| SHORT-TERM OBJECTIVES | THERAPEUTIC INTERVENTIONS |
| 1. Verbalize the emotions causing a need to escape from the home environment. (1, 2, 3) | 1. Actively build the level of trust with the client in individual sessions through consistent eye contact, active listening, unconditional positive regard, and warm acceptance to help him/her increase the ability to identify and express feelings. 2. Gather a history of the client's runaway behavior, precipitating events, any accomplices or facilitators, living conditions during runaway time, any substance abuse or sexual acting out, illegal behavior, emotional state, and so on. (or assign “Describe Life on the Run” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 3. Facilitate the client's expression of emotions that prompt the runaway behavior. |
| 2. Complete psychiatric evaluations. (4) | 4. Refer the client for an evaluation for ADHD, affective disorder, or psychotic processes that could benefit from psychotropic medications. |
| 3. Comply with all recommendations of the psychiatric evaluation. (5) | 5. Monitor the client's and the family's compliance with the evaluation recommendations. |
| 4. Disclose any history of substance use that may contribute to and complicate the treatment of the runaway problem. (6) | 6. Arrange for a thorough substance abuse evaluation and refer the client for treatment if the evaluation results would recommend it. |
| 5. Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship. (7, 8, 9, 10, 11) | 7. Assess the client's level of insight (syntonic versus dystonic) toward the “presenting problems” (e.g., demonstrates good insight into the problematic nature of the “described behavior,” agrees with others' concern, and is motivated to work on change; demonstrates ambivalence regarding the “problem described” and is reluctant to address the issue as a concern; or demonstrates resistance regarding acknowledgment of the “problem described,” is not concerned, and has no motivation to change). 8. Assess the client for evidence of research-based correlated disorders (e.g., oppositional defiant behavior with ADHD, depression secondary to an anxiety disorder), including vulnerability to suicide, if appropriate (e.g., increased suicide risk when comorbid depression is evident). 9. Assess for any issues of age, gender, or culture that could help explain the client's currently defined “problem behavior” and factors that could offer a better understanding of the client's behavior. 10. Assess for the severity of the level of impairment to the client's functioning to determine appropriate level of care (e.g., the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, vocational, or occupational endeavors); continuously assess this severity of impairment as well as the efficacy of treatment (e.g., the client no longer demonstrates severe impairment but the presenting problem now is causing mild or moderate impairment). 11. Assess the client's home, school, and community for pathogenic care (e.g., persistent disregard for the child's emotional needs or physical needs, repeated changes in primary caregivers, limited opportunities for stable attachments, persistent harsh punishment, or other grossly inept parenting). |
| 6. Identify and implement alternative reactions to conflictual situations. (12, 13) | 12. Ask the client to list all possible constructive ways of handling conflictual situations and process the list with the therapist. 13. Train the client in alternative ways of handling conflictual situations (e.g., being assertive with his/her wishes or plans, staying out of conflicts that are parents' issues), and assist him/her in implementing them into his/her daily life. |
| 7. Increase communication with and the expressed level of understanding of the parents. (14, 15) | 14. Conduct family therapy sessions with the client and his/her parents to facilitate healthy, positive communications. 15. Teach the client and parents problem-solving skills (i.e., pinpoint the precise problem, brainstorm possible solutions, list the pros and cons of each solution, select and implement a solution, evaluate the action taken for mutual satisfaction, adjust solution if necessary); use role-play and modeling to apply these steps to a current issue (or assign “Problem-Solving Exercise” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 8. Parents and client each express acceptance of and responsibility for his/her share of the conflicts between them. (16) | 16. Assist the parents and the client in each accepting responsibility for his/her share of the conflicts in the home. |
| 9. Parents terminate physical and/or sexual abuse of the client. (17, 18) | 17. Explore for the occurrence of physical or sexual abuse to the client with the client and his/her family (or assign “My Story” or “Identify the Nature of the Abuse” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 18. Arrange for the client to be placed in respite care or in another secure setting, if necessary, while the family works in family therapy to resolve conflicts that have led to abuse or neglect of the client. |
| 10. Parents acknowledge substance abuse problem and accept referral for treatment. (19) | 19. Evaluate the parents for substance abuse and its effect on the client; refer parents for treatment, if necessary. |
| 11. Parents identify unresolved issues with their parents and begin to move toward resolving each issue. (20, 21) | 20. Hold a family session in which a detailed genogram is developed with a particular emphasis on unresolved issues between the client's parents and their own parents. Then assist the client's parents in coming to see the importance of resolving these issues before change can possibly occur in their own family system (or assign the parents “Parents Understand the Roots of Their Parenting Methods” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 21. Facilitate sessions with the client's parents to assist in working through past unresolved issues with their own parents. |
| 12. Parents decrease messages of rejection. (22) | 22. Help the client's parents identify and alter parenting techniques, interactions, or other messages that communicate rejection to the client. |
| 13. Parents attend a didactic group focused on teaching positive parenting skills. (23) | 23. Refer the parents to a class that teaches positive and effective parenting skills. |
| 14. Parents identify and implement ways they can make the client feel valued and cherished within the family. (24, 25) | 24. Assign the parents to read books on parenting (e.g., Parenting Teens With Love and Logic by Cline and Fay; How to Talk So Kids Will Listen and Listen So Kids Will Talk by Faber and Mazlish; The Everything Parent's Guide to Positive Discipline by Pickhardt); process what theyhave learned from reading the material assigned. 25. Assist the parents in identifying ways to make the client feel more valued (e.g., work out age-appropriate privileges with the client, give the client specific responsibilities in the family, ask for client's input on family decisions) as an individual and as part of the family; elicit a commitment from the parents for implementation of client-affirming behaviors. |
| 15. Identify own needs in the family that are unsatisfied. (26) | 26. Ask the client to make a list of his/her needs in the family that are not met; process the list in an individual session and at an appropriate later time in a family therapy session. |
| 16. Identify ways that unmet needs might be satisfied by means outside the family. (27) | 27. Assist the client in identifying how he/she might meet his/her own unmet needs (e.g., obtain a Big Brother or Big Sister, find a job, develop a close friendship). Encourage the client to begin to meet those unmet needs that would be age-appropriate to pursue. |
| 17. Verbalize hurt and angry feelings connected to the family and how it functions. (28, 29, 30) | 28. Assign the client to write a description of how he/she perceives the family dynamics and then to keep a daily journal of incidents that support or refute this perception (or assign the exercise “Home by Another Name” or “Undercover Assignment” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 29. Assist the client in identifying specific issues of conflict he/she has with the family (or assign the “Airing Your Grievances” exercise from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). 30. Support and encourage the client when he/she begins to appropriately verbalize anger or other negative feelings. |
| 18. Identify and implement constructive ways to interact with the parents. (31) | 31. Help the client identify and implement specific constructive ways (e.g., avoiding involvement or siding on issues between parents, stating his/her own feelings directly to the parents on issues involving him/her) to interact with the parents. Confront the client when he/she is not taking responsibility for himself/herself in family conflicts. |
| 19. Verbalize fears associated with becoming more independent. (32) | 32. Explore the client's fears surrounding becoming more independent and responsible for himself/herself. |
| 20. Parents identify and implement ways to promote the client's maturity and independence. (33) | 33. Help the parents find ways to assist in the advancement of the client's maturity and independence such as giving the client age-appropriate privileges, encouraging activities outside of home, or requiring the client to be responsible for specific jobs or tasks in the home (or assign the parents “Transitioning from Parenting a Child to Parenting a Teen” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| 21. Verbalize an understanding of various emotions, and express them appropriately. (34) | 34. Educate the client (e.g., using a printed list of feeling adjectives) in how to identify and label feelings and in the value of expressing them in appropriate ways. |
| 22. Identify specifically how acting out behavior (such as running away) rescues the parents from facing their own problems. (35, 36) | 35. Assist the client in becoming more aware of her/his role in the family and how it impacts the parents; focus on runaway behavior as a distraction from underlying family conflicts. 36. Facilitate family therapy sessions with the objective of revealing underlying conflicts in order to release the client from being a symptom bearer. |
| 23. Family members verbally agree to and then implement the structural or strategic recommendations of the therapist for the family. (37, 38) | 37. Conduct family therapy sessions in which a structural intervention (e.g., parents will not allow the children to get involved in their discussions or disagreements, while assuring the children that the parents can work things out themselves) is developed, assigned, and then implemented by the family. Monitor the implementation and adjust intervention as required. 38. Develop a strategic intervention (parents will be responsible for holding a weekly family meeting and the client will be responsible for raising one personal issue in that forum for them to work out together) and have the family implement it. Monitor the implementation and adjust intervention as needed. |
| 24. Move to a neutral living environment that meets both own and parents' approval. (39) | 39. Help the parents and the client draw up a contract for the client to live in a neutral setting for an agreed-upon length of time. The contract will include basic guidelines for daily structure and for frequency of contact with the parents and the acceptable avenues by which the contact can take place (or utilize “Another Place to Live” from the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, and McInnis). |
| Axis I: | 314.01 | Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type |
| 312.82 | Conduct Disorder, Adolescent-Onset Type | |
| 313.81 | Oppositional Defiant Disorder | |
| 300.01 | Panic Disorder Without Agoraphobia | |
| 300.4 | Dysthymic Disorder | |
| 309.24 | Adjustment Disorder With Anxiety | |
| 309.4 | Adjustment Disorder With Mixed Disturbance of Emotions and Conduct | |
| 312.30 | Impulse-Control Disorder NOS | |
| V61.20 | Parent-Child Relational Problem | |
| 995.54 | Physical Abuse of Child (Victim) | |
| 995.53 | Sexual Abuse of Child (Victim) | |
| 995.52 | Neglect of Child (Victim) | |
| Axis II: | 799.9 | Diagnosis Deferred |
| V71.09 | No Diagnosis |
| ICD-9-CM | ICD-10-CM | DSM-5 Disorder, Condition, or Problem |
| 314.01 | F90.1 | Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive/Impulsive Type |
| 312.81 | F91.1 | Conduct Disorder, Childhood-Onset Type |
| 312.82 | F91.2 | Conduct Disorder, Adolescent-Onset Type |
| 313.81 | F91.3 | Oppositional Defiant Disorder |
| 300.01 | F41.0 | Panic Disorder |
| 300.4 | F34.1 | Persistent Depressive Disorder |
| 309.24 | F43.22 | Adjustment Disorder With Anxiety |
| 309.4 | F43.25 | Adjustment Disorder With Mixed Disturbance of Emotions and Conduct |
| 312.9 | F91.9 | Unspecified Disruptive, Impulse Control, and Conduct Disorder |
| 312.30 | F91.8 | Other Specified Disruptive, Impulse Control, and Conduct Disorder |
| V61.20 | Z62.820 | Parent-Child Relational Problem |
| 995.54 | T74.12XA | Child Physical Abuse, Confirmed, Initial Encounter |
| 995.54 | T74.12XD | Child Physical Abuse, Confirmed, Subsequent Encounter |
| 995.53 | T74.22XA | Child Sexual Abuse, Confirmed, Initial Encounter |
| 995.53 | T74.22XD | Child Sexual Abuse, Confirmed, Subsequent Encounter |
| 995.52 | T74.02XA | Child Neglect, Confirmed, Initial Encounter |
| 995.52 | T74.02XD | Child Neglect, Confirmed, Subsequent Encounter |
Note: The ICD-9-CM codes are to be used for coding purposes in the United States through September 30, 2014. ICD-10-CM codes are to be used starting October 1, 2014. Some ICD-9-CM codes are associated with more than one ICD-10-CM and DSM-5 disorder, condition, or problem. In addition, some ICD-9-CM disorders have been discontinued, resulting in multiple ICD-9-CM codes being replaced by one ICD-10-CM code. Some discontinued ICD-9-CM codes are not listed in this table. See Diagnostic and Statistical Manual of Mental Disorders (2013) for details.