Finding Help - Treatment Program Research & Questions to Ask When Seeking Help
Finding help for a substance use or mental health disorder is a complex process that is extremely hard to navigate especially for the non substance abuse professional. Addiction treatment in this country has become a highly specialized and profitable healthcare industry which makes selecting the right treatment facility or practitioner exceedingly difficult. Simply put, drug rehabs have become big business and there are now ove 13,000 treatment programs of various types in the US.
We at Chooper's Guide understand the emotional strain and confusion that always accompanies the research, referral, admisssion, treatment and recovery process and have assembled a series of assessment tools for both substance use and mental health issues in hopes that it will help our users to understand the symptoms of these disorders, evaluate the severity and identify potential addiction and mental health treatment providers. Additionally, we have included a series of questions to ask potential providers to empower our users in the selection process.
FINDING THE RIGHT TREATMENT PROGRAM
QUESTIONS TO ASK ABOUT ASSESSMENT
Does the program use a published assessment tool?
WHY THIS IS IMPORTANT TO ASK: Assessment is the cornerstone of the decision-making process from which all else should flow. As you look for a program, check to see if they use an assessment tool that has been tested and found to be reliable and valid versus an assessment that the program designed by itself. Within the assessment, see if the program asks about your child’s strengths, interests and resources for these will be important to build on – or develop – as your teenager begins a drug- and alcohol-free lifestyle. Also look to see that a comprehensive array of areas your son/daughter may be struggling with is assessed – like school, the law, his/her peers and your family – because teenagers with drug and alcohol problems generally have difficulties in a number of areas in their life.
What are the Levels of Care available?
WHY THIS IS IMPORTANT TO ASK: The American Society of Addiction Medicine (ASAM) Patient Placement Criteria are guidelines help match individuals to the appropriate level and type of care needed. There are five broad Levels of Care your child may be assigned to depending on the results of the assessment:
- Level 0.5: Early Intervention Services
- Level I: Outpatient Treatment
- Level II: Intensive Outpatient / Partial Hospitalization Services
- Level III: Residential / Inpatient Treatment Services
- Level IV: Medically Managed Intensive Inpatient
Will my child be re-assessed?
WHY THIS IS IMPORTANT TO ASK: In addition to assessment at the beginning of treatment, it is also important that your son/daughter be re-assessed during treatment to monitor progress and see if any new problems have come to light. Assessing adolescents throughout the course of treatment helps to guide treatment over time.
May I review your program’s eligibility criteria?
WHY THIS IS IMPORTANT TO ASK: You want a program that accepts adolescents they know they can treat – not a program that accepts anyone who walks through their door.
If your program is a good fit for my child, then how soon could we begin treatment?
WHY THIS IS IMPORTANT TO ASK: Generally you’ll want to start treatment quickly (within 24-72 hours after you’ve determined that treatment is necessary) so find out how long it will take to begin treatment if your son/daughter is eligible for the program and you believe it is a good fit for your child.
QUESTIONS TO ASK ABOUT ATTENTION TO MENTAL HEALTH AND MEDICAL CARE
Will my child be assessed for co-occurring mental health problems?
WHY THIS IS IMPORTANT TO ASK: Because mental health issues often go hand-in-hand with drug and alcohol abuse, it is important that your son/ daughter be assessed for co-occurring mental health problems.
Does the program use a published assessment tool that identifies symptoms and behaviors that would indicate depression, conduct disorder, impulsivity, attention deficit disorder, post-traumatic stress disorder and anxiety?
WHY THIS IS IMPORTANT TO ASK: As stated earlier, it is important that assessment tools used by a program have been tested and found to be reliable and valid, and that the tools assesses symptoms of disorders that frequently co-occur with substance abuse so that treatment for any additional disorders can be arranged.
Does the program treat mental health problems?
WHY THIS IS IMPORTANT TO ASK: If the assessment shows your child has a mental health issue, it’s important that the program requires staff to address mental health in treatment plans when appropriate.
Will diagnostic evaluations as well as mental health services be available either on-site or through referral?
Will there be a delay between identifying the need for a mental health diagnostic assessment or treatment and actually receiving the assessment or treatment?
If Yes, how long?
WHY THIS IS IMPORTANT TO ASK: Again, rapid access to these services is important. Like other areas of your teenager’s life, assessing your adolescent’s mental health status throughout the course of treatment will guide treatment over time.
Is the staff knowledgeable about and willing to consider the use of Medication-Assisted Treatment?
WHY THIS IS IMPORTANT TO ASK: Medication-Assisted Treatment is the use of medication to help address issues related to opioid dependence, including withdrawal, cravings and relapse prevention. The medication used with teens or young adults with an opioid dependence are Methadone, Buprenorphine/Suboxone and Naltrexone/Vivitrol. There are three, equally important parts to this form of treatment: 1.) Medication 2.) Counseling 3.) Support from family and friends. These three parts works together to help young people recover their lives. It is important that the treatment provider is aware of Medication-Assisted Treatment in the event that your child could benefit from it.when appropriate.
Does the program offer comprehensive integrated treatment?
Does the program offer or refer patients to:
- Medical Care
- Sexual Health and Infectious Disease Services such as STD testing and education
- Trauma Services
- Educational/Vocational Assistance
- Services that address other addictive behaviors such as excessive gaming, gambling and pornography
WHY THIS IS IMPORTANT TO ASK: Teenagers with drug and alcohol problems generally have difficulties in a number of areas in their life. Consequently, the program should have an array of services on site or through referral relationships with outside programs that address problem areas uncovered in the assessment(s).
Can the program connect my child with activities in the community that he/she is interested in and with peers who are not involved with drug or alcohol use?
WHY THIS IS IMPORTANT TO ASK: As your child begins his/her recovery, it will be important that he/she get engaged in positive activities to fill his/ her free time. Also given that most of your child’s friends were probably also using drugs or alcohol, it is important for him/her to get to know and possibly develop friendships with non-using peers.
Does the program maintain contact with probation officers while protecting my son/daughter’s rights to confidentiality?
What is the staff-to-patient ratio?
WHY THIS IS IMPORTANT TO ASK: If the caseloads of staff members are high, your child may not receive the individualized management and care he or she needs. Ask about the type (and hours per week) of individualized care your child will receive with his/her counselor
Are there staff members on-site trained in:
- Adolescent Development?
- Case Management?
- Family Therapy?
- Co-Occurring Disorders?
WHY THIS IS IMPORTANT TO ASK: Since adolescents are not adults, having staff that are knowledgeable and experienced with this age group is critical so they understand behaviors, the importance of peers, their need for autonomy, etc. Given that co-occurring disorders are not uncommon and that family-based approaches to treatment have the most research evidence of effectiveness behind them, employing staff who are also knowledgeable about and have experience in these two treatment areas is important.
What are the educational degrees of supervisors and direct service staff?
WHY THIS IS IMPORTANT TO ASK: A highly-skilled and expertly trained staff is critical to providing the array of quality services needed to treat adolescents. Hopefully you will see at least a few with master’s degrees.
Are there medical doctors on staff to manage and treat a patient’s other medical or mental health problems?
WHY THIS IS IMPORTANT TO ASK: Because mental health problems frequently co-occur and there may be medical issues that require attention, it is important for programs to have medical staff available for those patients who need those services.
What type of professional provides medical and psychiatric care (e.g. a medical doctor or nurse practitioner)?
- What is his/her availability?
- How often does he or she see the patients?
- Is there emergency coverage for medical or psychiatric care?
Do programs provide opportunities for staff to increase their skills (e.g., paid time off for training, on-site staff training opportunities)?
WHY THIS IS IMPORTANT TO ASK: Ongoing research continues to identify new treatment techniques so it is important that programs stay up-to-date on practices that could potentially benefit their patients.
Are clinical staff regularly supervised and provided with feedback to continually improve their clinical skills?
WHY THIS IS IMPORTANT TO ASK: Clinical supervision is good clinical practice. It helps to ensure that staff maintain a high level of skill and have access to another perspective when faced with a challenging patient.
What is the staff’s experience working with adolescents/young adults?
WHY THIS IS IMPORTANT TO ASK: You want to make sure that the staff has knowledge of adolescent development and experience working with adolescents with substance use disorders (see top of page 14 and bottom of page 24). Also, it is important that you are comfortable with the people who are caring for your child.
- What is the cost of the program?
- Is insurance accepted?
- Do you offer financial aid?
- Do you offer a payment plan?
- Do you offer a sliding fee scale (i.e. a flexible payment scale based on income)?
ADDITIONAL QUESTIONS ABOUT THE PROGRAM
Is the program licensed by the state?
What is the accreditation status of the program?
WHY THIS IS IMPORTANT TO ASK: Every program must be licensed by the state to operate. Many programs also go through the licensing process to receive accreditation. While national accreditation does not offer guarantees, accreditation is an indication that the program has been carefully reviewed by an independent organization. You may even want to call the accreditation organization to determine if the treatment program continues to be in good standing.
You may also ask other professionals in the community such as your primary care doctor, your child’s pediatrician, psychologists, and social workers about the reputations of specific programs.
QUESTIONS TO ASK ABOUT FAMILY INVOLVEMENT
If my son or daughter were to enter your program, what would you need to know about my family and what would you do with the information?
WHY THIS IS IMPORTANT TO ASK: It is important to see whether the program will assess how your family gets along, interacts and resolves problems so that they can talk with you about how things could get better if need be. It is also important that the program ask about whether anyone else in the household uses drugs or alcohol so that they can help that person enter treatment if appropriate and work to have an environment where temptations will not exist, i.e., little to no access to various substances of abuse.
What would I be expected to do while my son/ daughter receives treatment?
WHY THIS IS IMPORTANT TO ASK: It is important that the program work with you (and other involved family members) on issues that are important to you, your son/daughter, and others living in the home. You may want to be – or are expected to be - involved in family therapy where the entire family works with a therapist to help them get along better. You may also want to learn a more effective way of parenting your teenager. At a minimum, it is important that the program provide you with educational opportunities as well as access to support groups. Families should be an integral part of any adolescent substance abuse treatment program. Research clearly shows that family involvement in treatment leads to better results for the adolescent
Does the program provide and support legal opportunities for parents to obtain basic information and have input into decisions regarding the treatment and recovery plans for their child?
WHY THIS IS IMPORTANT TO ASK: Even though there are confidentiality laws which prohibit programs from sharing information with parent(s) without a signed release from their children, it is important that parents can share what goes on at home, their concerns, and what is important for their son/daughter and family to address. Programs should be able to talk with you about how they approach these issues with parents of adolescents in general and with adolescents who have and have not signed releases.
Does your program conduct satisfaction surveys or have family members on an Advisory Board or on the Board of Directors?
WHY THIS IS IMPORTANT TO ASK: This is a good way to see whether the family’s voice is part of programming and planning.
Are there services for parents and siblings of the patient?
If not, can they refer the family to appropriate services?
WHY THIS IS IMPORTANT TO ASK: The family — parents, any siblings, and significant household members such as a step-parent — need help learning how to trust again, build healthy relationships with their child or sibling, and learn how to function as a family with a child in recovery.
Does the program treat adolescents separately from adults?
WHY THIS IS IMPORTANT TO ASK: Adolescents are a unique patient group and as such require specialized care.
Does the program incorporate recreational and other activities into the treatment schedule that are of particular interest to adolescents?
WHY THIS IS IMPORTANT TO ASK: Few adolescents want to be in treatment and few think that they need treatment. As such, engagement can be difficult. If there are things at the program that they are interested in, they will be more likely to attend.
How do you handle varying ages and developmental levels of youth in the program?
WHY THIS IS IMPORTANT TO ASK: Because adolescence encompasses an age range with different cognitive abilities and thinking processes, it is important that staff do more than lecture. Programs may use a combination of techniques in sessions including role-play, exercises to sharpen concrete thinking skills and cognitive behavioral and motivational techniques to play to different skill sets and to keep youth engaged.
Are there opportunities for teens to have input into decisions regarding their own treatment and recovery plans, as well as in their personal goals?
WHY THIS IS IMPORTANT TO ASK: Autonomy is a key developmental task for adolescents. Providing opportunities for youth to have a say in what happens to them is not only good for the treatment process (e.g., they co-own the treatment and recovery plans) but it is also good for their overall well-being.
How is teen behavior — such as testing limits, moodiness and impulsiveness — handled?
WHY THIS IS IMPORTANT TO ASK: Adolescence is a time of many biological, psychological and social changes and hence behavior may at times be challenging. Understanding that youth will sometimes test limits and be impulsive and disruptive allows staff to put these behaviors in a developmental context and use them as teaching opportunities rather than for punishment.
How do you encourage teens to attend your program?
(Examples: offer convenient hours; help with transportation; employ staff members who like working with adolescents.)
How does the staff motivate youth from the first contact throughout the course of treatment?
WHY THIS IS IMPORTANT TO ASK: It is not always easy to engage teenagers in treatment that they do not want or feel they need, so programs need to work hard to engage and retain them.
What types of reinforcement or incentives are used to facilitate retention?
(Examples: praise for doing a good job, certificates of accomplishment, pizza nights.)
How do you support treatment attendance following one or several missed sessions?
QUESTIONS TO ASK ABOUT CULTURALLY COMPETENT TREATMENT
WHY THE FOLLOWING QUESTIONS ARE IMPORTANT TO ASK: Being able to engage youth from diverse cultures and backgrounds and having an understanding of different cultural perspectives is important throughout the course of treatment.
How does the treatment program address youth from different cultural backgrounds?
Does the program offers some sessions or groups just for girls or just for boys?
Does the staff have experience working with Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) teenagers?
Are there connections with community groups where adolescents (and their families) can meet people from similar cultural backgrounds?
Does the program offer staff training in cultural competence?
How does the program ensure the physical and emotional safety of all youth such as policies around bullying and especially of those who are different?
CONTINUING CARE AND RECOVERY SUPPORTS
The next set of questions will help you assess what the program does to prepare youth and families for when treatment is completed.
WHY ARE THESE IMPORTANT TO ASK: Recovery is an ongoing process and ideally discussion of how to maintain sobriety and abstinence, stay away from peers who use, and engage in positive activities should begin early in the treatment process. This way you and your son/daughter know what’s ahead and have a well thought through (and maybe even tested) plan.
Does the treatment taper off so youth gradually leave the safety of the program?
Does the program design a continuing care plan that specifies what youth should do after they are discharged — such as get involved with positive free time activities?
Does the program provide referrals to community services that offer things for your child to do that don’t involve drug or alcohol use?
Any other things the program does to help the ongoing recovery process?
Once the program ends, does the staff conduct a few check-ups to see how things are going?
WHY THIS IS IMPORTANT TO ASK: It’s important for the program to address any problems that might be cropping up, including the need to re-engage in treatment.
The next set of questions will help you determine whether programs have had an evaluation and what the results were. You are looking to see how many youth have a positive discharge, how many are linked with step-down care and how many are drug- and alcohol-free at various time points after leaving treatment.
Have you had your program evaluated?
What are the outcomes of the evaluation?
Choosing the best program for your child
Now that you have collected information about each drug and alcohol treatment program, you can begin deciding which one is the best fit for your child. Here are some suggestions:
- Figure out what is most essential and necessary for your son or daughter’s treatment. You may want to make a list of what your child needs most and what is most important to you and your family. Keep in mind that you may have to give up one aspect of a program to gain another more important one.
- Trust your judgment and your feelings about the answers you get from the people you talk to. The responses you receive should be clear and concise. You know your child best and what facility can be most helpful for his or her individual needs. Use your consumer education skills that you would use in any serious health care decision.
- Before making any final decision, make sure you and your spouse (or other primary caregiver) are involved in the decision about where to get help for your child and, most importantly, make sure your teen or young adult is part of the conversation and decision-process.
- Reassure your child about how the decision to enroll him in treatment program comes from your love for him/her and that you know h/she may be scared but ultimately it will allow him/her to live a healthier better life.
- Treatment for a substance abuse problem is not one-size fits all. Your child may not respond to a treatment program that worked really well for another child. Alternatively your child may do really well in a program that didn’t work for somebody else. What works for one individual may not work for your child. Different approaches to treatment help different kinds of people.
- Keep in mind, that your child may need to try a few different programs before finding the right one for him or her (Perhaps your son/daughter doesn’t click with the therapist or feel good at the program. etc.) Keep this workbook handy so that you can look back and select a different program if necessary.
Source: Treatment Research Institute and The Partnership at Drugfree.org