INTERVENCIÓN NORMATIVA, A PARTIR DE UN ESTUDIO DE DERECHO COMPARADO EN MATERIA PROCESAL PENAL

There are many practice settings where adolescents receive clinical services, as well as many ways in which these services are provided. Some adolescents may receive indi- vidual counseling from therapists who are in private practice. These counseling services can be provided by anyone who has a license to provide independent counseling ser- vices such as psychiatrists, psychologists, marriage and family therapists (MFTs), licensed

clinical professional counselors (LCPCs), and licensed clinical social workers (LCSWs).

Counseling typically occurs in the counselor’s office as often as the practitioner and par- ents deem necessary, but once a week is the most common schedule.

Counseling also occurs in many other settings, such as in schools by school social workers, counselors, and psychologists (see Chapter 12); human service agencies that specialize in adolescent issues; outreach organizations such as after-school programs; religious organizations such as Jewish Community Centers (JCC) (see Chapter 13); or- ganizations that provide therapeutic foster care; and the juvenile justice system.

Residential care is a practice setting often utilized for adolescents who are severely behaviorally disordered and at high risk of self-harm and destructive behaviors. Al- though institutionalized care has steadily decreased for most segments of the popula- tion, this institutionalized care for the adolescent population has literally skyrocketed since the 1980s (Wells, 1991). These institutions can be locked or open, private or gov- ernmental, short or long term, therapeutic or more punitive in nature, but all provide some level of mental health services in relatively large, dormitory-like settings, where the adolescent residents sleep and attend school.

Residential treatment programs vary widely in type and nature, with some residen- tial programs offering services making them sound more like a boarding school than a treatment facility, boasting equine programs, river rafting, and “therapeutic” skiing pro- grams, whereas others are far more sterile offering few extracurricular activities. One reason for this difference can be directly related to the range of populations served. For instance, behavior on the part of an adolescent that results in court intervention and juvenile detention in a residential facility would not necessarily be conducive to a thera- peutic ski trip to Vail, Colorado.

Placement times can also vary, with some adolescents being placed in a residen- tial facility for a few months to some who require several years, again depending on the severity of their problems. One popular short-term residential program is Outward Bound, a wilderness therapy program that uses physical challenges to help adolescents deal more effectively with their emotional problems. These programs are offered in vari- ous locations within the United States and range from 21 to 28 days in length.

Group homes (or therapeutic foster homes) offer less-structured residential care, where various community services are often accessed and where adolescents attend the local public high school and are not isolated from the general community.

More structured residential treatment programs are a bit more sterile in nature, offer- ing services to adolescents whose conduct problems or self-destructive behaviors require a more long-term, in-depth, and controlled environment. Adolescents in these programs are isolated from the general population and even attend school within the facility where they are housed. Treatment modalities in these facilities often include a combination of behavior modification where desirable behaviors are rewarded and undesirable behav- iors are punished, individual therapy, group therapy, and family therapy. Referrals to such programs can be made by parents, public schools, or the juvenile court system.

The most structured and most serious of all residential treatment programs include correctional institutions for adolescents, most commonly referred to as juvenile hall or juvenile detention centers. These facilities are reserved for adolescents who have been convicted of breaking some law, and although there is far more of an emphasis on reha- bilitation than in adult correctional facilities, there is a far greater emphasis on correc- tions and punishment than in a therapeutic treatment center.

A creative version of the juvenile correctional institution that has received mixed reviews is “boot camp” programs, which offer rehabilitation (as well as restraint) in the form of a military-like, highly structured environment. The philosophy behind these boot camps is that adolescents or young adults who suffer from poor impulse control, low self-esteem, and high rates of acting out behavior can benefit from a military- like structured setting that pushes them to their limit (both physical and emotional). The high emphasis on structure and self-discipline, coupled with the push to achieve, is believed to have a positive impact on both self-esteem and self- respect, which is hoped to generalize into more respectful behavior in society. Many parents and participants commonly claim dramatic changes in the behavior of participants after a boot camp experience, but research appears to indicate that boot camps do not necessar- ily reduce recidivism rates in young offenders (Peters, Thomas, & Zamberlan, 1997).

Another type of treatment facility for adolescents experienc- ing mental health problems is in-patient psychiatric hospitals. These programs tend to be acute (short term), focusing on stabiliz- ing the adolescent’s high-risk behaviors, such as suicidal behavior, self-abuse, substance abuse, and eating disorders. Some in-patient programs specialize in one or more of these disorders or are more general in nature, offering short-term acute services to any adoles- cent who cannot be maintained safely outside a hospital setting. Many of the same type of therapies are available in an in-patient setting as in a residential treatment center, with the exception that drug therapies may be more prevalent in a psychiatric hospital. In- patient hospitals also rely heavily on discharge planning, a task that typically falls to a hospital social worker or other human service

Human Services Delivery Systems

Understanding and Mastery of Human Services Delivery Systems: Range and characteristics of human services delivery systems and organizations

Critical Thinking Question: A wide vari- ety of therapeutic interventions exist for adolescents, ranging from weekly outpa- tient sessions with a counselor, through programs such as Outward Bound, to inpatient facilities with a range of pro- grams and supports. Ideally, adolescent clients would receive the level of treat- ment most appropriate to their situation; in reality, what other factors play a role in the type and level of treatment which adolescents receive?

professional who works with the family and community resources to ensure that the adolescent will transition back to home and school with enough outpatient support to minimize the need for rehospitalization.