Many people rely on individual therapy for psychological support, but there are times when people need more support than can be provided by individual therapy alone.

Teens requiring more comprehensive mental health services may be referred to an Intensive Outpatient Program (IOP). IOP may be a good treatment option for individuals in a variety of situations, including those stepping down from a Partial Hospitalization Program (PHP), on leave from school, those needing more support than once a week counseling, or those who have recently completed a hospitalization. An IOP provides an opportunity for people who are recovering from a mental illness to continue their recovery,

Intensive Outpatient Program (IOP) designates a specific level of care within mental health treatment. This level of care is a “High Intensity Community Based Service”, providing additional support and therapeutic modalities. For example, IOP may include individual therapy, family therapy, group therapy, and psychiatric medication management.  Teens are often “stepping down” to IOP from a Partial Hospitalization Program.

IOP is a more intensive level of care in comparison to a typical outpatient therapy setting. In IOP, clients are expected to attend treatment at a minimum of three days per week, for three hours each day. For this reason, clients who require additional support may benefit from an IOP program. Clients who are struggling to manage and cope in an outpatient therapy setting would benefit from the additional support that an IOP program provides.

In some cases, IOP serves the purpose of ensuring ongoing stabilization and support after a client completes a treatment episode in a higher level of care. In most cases, clients who are treated in a Partial Hospitalization Program will step down to an Intensive Outpatient Program at the completion of their treatment episode.  A typical IOP treatment episode is completed after the course of several months.

What are the Benefits of an Intensive Outpatient Program?

An IOP program provides many benefits as clients are provided with the structure and stability necessary to assist them in meeting their treatment goals. Clients have access to their individual and family therapists throughout their day in the program. Also, their clinical team is able to observe their behaviors and symptoms daily in order to optimize their treatment. Clients receive a wide variety of experiential and therapeutic groups including, but not limited to, dialectical behavior therapy, cognitive behavioral therapy, process groups, psychoeducation, art therapy, social skills groups, yoga, meditation and nutrition. An IOP program provides comprehensive and individualized support to meet each client’s unique needs.

Goals of an Intensive Outpatient Program

The goals of each IOP will vary depending upon the issue the program is designed to treat. Universal components of intensive outpatient programs include:

• Teaching participants coping skills
• Improving problem-solving skills
• Developing enhanced self-awareness
• Recognizing unhealthy behaviors
• Practicing asking for and receiving support

Unlike an inpatient program, an intensive outpatient program offers participants the ability to receive treatment while still living at home and engaging in their personal lives. Teens can attend an IOP without disrupting their school, routine or relationships.

What conditions does Intensive Outpatient Program Treat?

An IOP program treats behavioral health disorders that do not require staying overnight for treatment. PHP can be an effective level of care for those who struggle with depression, anxiety, stress, trauma, Bipolar Disorder, Obsessive Compulsive Disorder, Oppositional Defiant Disorder, Post Traumatic Stress Disorder, school refusal, substance abuse, and many others. It can also be a healing therapeutic environment for anyone who has recently experienced an emotional crisis, abuse or neglect.

ROWI’s IOP program treats clients with a primary mental health diagnosis, as ROWI does not treat clients with a primary substance use disorder diagnosis. ROWI can provide additional support for adolescents struggling with minor substance use; however, it is not the focus of treatment. Each client participates in creating an individualized Master Treatment Plan with their Therapist to assist with collaborating and working together to help clients meet their treatment goals.

What to expect when you enter an Intensive Outpatient Program?

When you enter an IOP program, you can expect to work closely with your therapist and clinical team throughout your stay in IOP, collaborating regarding your treatment plan and working together to assist you with meeting your treatment goals. You’ll meet with your individual therapist once each week and your family therapist once every other week. Together, you will collaborate with your clinical team to decide the best time to transition to a lower level of care after IOP.

As your child approaches their teenage years, they will face a number of different challenges; both physiological and psychological. It can be difficult for your teen to navigate the variety of changes that face them from puberty and hormones to social issues like bullying and peer pressure. As a parent/caregiver, it can be just as difficult to find ways to support your teen as they move through their teenage years to ensure their health and happiness.

In order to provide support, it is important to understand the variety of challenges your teen may be facing. One of these challenges is puberty.  Puberty can begin as early as age 10 or as late as age 16. Males and females will experience a variety of physical changes including but not limited to hair growth, muscle growth, changes in voice, breast development, menstruation, and acne.  Other physical changes and challenges your teen may experience include changes in body shape; including height and weight. Oftentimes, when our physical appearance changes, we will experience psychological changes as well.

In addition to your teen experiencing vast bodily changes, they may also experience social and psychological issues. Socially, teens face issues of peer pressure, bullying, sexual activity, drug/alcohol use, social media pressure, etc. on a daily basis. When not properly coped with, these stressors and issues can lead to symptoms of anxiety, depression, risk-taking behaviors, and academic problems; to name a few.

All of these changes and challenges that come with growing may affect your teen’s mental health.

The below tips can provide ways to raise a happy, healthy teen:

1. Praise/Acknowledgement
   • Does your teen feel loved? Do they know that you appreciate their positive efforts? The more you acknowledge and communicate what you like in your teen, the more likely they are to continue engaging in those behaviors.
2. Healthy Habits (Routines and Boundaries)
   • Does your teen have a routine? Do they know how to set healthy boundaries with themselves and others? Does your teen spend hours glued to their electronic devices? Something as simple as ensuring that your teenager is on a consistent sleep schedule will set them up for success; academically and socially.
3. Appropriate Communication/Validation
   • How often do you openly talk with your teen? More importantly, does your teenager feel heard? When we feel validated and listened to, we are more likely to open up and communicate more effectively.
4. Healthy Relationships/Positive Modeling
   • Does your teen know what a healthy relationship looks like? Do they know how to express all of their emotions in a safe and appropriate way? How much time do you spend with your teen? One on one? As a family? Showing our teens what it means to be in a healthy relationship and how to communicate their needs is important in any individual’s journey to adulthood. What they experience as teens, will follow them in their various relationships.
5. Provide Some Freedom and Trust
   • Do you trust your teenager? Allowing your teen to make their own choices and face the consequences (good and bad) for their choices will teach them how to navigate life’s many curveballs. Not only do choices allow for many teaching lessons, it also shows your teen that you trust them.

In addition to these tips, your teen may also benefit from mental health services specifically for teens. Mental health treatment can range from weekly, talk therapy to intensive, residential programs. It is important to talk with your teen and a mental health professional to determine an appropriate level of care.

• A Partial Hospitalization Program (PHP) is a full day, 5 days per week, structured psychiatric outpatient treatment setting.
• A PHP is specifically designed for the diagnosis and active treatment of a serious mental health condition wherein there is a reasonable expectation for improvement or when it is deemed necessary to prevent relapse or hospitalization.
• Contrary to the name of this treatment program, clients do not need to attend a PHP program in a hospital setting.
• A PHP program includes a variety of skill building groups and therapies.
• Clients return home nightly during their time in a PHP program, as this level of care can be an alternative to being hospitalized or receiving treatment in a residential treatment center.
• PHP is also a common step down from a residential treatment level of care.

ROWI’s Partial Hospitalization Program is designed for adolescents ages 12-18. ROWI’s PHP program provides a comprehensive program, which includes weekly psychiatry, twice weekly individual therapy sessions, weekly family therapy, along with an extensive variety of therapeutic and experiential group therapies. ROWI clients then transition to ROWI’s Intensive Outpatient Program (IOP).
 

How are outpatient care and partial hospitalization different?

Partial Hospitalization differs from an Intensive Outpatient Program in that it provides additional group therapies, additional individual and family therapies and includes weekly sessions with a psychiatrist. An Intensive Outpatient Program (IOP) generally does not provide the psychiatry component. IOP is typically a 3-hour, 3 days per week program whereas PHP provides a full day, structured program. The level of care necessary is determined on a case-by-case basis to best meet the needs of the client. There is also a standard outpatient option, which is generally one to two hours per week with an individual therapist.
 

What are the benefits of a PHP?

A PHP program provides many benefits as clients are provided with the structure and stability necessary to assist them in meeting their treatment goals. Clients have access to their individual and family therapists throughout their day in the program. Also, their clinical team is able to observe their behaviors and symptoms daily in order to optimize their treatment. Clients receive a wide variety of experiential and therapeutic groups including, but not limited to, dialectical behavior therapy, cognitive behavioral therapy, process groups, psychoeducation, art therapy, social skills groups, yoga, meditation and nutrition. A PHP program provides comprehensive and individualized support to meet each client’s unique needs.
 

What conditions does a partial hospitalization program treat?

A PHP program treats behavioral health disorders that do not require staying overnight for treatment. PHP can be an effective level of care for those who struggle with depression, anxiety, stress, Bipolar Disorder, Obsessive Compulsive Disorder, Oppositional Defiant Disorder, Post Traumatic Stress Disorder, school refusal, substance abuse, and many others. It can also be a healing therapeutic environment for anyone who has recently experienced an emotional crisis, abuse or neglect.
A PHP program is also suitable for clients struggling with suicidal ideations or self-harming behaviors. PHP has shown to be effective in helping clients who struggle with managing these symptoms on their own.
ROWI’s PHP program for teens treats clients with a primary mental health diagnosis, as ROWI does not treat clients with a primary substance use disorder diagnosis. ROWI can provide additional support for adolescents struggling with minor substance use; however, it is not the focus of treatment. Each client participates in creating an individualized Master Treatment Plan with their Therapist in order to assist with collaborating and working together to help clients meet their treatment goals.
 

What to expect when you enter a partial hospitalization program?

When you enter a PHP program, you can expect to work closely with your therapist and clinical team throughout your stay in PHP, collaborating regarding your treatment plan and working together to assist you with meeting your treatment goals. You’ll meet with your individual therapist twice each week, your family therapist once per week along with your psychiatrist weekly. Together, you will collaborate with your clinical team to decide the best time to transition to a lower level of care after PHP.

Mental Health Issues do not just go away and are often dangerously ignored.  Parents do not always recognize the symptoms of mental health problems or may not be aware of how severe the problem is.  Others may feel the behaviors will go away with time. Unfortunately, mental health and wellness issues must be addressed to avoid greater problems.  When a teen is exhibiting these kinds of behaviors, parents should seek professional help.

• Eating Disorders – Treatment is necessary as soon as any eating disorders are discovered;
• Family History – If there is a history of mental illness in the family, promptly act upon concerning behaviors;
• Cutting – If a teen is hurting him or herself, even if it is a one-time thing, it is important to seek help as cutting or self-harm may be a way of dealing with a serious mental health issue;
• School Avoidance – When teens do not go to school on a regular basis, this is often a symptom of a broader problem;
• Out of Control Behavior – If a teen’s behavior is causing chronic trouble in school or is seriously disrupting family life, it is important to get help.  Disruptive, explosive or dangerous behavior can be generated by anxiety, trauma and frustration from an undiagnosed learning problem, among other things; and
• Emotional Issues Over Time – if a teen seems unusually anxious or sad or irritable for a long period of time and it’s interfering with his or her ability to do things that are appropriate for kids his or her age, then it is time to get help.  A teen who is seriously anxious or depressed is not just suffering, they are missing out on important parts of their teenage year.

Like other medical problems, mental issues can be diagnosed and treated.  However, you do need a team of professionals to help you. ROWI Teen and Parent Wellness Centers can help you and your teen get through these tough times.  ROWI offers a comprehensive outpatient program where we provide our clients with evidence-based individual and group therapy as well as holistic treatments including mindfulness training, meditation, yoga, surf, equine, art and improvisational therapies, among others.  We also have in-house schools and accredited teachers at each of our locations to allow our teens to catch-up in school and get back on track.

There is help and it is close by.  ROWI accepts most insurance policies. Let us answer any questions you have.

3 Major Signs Your Teen Is Suffering from Depression

There are few things more painful for a parent than watching a child suffer. The Center for Disease Control reported in June of 2018 that 41% of high school girls and 33% of all high school students reported feeling sad and hopeless. UCLA has recently reported that the rate of teens experiencing at least one depressive episode has risen 60% between 2010 and 2016.

Navigating through the teen years has its challenges. Middle School and High School students face both academic and peer pressures all while dealing with surging hormones. But how do you know when a little teen angst has turned into a more serious depression?

At ROWI Teen and Parent Wellness Centers, we suggest you take note when your teen’s symptoms are more consistent. They have no energy, their grades are dropping, they’re threatening or attempting to run away or kill themselves, expressing low self-esteem, turning to drugs or alcohol to self-medicate and withdrawing into technology. Depression is no longer a rare occurrence.

Depressive symptoms can exhibit in teenagers and adolescents in three main categories:

1) MOOD SYMPTOMS

• sad, irritable, depressed
• hostile, frustrated, restless
• loss of interest in usual activities
• inability to experience pleasure
• tearfulness or frequent crying
• feelings of guilt or worthlessness
• thoughts of death or suicide

2) COGNITIVE SYMPTOMS

• inability to concentrate
• difficulty making decisions
• poor school performance

3) PHYSICAL SYMPTOMS

• fatigue
• lack of energy
• feeling restless or slow
• aches & pains (stomach ache, headache)
• changes in sleep, appetite, or activity levels

Teens are less likely to speak up and say they need help. Teen depression can also look slightly different than with adults. Teens may appear more irritable than sad. If you find your teen is increasingly grumpy, hostile, frustrated and prone to angry outbursts these can all be signs of depression.

They may also have unexplained aches and pains. If upon a physical exam there isn’t a medical reason, having headaches and stomach aches could indicate depression.

They may be extra sensitive to what feels like criticism and might withdraw from some people, but not all. Adults who are depressed tend to withdraw completely, but teens may stay social with some or a new group of friends.

If you’re feeling concerned about your teen here are some things to consider:

• How long have the symptoms been around?
• How severe are they?\How different is your teen from his or her normal self?
• Has this period of sadness, lethargy, irritability felt unrelenting?

Remember, your kids will not just snap out of it. Nor will depression go away over time. You need to act. Keep the communication open with your teen and focus on hearing them rather than lecturing.

ROWI is here with trained professionals in an intensive outpatient program or partial hospitalization program to help your teen get back to themselves and find joy again. We are also here as a support for parents to help you navigate the best ways to help your teen through their depression. For more information contact ROWI Teen and Parent Wellness Centers at (800) 721-ROWI or email us at info@rowiteen.com. We accept most health insurance plans. See our locations in California.

Do Not Ignore the Importance of Social Skills as We Raise Our Kids

By Dr. Candice Feinberg & Greg Feinberg

Depending on your age, you did not have nearly the schedule or technological advances that our kids have. We did not have powerful, hand-held computers. We were not on club soccer or baseball teams playing year-round. Our schools were not nearly as sophisticated as they are now.  Many of us had after school jobs, taking us away from study time or extra-curricular activities. Far less was invested into us than our kids today.  Why did we end up doing ok? When do we confuse investing in our child’s development with actually getting in the way? One of the answers is that we were not distracted from learning critical social skills. We have to make sure we are not ignoring the importance of these skills as well.

Jennifer Senior, the author of All Joy and No Fun, explains that “Today parents pour more capital – both emotional and literal – into their children than ever before, and their spending longer, more concentrated hours with their children than they did when the workday ended at five o’clock and the vast majority of women still stayed home,” writes Senior.

On the other hand, children today are not expected to contribute economically.

In her recently published book, Be the Parent Please: Strategies for Solving the REAL Parenting Problems, author Naomi Schaefer Riley points out that “The twentieth century marked the first time in human history that having children didn’t increase your economic standing,” Children today have become the receptacles of parents hopes and dreams.

“Perhaps without noticing, our parenting strategies evolved to be more geared toward ensuring that our children are never bored, uncomfortable, or at the slightest disadvantage when compared with their peers. By other measures, though, we are failing to prepare them for life as independent adults,” writes Riley.

What has occurred is a dramatic increase in attentional disorders, or what Dimitri A. Christakis of Seattle Children’s Hospital calls an “epidemic” of ADHD. He notes that an increase of one standard deviation in the number of hours of television watched at age one “is associated with a 28 percent increase in the probability of having attentional problems at age 7.”

Even in the case of educational software designed to increase readiness for school or enhance learning, there are unintended negative consequences.  “While it may seem as though our children can gain more academic skills through educational software, it is also possible that these touchscreen and button-pushing activities are inhibiting them socially and intellectually,” writes Riley. Cell phones can also be misinterpreted by parents as necessary safety nets for their children.

What all of this investment in and concern for our kids is really doing is allowing them to become deficient in key social skills.  People are not talking anymore. Today when you arrive at a meeting early, people are on their smartphones communicating with others or otherwise entertaining themselves. As parents, we are providing a grave disservice as the majority of healthy life in the adult world revolves around solid social skills.

As a lawyer and entrepreneur for over 30 years, I have succeeded more on my social skills than my substantive knowledge. Our world is still fundamentally the same. People want to work with, spend time and/or love others they trust. We interact with other people every day. We have taken great strides to ensure our kids are academically smart but are we spending any time making sure they have the social skills to even interact with others at a higher level?

You can go to the best law, medical, or B-School in the country. But if you do not have the skills to communicate and work with other people, you will not be the best lawyer, doctor or businessperson. It is critical that we remember the social skills our kids need to learn are as or more important than the bookwork.  We certainly had time to learn both.

At ROWI Teen and Parent Wellness, we have instituted “Wireless Wednesdays.” We ask our parents to lead by example and turn their cell phones off. The whole family follows, and they share an evening without smartphones. They can actually talk to each other.

Let’s minimize the technological distractions and community service hours to make sure our kids literally stop and smell the roses. Find the time to cultivate face-to-face communication and more social interactions. We ended up ok. So will our kids.

Candice Till-Feinberg, Ph.D. is the CEO & Chief Clinical Director for ROWI Teen and Parent Wellness center in Thousand Oaks, California.  Greg Feinberg is the President of ROWI.  ROWI focuses on helping teens and parents live happy and healthy lives together and offers outpatient services and counseling through its world-class team. Contact us for more information or call at (805) 356-3477.