An opportunity to practice goal-directed behavior is another component. "We enhance motivation toward a positive outcome rather than avoiding a negative outcome." Getting a job and/or their own apartment, as well as getting parents "off their backs" or to say something nice to them are the main factors that motivate this age group, Dr. Kane said.
There is a focus on positive reinforcement for positive behavior. For example, a girl living in her parents’ basement wanted her own apartment. Her parents were fearful because of her ongoing alcohol use. So program staff worked with her parents to set up a system whereby the parents put money away toward first and last months’ rent on an apartment each week that the girl maintains sobriety. If she fails, she does not lose everything, only the money allotted for that week, Dr. Kane said. "She had 4 straight weeks of sobriety. She is in control and everyone is working toward the same goal."
Multidimensional family therapy is another feature of the program. "What we added to our standard treatment in this population is engagement of families," said Dr. E. Nalan Ward, medical director of the West End Clinic at Massachusetts General.
"Families are the unrecognized factor," Dr. Kane said. "Kids 18-25 still have very active involvements with family."
For example, clinicians work with families to reduce any toxic environmental factors, including parental substance use. Psychological education and skills training (tailored for parents of transitional-age children) also is provided. "Parents learn that kids don’t need the same things from them as they used to," Dr. Kane said. Family participation is important, she added, because even after patients leave treatment they are still involved with their families.
Massachusetts General accepts insurance for the program, including Blue Cross Blue Shield and Massachusetts Behavioral Health (state Medicaid). A donor fund kicks in after insurance benefits and other options are exhausted. Some clients self-pay for a variety of prepackaged service options as well.
Dr. Kane and Dr. Ward had no relevant disclosures.