Child Psychology and Psychiatry

206

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Adolescence
•
An empathic and non-judgemental therapist,
who takes painstaking efforts to engage even
the ‘hard-to-reach’ youngster in the treatment
process and rekindles the ability to hope and
dream.
•
A therapeutic process that involves structured
and personalized feedback on risk and harm to
young people; emphasis on personal responsi-
bility for change; and strategies to increase self-
esteem, self-efficacy, practical problem-solving
skills and social skills.
•
Involvement of family and other ‘systems of
care’ – such as school, judicial system and social
services – to address the multiple complex needs
of young people.
•
A lengthy period of retention in service to ensure
good aftercare.
Treatment should be tailored to meet the needs
of the individual young person. Integrated men-
tal health and substance misuse treatment should
be offered to young people with comorbid psy-
chiatric disorders [29,31,32]. Inpatient treatment is
required for a very small minority: those with
severe and chaotic substance misuse; repeated
failed community detoxification; intravenous drug
use with complications; and severe mental ill-
ness and risk of self-harm. Variables consistently
related to successful outcome are treatment com-
pletion, low pre-treatment substance use, and peer
and parent social support [21]. Other factors pre-
dictive of outcome are involvement of family,
use of practical problem-solving, and provision of
comprehensive services such as housing, academic
assistance and recreation [26].