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Young Women’s Empowerment Center Program Manual

Table of Contents

Section 1: Program Philosophy and Model- Philosophy and Mission- Table 1:

- Major Criminogenic Risk and Need Factors- Minor Criminogenic Risk and Need Factors- Treatment Interventions

- What Works Principle- Risk- Need- Responsivity- Treatment- Fidelity

Section 2: Program Development- What Works Principle

- Risk- Need- Responsivity

- Table 2: Responsivity Factor Chart- Carey Guides- Stages of Change- Trauma Informed Care- Motivational Interviewing

- Treatment- Cognitive Behavior Therapy (CBT)- Thinking for a Change

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- Carey Guides- Behavior Modification- Skill Building- Role Playing

- FidelitySection 3: Treatment Program (Treatment Flow)

- Referral- Admission- Assessment- Initial Team Meeting- Treatment

- Initial Treatment Plan- General Program Structure- Detailed Program Structure and Strategies

- Quarterly Reports/Progress Reports- Ongoing Team Meetings- Transition Planning- Discharge

- Discharge ReportSection 4: Admission Criteria

- Inclusionary Criteria- Exclusionary Criteria

Section 5: Individualized Treatment Planning- Assessment- Treatment plan information- Smart Goals- Action Steps

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- Sample treatment plan- Sample Mental Health Assessment- Sample Court Report- Sample Quarterly/Progress Report- Sample Psychosocial Rehabilitative Services Report- Relapse Prevention Plan

Section 6: Program InterventionsSection 7: Program Intensity and Length of StaySection 8: Rewards and ConsequencesSection 9: Measurement of ProgressSection 10: Transition Planning and AftercareSection 11: Program FidelitySection 12: Completion Criteria

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Section 1. Program Philosophy and modelPhilosophy and Mission

Young Women’s Empowerment Center (YWEC) is a licensed gender specific residential treatment facility that empowers adolescent females in their endeavors to become responsible, functional, and contributing citizens. We assist each young woman in finding the hope, vision, courage and will to succeed. We provide a safe environment with structure, stability, and an opportunity to learn and grow. The residential setting gives youth the chance to make behavioral changes, change problem thinking, and improve prosocial behavioral skills without the situations they have previously been exposed to in their environment. This allows the client time to practice the new skills they learn.

Young Women’s Empowerment Center’s primary goal is to reduce risk by targeting the youth’s criminogenic risk and need factors. YWEC has adapted into their programming the eight major criminogenic risk and need factors and the three non-criminogenic minor needs identified by D.A. Andrews and James Bonta. (See Table 1)Table 1.

Major Risk/Need Factor Indicators/Risk Intervention Goals/Need

History of Antisocial Behavior

Early and continued involvement with antisocial and criminal acts

Build non criminal alternative behaviors to risky situations

Antisocial personality pattern

Impulsive, adventurous pleasure seeking, restlessly aggressive and irritable

Build self management skills, teach anger management, problem solving, coping skills

Pro-criminal attitudes/Antisocial Cognition

Rationalizations for crime, negative attitudes towards the law

Counter rationalizations with prosocial attitudes; build up a prosocial identity

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Major Risk/Need Factor Indicators/Risk Intervention Goals/Need

Social supports for Crime/Antisocial Associates

Criminal friends, isolation from prosocial others

Replace pro-criminal friends and associates with prosocial friends and associates

Substance abuse Abuse of alcohol and/or drugs

Reduce substance abuse, enhance alternatives to substance use

Family/marital relationships

Inappropriate parental monitoring and disciplining, poor family relationships

Teaching parenting skills, enhance warmth and caring

School/work Poor performance, low levels of satisfactions

Enhance work/study skills, nurture interpersonal relationships within the context of work and school, rewards and satisfaction

Prosocial recreational activities

Low levels/lack of involvement in prosocial recreational/leisure activities

Encourage participation in prosocial recreational activities, teach prosocial hobbies and sports

Non-criminogenic, minor needs

Indicators/risk intervention Goals/Need

Self-esteem Poor feelings of self-esteem, self worth

Build self esteem, positive self talk

Vague feelings of personal distress

Anxious, feeling blue Reduce anxiety and depression, learn coping skills

Physical health Physical deformity, nutrient deficiency, other medical needs

Physical conditioning, Health care exams and follow ups

Young Women’s Empowerment Center uses a variety of treatment interventions to reduce risk and help the youth. We promote behavioral changes through but not limited to mediation of resolving conflict,

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community service, skill building which includes CBT, DBT, social skills, behavioral approaches, individual therapy, group therapy, and family therapy.

The foremost tool used at YWEC is the “What Works Principles”The what works principle is a treatment process used for juvenile offenders to ensure that the targeted problem is addressed correctly and efficiently.There are five sections/principles under the what works principles. They are risk, need, responsivity, treatment, and fidelity.

The Risk principle is the level of service a youth needs. Supervision and treatment levels should match the offender’s level of risk.This is determined by the PRA. The Protective and Risk Assessment (PRA) is an informational more in-depth assessment that examines a wide variety of factors related to the youth’s strengths and challenges in ten different areas called domains. These domains include: delinquency history, school, employment, relationships, environment, current living arrangements, alcohol and drugs, mental health, attitudes and behaviors, and skills. The assessment of each domain is based on identification of protective factors that are related to the reduced likelihood of reoffending and risk factors that are related to the increased likelihood of reoffending. (Refer to Table 1)

The Need principle maintains that treatment services should target an offender’s specific criminogenic needs, the dynamic risk factors most associated with criminal behavior. This is the overall general program and the targeted treatment plan of a client.

The Responsivity principle contends what treatment interventions will be used in the program. It states that the program staff and treatment should be matched to personal characteristics of the youth. General responsivity relates to behavioral, social learning, and cognitive behavioral programming. Specific responsivity relates to matching the service with youth’s personality, learning styles, their abilities, culture, and motivation to change. Responsivity should be tailored to the offender’s specific learning style, and strengths.

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The Treatment principle relates to implementing evidence based treatment into programming. The most effective programs are behavior and cognitive behaviors. Treatment should be action oriented and focused on modeling and teaching behavioral skills.

The Fidelity principle relates to delivering the treatment as it is designed. Staff need to implement the programming as defined in the program manual. Fidelity is the strategies that monitor the accuracy and consistency of the program to make sure that it is delivered and implemented to the youth all the same. These strategies can include staff observation, providing feedback, quality assurance reviews, and training.

YWEC is a behavioral structured program. The level system of YWEC is based on both the client’s behavior and progress of the client’s goals indicated on their treatment plan. The program implements rules that direct the clients to the desired behavior outcome. A complete set of rules can be found in the Client Handbook. Clients are required to attend school which is located on the property, and also required to participate in therapy. Each client is expected to follow and participate in all aspects of the schedule. Clientele are also expected and required to demonstrate the following skills on a daily basis;*Respect for peers and staff *Follow the program rules *Use appropriate language/manners *Complete tasks and chores *Accountability *Appropriate conflict resolution skills *Follow the chain of command *Keep appropriate boundaries *Report any abuse *Communicate appropriately.Any act of abuse by a client on a peer and/or employee of YWEC is unacceptable and law enforcement will be notified.

Section 2. Program Development

Young Women’s Empowerment Center stays true to achieve our goal by using the “What works Principles” in order to reduce the youth’s risk.

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Risk: YWEC is contracted under the DBE code. Clients are committed to community placement who are transitioning from secure care, or those who are at moderate risk and need intervention to prevent high risk ie. secure care. Clients POE includes acts of violence or aggression toward person(s); crimes against property such as vandalism, theft, arson, burglary, or destruction of property; or who are exhibiting delinquent or non-compliant behavior such as probation violations, contempt charges, truancy, or substance abuse, and that require awake night supervision. Clients in DHS/DCFS custody whose behaviors effect normal life functioning. Behaviors in this category may include (but are not limited to): acts of violence, aggression toward others; destruction of property; truancy; excessive running away, and ungovernable behavior. Clients may also have delinquency charges against them and/or may be dually adjudicated in both the child welfare and juvenile justice systems. While the client may have co-occurring mental health and or substance abuse treatment needs, these needs are secondary to the unacceptable behaviors. For instance, a client may have mental health issues stabilized but continue to engage in unacceptable behaviors, or a client’s substance abuse is part of the client’s overall disregard for rules, and that require awake night supervision.

The level of service for YWEC is Moderate and therefore has 200+ hours of behavioral intervention, skills development with role playing and therapy hours. The risk of client is determined by the caseworkers by using the UFACET tool. Clients who are unable to remain safely in the care of a parent may be placed in the custody of DCFS. Clients enter the custody of DCFS through the authority of the Juvenile Court based on direct court orders or a petition based on abuse, neglect, or dependency. Offenders at this level may be confined to secure or nonsecure residential programs.

Need: Clients who enter DCFS custody often have behavioral, emotional, developmental, and interpersonal challenges that require specialized services. DCFS has the responsibility to determine the least

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restrictive and most appropriate placement based on the client’s needs. Once the risk level and need level is reached, a client will be placed base on the levels of care. YWEC is level 5 residential support. A client’s dynamic risk items are used as primary targets of the treatment plan and the program interventions that will be used. Dynamic risks can be changed and generally 4-6 are targeted throughout treatment. Although not all needs of the clients will be the same, YWEC focuses on each of the needs outlined on Table 1. Once a treatment plan is created, and individual goals are made, the needs become more specific and individualized. This will be detailed in the Treatment Plan section of the program manual.

Responsivity: Individuals vary in terms of the ways in which they are best able to respond to treatment. The basic idea of responsivity is that interventions should be tailored to individual clients’ traits and circumstances to maximize learning. As previously mentioned in the need principle section; once a treatment plan has been created and needs become more specific and individualized, YWEC can individualize treatment even more by knowing the specific responsivity factors that a client has. One of the ways that YWEC does this is by using the Responsivity Factor Chart handout, found in the Carey Red Guides: Effective Case Management 2nd Edition. (See Table 2) This particular handout is part of the intake process. When a client comes into care, they will be given the handout to complete.

Table 2.

Responsivity Factor Possible Indicators yes no

Functional ability:attention span

*I have a hard time concentrating for long periods of time.*I get bored easily.*I often have lots of different thoughts racing through my mind.*I misplace things often.*I’ve been told that I have a hard

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time sitting still.

Functional ability:Cognitive deficits

*I often find directions confusing.*I have trouble following a conversation when a lot of people are throwing in their ideas.*I need to do things over and over again before they stick.*I find reading difficult.*I find writing difficult.*I’ve been diagnosed with a learning disability or I believe that I may have one.

Functional ability:Emotional age

*I’m most comfortable with people who are younger than me.*I have difficulty handling criticism.*I have more needs than others.*I often get overwhelmed by emotions.*I tend to overreact to minor problems.

Language *I need help understanding spoken English.*I need help understanding written English.*I prefer learning in a language other than English.

Learning style *I learn best by reading.*I learn best when I write things down.*I learn best when I practice what I’m trying to learn.*I learn best when I can see in a diagram or picture what I’m

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supposed to do.*I learn best in groups or with other people.

Level of motivation *I can figure out and deal with my issues on my own.*I don’t understand why I’m being asked to work on some of the things my caseworker has asked.*I don’t think I can make the changes that I need to make.*I have failed so often in the past that I don’t have a lot of hope that this time will be much different.

Mental health condition *I often get highly anxious in group settings.*I’ve been diagnosed with a mental health condition.*I need or am on medications for reasons other than my physical health.

Cultural background *My cultural background is important to me.*I learn best when the things I’m involved in relate to my cultural background.

Gender (women) *In order for me to open up, I need to feel comfortable and trusting.*It’s very important to me to have a surrounding that feels emotionally and physically safe.

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YWEC will use evidence based practices to address responsivity of the client. YWEC follows five sequential steps: Assess, Target, Engage, Match, and Plan. By following the skill building tools found in The Carey Guides: Responsivity section and The Carey Guides: Motivating Offenders to Change section, this better prepares YWEC to get an idea of specific responsivity factors of the client.

Addressing the client’s internal motivation to behave in prosocial and legal ways is key to helping them achieve long term change. If their motivation is low then efforts to change will likely be short lived. If the client’s motivation to change is high, results will most likely be long lasting and more positive. One way to increase the effectiveness of what is being taught is to match programming with where a client is in the Stages of Change process. The key is to help the client find their own reasons for change rather than trying to force it.

Stages of Change:

Precontemplation: Not yet acknowledging that there is a behavior that needs to be changed. In this stage the client has no intention to change. They do not see that there is a problem that needs to be addressed. They may know that their behavior is against the law or that others don’t approve of it, yet they see nothing wrong with themselves doing it. They tend to defend their current behavior. When positive relationships exist, offenders will tend to be more open to listening, and staff may be better able to help raise the client’s awareness of how their behavior is leading to unwanted consequences. It is important for staff to use empathy, and reflective listening. Other strategies that can be used are to raise doubt. Increase the client’s perceptions of the risks and problems associated with their current behavior. Help them see the discrepancy between where they want to be in life and their current behavior.

Contemplation: Acknowledging that there is a problem but not yet ready or sure of wanting to change.

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In this stage the client is more aware of the personal consequences of their behavior and spend time thinking about it. Although they are able to consider the possibility of changing, they tend to be teeter-tottering, often considering the pros and cons of changing their behavior. It is important for staff to help the client envision success. Help them identify past successes and introduce new skills that will enable them to have future success. Staff need to help the client identify reasons to change and risks of not changing.

Preparation: Getting ready to change.In this stage the client has made a commitment to make a change. This is often noticed by statements such as “I’ve got to do something about this… this is serious”, or “What am I thinking”, “What am I doing.” The client starts identifying a plan to change. They will set goals and skills that they need to work on such as anger management skills. It is important that the client practice the new behaviors and skills. Staff can help in this stage by helping the client develop plans of action for changing their behavior. They can also help by modeling the skill that is needed and by practicing it with the client. Guidance by the staff is very important.

Action: Changing behavior.In this stage the client believes they have the ability to change their behavior and are actively involved in taking steps to change their bad behavior by using a variety of methods. During this stage the youth is actively participating in their attempt to learn the skills necessary and is making changes in their behavior. The client attends therapy, follows program rules and guidelines and is actively working on their goals that were set in the preparation stage. This also refers to their treatment plan that is created with their therapist. Staff support the client by prompting when necessary, correcting behavior when necessary and help the client identify changes and success being made. Staff also help the client by reviewing the plan, reviewing progress, setbacks, and making adjustments to strengthen the plan. Staff help clients identify how their changes are improving various aspects of their lives such as safety, relationships, and

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self respect. It is important for staff to reinforce positive changes being made with specific praise. Reinforcements that the program uses can be found in Section 8 of the manual and also in The Client Handbook.

Maintenance: Maintaining the behavior change.In this stage the client can view their new way of behaving as more comfortable or automatic rather than difficult and requiring effort. In this stage the client has made significant changes, goals have been met and a new behavior has replaced the old. The client is working to maintain the new behavior. In this stage it is important for staff to continue positive reinforcements and help the client identify how their efforts have led to other benefits. It is also important to help the client identify and use strategies to prevent relapse. While the client is in the maintenance stage it is important to set up a transition plan and help support the transition.

Staff will also be trained in trauma informed care; including separation, grief, and loss. Trauma informed care is outlined into four guidelines for the program. They are realize, recognize, respond and seek. Staff will realize the widespread impact of trauma and understand potential paths to recovery. They will be able to recognize the signs and symptoms of trauma in clients, families, staff, and others involved in the system. Staff will also be able to respond with knowledge about trauma into policies, procedures, and practices and will seek to actively resist retraumatization. There are also six principles that will help guide YWEC. 1. Safety: The client must feel safe physically and emotionally, and staff must be responsive. 2. Trustworthiness: Clients must trust staff and staff must be fair, informed and neutral. 3. Peer Support: Peer models should be involved, which is why we have the mentor system. 4.Collaboration and Mutuality: Everyone must work together for success, teamwork at YWEC is a must. 5. Empowerment: The client must have a voice and be able to make choices even if they do not seem right to us as staff. 6. Cultural, historic and gender issues: Staff need to be aware of the client’s cultural, history, and gender issues that they face. Trauma informed care directs us to be aware, make right goals, helps in responsivity and enhances treatment motivation and effectiveness.

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YWEC also uses motivational interviewing. Motivational interviewing is a style of communicating to the client that helps them explore their ambivalence toward changing their behavior. This involves using open ended questions and reflective listening to understand the client’s views. It helps develop discrepancy between their values and their behavior. Staff learn to be empathetic, understanding, non confrontational which thus builds the client’s confidence so that they can change their behavior.

Treatment: YWEC uses many approaches to changing a client’s behavior to reduce the risk of recidivism.

Cognitive Behavior Therapy: (CBT) is widely used and a great deal of research has been conducted regarding its effectiveness and it is currently the most evidence-based form of psychotherapy. CBT combines cognitive therapy and behavior modification. CBT is active and focuses on the present, emphasizing problem thoughts and behaviors and taking direct steps to change both.To be most successful, YWEC has adapted the manual from Thinking for a Change (T4C).

Thinking for a Change is a cognitive-behavioral program, governed by simple, straightforward principle-thinking (internal behavior) controls actions (external behavior). Therefore, it is necessary to target a client’s thinking in order to change their actions that lead to criminal conduct. Client’s engage in planned and deliberate criminal acts supported by strong antisocial attitudes and beliefs. Their way of thinking supports and justifies the serious offenses they commit. Behavior change cannot take place for them until they become aware of their thinking and see a reason to change.

Thinking for a change uses a combination of approaches to increase client’s awareness of self and others. This deepened attentiveness to attitudes, beliefs, and thinking patterns is combined with explicit teaching of interpersonal skills relevant to the client’s present and future needs. The goal is to provide instruction and related experiences so that the client is

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confident and motivated to use prosocial skills when faced with interpersonal, antisocial and stressful problems.

The philosophy of T4C endorses that clients should be empowered to be responsible for changing their own problem behavior. The intervention program provides the offender the tools to take pro-social action and change their offending ways. Each component is presented in a systematic, logical fashion using the standard procedures for cognitive behavioral interventions. The three components of Thinking for a Change are: Cognitive Self Change, Social Skills, and Problem Solving Skills.

Cognitive Self Change teaches a concrete process for self-reflection aimed at uncovering antisocial thoughts, feelings, attitudes and beliefs.Social Skills instruction prepares group members to engage in prosocial interactions based on self understanding and consideration of the impact of their actions on others.Problem Solving Skills integrates the two interventions to provide an explicit step by step process to address challenging and stressful real life situations.T4C integrates these three types of interventions in the following way: Lesson 1 begins with an overview and introductionLessons 2-5 and 11-15 teach Social SkillsLessons 6-10 teach the Cognitive Self Change processLessons 16-24 teach Problem Solving SkillsLesson 25 provides a wrap up of T4C

In addition to Thinking for a Change YWEC also teaches lessons from the Carey Guides.

Carey Guides: Research demonstrates that traditional methods of supervision are ineffective in reducing recidivism among juvenile offenders. For behavior change and recidivism reduction to be possible, clients must understand the personal and environmental factors underlying their illegal behavior and be taught the skills they need in order to make positive changes in the future. The Carey Guides are designed to teach the clients

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the information and tools they need to support change. The Carey Guides includes 33 handbooks. There are 14 blue guides that specifically address the client’s criminogenic needs and 19 red guides that help staff address common issues. Each guide also contains two to five worksheets. These worksheets are designed for use by the client with assistance of staff to understand and address risk factors, triggers, and other conditions that are essential for the client’s success and making positive changes in their lives.

Behavior Modification: In Behavior Modification, clients are helped to recognize and change problem behaviors. To modify behaviors, current behaviors are examined to find what is reinforcing the behavior. Those reinforcers are then eliminated and new reinforcers for positive behaviors are added. Punishers may also be added, which also help to eliminate problem behaviors.

Skill Building: Skill building is also a primary treatment method used at YWEC. Skill building teaches alternative skills and behavior to problem behavior. Both behavioral skills and social skills are taught at the program. As previously mentioned, both T4C and the Carey Guides teach skill building. Not only does YWEC rely on these evidence based treatments for skill building, we also teach academic skills and everyday living skills. The purpose of having social skills training is to assist the client in developing prosocial behaviors and interactions with others. Research has shown that poor social skills goes hand in hand with emotional and behavioral problems. Clients with good social skills are less likely to engage in delinquent behavior and associate with delinquent youth and more likely to have positive school involvement, and engage in prosocial activities and with other prosocial youth.

Role Playing: Why is role-playing important? It helps to gain insight into one’s self and enable clients to practice new skills while receiving support and insight of therapists and staff. Role plays are used to practice prosocial behaviors. It is through repeated practice of the behaviors that clients are able to use the new skill spontaneously in the “real” world.

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How to Teach Skills using Role-PlaysThere are 7 steps that YWEC uses in teaching behavioral and social skills. 1. Define the skill, review steps 2. Establish skill need 3. Facilitator (staff) models the skill 4. Client role-play 5. Provide feedback and reinforcement 6. Assign homework 7. Follow up on skill useThese steps are also in the Thinking for a Change manual and the Carey Guides so that no matter what skill is being taught, the client will become familiar and more successful.Detailed Steps:

1. Define the skill, review stepsa. Tell the client what the skill is b. Describe each step of the skill- write the steps on the boardc. Define the purpose of the skill- the purpose should be from the

client’s point of view 2. Establish Skill Need

a. Give concrete examples of when the skill might be used (more than one)

b. Have clients identify situations when the skill would be useful in their lives *All clients should answer. Have them think of multiple situations and give detailed concrete examples

3. Facilitator (Staff) Models the Skilla. Ensure the clients are attentive and engaged-ask them to watch and

listen carefullyb. Act the skill out

i. Speak aloud the steps and the reasoning you are followingii. Be clear and detailed but do not provide irrelevant detailsiii. DO NOT model inappropriate behaviorsiv. DO NOT simply “talk about” a situation

c. Repeat the Skill- use different scenarios so the clients can see how to apply it in different situationsd. Have the clients describe what they saw - ask what did you see me do4. Client Role-play

a. Have client identify a situation- pick one in which she could use the skill and use that for the role-play. Enough details should be given so that the skill can be practiced as realistically as possible.

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b. Have client act out the situation using the skilli. The client should use “think aloud” where she talks out loud and

verbally repeats each step of the skill before acting out that skill and also describes her thoughts

ii. Remind the clients to use the steps and stay in character. Staff may need to verbally coach and point to the skill steps on the board

iii. Do not allow the client to role-play inappropriate behaviorsiv. If the client needs assistance, staff and the client can switch

roles with the staff modeling how to use the skill. The client should then attempt the role-play again

v. Have the client continue to role-play the skill until they can perform the skill with no coaching

5. Feedback and Reinforcementa. Provide Reinforcement- after the client has followed the correct steps

i. Provide reinforcement in an amount equivalent to the level quality of the role-play

ii. Remember Verbal praise is an excellent reinforcementiii. Do not provide reinforcement for role-plays that depart

significant from the steps of the skills b. Provide Feedback- feedback should highlight specific aspects of the role-play, not general comments c. Redo the role-play6. Assign Homework

a. Assign homework to each client- have the clients identify a specific situation and person they use the skill with

b. Encourage client to use skill in increasingly difficult situations- first in situations that may not be too difficult or scary for the client and then in situations that would be harder for the client

7. Follow-up on Skill Usea. Review previous sessions- remind clients what skill they learned last

sessionb. Remind clients the steps of the skills-refer back to your visual aidsc. Discuss skill usage- have clients report on a situation when they used

the skill, how it went, and what could be improved

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d. Apply to future situationsi. Review what situations may come up that the client could use

the skill in the futureii. Staff should encourage skills usage

Repeat all steps with each client

Fidelity: The Fidelity principle states that staff will implement the programs found in our program manual as defined. YWEC address fidelity by using staff observations. YWEC’s Quality Assurance Team also meets at least quarterly to review staffs’ performance, providing feedback. We also use training as a tool for fidelity.

Section 3: Treatment Program(Treatment Flow)

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Treatment flow refers to the general treatment timeline from referral to the program until the client is discharged from the program. Here you will find a general description of events that will be covered during the time at Young Women’s Empowerment Center. More detailed information can be found within the various sections of the program manual.

● Referral: DCFS will make a determination of placement based upon the Division’s assessment and placement selection process. The caseworker will initiate a referral for replacement with Young Women’s Empowerment Center. * Prior to making a determination of the client’s appropriateness for placement, YWEC will obtain at a minimum the following written information:

■ Client’s name■ Case #■ Age■ Name and contact information of caseworker■ Client’s current placement■ Summary of client’s available mental health, medical and

behavioral issues■ Type and intensity of client’s supervision needs■ Reason for placement■ Risk Level■ Most recent health records, medical, dental and vision

* Once a client is accepted to YWEC, a PSA must be obtained; completed and signed.* Within 5 business days of placement, YWEC shall obtain from the caseworker copies of essential records from the client’s file including:

-Client identifying information: Copy of Social Security card and birth certificate-Current education records-Insurance/Medicaid card-Consent form authorizing YWEC to obtain medical/dental care for the client-Approved contact list

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-Upcoming scheduled appointments such as court or medical

● Admission: Upon admittance into Young Women’s Empowerment Center a client will be placed on orientation. During the orientation the client will have a tour of the program and will be given instructions of the rules. The rules will be stated in the Client Handbook and will outline individual rights, visitation, mail, phone calls, grievance procedures, youth expectations in program participation and compliance. Staff will review all sections of the client handbook and will then have the client sign stating that they understand the information and what is expected of them.Throughout the orientation period the client will have completed the following: risk assessment, needs assessment, if needed medical well child check, dentist appointments, and eye appointments. Service plans and initial paperwork are completed.

● Assessment: Each client will meet with the therapist and have an initial meeting and session. At this time a Mental Health Assessment will be conducted. The therapist in conjunction with the client, and supporting information/assessments, will develop an individualized treatment plan within 30 days of admission that will include; findings of intake evaluation and assessment, measurable long and short term goals and objectives, input from client and other team members of the treatment team, and methods for evaluation. Each assessment will define and target problem behavior, and will include the desired alternative behavior.All staff members working directly with the clients will be informed and knowledgeable of each client’s individual treatment plan.

● Initial Team Meeting: An initial team meeting will be held within 30 days of admittance. Attendance shall include but is not limited to: the client, client’s guardians, caseworker, program director, therapist, and teacher. At all team meetings, the next one will be scheduled. Prior to the team meeting, program director will meet with the client using the Youth Treatment Meeting Packet to prepare the client for the

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team meeting. In general, it will be the responsibility of the client to run the meeting and the staff and therapist to assist her in addressing the meeting requirements. These requirements are addressed in more detail in the packet and an agenda is required. See Appendix III for Youth Treatment Meeting Packet.

● Treatment: ○ Initial Treatment Plan: The treatment plan will be developed by

the therapist. A tentative draft will be ready by the initial team meeting and completed within 2 weeks of the meeting. The treatment plan will contain the following information.

■ Statement of Disability that requires treatment and skills development

■ Needs Assessment from case manager documentation■ Client information including name, date of birth,

caregiver(s), Medicaid number, intake date■ Caseworker information including name, phone number,

address, and region■ Evaluator’s name■ Medical needs■ Client’s background which includes: presenting problems,

identifying problems, strengths, previous emotional and social history, educational history, psychotropic medication, background and family history, legal and criminal history, physical/sexual abuse history, sexual history

■ DSM V Diagnosis: Clinical disorders■ Treatment Goal #1- Life Skills

● Domain● Goal● Action Steps● Progress● Strategy● Projected Method● Provider

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■ Treatment Goal #2-Social Skills● Domain● Goal● Action Steps● Progress● Strategy● Projected Method● Provider

■ Treatment Goal # 3- Daily Skills● Domain● Goal● Action Steps● Progress● Strategy● Projected Method● Provider

■ Treatment Goal #4- Behaviors● Domain● Goal● Action Steps● Progress● Strategy● Projected Method● Provider

■ Treatment Recommendations including treatment type and frequency

■ Discharge Criteria■ Post Discharge Plan■ Signatures■ Date

- A sample treatment plan can be found in Section 5 of the program manual.

○ Treatment Processes: General Program Structure

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● Clients will participate in a morning and a night group. During morning group client will set a daily goal to work on throughout the day. At night group client will take accountability on how they did on that goal. (Daily goal is usually a part of a goal from the treatment plan.)

● Clients will participate in individual, group and family therapy (if applicable).

● Clients will participate in Psychosocial Rehabilitation Services. (PRS)

○ These classes will be taught from Thinking For a Change and The Carey Guides

■ They include skill building with role-play● Clients will attend school on YWEC property with South

Sanpete School District (YIC)

● Quarterly Reports: Quarterly reports will be written at least every 90 days by the Administrative Director or Program Director and will summarize treatment progress. A copy of the report addressing progress should be completed prior to the ongoing team meetings. The report will cover the following areas: (See Section 5 for a Quarterly Report Sample)

○ Heading with program name and address○ Client Name○ Client ID#○ Direct oversight: Week 1-4 summary○ Case Activity expectation○ Family Visitation and other contacts○ Health Services

■ Current Medications○ Linking direct care of clients with mental health services

■ Group therapy topics○ Linking direct care of clients with education○ Court Attendance○ Clients use of electronics or social media○ Team and Child and family team meetings

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○ Name and Signature of the person who prepared the report○ Date

● Ongoing Team Meetings:○ Ongoing team meetings will be scheduled every 90 days.

During the previous team meeting, the next meeting will be scheduled. The quarterly team meetings will follow the same procedures as the initial team meeting. The client (with help from staff) will prepare the agenda, using the Youth Treatment Meeting Packet. In addition, progress on treatment goals will be summarized and ready to present at the team meeting. Emphasis will also be directed towards discharge planning and transition needs as the team develop a tentative discharge date.

● Transition Planning:○ Transition planning will begin at the entry level of the program

and will be worked on throughout treatment. By the discharge team meeting a plan must be in place. Transition will be addressed in the treatment plan and team meetings. Transition planning will address the behavioral risk factors including target behaviors and desired behaviors and have supports in place. Transition planning will address the stability factors, including medical needs, living arrangements and supports, family involvement, school supports, transportation and employment (if applicable).

○ As the client progresses nearer to discharge, the specifics of transition should be more clearly defined. These include what programs will provide services, where will the client go to live, to school, for medical, dental services etc. Prior to discharge these services will be identified.

● Discharge: Discharge will occur after a treatment/transition plan has been developed and completed.

○ Discharge Report: The discharge will include a report that summarizes the responsivity and treatment pieces that should be in place for successful transition. The report will address the following:

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■ Heading with program name and address■ Date of Report■ Client Information: name, date of birth, gender,

caregiver(s), Medicaid number■ Caseworker Information: name, phone, address, region■ Discharge Information:

● Length of Stay● Reason for discharge or transfer● Summary of services provided

■ Evaluation of Achievement of Treatment Goals or objectives

● Treatment Goal #1○ Update and progress on treatment goal #1




● Recommendations: Recommendations for future services or treatment needs

● Therapist Signature● Date

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Section 4. Admission Criteria

Young Women’s Empowerment Center serves female adolescents ages 12-19. These clients demonstrate Moderate level/Behavioral Disorders (DBE). Clients that are committed for community placement or who are transitioning from secure care, and their POE includes acts of violence or aggression toward person(s); crimes against property such as vandalism, theft, arson, burglary, or destruction of property; or who are exhibiting delinquent or non-compliant behavior such as probation violations, contempt charges, truancy, or substance abuse, and that require awake night supervision.Clients in DHS/DCFS custody whose behaviors effect normal life functioning. Behaviors in this category may include (but are not limited to): acts of violence, aggression toward others; destruction of property; truancy; excessive running away, and ungovernable behavior. Clients may also have delinquency charges against them and/or may be dually adjudicated in both the child welfare and juvenile justice systems. While the client may have co-occurring mental health and or substance abuse treatment needs, these needs are secondary to the unacceptable behaviors. For instance, a client may have mental health issues stabilized but continue to engage in unacceptable behaviors, or a client’s substance abuse is part of the client’s overall disregard for rules, and that require awake night supervision. These youth may or may not have an adjudicated criminal history but must meet the following criteria:It is the general practice for the Family Program to work with all referred children, youth, and families referred for intensive in-home services. However, four exclusionary criteria exist for all referrals:1. Actively suicidal youth, based off assessment and staffing with case manager or program staff.2. Actively high risk self-harming3. Lower functioning inhibiting youth’s ability to participate or complete the program

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a. This will be defined with IQ score AND consultation with case manager or program staff. Low IQ alone does not exclude a youth from programming.4. Untreated, active visual or auditory hallucinationsa. Youth who are receiving treatment or under medical management for these diagnosesYoung Women’s Empowerment Center targets youth with the following issues:Inclusionary1. Caregiver (parent/grandparent) relationship issues2. Substance abuse issues (with or without a pre-existing diagnosis)3. Mood disorders4. Externalizing problems (behavioral issues)

Inclusionary Criteria: *Female*Age 12-19*Score “moderate” to “high” on PRA*POE includes items from the following list:

-Number of acts of anger that are “situational” in nature such as Acting out against authority figures or school personnel.

-Clients whose acts include adapting to a situation rather thanControlling a situation.-Destruction of property offenses-Probation violations-Contempt, curfew, or status offenses-Truancy related violations-Ungovernable behavior-Substance Abuse

The risk level for DCFS is the level of probability and degree of harm to self or others.

* Primary treatment needs include, but are not limited to antisocial behavior, antisocial personality pattern, antisocial cognition, antisocial associates, substance abuse, family relationships, school/work,

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prosocial recreational activities, self esteem, vague feelings of personal distress (anxiety etc.) and physical health.Exclusionary Criteria:

* Clients that are currently at “high risk” of seriously harming self or others* Clients that have a low level of risk* Clients that have medical issues that would prevent them from fully participating in the program.* Clients that have a history of sexual perpetration.* Clients with a high level of mental illness that would prevent them from fully participating in the program.

Section 5. Individualized Treatment Planning

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When a client comes into custody, the caseworker gathers information needed to develop a case plan. A case plan is the plan created with the youth’s input that contains up to three dynamic risk factors that need to be addressed in order to change the targeted behavior. This information is a series of questions and assessments given to the client. Two of the assessment tools used in the Utah juvenile justice system are the Pre-Screen Risk Assessment (PSRA) and the Protective and Risk Assessment (PRA). The PSRA is used to determine the youth’s risk to recidivate. The PRA is an assessment tool that combines static, dynamic, and identify protective factors used to determine risk and intervention needs. The caseworker will then use a conceptualization worksheet that helps determine the dynamic risk factors and level of care the client needs. Risk factors are selected from the thoughts, emotions, physical sensations, beliefs and behaviors identified. If a client has a moderate-high level/behavioral disorders then they will be committed to community placement. The caseworker will then create a Needs Assessment Service Plan. DCFS caseworkers will use the Utah Family and Children Engagement Tool (UFACET) case planning guide. UFACET is an assessment of a Family and Client to identify the intensity of services to be provided. It includes the family’s strengths and needs, the parent’s specific needs, and the client’s functioning. It is informed by other formal and informal assessments such as mental health, medical and school assessments and input from Child and Family Team members.

Once a client has been placed at Young Women’s Empowerment Center, the therapist and administration will collaborate with the caseworker to get the information conducted including a copy of the service plan.

Each client will meet with the therapist and have an initial meeting and session in which a Mental Health Assessment will be conducted. The role of the Mental Health Assessment is to look at factors that are barriers to treatment motivation and participation. The therapist in conjunction with the client, and supporting information, including the service plan will develop an individualized treatment plan. The targeted risk factors found from the caseworker’s Needs Assessment will be integrated into the

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treatment plan. A tentative draft will be ready the initial team meeting. During the initial team meeting the team will discuss the treatment plan and the caseworker must approve the clinical treatment goals and plans. A completed treatment plan with the therapist and client signatures must be sent to the caseworker within 2 weeks of the meeting. The plan will include; findings of intake evaluation and assessments, measurable long and short term goals and objectives, input from the client and other team members of the treatment team, and methods for evaluation. Each treatment goal will define and target problem behavior, and will include the desired alternative behavior. All staff members working directly with the clients will be informed and knowledgeable of each client’s individual treatment plan.The treatment plan will contain the following information:

■ Statement of Disability that requires treatment and skills development

■ Needs Assessment from case manager documentation■ Client information including name, date of birth,

caregiver(s), Medicaid number, intake date■ Caseworker information including name, phone number,

address, and region■ Evaluator’s name■ Medical needs■ Client’s background which includes: presenting problems,

identifying problems, strengths, previous emotional and social history, educational history, psychotropic medication, background and family history, legal and criminal history, physical/sexual abuse history, sexual history

■ DSM V Diagnosis: Clinical disorders■ Treatment Goal #1- Life Skills

● Domain● Goal● Action Steps● Progress● Strategy

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● Projected Method● Provider

■ Treatment Goal #2-Social Skills● Domain● Goal● Action Steps● Progress● Strategy● Projected Method● Provider

■ Treatment Goal # 3- Daily Skills● Domain● Goal● Action Steps● Progress● Strategy● Projected Method● Provider

■ Treatment Goal #4- Behaviors● Domain● Goal● Action Steps● Progress● Strategy● Projected Method● Provider

■ Treatment Recommendations including treatment type and frequency

■ Discharge Criteria■ Post Discharge Plan■ Signatures■ Date

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The treatment goals must align with the Needs Assessment Service Plan. Each treatment goal must follow the SMART acronym. Specific, Measurable, Attainable, Realistic, and Timely. Specific: A specific goal has a much greater chance of being accomplished than a general goal.Measurable - Establish concrete criteria for measuring progress toward the attainment of each goal you set.Attainable – When you identify goals that are most important to you, you begin to figure out ways you can make them come true. You develop the attitudes, abilities, skills, and financial capacity to reach them. You begin seeing previously overlooked opportunities to bring yourself closer to the achievement of your goals.Realistic- To be realistic, a goal must represent an objective toward which you are both willing and able to work.Timely – A goal should be grounded within a time frame. With no time frame tied to it there’s no sense of urgency.

Examples of Smart Goals and Action Steps used:

Relationship DomainFriends youth spends time with

Goal:Client will align herself with peers who are trying to make a positive change and will avoid negative peers. Client will engage in positive activities.

Action Steps:1. Identify what a positive friend is, what to look for in positive people,

and identify who your pro-social peers are and how to renew past positive friendships.

2. Role play strategies of making or renewing positive friendships.3. Identify pros of having pro-social friends and strategies for distancing

self from negative peers.

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4. Identify 3 positive activities you enjoy, people you can engage with and the benefits of positive activity.

5. Identify days and times you are most at risk for negative/illegal behavior. Make a plan to engage in positive activity during these times.

Action Steps:1. Identify what has been problematic about past friends. 2. Identify the ways in which these friends influence the client.3. Create a list of alternatives to associating with negative peers. 4. Identify possible pro-social peers.5. Build friendships with pro-social peers.6. Attend family, group and individual therapy regularly.

Alcohol/Drugs Domain

Drug/Alcohol

Goal:Client will remain drug free

Action Steps:1. Identify 3 reasons she uses substance, how often she uses and what

the substances of choice are.2. Identify people, places and feelings that contribute to her substance

use.3. Identify how much have drugs/alcohol use affected her life in the past

year.4. Identify what the more positive ways are she could experience the

good feelings that come from using.

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5. Identify strategies she can use to avoid problem situations. Role play these strategies and use what she learns.

Action Steps:1. Create a substance abuse cycle (Identify triggers, high risk situations,

places, people, emotions, etc.)2. Learn coping skills (avoidance, peer refusal, etc.)3. Create a relapse prevention plan.4. Provide a urine sample when requested for the purpose of drug

testing. 5. Attend family, group, and individual therapy regularly.

Skills DomainConsequential thinking/Compliant with rules and laws

Goal:Client will identify short and long term consequences of her actions before engaging in any behaviors.

Action Steps:1. Identify her problem behavior and understand the consequences of

each behavior.2. List her problem behavior and address long and short term

consequences.3. List and discuss the internal and external triggers that happen prior to

situations that lead to problem behavior. Come up with positive responses to these triggers.

4. Identify problem situations as they occur and recognize triggers and apply the positive responses.

5. Demonstrate the use of consequential thinking and say now she is avoiding the negative behaviors.

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Action Steps:1. Client will define the problem behavior.2. Client will identify alternative solutions.3. Client will identify the consequences of each action.4. Client will choose a positive solution.5. Client will process with staff/guardians.6. Client will attend individual, group and family therapy on a regular

basis.

Attitudes/Behaviors DomainTolerance for frustration/Anger Management

Goal:Demonstrate appropriate emotion regulation when interacting with peers, staff, family and others.

Action Steps:1. Write her beliefs, thoughts, behaviors and emotions as they relate to

her anger and frustrations.2. LIst and recognize internal and external triggers. Come up with a

solution for each identified trigger.3. Develop interpersonal skills (listening, asking for things, politely,

accepting the answer no, problem solving). Demonstrate these skills.

Current Living DomainConflict between youth and parents/guardians

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Goal: All members of the family will demonstrate listening and negotiation skills when resolving conflict without verbal and physical outbursts.

Action Steps:1. Family builds a behavior contract that establishes house rules.2. Each family members will complete an identified lesson on: saying

yes and no, conflict resolutions, effective communication, distress tolerance skills, compromise, and other identified skills.

3. Each family member demonstrates an ability to use improved skills.

Skills DomainExpress needs/feelings

Goal:Client will express her needs and wants using effective, pro-social interpersonal skills.

Action Steps:1. Learn about the importance of a positive self concept, and positive

interpersonal relationships.2. Complete a behavior chain analysis that define problem situations

and the behavior, antecedents (thoughts, physical sensations, beliefs and emotions) and consequences.

3. Identify the situations and context that are appropriate expressions of needs and feelings.

4. Identify the consequences of personal actions and the impact it has on others.

5. Role play distress tolerance skills that can be used to successfully manage a difficult situation.

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6. Role play interpersonal skills (respect, understanding, asking for help, being assertive, responsibility) that can be used to express needs and feelings.

Attitudes/Behaviors DomainRespect authority figures/Rules

Goal:The client listens to what authority figures say and complies with their directives without disruption or disrespectful behavior.

Action Steps:1. Define specifically and with examples what respect for authority

figures looks like.2. Define specifically and with examples what disrespect looks like.3. Develop a behavior/chain analysis (description of behavior cycle) of

situations that result in disrespectful behavior.4. Define what can trigger negative behaviors.5. Define intervention strategies.6. Demonstrates the following behaviors: saying please and thank you,

accepts no as a response, asks for a time out when upset, asks for permission, seeks clarification of rules, accepts feedback without defensiveness, looks for solutions and problem solves.

7. Attend family, group and individual therapy.

Psychiatric DomainMood Regulation

Goal:The client will successfully identify and acknowledge emotions and learn skills to regulate them appropriately, enabling her to not be reactive.

Action Steps:

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1. Identify a variety of emotions and define specifically what each emotion feels like and looks like.

2. Identify what triggers each emotion.3. List positive and negative behaviors that typically result from each

emotion.4. List specific strategies to decrease symptoms of anxiety and

depression.5. Assess need for psychotropic medication and monitor.6. Attend individual, group and family therapy.

Life Skills:Honesty

Goal: The client will make progress towards being honest in her words and actions.

Action Steps:1. Client will identify what is meant by honesty.2. Client will identify what is meant by honest words and honest actions.3. Client will identify behaviors that are dishonest, both verbal and

nonverbal.4. Client will quickly acknowledge dishonest behavior and will correct

her dishonest words or actions.5. Attend individual, family and group therapy regularly.

Trauma:Trauma and PTSD

Goal:The client will process traumatic events and will decrease symptoms of PTSD.

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Actions Steps:1. The client will develop a Trauma Narrative, detailing traumatic events

in her life.2. The client will identify how trauma has impacted her life, such as

having difficulty in relationships, acting out, addiction, depression and anxiety.

3. The client will identify ways to cope with flashbacks and nightmares.4. The client will share the trauma and effects with loved ones.5. The client will identify ways to move forward with positive

relationships and behaviors.6. Attend individual, group and family therapy regularly.

IndependenceSkills to increase ability to be independent/school attendance

Goal:The client will learn and practice skills toward independence and school attendance.

Action Steps:1. The client will increase independence skills, such as completing all

school work, budgeting, organizing, time management, chore completion, assignment completion, public speaking, interviewing, being responsible, etc.

2. The client will utilize opportunities in treatment to learn and practice independence skills and will demonstrate school achievement.

3. The client will role play during group and other classes to increase her proficiency.

4. The client will demonstrate an ability to be consistent and responsible each day in treatment and in school.

5. Attend individual, group and family therapy regularly.

Attitudes/Behavior Domain

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Sense of responsibility for anti-social behavior

Goal:Client will accept responsibility for her actions and will acknowledge the impact her behavior has on those around her. Client will make choices that respect others and her own property and personal space.Action Steps:

1. Client will identify what anti social and risky behaviors look like.2. Client will acknowledge and describe her own anti social and risky

behaviors.3. Client will acknowledge her part in anti social behaviors without

blaming others.4. Client will identify the ways that anti social behaviors harm others and

herself.5. Client will identify the dangers to her and others of her risky behavior.6. Client will make pro-social choices that reflect her understanding of

the issue.

Current Living DomainCompliance with parent authority

Goal: Client will follow rules of the home, written by she and parents, for 3 consecutive months.

Action Steps:1. Client and her parents will discuss parameters for family rules and to

ensure that rewards and consequences are appropriate.2. Client and her parents will write down the rules of the home and then

agree on consequences/rewards.3. Client and her parents will discuss the rules and general compliance

with them, once per week.4. Client’s parents will follow through with appropriate rewards and

sanctions for compliance and violation of the rules.

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5. Client will comply with the sanctions for rule violations and comply with all home rules.

Also based upon the assessments given the client and the information gathered from the client and caseworker, ie. conceptualization worksheet, the program must be aware of the responsivity factors and barriers the client may have towards their treatment goals. That is why it is very important to individualize the treatment plan. Based upon the stages of change, not all clients are going to be in the same stage and therefore may need to start at a smaller goal. A goal within a goal. It is important that all those working with the client is familiar with the client’s background, trauma they may have experienced and what level of change the client is at.

In the sample treatment plan found below you see that the clinician goals address the risk factors that are aligned with the Needs Assessment Service Plan. Each goal is a smart goal and some are also considered to be therapeutic. The action steps are written to reflect skills learned; as well as participation and improving behavior criteria.

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Individual Treatment Plan (Example)Young Women’s Empowerment Center

LT366 North 180 West Ephraim Utah 84627

435-283-0164 Fax: 435-283-2213

Initial Treatment Plan

Date of Report: February 04, 2016Statement of Disability that Requires Treatment and Skills DevelopmentJane is a 16 year old female in JJS custody. Jane was raised by her mother and her step father, but indicates that her step father was emotionally and physically abusive to her mother and the children many years prior to separation. Jane appears to have some symptoms of PTSD, such as nightmares and flashbacks. Jane began to spend time with negative friends in 7th grade and began drinking and smoking marijuana on a regular basis. She also developed a habit of missing school with her friends. At least part of this behavior was driven by the abuse she experienced at home. Jane appears to have symptoms of anxiety, especially anxiety about peers. She identifies as having low self esteem and poor body image.

Needs Assessment from Case ManagerCoordinated with the Division’s Service Plan and Treatment Team: YesDate Requested; February 03, 2016Method of Request: Email and phone call with caseworker

Client InformationName Jane DoeDate of Birth(age) 12/16/1999(16)Gender FemaleCaregiver(s) (Mother) Sally Doe

(Sister) Julie Doe (Father (Step)) John Doe

Medicaid Number 0123456789Intake Date 2/2/2016

Caseworker InformationName Joe SmithPhone xxx-xxx-xxxxAddress 100 West 500 North

Some town, Utah 84627Region Northern

Report DetailsType Date Start Time End Time Duration Setting Counseling TypeInterview-PDIE 2/4/201611:00 AM 12:00 PM 60 Minutes YWEC Face to FaceMedical Needs Jane has asthma and uses an inhaler 2-3 times daily

Client BackgroundPresenting ProblemsJane states in November 2015 she was missing school almost every day. She was on Drug Court and they asked why she was missing school, and she said it was because she didn’t have energy. Drug Court recommended she get evaluated for depression. She was prescribed medication (fluoxetine) for depression but seems to have had a

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negative reaction to it. Jane had court on January 21, 2016. She says she wasn’t feeling well because of the medication. At court she tried to tell them about the medication but says “they didn’t listen”. Jane says her probation officer recommended a placement for her. Jane states she didn’t want to be in a placement and just wanted to go home, but now is thinking that being at YWEC will benefit her in some ways.

Identifying ProblemsJane says her issues are low self esteem, anxiety and that she is “not really that social”. She says she tends to hold grudges for a long time and she needs to work on forgiving others and herself and to fix her relationships. Jane says the school absence is a long time habit. She states she had a miscarriage (January 2015) and that added to her low energy.

StrengthsJane says she “doesn’t honestly know” her strengths, but says she gets strength from her nephew (Josh) and her family. Jane says she has a positive mind set. Jane says she likes to spend time with family, free writing, and listening to music. She says she likes being alone but at the same time doesn’t like to feel alone.

Previous Emotional and Social HistoryJane says she started getting treatment when she was placed on Drug Court (December 6, 2014). She notes that she was in a car accident the day before. She was going to therapy and group therapy through Drug Court. She went to O&A in March 2015 and got out in May 2015. Jane says she felt O&A benefitted her in some ways as she matured and realized she was responsible for her choices. She says it also improved her relationship with her mother significantly.

Education HistoryJane is a 10th grader and has been attending George Washington High (alternative school). Jane states she has a long history of not attending school and it became a habit that was hard to break. She states she has about 4 high school credits earned at this point. She says in 7th grade she was doing okay at first but began to cut class to hang out with the “wrong crowd” and smoke weed. She began to get charges, one for fighting, and then got suspended for fighting. Jane says she does want to graduate from high school and wants to go to college as well. She would like to be a cosmetologist, veterinarian, therapist, or a nurse.

Psychotropic MedicationJane began to take fluoxetine in December 2015 but says it gave her headaches and made her “want to just sleep”. Her mother commented that she looked pale and was distancing herself from the family while on the medication.Jane says she has not tried any other psychotropic medications and feels she can learn to cope with things without medications at this point. She states she would like to learn skills to help her cope better.

Background and Family HistoryJane states she was born in Ogden and lived with her mother Sally Doe. Her biological father (George, last name unknown) was deported to Mexico and she has talked to him on a phone with him off and on when he initiated it. She states he typically would message her mother and they would talk. Siblings: Julie age 18 (has two children, ages 4 and 2), James age 11. Jane says her mother’s husband (John Reyes) is the father of her sister and brother. She comments her mother and step father have been in the process of getting divorced for a long time. She states her mother had a relationship with her father (George) in between having the two other children with John. Jane says she thought of her step father John as her father growing up, but they stated that although he was there, he didn’t really get involved in any of their lives. She says her mother was the person that took care of them. Jane says her mother works at a medical supply company.Jane says when she was younger, her life was good but she comments that she didn’t like to go home. She says John was always drinking and he was abusive to her mother and the children. Jane says they would argue and John would say very offensive things to them and also would hit them with a belt or his hands or threw things at them. In Junior High she started to go on the run and did not want to be at home because of John.

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Jane says her mother and John separated in 2012 or 2013. Jane says her mother was getting tired of John not helping out with any of the bills or being involved with them in a positive way. One day he hit Julie again and their mother said she wanted a divorce.Jane says in 7th grade she met friends who were missing school and smoking marijuana. This was the first time she smoked and she says she was instantly attracted to it because it was a stress reliever for her. Jane says she would sometimes give her friends money for marijuana or she got it from her boyfriend who was selling it at the time. Jane says in 7th grade she began to get into trouble due to missing school. Jane says she was “running away” but couldn’t explain to her mother why she was doing it. Eventually her mother “caught on” to what she was doing and why. Jane says she would typically leave home for a few days to a few weeks, and would hang out with friends smoking marijuana and drinking.Jane says her mother would text her and at times she would respond to her but other times she wouldn’t. Jane comments her mother would search for her. Jane says her mother would worry and not be able to sleep. She says her sister Julie had a boyfriend and spent a lot of time with him and got pregnant at age 14 and then at 16 with a different boyfriend.Jane says she was in shock when she (Jane) got pregnant but then started to think it might be fun to have a baby. Jane says her boyfriend was excited at first but later said her got her pregnant to get back at his ex. She says her boyfriend left her before she had a miscarriage but she says she felt okay about it because the baby was going to be like “keeping a part of him” with her. Jane says in December 2015 she visited her former boyfriend and that helped her to get over him and move on. Jane says a lot of her mother’s extended family live around the area and they are a big part of her life.Jane says she started to self harm when she was 13 or 14 years old. She used a broken glass to cut her wrist when her family was asleep. She says she used it to distract herself when she was upset with the issues in her life. She stopped for a while but began to cut again when she was 14. She says it got worse as she got razors and would cut fairly deeply. At age 15 she began to use the skills she learned in therapy and stopped self harming. Recently on January 15, 2016 she had an incident and cut on her thighs and on her arms. The next day she told her mother. She says her mother was “speechless” because she had thought she was past that. Jane says she felt triggered, had anxiety and was worried about court. The therapist observed numerous scars on both arms.Jane states she will talk to staff or her mentor if she feels triggered to self harm. She comments that writing down her feelings seems to help her the most. Jane denies any suicidal ideation or history, or eating disorders.

Legal and Criminal HistoryJane has the following charges: fighting, contempts, school truancy, trespassing, false information. Jane says she owes about 104 hours and her mother already paid her fines.

Physical/Sexual Abuse HistoryJane states her step father John was verbally and physically abusive to her mother and the children. Jane denies any other abuse or sexual abuse in her history.Jane says at times she wondered if John would end up killing one of them. She talked about having bruises and being sore from him beating them. She says they went to school worried that someone would notice the bruises and tried to cover them up. She states no one ever reported the abuse that she’s aware of. Jane states her mother protected John, thinking it was better to have him there than have him leave, but eventually she got tired of his behavior.

Sexual HistoryJanes say her mother talked to her about sex and being safe due to her sister getting pregnant when she was fourteen years old. Jane says she was already being sexually active at age fourteen and became pregnant when she was turning fifteen years old but then miscarried. Jane says when she as in a car accident she felt that caused the miscarriage. Her boyfriend at the time was the father of the baby. She states she has had four other partners.She states she identifies as straight.

DSM V Diagnosis_______________________________________________________________________________________Clinical Disorders

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Diagnosis Code RationalePost-traumatic Stress Disorder, chronic F43.12Generalized anxiety disorder F41.1Attention-deficit hyperactivity disorder, combined type F90.2 By historyCocaine abuse, uncomplicated F14.10Alcohol abuse, uncomplicated F10.10Disruption of family be separation or divorce Z63.5Cannabis abuse, uncomplicated F12.10

Treatment Goal #1- Life Skills_______________________________________________________________________________________Skills Domain Consequential thinking GOAL: Client will identify short and long term consequences of her actions before engaging in any behaviors. ACTION STEPS: 1. Identify her problem behavior and understand the consequences of each behavior. 2. List her problem behavior and address long and short term consequences. 3. List and discuss the internal and external triggers that happen prior to situations that lead to problem behavior. Come up with positive responses to these triggers. 4. Identify problem situations as they occur and recognize triggers and apply the positive response. 5. Demonstrate the use of consequential thinking and say how she is avoiding the negative behaviorsReview in 90 days. Progress: GoodStrategySkills Domain Consequential thinking GOAL: Client will identify short and long term consequences of her actions before engaging in any behaviors. ACTION STEPS: 1. Identify her problem behavior and understand the consequences of each behavior. 2. List her problem behavior and address long and short term consequences. 3. List and discuss the internal and external triggers that happen prior to situations that lead to problem behavior. Come up with positive responses to these triggers. 4. Identify problem situations as they occur and recognize triggers and apply the positive response. 5. Demonstrate the use of consequential thinking and say how she is avoiding the negative behaviors. Review in 90 days. Progress: Good. The therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy.Projected MethodCognitive Behavior, DBT- Dialectical Behavior Therapy. The therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy. ProviderSam Smith, LCSWTreatment Goal #2- Social Skills_________________________________________________________________________________________Attitudes/Behaviors Domain Tolerance for frustration/Anger Management GOAL: Demonstrate appropriate emotion regulation when interacting with peers, staff, family, and others. ACTION STEPS: 1. Write her beliefs, thoughts, behaviors, and emotions as relate to her anger and frustrations. 2. List and recognize internal and external triggers. Come up with a solution for each identified trigger. 3. Develop interpersonal skills (listening, asking for things politely, accepting the answer no, problem solving). Demonstrate these skills.Review in 90 days: Progress: GoodStrategyAttitudes/Behaviors Domain Tolerance for frustration/Anger Management GOAL: Demonstrate appropriate emotion regulation when interacting with peers, staff, family, and others. ACTION STEPS: 1. Write her beliefs, thoughts, behaviors, and emotions as relate to her anger and frustrations. 2. List and recognize internal and external triggers. Come up with a solution for each identified trigger. 3. Develop interpersonal skills (listening, asking for things politely, accepting the answer no, problem solving). Demonstrate these skills. Review in 90 days: Progress: GoodThe therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy.Projected MethodCognitive Behavior, DBT- Dialectical Behavior Therapy. The therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy.

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ProviderSam Smith, LCSW

Treatment Goal #3- Daily Skills_________________________________________________________________________________________Independence- Skills to increase ability to be independent/school attendance GOAL: The client will learn and practice skills towards independence and school attendance. ACTION STEPS: 1. The client will increase independence skills, such as completing all school work, budgeting, organizing, time management, chore completion, assignment completion, public speaking, interviewing, being responsible, etc. 2. The client will utilize opportunities in treatment to learn and practice independence skills. 3. The client will role play during group and other classes to increase her proficiency. 4. The client will demonstrate an ability to be consistent and responsible each day in treatment. Review in 90 days. Progress: GoodStrategyIndependence- Skills to increase ability to be independent/school attendance GOAL: The client will learn and practice skills towards independence and school attendance. ACTION STEPS: 1. The client will increase independence skills, such as completing all school work, budgeting, organizing, time management, chore completion, assignment completion, public speaking, interviewing, being responsible, etc. 2. The client will utilize opportunities in treatment to learn and practice independence skills. 3. The client will role play during group and other classes to increase her proficiency. 4. The client will demonstrate an ability to be consistent and responsible each day in treatment. Review in 90 days. Progress: Good The therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy.Projected MethodCognitive Behavior, DBT- Dialectical Behavior Therapy. The therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy. ProviderSam Smith, LCSW

Treatment Goal #4 Behaviors_________________________________________________________________________________________Alcohol/Drugs Domain Drug/Alcohol GOAL: Client will remain drug free ACTION STEPS: 1. Identify 3 reasons she uses substance, how often she uses and what the substances of choice are. 2. Identify people, places, and feelings that contribute to her substance use. 3. Identify how much have drugs/alcohol use affected her life in the past year. 4. Identify what the more positive ways are she could experience the good feelings that come from using. 5. Identify strategies she can use to avoid problem situations. Role play these strategies and use what she learns.Review in 90 days. Progress: GoodStrategyAlcohol/Drugs Domain Drug/Alcohol GOAL: Client will remain drug free ACTION STEPS: 1. Identify 3 reasons she uses substance, how often she uses and what the substances of choice are. 2. Identify people, places, and feelings that contribute to her substance use. 3. Identify how much have drugs/alcohol use affected her life in the past year. 4. Identify what the more positive ways are she could experience the good feelings that come from using. 5. Identify strategies she can use to avoid problem situations. Role play these strategies and use what she learns. Review in 90 days. Progress: Good The therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy.Projected MethodCognitive Behavior, DBT- Dialectical Behavior Therapy. The therapist and staff will monitor progress or any infractions with this goal. This goal will be discussed and monitor progress or any infractions with this goal. This goal will be discussed and monitored in individual therapy. ProviderSam Smith, LCSWTreatment Recommendations

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Treatment Type FrequencyResidential TreatmentIndividual Therapy WeeklyFamily TherapyGroup Therapy WeeklyAddictions Group WeeklyMed ManagementPsychosocial Rehabilitation WeeklyDischarge CriteriaStudent is no longer involved in inappropriate behaviors.Student will not be truant at school and successfully completes school work.Student is compliant and follows the rules in the treatment center.Student learns the appropriate ways to handle life without self-harm, suicide ideation, or cutting.Student no longer uses drugs or alcohol.Post Discharge PlanJane’s plan is to return to live with her mother and siblings upon graduation from YWEC.

SignaturesNext Treatment Review: Three Months

______________________________ _____________Therapist Date

______________________________ _____________Client Date

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Mental Health Assessment (Example)

Young Women’s Empowerment CenterLT3

66 North 180 West Ephraim Utah 84627Phone (435) 283-0164 Fax (435) 283-2213

Mental Health Assessment -- Psychiatric Diagnostic Examination__________________________________________________________Date of Report: February 03, 2016Client InformationName Jane DoeDate of Birth (age) 12/16/1999Gender FemaleCaregiver(s) Sally Doe (Mother)

Julie Doe (Sister)John Doe (Father (Step))

Medicaid Number 0123456789Intake Date 02/02/2016

Caseworker InformationName Joe SmithPhone xxx-xxx-xxxxAddress Some town, Utah 84627Region Northern

Report DetailsType Date Start Time End Time Duration Setting Counseling TypeInterview-PDIE 2/3/16 1:05 PM 3:05 PM 120 Minutes YWEC Face to FaceEvaluated by: Therapist Name

Client BackgroundPresenting ProblemsJane states in November 2015 she was missing school almost every day. Seh was on Drug Court and they asked why she was missing school, and she said it was because she didn’t have energy. Drug Court recommended that she get evaluated for depression. She was prescribed medication (fluoxetine) for depression but seems to have had a negative reaction to it. Jane had court on January 21, 2016. She says she wasn’t feeling well because of the medication. At court she tried to tell them about the medication but says “they don’t listen.” Jane says her probation officer recommended a placement for her. Jane states she didn’t want to be in a placement and just wanted to go home, but now is thinking that being at YWEC will benefit her in some ways.

Identifying ProblemsJane says her issues are low self esteem, anxiety and that she is “not really that social”. She says she tends to hold grudges for a long time and she needs to work on forgiving others and herself and to fix her relationships. Jane says the school absence is a long time habit. She states she had a miscarriage (January 2015) and that added to her low energy.

StrengthsJane says she “doesn’t honestly know” her strengths, but says she gets strength from her nephew and her family. Jane says she has a positive mind set. Jane says she likes to spend time with family, free writing, and listening to music. She says she likes being alone but at the same time doesn’t like to feel alone.

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Previous Emotional and Social HistoryJane says she started getting treatment when she was placed on Drug Court (December 6, 2014). She notes that she was in a car accident the day before. She was going to therapy and group therapy through Drug Court. She went to O&A in March 2015 and got out in May 2015. Jane says she felt O&A benefitted her in some ways as she matured and realized she was responsible for her choices. She says it also improved her relationship with her mother significantly.

Educational HistoryJane is a 10th grader and has been attending George Washington High (alternative school). Jane states she has a long history of not attending school and it became a habit that was hard to break. She states she has about 4 high school credits earned at this point. She says in 7th grade she was doing okay at first but began to cut class to hang out with the “wrong crowd” and smoke weed. She began to get charges, one for fighting, and then got suspended for fighting. Jane says she wants to graduate from high school and wants to go to college as well. She would like to be a cosmetologist, veterinarian, therapist, or a nurse.

Psychotropic MedicationJane began to take fluoxetine in December 2015 but says it gave her headaches and made her “want to just sleep”. Her mother commented that she looked pale and was distancing herself from the family while on the medication.Jane says she has not tried any other psychotropic medications and feels she can learn to cope with things without medications at this point. She states she would like to learn skills to help her cope better.

Background and Family HistoryJane states she was born in Ogden and lived with her mother Sally Doe. Her biological father (George, last name unknown) was deported to Mexico and she has talked to him on a phone with him off and on when he initiated it. She states he typically would message her mother and they would talk. Siblings: Siblings: Julie age 18 (has two children, ages 4 and 2), James age 11. Jane says her mother’s husband (John Reyes) is the father of her sister and brother. She comments her mother and step father have been in the process of getting divorced for a long time. She states her mother had a relationship with her father (George) in between having the two other children with John. Jane says she thought of her step father John as her father growing up, but they stated that although he was there, he didn’t really get involved in any of their lives. She says her mother was the person that took care of them. Jane says her mother works at a medical supply company.Jane says when she was younger, her life was good but she comments that she didn’t like to go home. She says John was always drinking and he was abusive to her mother and the children. Jane says they would argue and John would say very offensive things to them and also would hit them with a belt or his hands or threw things at them. In Junior High she started to go on the run and did not want to be at home because of John.Jane says her mother and John separated in 2012 or 2013. Jane says her mother was getting tired of John not helping out with any of the bills or being involved with them in a positive way. One day he hit Julie again and their mother said she wanted a divorce.Jane says in 7th grade she met friends who were missing school and smoking marijuana. This was the first time she smoked and she says she was instantly attracted to it because it was a stress reliever for her. Jane says she would sometimes give her friends money for marijuana or she got it from her boyfriend who was selling it at the time. Jane says in 7th grade she began to get into trouble due to missing school. Jane says she was “running away” but couldn’t explain to her mother why she was doing it. Eventually her mother “caught on” to what she was doing and why. Jane says she would typically leave home for a few days to a few weeks, and would hang out with friends smoking marijuana and drinking.Jane says her mother would text her and at times she would respond to her but other times she wouldn’t. Jane comments her mother would search for her. Jane says her mother would worry and not be able to sleep. She says her sister Julie had a boyfriend and spent a lot of time with him and got pregnant at age 14 and then at 16 with a different boyfriend.Jane says she was in shock when she (Jane) got pregnant but then started to think it might be fun to have a baby. Jane says her boyfriend was excited at first but later said her got her pregnant to get back at his ex. She says her boyfriend left her before she had a miscarriage but she says she felt okay about it because the baby was going to be like “keeping a part of him” with her. Jane says in December 2015 she visited her former boyfriend and that helped her to get over him and move on.

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Jane says a lot of her mother’s extended family live around the area and they are a big part of her life.Jane says she started to self harm when she was 13 or 14 years old. She used a broken glass to cut her wrist when her family was asleep. She says she used it to distract herself when she was upset with the issues in her life. She stopped for a while but began to cut again when she was 14. She says it got worse as she got razors and would cut fairly deeply. At age 15 she began to use the skills she learned in therapy and stopped self harming. Recently on January 15, 2016 she had an incident and cut on her thighs and on her arms. The next day she told her mother. She says her mother was “speechless” because she had thought she was past that. Jane says she felt triggered, had anxiety and was worried about court. The therapist observed numerous scars on both arms.Jane states she will talk to staff or her mentor if she feels triggered to self harm. She comments that writing down her feelings seems to help her the most. Jane denies any suicidal ideation or history, or eating disorders.

Legal and Criminal HistoryJane has the following charges: fighting, contempts, school truancy, trespassing, false information. Jane says she owes about 104 hours and her mother already paid her fines.

Physical/Sexual Abuse HistoryJane states her step father John was verbally and physically abusive to her mother and the children. Jane denies any other abuse or sexual abuse in her history.Jane says at times she wondered if John would end up killing one of them. She talked about having bruises and being sore from him beating them. She says they went to school worried that someone would notice the bruises and tried to cover them up. She states no one ever reported the abuse that she’s aware of. Jane states her mother protected John, thinking it was better to have him there than have him leave, but eventually she got tired of his behavior.

Sexual HistoryJanes say her mother talked to her about sex and being safe due to her sister getting pregnant when she was fourteen years old. Jane says she was already being sexually active at age fourteen and became pregnant when she was turning fifteen years old but then miscarried. Jane says when she as in a car accident she felt that caused the miscarriage. Her boyfriend at the time was the father of the baby. She states she has had four other partners.She states she identifies as straight.

Substance AbuseJane states she started smoking marijuana at age 14 with friends while they missed school. Jane also was drinking at age 14 with friends and drank frequently at parties and when she went on the run. She states she started using cocaine in November 2015 and used frequently for the whole month until she found out she was pregnant at the end of November.

SubstancesSubstance Age of Use Current Use Last UsedMarijuana 14, several times a week Over a year agoAlcohol 14, drank when she went on the run and to parties Over a year ago on the runCocaine 15, November 2015, used frequently with her ex boyfriend End of Nov. 2015 (pregnant)

Mental StatusAbusePhysically Abuse, Verbal Emotional AbuseAffect (observed)DepressedAppearanceClean,Assaultive IdeationPast IncidentsConsciousness

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LethargicHallucinations/DelusionsNoneMood (Inquired)SadMotor BehaviorReducedOriented ToPerson Place Situation TimeSelf HarmPast HistoryRisk ConcernsAWOL Drug/Alcohol Self Harm withdrawn and isolative behaviorsSexual BehaviorUnprotected sex has had a miscarriageSpeechSlowSuicidal IdeationNoneMemoryIntact

DSM V DiagnosisClinical Disorders

Diagnosis Code RationalePost-traumatic Stress Disorder F43.12Generalized anxiety disorder F41.1Attention-deficit hyperactivity disorder, combined type F90.2 By historyCocaine abuse, uncomplicated F14.10Alcohol abuse, uncomplicated F10.10Disruption of family by separation or divorce Z63.5Cannabis abuse, uncomplicated F12.10

Treatment RecommendationsTreatment Type Frequency

Residential TreatmentIndividual Treatment WeeklyFamily TherapyGroup Therapy WeeklyAddictions Group WeeklyMed ManagementPsychosocial Rehabilitation WeeklyTherapist Signature Date

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Discharge/Aftercare Plan (Example)Discharge Form

Date of Report: July 16, 2016

Client Information Name Jane Doe Date of Birth (age) 12/16/1999 Gender Female Caregiver(s) Sally Doe (Mother)

Julie Doe (Sister) John Doe (Father (Step))

Medicaid Number 0123456789 Intake Date 02/02/2016 Caseworker Information Name Joe Smith Phone xxx-xxx-xxxx Address Some town, Utah 84627 Region Northern

Discharge Information Length of Stay 2/2/2016-7/22/2016 (5 months)

Reason for Discharge or TransferJane has completed all requirements for graduation and discharge from YWEC

Discharge PlanJane will return to live with her mother Sally and her siblings.

Summary of Services ProvidedJane has participated in a wide range of treatment while at YWEC. She has participated in individual therapy twice each week and has been engaged and present. The client has completed a treatment manual for each level of YWEC, for instance, “Dialectical Behavior Therapy, Adolescent Relapse Prevention Plan, Voices (female empowerment), Trauma Narrative, and manuals to focus on regulating emotion. She has attended group therapy once a week and this addresses subjects such as refusing negative peer pressure, increasing positive behaviors such as respect for others, and improving communication. The client has also attended a weekly addiction group and has done quality work in this area as she has recognized her pattern of addiction and has worked on a relapse prevention plan. The client has participated in twice a day goal setting groups and written assignments in conjunction with those goals. She has attended daily PRS classes which feature subjects such as anger management, goal setting, and problem solving. The client has also taught classes to her peers and attended peer-led classes on approved subjects. The client has daily chores and responsibilities. The client has attended school each day and worked to recover credits. Each client participates in weekly community service opportunities.Jane has also been a peer mentor for several months with responsibility to supervise peers. She has been especially helpful in assisting several peers to be more successful in treatment. Evaluation of Achievement of Treatment Goals or ObjectivesTreatment Goal #1Skills Domain: Consequential Thinking GOAL: Client will identify short and long term consequences of her actions before engaging in any behaviors. ACTION STEPS: 1. Identify her problem behavior and understand the consequences of each behavior. 2. LIst her problem behavior and address long and short term consequences. 3. List and discuss the internal and external triggers that happen prior to situations that lead to problem behavior. Come up

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with positive responses to these triggers. 4. Identify problem situations as they occur and recognize triggers and apply the positive responses. 5. Demonstrate the use of consequential thinking and say how she is avoiding the negative behaviors.Review in 90 days. Progress: Good

Update and Progress on Treatment Goal #1Jane is reducing risk on this goal and is making good choices in her life which is leading to positive consequences. Jane says she is thinking through her options during different situations such as when someone is arguing with her and she thinks through what would be in her best interest and she walks away from the situation. Jane says on a recent home visit, someone messaged her asking her to come to a party. She told them she didn’t want to drink and didn’t want to put herself in a bad situation. Jane says the friend came to her house to pick her up and kept messaging her to come out, but she still resisted. Jane has made many changes in her life and expresses a desire to spend time with her family and be a support to them, rather than going to parties. Jane has experienced friends ridiculing her choices. Jane has had many extended home visits and she has shown that she can resist peer pressure. When she is discharged from YWEC, Jane is anticipating being able to continue to say “no” to friends.

Treatment Goal #2Attitudes/Behavior Domain: Tolerance for frustration/Anger Management GOAL: Demonstrate appropriate emotion regulation when interacting with peers, staff, family and others. ACTION STEPS: 1. Write her beliefs, thoughts, behaviors and emotions as relate to her anger and frustration. 2. List and recognize internal and external triggers. Come up with a solution for each identified trigger. 3. Develop interpersonal skills (listening, asking for things politely, accepting the answer no, problem solving). Demonstrate these skills.Review in 90 days. Progress: Good

Update and Progress on Treatment Goal #2Jane has reduced risk on this goal as she has demonstrated a better ability to handle her frustrations appropriately. Jane says she feels this is something she will continue to work on when she finds herself frustrated or angry. She notes that when she is at the point of feeling like she could explode, she is able to detach and take some time to calm down by listening to music or by calling her mother Sally, or talking to staff about her feelings. Jane appears to have significant improvement in symptoms relating to that as well.

Treatment Goal #3Independence: Skills to increase ability to be independent/School attendance GOAL: The client will learn and practice skills towards independence and school attendance. ACTION STEPS: 1. The client will increase independence skills, such as completing all school work, budgeting, organizing, time management, chore completion, assignment completion, public speaking, interviewing, being responsible etc. 2. The client will utilize opportunities in treatment to learn and practice independence skills. 3. The client will role play durin groups and other classes to increase her proficiency. 4. The client will demonstrate an ability to be consistent and responsible each day in treatment. Review in 90 days. Progress: Good

Update and Progress on Treatment Goal #3Jane has reduced risk on this goal. She shows that she is taking school seriously, works hard and is able to accomplish things in each school day. She feels very proud of herself each time she has earned a quarter credit. It helps her feel that she can indeed graduate from high school. Jane is an 11th grader. Jane’s family is in the process of moving and this may determine where she will continue her schooling, but Jane comments that she feels she does better in a smaller school setting with the ability to work at her own pace.Jane is working on being more independent and taking care of her own needs. Jane shows growth and maturity in her behaviors. Jane comments she has learned she can take care of some things herself, where in the past she would have relied on her mother to take care of things. She has learned to complete chores and other tasks and not leave them for someone else to do. Jane states she is learning that some things she can control and to focus on that, and other things are out of her control.

Treatment Goal #4

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Alcohol/Drugs Domain Drug/Alcohol GOAL: Client will remain drug free. ACTION STEPS: 1. Identify 3 reasons she uses substances, how often she uses and what the substance of choice are. 2. Identify people, places, and feelings that contribute to her substance use. 3. Identify how much have drugs/alcohol use affected her life in the past years. 4. Identify what the more positive ways are she could experience the good feelings that come from using. 5. Identify strategies she can use to avoid problem situations. Role play these strategies and use what she learns.Review in 90 days. Progress: Good

Update and Progress on Treatment Goal #4Jane has reduced risk on this goal. She has a goal of keeping herself busy and productive to help her not relapse. Jane is making better choices in who her friends are because she knows this can be a big influence on her. Jane says she knows she has to deal with being around some substances such as when family members drink and she is finding that she can be okay and not be triggered. Jane says if she does feel triggered, she has learned that detaching, going for a walk, or reaching out for support such as from her sister, can help her cope. Jane is working on letting friends know that she is serious about staying clean. Jane is communicating to them that if they are going to be her friend, they won’t ask her to drink or smoke. Jane is cleaning up her social media as well and deleting people who continue to trigger her to use.

RecommendationsRecommendations for future services or treatment needsJane would benefit from continued individual and family therapy to assist her in making a successful transition to home.

Therapist Signature Date

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Court Report (Sample)

Young Women’s Empowerment CenterLT3

66 North 180 West Ephraim UT 84627Phone (435) 283-1064 Fax (435) 283-2213

Client Jane DoeReport Date 5/18/2016Court ID 24681012Reason for Referral: 90 Day Review/UpdatePresent Mental: See Therapist Report for Mental Health Health Status:Parental Involvement: Jane has been having weekly phone calls with her mom and her siblings. She has also had a successful home visit in which both her and mom report was positive. Jane followed the rules and worked on building her family relationships.Progress-to-Date: Jane has been attending weekly individual and group therapy. She completes the assignments that are given to her. Jane is learning consequential thinking and has been making better choices while at the program. She is improving her relationship with her family and has been showing respect to her staff and peers. Jane is learning the importance of having healthy relationships. Jane is making progress towards her treatment goals.Recommendations: YWEC recommends that Jane continue her placement in the program and continues to engage in individual and group therapy. It is also recommended that Jane completes the program.

Signature Date

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Quarterly/Progress Report (Example)

Young Women’s Empowerment CenterLt3

66 North 180 West Ephraim UT 84627Phone (435) 283-0614 Fax (435) 283-2213

Progress ReportAugust 10 2016-September 9, 2016

*Confidential: The information contained in this report is privileged and confidential information. It is intended only for the use of the case worker to whom it is addressed

Client: Jane Doe

Client ID# 1234567890

Direct Oversight: Jane sets healthy goals and works daily towards them. Jane can be combative and struggles with getting along with her peers however after being placed on reflection she rejoined the group and was more positive. Jane has shared with the group her solutions for managing her behavior and emotions appropriately. Jane has had less conflict with her roommates. Jane has the potential of being a strong leader. Jane has two roommates whom are also new to the program. Jane used her leadership skills this week by helping her roommates out and was a positive role model to them.

Case Activity Expectation: Jane has 54 out of 60 points needed for level 1. It is estimated that she will progress to the second level of the program on September 13th. Jane has completed 10 community service hours.

Family Visitation and other contacts: Jane has had one phone call with her father John. She also has had weekly phone calls with her grandmother.

Health Service:9/7/16 Dermatologist appointment for acneCurrent Medications:Amoxicillin 1000 mg BIDBenzaclin cream

Linking direct care of client to mental health services:Group therapy822/16 For group, the members participated in a goodbye group for one of their peers. Each of the group members were able to offer advice to the peer graduating. They were then able to hear from the peer graduating and were open and receptive to the advice and feedback she offered them.8/16/16The group participated in a communications activity in which they were divided into teams and given several pieces of paper and tape. The groups were then told to build a tower. After several minutes, the groups then participated in a discussion about the activity. The groups took turns sharing some of the insights that they identified with the activity. They identified some of the problems and issues they had in communicating their ideas of how to construct the towers. They also identified how one of their group members took charge of the activity and how other group members tended to follow. The groups were then able to compare and contrast how the communication in this activity related to how they communicate in other activities in their lives.

Linking direct care of the client with education:Jane attends school on campus with the South Sanpete School Educational Support Center. She has been working well and has been completing her assignments. Jane had her computer privileges revoked for two weeks for breaking the technology rules.

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Court Attendance:Jane did not have court during this time.

Client use of Electronics or Social Media:It is YWEC’s policy that no electronics are used. There also is no social media.

Team and Child and Family Team Meetings:Jane did not have a team meeting during this time.

Report prepared by:Signature Date

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PRS (Psychosocial Rehabilitative Services) Report (Example)

Young Women’s Empowerment CenterLt 3

66 North 180 West Ephraim Utah 84627Phone (435) 283-0164 Fax (435) 283-2213

PRS Report

Client: Jane DoeMedicaid #: 24681012Dates of Service: 2/16/16-2/29/16Setting: YWEC

Treatment Goal:Skills Domain Consequential Thinking GOAL: Client will identify short and long term consequences of her actions before engaging in any behaviors. ACTION STEPS: 1. Identify her problem behavior and understand the consequences of each behavior. 2. List her problem behavior and address long and short term consequences. 3. List and discuss the internal and external triggers that happen prior to situations that lead to problem behavior. Come up with positive responses to these triggers. 4. Identify problem situations as they occur and recognize triggers and apply the positive responses. 5. Demonstrate the use of consequential thinking and say how she is avoiding the negative behaviors. Progress: Good

Method: Face to Face Group SettingSessionsDate Start Time End Time Duration # In Group Topic PRS Staff2/16/16 5:00 PM 6:00 PM 60 13 The ways they learn best Angela/AutumnSession Data: I had them fill out a packet that identified what worked best for them to learn. It helped them think about different situations about things that did and did not work for them in the past. I collected the packets after the group discussion so that if could help me tailor my classes for the learning strategies could be more individualized.Date Start Time End Time Duration # in Group Topic PRS Staff2/22/16 5:00 PM 6:00 PM 60 10 EmpathyJudySession Data: Lack of empathy is often the result of self-centeredness, cognitive distortions, and a general lack of insight into one’s own feelings and the feelings of others. Patterns and traits take time to develop, they take time to change, and progress toward change must be measured incrementally.Date Start Time End Time Duration # in Group Topic PRS Staff2/29/16 5:00 PM 6:00 PM 60 13 Anger Management Autumn/JudySession Data: Understanding anger and responding versus reaction to the feelings. Clients spoke about sensations and feelings they get when they get angry. We discussed how we can better deal with these feelings.

Progress: Jane has been using her consequential thinking by laying out what could happen if she chooses to do something. This has been evident by when peers make her frustrated and she has the choice to either react to them or walk away and take a moment to herself. Jane knows that reacting to the situation would not benefit her and she would get in trouble. Jane always is respectful during PRS classes.

Signature PRS Provider Date

Signature Co-Facilitator Date

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The Relapse Prevention Plan

A relapse prevention plan is simply a plan for how you can prevent a relapse or a return to drug use after a period of abstinence. This is a detailed plan for making changes to all the areas of your life that have been damaged by your drug use. The more work you put into recovery, the more it will improve your life. A relapse plan can be something you continue to work on and at to for months or even years. It can be a guide to help keep you on the right track and focus your energy on recovery.

Triggers:Triggers are people, places, and things that can cause an addict to experience a craving or an urge to use a substance. Questions to answer:

● Who could I see that would remind me of drug use?● What places did I use drugs that could trigger me?● What paraphernalia did I use?● What emotions could make me want to use?● What addictive thoughts could make me relapse?● What kind of situations could make me feel like using drugs?● What can I do if I cannot avoid things that trigger me?

Cravings:Cravings will always be part of recovery from any addiction. Your plan should include what you will do if you have a craving. Think about people you can call if you feel like using, safe places you can go and what will comfort you and calm a craving. Questions to answer:

● Who can I talk to if I feel like using?● What will calm me down if I have a craving?● What can I do to distract myself from a craving?● Where can I go if I have a craving?● What can think about that will help me stop a craving?

Relapse:Relapse is something that happens before you ever pick up a drink or drug. We often say that relapse is a process, not an event. This means there are cues to alert you to a relapse before it happens. If you pay attention to these cues, you can stop a relapse before it happens. You can keep a section of your relapse prevention plan to look at whether there are emotional, mental or physical signs that indicate you may be heading for relapse. Since it can be difficult for an addict to notice relapse signs as they occur, it is important to ask the people closest to you if they see any signs of relapse in your behavior. Questions to answer:Emotional Cues:

● Are you more angry, defensive or frustrated than usual?● Do you have more anxiety or depression?● Are you not asking for help when you need it?● Are you having more mood swings?● Are you feeling restless or bored?

Mental Cues

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● Are you keeping secrets or isolating?● Are you thinking about using and not talking about it?● Are you glamorizing drug use and only thinking about the good parts of it?● Are you fantasizing about using?● Did you stop going to meetings?● Did you stop going to counseling?● Are you hanging out with old friends?● Have you tried to call a dealer, or driven to where you used to get drugs?

Useful ToolsList of Consequences: Keeping a list of consequences can help you stay focused on your recovery. It can help remind you of why you don’t want to relapse. It can remind you of what you will have to face if you relapse. No matter what you do, there will always be some consequences of addiction that cannot be avoided. Addiction damages health and peace of mind and can lead to jail or even death. Write your list of consequences.Gratitude List: Keeping a list of what you are grateful for is the opposite of a consequence list. Your gratitude list will remind you of the many wonderful things you have in recovery. It will help you realize that you have much to lose by relapsing. It can help you stay focused on the positive side of recovery. A gratitude list can also help you feel better when you are feeling down. When you realize all the things you have to be thankful for, it is hard to remain sad. Create your gratitude list. Relaxation and Stress Management: Since stress and anxiety can trigger cravings, you can include some relaxation and stress management options that you can try when you feel anxious or under stress. Ideas: Hot bath, deep breathing, exercise, writing, art, music, yoga, meditation. What types of positive things help you relax?Support: Support is an important part of recovery. Having someone who understands how you feel will make you realize you are not alone. Make a list of people who are supportive to you and your plan so you know who to call when have a craving or are under stress. You should have at least 5 to 10 people you can call when you need someone to talk to. Mental and Physical Wellness: Your plan can include ways to improve your mental and physical wellness. Questions to ask:

● How can I improve my mental health?● What steps can I take to reduce depression, anxiety etc.?● Do I have a mental health disorder that needs treatment?● Do I need to take medicine?● What appointments do I need to keep with a doctor or mental health provider?● How can I improve my physical health?● What diet and exercise changes do I want to make?

Recovery Program: Take part of a recovery program such as the 12 step program. Include the work you are doing in your program. You can include what meetings you will attend and set a goal for how many meetings you will go to. Include space to write about each of the 12 steps and your moral inventory, work on character defects, and amends. Track your progress on your 12 step work and include a daily inventory to check if you have done anything during the day that might hurt anyone. Questions to answer:

● What meetings can I attend each week?

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● Where are the meetings located?● Who can I go to a meeting with?● What step am I working on?● What step am I working on?● What do I need to do for step work?● When do I meet with my sponsor?● What service work can I commit to?

Life Improvement: Finally your plan can include how you intend to repair the damage to different areas of your life. Think about all the areas of your life that have been damaged by addiction and how you can improve each one. This part of your relapse prevention plan can be about setting goals for life improvements. The more you change your life and make it about recovery, the less likely you will be to relapse. At some point you may want to work on deeper issues like spirituality or finding a purpose for your life. Questions to answer:

● What areas of my life need the most immediate attention?● What are my short term goals?● What are my long term goals?● What are some small steps I can take each day to help me reach my goals?● Who can help me with my goals?● What information do I need to reach my goals?

After making your list of goals to work on, prioritize them so you know what to work on first and what can wait. There is no hurry to complete everything on your plan. Your relapse prevention plan can be more than just a plan to prevent relapse, it can be a recovery plan for your whole life. If you use it as a recovery plan you can work on it over your whole lifetime.

Think of your relapse prevention plan as a plan to help you not only directly avoid relapse but to make improvements to your life which will help you want to stay clean and sober. If your life gets better, you may be more motivated to avoid a relapse because you won’t want to go back to the way you lived in active addiction.

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Section 6. Program InterventionsYoung Women’s Empowerment Center has developed a structured program to assist each client in finding the hope, vision, courage and will to succeed. The residential setting gives youth the chance to make behavioral changes, change problem thinking, and improve prosocial behavioral skills without the situations they have previously been exposed to in their environment. This allows the client time to practice the new skills they learn. YWEC uses a variety of treatment interventions to reduce risk and help the youth. We promote behavioral changes through but not limited to mediation of resolving conflict, community service, skill building which includes CBT, DBT, social skills, behavioral approaches, psychosocial rehabilitative services, individual therapy, group therapy, and family therapy.Individual Therapy:Individual psychotherapy is conducted during treatment a minimum of once weekly. These private sessions with a therapist provide an opportunity for the resident to examine their methods of handling feelings and problems in their lives, to try out new ways of behaving and coping in their relationships with others, and to deepen their understanding of their own selves as persons. Individual therapy sessions provide opportunities for the young person to privately discuss their problems and to develop more adaptive ways of handling them. Group Therapy:Clients participate in group psychotherapy a minimum of two times each week. Group Psychotherapy provides an opportunity to explore group dynamics, interpersonal relationships, and patterns of behavior and perception in social situations. Group Psychotherapy encourages the development of an increased understanding of self and others, and facilitates the development of healthier patterns of social interaction among clients.Family Therapy:Whenever possible, efforts are made to ensure that the residential treatment remains family-centered throughout the resident’s stay. Therefore, treatment participation by the resident’s family or support

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system is mandated whenever possible. The frequency of family therapy sessions may vary depending upon the individual treatment plan and the family’s geographic distance from the treatment center. Family therapy is required a minimum of once monthly, occurs more frequently whenever possible, and is available on a weekly basis when feasible for the family. Family therapy provides an opportunity to discuss family problems and issues and to explore how these problems affect each family member. Early in the client’s stay, an emphasis is placed upon engaging the family members in the client’s treatment, maintaining regular participation by the family, and enhance the relatives’ understanding of the client’s behavioral and emotional difficulties. The therapy works toward providing new avenues of positive, healthy, and enjoyable interaction between the client and their family members. As the client and the family make progress toward accomplishing their treatment goals, the emphasis shifts toward empowerment of the family, reunification of the client with the family, and a successful return of the client to the home. When circumstances do not allow for placement with the family upon discharge, family therapy work will facilitate successful adjustment to further out-of-home treatment or placement.

Thinking for a Change is a cognitive-behavioral program, governed by simple, straightforward principle-thinking (internal behavior) controls actions (external behavior). Therefore, it is necessary to target a client’s thinking in order to change their actions that lead to criminal conduct. Client’s engage in planned and deliberate criminal acts supported by strong antisocial attitudes and beliefs. Their way of thinking supports and justifies the serious offenses they commit. Behavior change cannot take place for them until they become aware of their thinking and see a reason to change.

Thinking for a change uses a combination of approaches to increase client’s awareness of self and others. This deepened attentiveness to attitudes, beliefs, and thinking patterns is combined with explicit teaching of interpersonal skills relevant to the client’s present and future needs. The goal is to provide instruction and related experiences so that the client is

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confident and motivated to use prosocial skills when faced with interpersonal, antisocial and stressful problems.

The philosophy of T4C endorses that clients should be empowered to be responsible for changing their own problem behavior. The intervention program provides the offender the tools to take pro-social action and change their offending ways. Each component is presented in a systematic, logical fashion using the standard procedures for cognitive behavioral interventions. The three components of Thinking for a Change are: Cognitive Self Change, Social Skills, and Problem Solving Skills.

Cognitive Self Change teaches a concrete process for self-reflection aimed at uncovering antisocial thoughts, feelings, attitudes and beliefs.Social Skills instruction prepares group members to engage in prosocial interactions based on self understanding and consideration of the impact of their actions on others.Problem Solving Skills integrates the two interventions to provide an explicit step by step process to address challenging and stressful real life situations.T4C integrates these three types of interventions in the following way: Lesson 1 begins with an overview and introductionLessons 2-5 and 11-15 teach Social SkillsLessons 6-10 teach the Cognitive Self Change processLessons 16-24 teach Problem Solving SkillsLesson 25 provides a wrap up of T4C

In addition to Thinking for a Change YWEC also teaches lessons from the Carey Guides.

Carey Guides: Research demonstrates that traditional methods of supervision are ineffective in reducing recidivism among juvenile offenders. For behavior change and recidivism reduction to be possible, clients must understand the personal and environmental factors underlying their illegal behavior and be taught the skills they need in order to make positive changes in the future. The Carey Guides are designed to teach the clients

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the information and tools they need to support change. The Carey Guides includes 33 handbooks. There are 14 blue guides that specifically address the client’s criminogenic needs and 19 red guides that help staff address common issues. Each guide also contains two to five worksheets. These worksheets are designed for use by the client with assistance of staff to understand and address risk factors, triggers, and other conditions that are essential for the client’s success and making positive changes in their lives.

Behavior Modification: In Behavior Modification, clients are helped to recognize and change problem behaviors. To modify behaviors, current behaviors are examined to find what is reinforcing the behavior. Those reinforcers are then eliminated and new reinforcers for positive behaviors are added. Punishers may also be added, which also help to eliminate problem behaviors. YWEC uses the following targeted intervention packet:

Targeted Intervention Packet:The purpose of this intervention packet is to help you develop ways to manage your problem behavior. You will look at things that happen before the problem behavior and develop interventions that will stop the behavior from occurring. You will learn a way of looking at your behavior, the things (events) that happen before the behavior (triggers or antecedents) and the things that happen after the behavior (consequences). Once you have reviewed these things, you will develop an intervention plan and learn skills that will help you avoid doing the problem behavior and obtain what you want through more positive means.This packet has five sections that have several parts for you to complete. You will work through the packet one section at a time. Each section has assignments that will teach you skills that help you stop the problem behavior from occurring. Below is a general outline of the material covered in this packet.

● Defining the Problem Behavior○ Describe what the behavior looks like -what, who, when, where○ Describe how severe the behavior is-intensity, dangerousness,

duration.● Completing a behavior chain analysis for all target behaviors

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○ Identifying antecedents, behaviors and consequences in chronological order

○ Selecting an intervention point in the chain○ Building an antecedent scenario and writing a description of the

triggering event● Trigger Scenario(s)-Write a trigger script for problem behavior● Building a(n) Intervention(s)

○ Selecting an intervention○ Developing staff prompts for living environment intervention○ Writing a description of the intervention and staff prompts

● Skill practicing/role playing/behavioral rehearsal interventions to trigger scenarios

○ Practicing verbal descriptions of triggers○ Practicing staff role plays of triggers○ Practice ignoring antecedents and responding to staff prompts○ Graduated practicing to more difficult variations of triggers.

● Generalization○ Using interventions in living environment○ Responding to staff cuing techniques if needed

You and staff should work together when completing this packet. You have the responsibility to get and accept staff feedback(not necessarily take it) and to complete the information in the packet as honestly as possible. Realize that it may take a few sessions to get through each section and staff must approve of a section’s completion before you move on. Staff have the responsibility to review each section thoroughly prior to the youth reviewing the lesson. The staff will explain each section and ensure that the youth is familiar with all new concepts and the expectations of the assignment.

Defining the problem behavior● Describe what the behavior looks like-what, who when, where● Describe how severe the behavior is-intensity, dangerousness,

duration● Work on one designated behavior at a time with the packet

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The first step in defining an intervention strategy is to understand and define what the problem behavior is-what the target of intervention or change is. The behavior should be defined specifically enough so that it can be measured and the conditions under which it occurs determined. Everybody should be able to agree on exactly what we are talking about. We want to know what the behavior looks like in both its mild and most severe forms, the impact of that behavior on the person or others and the conditions under which it occurs--people, places, time and environments, etc.Youth have the following responsibilities in this section:

● Listen to the introduction to section by staff and complete the assignment as described

● Describe behavior truthfully and answer staff questions● Write out answers as best as possible● Review with staff and use staff information to more fully

describe some of the aspects of the behavior in more detailThe goal of the staff is to assist the youth in describing behavior so that it is clear, staff have the following responsibilities in this section:

● Review youth behavior history from file ○ Note reports of problem behavior and what it looks like○ Try to determine the context of the behavior and the

function it may have○ Note whether there are known antecedents to the

behavior○ Note the consequences that seem to maintain the

behavior● Help youth define key concepts: duration, topography, severity

and conditions under which the behavior occurs.○ Topography-the physical form of the behavior○ Duration-how long the behavior lasts○ Severity-history of the result○ Conditions under which it occurs and does not occur

■ People targeted■ Places■ Requests to do things, certain things

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● Review each area completely with the client● Have her tell you verbally what the question requires● Make sure that all forms of the behavior are listed, severity and

duration are addressed as well as who the targets are and settings and times it may occur

● Prompt and ask questions to clarify issues● Review each answer and prompt client in areas that need more

detailClient WorksheetIn the box below, give the behavior a generic name and describe the behavior. When describing the behavior talk about all its forms, who it is directed at, accompanying behaviors and finally, how severe is the behavior. Be sure to indicate how long the behavior lasts. Also list the impact of the behavior, that is, how harmful it is. Finally list some times, places and/or people in which it is more or less likely to occur.

Behavior Chain AnalysisCompleting a behavior chain analysis for all targeted behaviors

● Identifying antecedents, behaviors and consequences in chronological order

● Selecting an intervention point in the chain● Building an antecedent scenario and writing a description of the

triggering event

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The purpose of the behavior chain analysis is to help you understand how your problem behavior happens. The behavior chain analysis will help you understand how the problem behavior occurs and what it looks like. You will look at the events that happen before the behavior -what happened and how you were feeling- and what happened afterwards.Events that happen before the behavior are called antecedents. There are two types of antecedents to look at that happen before the behavior. One type of antecedent is called a vulnerability factor or setting event. These are things that affect your interest and motivation. Examples of these are things like sickness, headache, sadness, anxiety, depression and tiredness. The importance is that they affect your general feeling about things that normally may interest you or not. For example, if you had to go to school after a night of no sleep, you might be more likely to yell at someone, or, if you are really hungry, you might work harder in school if you know there was a really desirable snack waiting for you for good behavior. The second type of antecedent is called a trigger. A trigger is an event that precedes the problem behavior that makes it more likely the problem behavior will occur. Note that there can be more than one trigger in a behavior chain.

Youth has the following responsibilities in this section.● Describe the behavior chain as completely as possible

○ Describe the events that occur before the problem behavior

■ Describe your thoughts, feelings, physical sensations, attitudes, beliefs and other behavior that occur.

● After behavior of others and in certain situations

● And behavior after some of the thoughts and feelings

● Listen to staff input about the completeness of the description and include thoughts, feelings, attitudes and physical sensations into your chain.

● Make changes in chain if it makes it more complete

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Staff have the following responsibilities in this section:● Review expectations and explain key concepts: behavior chain,

antecedent, trigger, vulnerability, setting event, consequence○ Antecedent/trigger-- events that occur before the problem

behavior that have a high probability of association with the problem behavior occurrence; these are internal like thoughts and feelings as well as external environmental events like being around antisocial peers. These are sometimes called fast triggers.

○ Setting Events/vulnerability-- internal event, events like sickness, hunger, tiredness, depression and external events like heat, cold, noise that change normal motivational states generally may have a deleterious effect. These are also called a slow trigger.

○ Behavior Chain- a description of all the antecedents and consequences that occur before the problem behavior and the consequences of the problem behavior.

○ Consequence- Anything that occurs after a behavior that makes it more or less likely to occur.

● Ensure the behavior chain is complete and addresses thoughts, feelings, attitudes, beliefs, physical sensations and behavior through all stages of the behavior chain. Staff should probe and ask questions to define each of these better.

○ What is the youth thinking at each stage in the chain before and after the target behavior?

○ What are the youth’s attitudes and beliefs about the behavior? Is it ok, sometime it is ok, did someone deserve it because she is a jerk or she is non-white, etc. Probe the belief.

○ What are the feelings and physical sensations occurring at each stage of the escalation process? Did anxiety increase, was the youth angry, why, did she ruminate about something, etc.

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○ Are there specific behaviors that the youth has feelings and thoughts about that increase escalation toward the problem behavior?

● Provide feedback on chain detail that directs the youth to what still needs to be considered.

● Ensure that the behavior chain is descriptive enough to understand the sequence of events leading to the problem behavior.

Client worksheet:In the box below, list and describe any setting events/vulnerability factors that may make the behavior more likely. Talk about health issues, moodiness, if hungry, headaches, significant family events, etc.

In the box below, list the antecedents/triggers that make the problem behavior more likely. Describe in detail. Be sure to talk about your attitudes and beliefs about the problem behavior, feelings and thoughts that occur as well as any physical sensations.

In the box below, write a story of the events that led up to the problem behavior using the material from the previous sections. Start with what happened right before you noticed a trigger and list all the details leading to the behavior and what happened afterwards. Include what

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happened in the environment, how you responded behaviorally, what you were thinking and feeling, who was around, how others responded, and on until the problem behavior occurred.For example: We had just gotten out of school and I was tired. When Sally walked in the room, I felt there was going to be trouble. She had been teasing me all day and I felt angry and wasn’t going to take it anymore if she teased me again. Staff seated her right next to me and I became very anxious. When she called me a jerk, I stood up and hit her in the face and we started fighting. After staff broke it up, I felt so good and some of the other youth were smiling at me and thanking me for doing that. The story can be specific to an event that happened but later in this section you will have to write a script for you and staff to use that you will role play to.

What vulnerabilities do you have? What triggers were there that affect you?

List your vulnerabilities. Then, on the ABC chart (Antecedent/trigger-behavior-consequences chart) draw out your story in order assigning each event in the behavior chain to one of the columns. Remember, behavior is anything you did (felt/thought or did), antecedents and consequences are things that happen in the environment or things you felt- this can be confusing so make sure you get staff help on this. ABC Chart

Antecedent/Trigger Behavior Consequence

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Trigger ScenarioNext, an antecedent scenario will be developed. This is a script or detailed description of all the triggers that lead up to the problem behavior. This will be used by you and staff to set up a situation, first verbally, then by acting out by staff, where you will practice your interventions.

Look at the previous assignment and write up a script, like a play, that acts out all the things that happen before your problem behavior. You may use words and gestures that you and others us if necessary. Make it as close to what happens as possible.

Talk with staff and determine where you want to have interventions, having two intervention points is best especially if a few things have to happen before the problem behavior. The first place in the behavior chain that indicated that a problem behavior may be coming is a good place for your first intervention. For example, if you know that when a rival comes in the room, you will exchange words that will probably lead to a fight, your first intervention might be to get up and talk to the staff, move to a different area or take some deep breaths when they walk in. The next intervention would be where there is some escalation, for example, if the person sits next to you, and/or says something.Also a part of intervention development is determining when and how staff should prompt if you do not use your intervention or you use the intervention and you still continue to escalate. This section will have you pinpoint an intervention point.Go back to the previous assignment and circle where your intervention point will be and put an “I” outside the box and left of the antecedent. Next, circle the intervention point for the staff if you do not respond and put an “S” outside the box and to the left. Then intervention point could be the same if there is a safe period of time and would require staff to observe for an intervention response and respond if you don’t use the intervention.

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Intervention DevelopmentBuilding a(n) intervention(s)

● Selecting an intervention● Developing staff prompts for living environment intervention● Writing a description of the intervention and staff prompts

In intervention development, you will have to determine where you are going to intervene and how. Generally, you will pick the antecedent/trigger that is farthest away from the problem behavior. (If there are several identified triggers, you might want to select a second trigger to work on.) That trigger then becomes the intervention point, the place that you put your energy into to prevent the problem behavior. The second major part of this section is to develop an intervention and determine how staff will prompt you to use your intervention if you do not.Staff will have a list of interventions that you can look at and select from. Before you select one, be sure to role play several and see what you think. Pick an intervention that you think might be most successful using. Some examples include: deep breathing, walking away, moving from where you are, counting to 10, listening without interrupting, not saying anything back, asking why someone feels the way they do, ignoring, etc. The interventions you choose might change as you learn new skills and want to try them. For example, you might get so angry when feedback from staff that you need to walk away. After some skill training and practice, you might be able to ask why and actually have a dialogue with someone you disagree with.

Youth have the following responsibilities in this section:● Select the trigger farthest away from the problem behavior that you are aware of and

think you can intervene upon● Work with staff to determine an intervention● Write a script on how it will work● Decide with staff on some prompts that can be used to help you- in case you get caught

up in the moment- and write them into the script● Select another trigger closer to the behavior that you might intervene on

Staff have the following responsibilities in this section:● Work with youth to identify two interventions points● Provide the you with some strategies or interventions -role play a couple out before the

youth decides● Ensue the script is detailed enough that any staff can pick it up and know how it works● Work with the youth to ensure that the triggering event has enough detail

Client worksheet:What do you think is the purpose of the problem behavior and why? (social, escape, avoidance, self-stimulation, tangibles)

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What can you do about your vulnerabilities?

Interventions to triggers. What triggers do you select for interventions and what do you want to do?Trigger:Intervention:

Prompts to help. What are ways that staff can prompt you when they see antecedents and you becoming irritated? For example, if I have problems with Sally, maybe staff do not allow us to sit together and prompt the person who sits near the other to sit elsewhere.

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Prompted interventions to triggers: Write a detailed script of your intervention(s). When x occurs, I will do y, if i do not do y, then staff will prompt me by doing z. For example, when Sally, a person who teases me and I am angry with walks in the room and sits by me, I will take three deep breathes and nod to staff I am ok. If I am agitated I will get up and go to staff and ask to it elsewhere. If I do not take three deep breathes and not to staff, staff will call me over to where they are sitting by saying, “Jane, I would like to talk to you, could you please come here.”

Problem Behavior Intervention. Also important is for you to know how staff will intervene when the problem behavior occurs. In the following box say what the problem behavior is and then how staff should prompt you to end problem behavior and help you leave the area. This should be agreed upon by you and staff.

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Antecedent 1:

Intervention 1:

Staff prompting (If I do not respond):

Problem Behavior

Staff Prompt:

Staff response if you do not follow prompt to “stop” behavior and leave:


The last assignment in this section is the completion of an intervention worksheet. This worksheet will state your vulnerabilities, triggers, and trigger intervention and staff response when you do not follow the intervention procedure. (Refer to intervention worksheet packet)

Practicing Interventions

You will be asked to practice your interventions in groups and in daily feedback sessions. There are four levels of practice and you will go through them one at a time. First: you will be asked to describe the antecedent and then demonstrate what you will do. If it is take three deep breathes, you will take three deep breathes. Second, the practices will then have the staff person describe the event and you doing what your intervention states you will. Third, the staff person will act out the antecedents and you will skill practice your intervention. Last, staff will slowly increase the difficulty of the antecedent presentation (making it more real) and you will be asked to respond. For example, out of the blue, staff might say “I’m Sally and I say “screw you.” You will automatically do what your intervention states. Staff will prompt you if necessary.

Youth have the following responsibilities in this section:● Review practice protocol in the first section● Review antecedent scenario before practicing● Skill practice the intervention with the staff● Skill practice a prompted intervention with staff

○ You will be instructed to ignore performing your interventions until prompted by staff.

○ You will ignore all interventions by staff until you are told by staff to assume you engaged in the problem behavior. Then, you will follow the staff instruction to stop and go to a designated area.

● Review session and see if adjustments are needed; also, your thoughts feelings, and physical sensations will be reviewed by staff.

● Youth must have three sessions at each practice level before moving on to the next.

Staff have the following responsibilities at this level:● Provide the antecedent scenario based upon the level of skill practice the youth is on.● Review the youth’s thoughts, feelings and physical sensations afterwards● Provide feedback as necessary

GeneralizationIn generalization, you are expected to implement your interventions in the living environment and not engage in the target behavior. Staff are observing you and determining if you are using the strategies that you have developed in your living environment. Staff will attempt to prompt you when you do not follow your intervention guidelines. If there is breakthrough problem behavior, you will have to participate in group again to review your intervention and discuss and determine ways to improve them; you will also have to redo sections of your intervention plan.Staff have the following responsibilities for this section:

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● Role play/skill practice with the youth triggers and interventions at daily feedback session.

● Prompt youth in living environment when not using interventions to targeted triggers.● Reinforce youth for successful interventions.

Youth have the following responsibilities in this section:● Review all previous materials and redo lessons as directed.● Role play interventions with staff during daily feedback.● Follow staff directed prompts when interventions are not followed

Skill Building: Skill building is also a primary treatment method used at YWEC. Skill building teaches alternative skills and behavior to problem behavior. Both behavioral skills and social skills are taught at the program. As previously mentioned, both T4C and the Carey Guides teach skill building. Not only does YWEC rely on these evidence based treatments for skill building, we also teach academic skills and everyday living skills. The purpose of having social skills training is to assist the client in developing prosocial behaviors and interactions with others. Research has shown that poor social skills goes hand in hand with emotional and behavioral problems. Clients with good social skills are less likely to engage in delinquent behavior and associate with delinquent youth and more likely to have positive school involvement, and engage in prosocial activities and with other prosocial youth.

Role Playing: Why is role-playing important? It helps to gain insight into one’s self and enable clients to practice new skills while receiving support and insight of therapists and staff. Role plays are used to practice prosocial behaviors. It is through repeated practice of the behaviors that clients are able to use the new skill spontaneously in the “real” world. How to Teach Skills using Role-PlaysThere are 7 steps that YWEC uses in teaching behavioral and social skills. 1. Define the skill, review steps 2. Establish skill need 3. Facilitator (staff) models the skill 4. Client role-play 5. Provide feedback and reinforcement 6. Assign homework 7. Follow up on skill useThese steps are also in the Thinking for a Change manual and the Carey Guides so that no matter what skill is being taught, the client will become familiar and more successful.

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Detailed Steps:2. Define the skill, review steps

d. Tell the client what the skill is e. Describe each step of the skill- write the steps on the boardf. Define the purpose of the skill- the purpose should be from the

client’s point of view 2. Establish Skill Need

c. Give concrete examples of when the skill might be used (more than one)

d. Have clients identify situations when the skill would be useful in their lives *All clients should answer. Have them think of multiple situations and give detailed concrete examples

3. Facilitator (Staff) Models the Skillc. Ensure the clients are attentive and engaged-ask them to watch and

listen carefullyd. Act the skill out

i. Speak aloud the steps and the reasoning you are followingii. Be clear and detailed but do not provide irrelevant detailsiii. DO NOT model inappropriate behaviorsiv. DO NOT simply “talk about” a situation

c. Repeat the Skill- use different scenarios so the clients can see how to apply it in different situationsd. Have the clients describe what they saw - ask what did you see me do4. Client Role-play

c. Have client identify a situation- pick one in which she could use the skill and use that for the role-play. Enough details should be given so that the skill can be practiced as realistically as possible.

d. Have client act out the situation using the skilli. The client should use “think aloud” where she talks out loud and

verbally repeats each step of the skill before acting out that skill and also describes her thoughts

ii. Remind the clients to use the steps and stay in character. Staff may need to verbally coach and point to the skill steps on the board

iii. Do not allow the client to role-play inappropriate behaviors

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iv. If the client needs assistance, staff and the client can switch roles with the staff modeling how to use the skill. The client should then attempt the role-play again

v. Have the client continue to role-play the skill until they can perform the skill with no coaching

5. Feedback and Reinforcementb. Provide Reinforcement- after the client has followed the correct steps

i. Provide reinforcement in an amount equivalent to the level quality of the role-play

ii. Remember Verbal praise is an excellent reinforcementiii. Do not provide reinforcement for role-plays that depart

significant from the steps of the skills b. Provide Feedback- feedback should highlight specific aspects of the role-play, not general comments c. Redo the role-play6. Assign Homework

c. Assign homework to each client- have the clients identify a specific situation and person they use the skill with

d. Encourage client to use skill in increasingly difficult situations- first in situations that may not be too difficult or scary for the client and then in situations that would be harder for the client

7. Follow-up on Skill Usee. Review previous sessions- remind clients what skill they learned last

sessionf. Remind clients the steps of the skills-refer back to your visual aidsg. Discuss skill usage- have clients report on a situation when they used

the skill, how it went, and what could be improvedh. Apply to future situations

i. Review what situations may come up that the client could use the skill in the future

ii. Staff should encourage skills usageRepeat all steps with each client

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YWEC’s emphasis is on the criminogenic risks and needs. Our main focus is on the following domains from the Protective Risk Assessment:Domain 5: Relationships

-32 Friends the youth spends the most time with-36 Strength of antisocial peer influence

Domain 6A: Environment in which the Youth was primarily raised-40 Number of times the youth has runaway or been kicked out of

homeDomain 6B: Current Living Arrangements

-53 Current level of conflict between parents, between the youth and parents, and among siblingsDomain 7: Alcohol and Drugs

-61 Is alcohol a main contributor to the youth’s delinquent behavior-64 Are drugs a main contributor to the youth’s delinquent behavior

Domain 8: Mental Health-65 Is the youth suspected to be a victim of physical or mental abuse-71 Have there been reports of youth’s violence or anger

Domain 9: Attitudes/Behaviors-75 Youth’s sense of responsibility for antisocial behavior-78 Youth’s view of pro-social rules and law abiding behavior-79 Youth’s respect for authority figures-80 Youth’s tolerance for frustration-81 Youth’s belief in the use of verbal aggression to resolve a

disagreement or conflict-82 Youth’s belief in use of physical aggression to resolve a

disagreement or conflictDomain 10: Skills

-86 Consequential Thinking-87 Critical Thinking/Social Perspective Taking-88 Problem Solving-89 External Self Monitoring Skills-90 Internal Self Monitoring Skills-91 Youth sets clear steps to accomplish prosocial goalsGoal and Action Steps Outline Example : Consequential thinking

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Goal: For 3 consecutive months, Jane will use consequential thinking skills to obtain good consequences and avoid bad ones.

Consequential Thinking is assessing the result of the choices of acting and not acting to avoid problem behavior

Objectives of Lesson/Action StepsUnderstand consequences

● What good and bad consequences are○ Relativity○ Socially determined○ Recognizes behavior has effects

● Understands logical, natural and legal consequences● Understands consequences can be immediate and long term● Skills

○ Can define problem and why it is a problem○ Understands behavior has consequences, that people respond to good and bad

things-- can verbalize competing perspectives○ Understand and can verbalize how behavior leads to consequences

Identifies consequences of personal behavior● Recognizes/understands consequences of own behavior● Can describe how she gets closer or further from the problem● Can describe the impact of personal behavior on others● Can describe how personal behavior can be reinforcing and punishing at the same time● Understands how others might respond to behavior● How to make the right choice● Skills

○ Can identify antecedents that predict the behavior○ Can make conclusions about behavior based on evaluation○ Can describe good and bad aspects of behavior○ Can look at consequences others get and explain the rules and laws that justify it○ Can describe the kinds of consequences people and the law might give her

problem behavior○ When given problem situations, she can describe the impact of doping and not

doing the behavior on self and others.Acts to avoid bad consequences and seek appreciate ones

● Can recognize antecedent to problem behavior● Can identify alternative ways to behave● Skill practices other ways to behave● Can explain how she can get what she wants by using new defined skills● Skills/lessons

○ Can explain and use a problem solving model○ Can apply skills learned when using model-recognizes antecedents and uses

solutions to avoid negative consequences.

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○ Can respond to staff prompts to use the skills in living environmentValues and concepts

● Honesty--we strive to tell the truth about ourselves at all times● Humility--we can always learn something from others, we do not know everything● Empathy--we can see the impact of our behavior on others● Integrity--we gain knowledge of what we can do and we do it● Perseverance--we go on despite the setbacks of our behavior

Processing model for staff1. If I do problem behavior what might happen?2. Instead of doing problem behavior, what else could I do?3. Of the things I could do, what would generate the most positive outcome?4. If I do nothing, what else might happen?

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Section 7. Program Intensity and Length of Stay

YWEC is contracted under the DBE code. Clients are committed to community placement who are transitioning from secure care, or those who are at moderate risk and need intervention to prevent high risk ie. secure care. Clients POE includes acts of violence or aggression toward person(s); crimes against property such as vandalism, theft, arson, burglary, or destruction of property; or who are exhibiting delinquent or non-compliant behavior such as probation violations, contempt charges, truancy, or substance abuse, and that require awake night supervision. Clients in DHS/DCFS custody whose behaviors effect normal life functioning. Behaviors in this category may include (but are not limited to): acts of violence, aggression toward others; destruction of property; truancy; excessive running away, and ungovernable behavior. Clients may also have delinquency charges against them and/or may be dually adjudicated in both the child welfare and juvenile justice systems. While the client may have co-occurring mental health and or substance abuse treatment needs, these needs are secondary to the unacceptable behaviors. For instance, a client may have mental health issues stabilized but continue to engage in unacceptable behaviors, or a client’s substance abuse is part of the client’s overall disregard for rules, and that require awake night supervision.

The level of service for YWEC is Moderate and therefore has 200+ hours of behavioral intervention, skills development with role playing and therapy hours. Clients will participate in daily psychosocial rehabilitative classes, individual therapy 1 to 2 times weekly, group therapy weekly and family therapy when applicable. The targeted length of stay at YWEC is 4 to 6 months and must include a reduction of risk and significant improvement/completion of treatment goals. Each client’s treatment goals will be addressed in therapy and monitored by the therapist, administration and staff. If progress is not being made a client’s length of stay can be extended. If every measure has been taken and the client has not shown any significant improvement over 6 months, the treatment team may make

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the decision that an additional length of stay may be detrimental to the client. A detailed description of how the level system works, and what can warrant an extension of a client’s length of stay, can be found in section 8 of the program manual. Information can also be found in the client handbook.

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Section 8. Rewards and Consequences

YWEC has a level system that is based behaviorally and therapeutical. We have developed a level system to help the client learn the necessary behavioral and therapeutic skills to advance in our program as well as to reduce risk and become productive members of society. Each level consists of daily behavior goals as well as progress on all the client’s treatment goals that they have developed.Given that YWEC’s level service is moderate, we have developed a daily schedule and level system that works together in order for the client to receive 200+ hours of behavioral intervention, skill developing with role playing, and therapy hours. The level system at YWEC consists of four levels. Each level includes a duration of intensity (set number of points that a client must reach in order to advance to the next level. With each new level comes more privileges.Level one privileges consist of: Return to bedroom before lights out to read, journal etc. Level two privileges consist of: Off campus day visit however must stay in Sanpete County and level one privileges.Level three privileges consist of: all privileges from level one and two in addition to home visits.Level four privileges consist of: all other privileges.Not only do clients receive level privileges, they receive rewards based on their behavior such as incentive. Incentives are given weekly, if the group has earned enough group points and they have behaved throughout the week. Incentives don’t always have to be a movie. Some nights for incentive, clients will choose to have game night where they play cards and different board games. Staff will observe the clients and their behavior daily. At the end of their shift, they will then chart on optomiser (electronic data management program). Staff will mark yes or no if the client had appropriate behaviors/completion in the following categories: accountability, self-supervision, respect, appropriate language and manners, following rules, completing tasks and chores, positive attitude and virtue/journaling. The

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staff will then add a small note to the charting about what they observed the client doing or not doing. It is very important for staff to chart on each shift. This provides information to the program treatment team. Client progress will also be recorded in individual and group therapy notes, which will also be used in determining readiness of level movement. Any time a client is given a consequence for negative behavior, the staff must document it in the charting.

Working with youth in custody:Staff members working at YWEC should keep in mind that the example of your own behavior and attitude will serve as one of the most powerful teaching tools you can use with the clients. Staff members help the clients best when they model kindness, consideration, and fairness in daily work with clients. Encouraging and praising compassionate and caring feelings and behavior in our residents will help them develop non-destructive and non-hurtful ways of expressing their own feelings, conflicts, and frustrations while in the program and throughout their lifetime. While enforcement of rules and the level system is critical in ensuring a consistent reward for positive, pro-social behavior in the program, it is important to remember that we want residents to become more caring and cooperative individuals during their stay, not simply more obedient ones. Clients will succeed at this if they feel cared for by staff members, and believe that staff members want them to succeed. Clients will only learn to cooperate with society by our cooperating with them, taking their interests and opinions seriously, and respecting their right to grow and develop as distinct individuals.

There are times when a client must be corrected with consequences for inappropriate behavior. Physical punishment, and any method designated to humiliate or frighten a client is unacceptable, possibly illegal and can result in termination of employment and notification of the authorities.

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Each of our clients are being served with an individualized treatment plan therefore consequences are not the same for every client depending on each client’s learning ability, attitude, motivation, treatment plan and actions. However certain offences will have consequences that are set for all clients. These are as follows, but not limited to; *Clients that are absent without leave (AWOL) upon return to the program will have her level dropped one full level. If a client is AWOL for more than 24 hours the client may be required to restart the program.The following are also examples of undesirable behaviors that may result in consequences: inappropriate verbal behavior, ie. yelling, profanity, insults, persistent rudeness, teasing, disrespect. Horseplay ie. running, jumping, hitting walls, slamming doors. Manipulation, staff shopping, not accepting no as the answer.YWEC believes that all consequences must be in equal balance to the offense. Consequences should always serve the purpose of behavior modification, and teach the client the benefits of making better choices in the future. Staff members must always process with the client about the behavior that needs correcting. Consequences must be agreed upon by all staff members on shift. Consequences should occur on the same shift on which an incident took place.

YWEC only uses intrusive behavioral interventions (physical restraint) to control a client’s behavior in an emergency situation and under the following circumstances; *Danger to others: Physical violence towards others with sufficient force to cause bodily harm *Danger to self: Self abuse of sufficient force to cause bodily harm *Threatened abuse: Threatened abuse towards others or self that may with evidence of past threats or actions, result in danger to others or self.

Intrusive behavioral interventions will; *Only be used after less intrusive interventions have been determined to be ineffective * Not to be used in a manner that causes undue physical discomfort, harm, or pain to the client. Interventions that use painful stimuli are prohibited; *Be continued only as long as the client presents danger to self or others; *Not be employed as punishment, for the convenience of staff or as a substitute for

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programming; *Only be implemented by staff members that have completed an annual training in Positive Control Systems (PCS) de-escalation techniques. Lead staff member on shift with the appropriate training in restraint and seclusion shall assess the mental and physical well-being of any client being restrained or secluded, continuously monitor the restraint or seclusion procedure and assure that the restraint or seclusion is being done in a safe manner. The assessment required shall take place as soon as practicable, but no later than one hour after the initiation of the restraint or seclusion. Clients are not allowed to be used to implement or assist with any intrusive behavioral intervention involving any other client. Reflection time (staff directed timeout): Clients may at times experience drug cravings, feelings of anxiety, anger and sorrow throughout the day. These feelings can be triggered by many different factors; the group topic, peers, music, language, transference with staff members. When these feelings interfere with the client’s ability to participate appropriately and/or the treatment and programming of other clients it may be appropriate to allow or direct the client to take a “time out”. While in time out the client is to reflect on the situation, her actions, possible alternatives, and future coping skills. This is to be done with a staff member. Staff must monitor the client while she is in time out and always maintain visual contact. Time out should take place away from the area of activity and other clients. This will allow the client to calm herself and reflect on the situation. Time out must never exceed 1 hour. A client in time out must never be physically controlled to prevent leaving the time-out area. The time out area must not have locking capability and should not be a bathroom, closet, etc. Time-out is used to allow the client to calm herself and reflect not for punishment. Protocols for Staff Intervention:Crisis Intervention Program: Positive Control SystemsWarning signs of Escalation:

1. Increased voice volume2. Overt resistance to directions3. Direct challenges to authority4. Challenges you to assert yourself5. Loss of objectivity

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6. More animated body language7. Use of obscenities and harsh voice tones8. Verbal threats (open hostility)9. Face flushed (red) - angry10. Tight white lips, mouth open slightly11. Body tense, fists or arms cocked

Our intent is to develop effective communication skills, de-escalate hostilities to prevent physical crisis in a therapeutic environment, re-establish voluntary cooperation and process and report critical incidents.To be effective in a therapeutic environment, staff need to maintain a working rapport with the residents. This relationship requires a certain level of voluntary cooperation and trust. There are times, however, when emotional control wanes and situations begin to escalate toward confrontations. During these stressful periods the use of specific communication skills can go far in preventing a disaster.All crisis communications must be structured to restore voluntary cooperation as quickly as possible. Remember: ALL BEHAVIOR IS A COMMUNICATION. Verbal and non-verbal skills must be in agreement to communicate clearly and precisely.Once voluntary cooperation is lost and intervention appears necessary, staff response should be timely and designed to de-escalate the situation to a cooperative level. An inappropriate response will tend to escalate the tension and produce negative results. Using the right tools at the right time produces a more desirable result.Utilizing AssetsResourceful Mental State- Remaining objective and professional in tense situations empowers you to prevail in the crisis. You are responsible for your own internal state and emotional control. Refuse to allow the clients to “push your buttons” or know that they are getting to you. A major point here is to RESPOND rather than REACT. This is the same idea that we teach the clients when dealing with frustrations towards others. You are the responsible one. Don’t tell the client’s you are in charge. Show them with mature and professional attitudes and responses. Non-Judgemental Approach

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There is a positive intent behind all behaviors. Recognize that acting out behaviors are chosen methods of a client to assert a sense of control in their situation. Discover what they truly want to achieve with their behavior, and then guide them into a “positive way” of expressing intent. It is easier and more effective to be non-judgemental if you separate their behavior from their person. Inappropriate behavior does not change if you insult them with identity statements or name calling. Identify the behavior you want them to change. Say “I don’t like the way you….” Confront the behavior, not the person. Communication SkillsSince all behavior is a communication, being skilled in the art of communication is essential to positive control. The clients must know what is expected of them and understand the parameters of the program. Staff must be united and consistent in maintaining and communicating standards of acceptable behavior and the consistency of consequences for unacceptable behavior.PromptingPrompting is signaling to the young person to either begin a desired behavior or to stop an inappropriate action. This can be done verbally (e.g., “It’s about time to put the game away”) or nonverbally (e.g., with a glance or nod which reminds the young person of what is expected). It is a simple, non-critical direction given when the client needs help in taking the next stepThere are several ways of verbally prompting a client. We can use gentle reminders, such as, “Dinner will be ready in 10 minutes,” or “Lights out in 15 minutes.” Sometimes we can help the clients remind themselves by asking them a question, “What happens at 5:00?” or “Do you realize how loud the music is?” We may even ask the young person to repeat a rule or an agreement. “What is the rule about doing homework?” or “Do you remember the agreement you made with Sally yesterday?”Nonverbal prompts that help stop clients from continuing inappropriate behaviors include hand gestures and facial cues. Raising one’s hand is a call for attention; eye contact, facial expressions, and coughing can be used to remind young people of what they should be doing. A prompt should be given only once or twice. It is not nagging, which is a constant

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unpleasant urging or scolding. Prompts should be given pleasantly as privately as possible, calmly, and non-critically.

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Section 9. Measurement of Progress

Young Women’s Empowerment has implemented the level system into our program to measure the client’s progress and successful program completion. The program curriculum is based on the individual client’s progress toward their personal treatment goals.

Level 1: During this time, the client is in “orientation.” The client completes the Mental Health Assessment Interview, the treatment plan is created, a team meeting has taken place, medical needs have been addressed, and other needs have been assessed and met. The client also has specific programming curriculum that must be completed on a daily basis as stated in above sections. The client is assessed at the end of each day to determine if the client is making progress. This assessment is then recorded on optomiser. Also based on the targeted treatment needs, the client will need to complete a treatment manual with the mental health therapist. Manuals include but are not limited to: Substance abuse, trauma, anxiety, anger management, etc. Once the client completes the daily-required components for level 1 and their treatment manual the client is advanced in the program to level 2.

Level 2. Client progress is monitored daily to assure the client is on schedule to graduate from the program. Early interventions are essential to assure the client progresses in their treatment process. Another team meeting will take place to ensure the client has progressed from level 1. The client is required to actively participate in all programming components for this level. Clients are offered daily feedback to assure the client understands the progress that is expected daily. Through daily monitoring, early interventions are possible, thus the client can remain on schedule to graduate from the program. On this level clients are introduced to having day visits with family to monitor what skills they are using and what progress is being made towards reunification and healthy relationships. A treatment manual is also required. Once the client completes the daily-

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required components for level 2 and their treatment manual, the client is advanced in the program to level 3.

Level 3. Client progress continues to be monitored on a daily basis. Specific measurable requirements continue to be assessed daily to assure the client is on schedule to graduate from the program. Curriculum requirements become more intense on this level, however, previous levels facilitate the client’s ability to progress in this level. Daily feedback is offered to the client to assure the client understands the importance of actively participating during this level. Early interventions are essential for the client to be on schedule to graduate the program. Home visits are to be taking place on this level to assure that what the client is working on in treatment, both programming and therapeutic are being implemented and measured. Once again, a team meeting will take place to ensure the client is on schedule for graduating the program. Another treatment manual is in place based on the client’s individual treatment needs. Once the client completes the daily required components for level 3 and their treatment manual the client is advanced to level 4 of the program.

Level 4. Client progress is monitored on a daily basis. During this level, the programming curriculum is more intensely focused on successfully transitioning the client to a lower level of care. Throughout treatment, discharge planning is addressed. Clients on this level practice skills they have developed and ready themselves for re-integration into society. Clients will put together a relapse prevention/exit plan. A discharge team meeting is then held to determine the client’s progress throughout their treatment and what transitioning will need to take place. Once the client completes the daily- required components for level 4 and has completed their treatment goals, the client is deemed successfully graduating the program.

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Section 10. Transition Planning and Aftercare

Transition Planning:○ Transition planning will begin at the entry level of the program

and will be worked on throughout treatment. By the discharge team meeting a plan must be in place. Transition will be addressed in the treatment plan and team meetings. Transition planning will address the behavioral risk factors including target behaviors and desired behaviors and have supports in place. Transition planning will address the stability factors, including medical needs, living arrangements and supports, family involvement, school supports, transportation and employment (if applicable).

○ As the client progresses nearer to discharge, the specifics of transition should be more clearly defined. These include what programs will provide services, where will the client go to live, to school, for medical, dental services etc. Prior to discharge these services will be identified

● YWEC Shall:○ Coordinate with the case worker to initiate transition planning

for the client at the time of admission, and continue transition planning throughout placement to help the client and their family prepare for the client’s return home, move to another treatment program or foster placement, or transition to an independent living arrangement.

○ Work and coordinate with a client’s family with which reunification, adoption or permanent guardianship is a goal, unless it will negatively impact the client. Assist the client and family in obtaining community resources. Coordinate treatment with direct care staff in reinforcing treatment during day to day activities.

○ Assist the client in building support systems outside of the program, including family and community members that can be

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used to increase prosocial relationships and activities and provide support needed for successful after care.

○ Develop a written transition and aftercare plan for the client within the first 30 days of program entry and update it at each Child and Family Team Meeting.

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Section 11. Program Fidelity

Adherence to Cognitive Behavioral Therapy (with adaption of FT-CBT and DBT), is maintained via staff training to assure competence, therapist supervision, YWEC programming, and quality assurance procedures. Ywec is dedicated to accomplish common goals and to solve problems, by implementing the interventions in accordance with CBR technique, consistency between staff interventions, and behaviors prescribed in the intervention. YWEC is devoted to the client’s success; therefore, consistent monitoring of program policies and procedures is fundamental. Quality assurance procedures cover all components of YWEC program delivery.Quality assurance is recognized as being the responsibility management, all employees and YWEC contractors. YWEC Management oversees implementation of policies and procedures. Management audits program implementation and effectiveness and approves changes in collaboration with clinical staff and supervisors. Any changes that are implemented will be subject to a pilot test to ensure that they have the intended effect. The pilot testing will include a way of measuring the target behavior, a formal start and end date and last for a period of at least one month. The Executive Director initiates quality assurance audits. They are responsible for verifying completion of the program audits, and that all quality assurance steps specified in the policies and procedures manual are followed. All staff share responsibility for identifying and reporting any observed quality issues and for recommending corrective actions. Management monitors and updates the operational procedures by using specific checklists, to assure that YWEC meets or exceeds the requirements of the State and Contracting Agencies. The program will implement periodic, objective, and standardized assessments of the clients with a focus on meeting target behaviors. The CANS assessment is one example that will be used. The quality assurance committee is responsible for measuring, reporting the number of clients showing improvement.Management is aware of our contract agreements and assures that those agreements are followed according to contracting agency guidelines.

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YWEC management audits personnel files and client files at least monthly to assure that they are in accordance with licensing standards, contracting agency standards, and program standards. This includes assuring that all employees are complete and up to date with training. YWEC audits program delivery and assures that it is consistent with the program model.

Qualitative and Quantitative internal audits with specific checklists are used to improve program efficiency, effectiveness and program delivery. These internal audits performed by the staff; a quality assurance committee which is made up of the program director, staff supervisors, medical coordinators, mental health professionals (therapists), with sufficient knowledge, skills, and experience. The quality assurance committee is part of quality management whom focus on providing confidence that quality requirements are fulfilled. Quality assurance meetings are held at least monthly. The committee also will review the formalized and written method to measure the progress related to the Priority Risk Factors and Targeted Treatment Needs. They will document this process in writing. In addition, the committee is responsible for reporting to the Division quarterly the number of clients successfully and unsuccessfully completing the program, and the number of clients that are showing improvement in their treatment based on the priority risk factors and targeted treatment needs; and shall document this in writing as well. The Quality Assurance Committee will then meet with the Executive Director to report needed changes and recommendations.YWEC is participating in a study facilitated by the University of Utah Social Research Institute to determine factors that can and/or should be implemented into our programming. Clients complete “Client Satisfaction Surveys” upon program completion. The information gathered is taken into account when identifying areas of improvement and implementing changes. YWEC participates in the program improvement process conducted by the Division. This includes participating and complying with audits. The program completes all corrective actions mandated by the Division and complies with the contract requirements within the timeframes specified by the Division.

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YWEC is implementing that all youth and their family, when possible, completes a satisfaction survey from the program. This information will be used to inform the services that are provided and to make adjustments as needed. In addition, completion rates of successful completion and treatment fails will be tracked to implement changes and adjustments as needed. The information gathered by these surveys will be reviewed by the Quality Assurance Committee and reported to the Executive Director.

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Section 12. Completion Criteria

Young Women’s completion criteria is based on behavior changes (level system) and skills learned that relate to the client’s reasons for Division involvement. In order for a client to be deemed successfully graduated, they must complete each level of the program and make progress on their treatment goals. In addition for the client to be considered to have successfully completed the program the client must:

1. Attend a minimum of 90” of groups/classes2. Completed a minimum of 90% of the homework assignments3. Have engaged in meaningful participation during the groups/classes

as exampled by:a. Actively participating in a prosocial mannerb. Actively listening to others

4. Have willing/able to implement the prosocial skills/behaviors acquired in treatment, as exampled by:

a. Practice of skills/behaviors in group/classb. Practice of the skills/behaviors in the community

In addition to the above clients must:1. Actively participate2. Demonstrate an understanding of homework assignments3. Take responsibility for her offending behavior and its consequences4. Use skills and techniques taught in the program 5. Complete all program requirements6. Demonstrate use of respectful language regarding her

victim/parents/staff/teachers and authority figures7. No reports of any recent violence or abusive behaviors8. Has followed through on necessary mental health and substance

abuse assessments and treatment.

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