying pro-social behavior
• When placed out of home, exploring specific options for returning to the home community
• Monitoring competency development

Practicing the Plan

Leading a life free of violence requires dedication and commitment. All involved adults can encourage a youth to stick to his, or her plan for success. This involves consistently responding to difficult situations in pro-social ways.

Practicing the Plan involves:

• Transitioning out of services
• Planning specific termination activities with primary service providers and social support network members
• For those in residential treatment, having graduated lengths of stay in the community
• For those in residential treatment, meeting with primary and clinical staff after each community visit in order to assess the experience and plan for continued success
• For those in residential treatment, participating in family meetings to assess reconciliation, reconnection and preparation for reunification
• Clarifying and implementing the transition plan
• Monitoring competency development

Planning for Continued Success

Successful outcomes are dependent upon a youth’s commitment to live respectfully. This commitment can be honored and witnessed by people who have supported the youth throughout treatment. For youth in residential care, discharge is a time of high risk when they may be returning to the environment where the violence began.

Planning for Continued Success involves:
• Creating a ritual, or celebration for completing services
• Facilitating the ritual with social support network members
• Participating in a celebration of success
• Discharging from residential treatment (when applicable) or other formal services
• Offering connections for youth and families when youth are in transition between services
• Monitoring competency development

Transitional Services

Transitional services focus on successful practice of newly acquired skills and abilities for life-long pro-social behavior. Maintaining ethical connections with service providers and developing new relationships can help youth settle in with new competencies for violence prevention.
Practically speaking, if a service provider is only focused on a youth’s needs during the time he or she is receiving services, chances for long-term success are reduced. Programs that envision their responsibility ending when youth simply master only those tasks required for successful program completion do not promote life-long success. Life-long success requires all services, beginning immediately when a youth is referred for services, to provide a holistic approach throughout a full continuum of care.
Treating youth away from home and possibly a distance from family can have negative effects and creates barriers to reintegration home. Potential for out of home placement should be considered and discussed right from the beginning of service delivery.

Transitional Services involve:
• Maintaining telephone contact with service providers on a scheduled basis after service completion
• Monitoring progress towards goals for continued success
• Notifying designated service providers immediately when success is threatened
• Facilitating connections with new service providers and other supportive community members
• Returning for treatment if necessary
• Documenting outcomes:
• Intermediate Outcomes are those measured at termination or case closing
• Long-term Outcomes are those measured as some point after case closing, and indicate whether ultimate goals have been achieved