What works with adolescents?

1. What works with adolescents? Family connections and involvement in interventions Lyndal Power ACWA Conference, 2-4th August, Sydney

2. Adolescence • An incredible time of growth • Physical development- brain research • Identity, social and emotional development • Cognitive development • Sexual development • Not children, but not adults either

3. Family in Adolescence • Still important? Yes! • Family offers a “secure base”- a safe place to return – (caring, connectedness and belonging)- linked to positive outcomes (Luthar 2006) • Peer relationships develop but not at expense of family • Inter-dependence rather than independence-family, friends, partners (Daniel et al 1999) • Parents continue to advise and support young adults- parents underestimated their support- valued by young adults. (Vassallo et al 2009)

4. Adolescent Attachment • Five elements of a secure parent-adolescent attachment: • Availability-helping young people trust; • Sensitivity-helping young people manage emotions and behaviour • Acceptance-building self esteem • Co-operation- helping young people to feel effective • Family membership- helping young people belong (Schofield & Beek 2009)

5. Service Provision to Young People • Traditionally, youth services have been focused on individuation and autonomy (Robinson & Pryor 2006) • Historically, family has been cast as irrelevant, then relevant in a negative sense eg the cause of the problem, the “enemy” Garfat (2003)

6. Involving Family-What Works? • Research in its infancy, but showing promise • Family based interventions for adolescent psychiatric disorders, particularly depression • Also substance use eg.BEST-plus program • Improving communication skills • Increase in family-based problem solving • Addressing negative and critical interactions • Building family resilience and hope • Helping families manage depression/suicide risk

7. Types of Therapies • Functional family therapy, structural family therapy and multisystemic therapy • Multisystemic therapies have most support • Strengths-based family intervention that sees problems as having multiple determinants- family therapy a key element

8. What is RAPS • RAPS [Resources for Adolescents & Parents] • Established 1990 • RAPS set up to prevent youth homelessness after Burdekin Report (1989) • Burdekin Report sees conflict as biggest issue leading to youth homelessness • RAPS works with issues which may lead to youth homelessness

9. Typical issues seen at RAPS • Parent-adolescent conflict • Truancy • Running away • Violence • Substance use • Depression and Self harm

10. Seven principles behind RAPS work • Adolescence-unique developmental stage • Balance between connection & limits • Effective work involves working whole family • Need a wider systems perspective • Early intervention is preferable • Staff have postgraduate training in family therapy • Staff need good consultation and supervision

11. Seven principles behind RAPS work • Adolescence- a unique developmental stage

12. Adolescence- a unique stage • Brain changes take over a decade to complete • Last part of brain that develops is the part that makes good decisions • Common misconception-time of separation • Fragile sense of self and new intense feelings • Parents’ role is to help young person work through and manage themselves by empathising, guiding and setting boundaries

13. Seven principles behind RAPS work • Adolescence- a unique developmental stage • Balance between connection & limits

14. Balance between connection & limits • Children/adolescents need parents to be in a position of hierarchy- they feel secure (limits) • For adolescents to reach adulthood- need balance between connection and sufficient limits from their parents • Parents may not be aligned- may undermine- staff assist parents to work as a united team • Staff may be working with parents to improve their connection or limits or both

15. 2. Balance between connection & limits

16. Seven principles behind RAPS work • Adolescence- a unique developmental stage • Balance between connection & limits • Effective work involves working whole family

17. 3.Effective work involves whole family • ‘Web’ of attachment-all the family relationships • To understand one relationship, must consider other relationships • Example- family where father dies and older son moves closer to mother, younger daughter feels on the outer and runs away • Staff see whole family initially- may later split sessions eg couple, adolescent

18. Seven principles behind RAPS work • Adolescence- a unique developmental stage • Balance between connection & limits • Effective work involves working whole family • Need a wider systems perspective

19. 4. Need a wider systems perspective • RAPS assessments include the wider system surrounding the young person • Staff identify parts of the system that offer risk or protective factors and develop interventions • Risks=peer group; parent undermining a school; separated parents undermining the other parent • Protective=extended family or significant others • Structure is important-work and school • Example- helping parents align with school

20. Seven principles behind RAPS work • Adolescence- a unique developmental stage • Balance between connection & limits • Effective work involves working whole family • Need a wider systems perspective • Early intervention is preferable

21. 5. Early intervention is preferable • Early intervention in problem behaviours is preferable • Staff also work at the serious end • Example- substance use

22. Stage1 Stage2 Stage 3 Stage 4 Curious times Good times Necessary times Desperate times Young Person Experimenting Partying Plotting Failing Parents Reacting vs Minimising Networking vs Normalising Taking charge vs Enabling Rehabilitating vs Resigning Therapist Inquiring & Educating vs Escalating & Confronting vs Empowering vs Strengthening vs Reassuring & Normalising Normalising Tolerating Resigning

23. Seven principles behind RAPS work • Adolescence- a unique developmental stage • Balance between connection & limits • Effective work involves working whole family • Need a wider systems perspective • Early intervention is preferable • Staff have post graduate training in family therapy

24. 6. Staff have training in family therapy • RAPS staff are social workers and psychologists with post-graduate training in family therapy • Staff need to be competent in engaging both parents and adolescents, managing them in the room together and conceptualising what is occurring between them • Family therapists also have the skills to work with the parents’ couple relationship

25. Seven principles behind RAPS work • Adolescence- a unique developmental stage • Balance between connection & limits • Effective work involves working whole family • Need a wider systems perspective • Early intervention is preferable • Staff have post graduate training in family therapy • Staff need good consultation and supervision

26. 7. Staff need good supervision • Stakes are high working with at-risk young people- great demands on staff • Regular and back-up supervision is needed • RAPS uses an external consultant who provides “live” supervision of family work and develops best practice with the whole team • RAPS staff work in teams where a therapist behind a one-way screen phones in questions- shared responsibility

27. Conclusion • Adolescence is a unique developmental stage • Adolescents still need parents in two ways- • Connection • Limit setting • Importance of parents working together • Importance of parents and wider system working together • Importance of whole of family approach • Staff need training and support for family work

28. Contact details • Lyndal Power lyndalp@ransw.org.au • AFRC Briefing No.16- “What works with adolescents?” • http://www.aifs.gov.au/afrc/pubs/briefing 16.html Elly Robinson, Lyndal Power and David Allan