Chronically suicidal and/or self-injuring young adolescents with significant difficulties in emotion regulation can be challenging to treat, impose a substantial burden on healthcare systems, and cause significant family distress. To this day, suicide continues to be the second leading cause of death among Canadian among 10-19 years old, representing approximately 19.7% of deaths (Statistic Canada 2009).
Many aspects of family distress can influence suicide risk for adolescents, such as poor relationships, parent-teen conflict and poor communication. Indeed, adolescents’ self-injurious behaviours are often precipitated by conflicts related to family relationships. Often when adolescents are struggling with complex mental health needs, family members are perhaps the most affected and, in turn, are the people most likely to affect the adolescent.
Clinicians at the Mood and Anxiety Team have developed a concurrent 16-week Dialectical Behavior Therapy (DBT) for the caregivers of adolescents in the DBT program. Adaptations for families include education in attachment, Collaborative Problem Solving, neurobiology, and parenting skills in addition to the traditional DBT skills.
Due to its success, a modified 12-week DBT for caregivers only group has also been developed for caregivers of emotionally dysregulated multi-problem youth who for a variety of reasons, including age, significant substance abuse, or lack of commitment, are unable to participate in the standard DBT program. The goals of intervention are to help caregivers learn new skills and strategies to support their difficult-to-parent teens, as well as practice skills to help them with their own emotion regulation and capacity for distress tolerance.
Parents report positive changes in their youth’s behaviour, improvements in family functioning, as well as in their own perceived competence as parents. Data from the concurrent parent and youth group has shown a significant reduction in hospital service use, including emergency room visits and inpatient admissions. These reductions are sustained over 12-months following the intervention. Additionally, preliminary results of a cost-benefit analysis suggest an overall cost saving.
The DBT program for caregivers is innovative as it is the first of its kind. Although, caregivers are included in some other youth DBT programs, they are usually within the same room with their child. The CHEO DBT approach allows parents to feel comfortable and focus on their needs, providing them with the proper support to create parental expertise and hope. Furthermore, it also gives an option for parents of youth who are unable to participate due to various circumstances, such as lack of commitment, age or other complicating factors. For a long time, these parents felt isolated and un-supported as traditional services mostly focused on the direct patient only.
Contact Information:
Contact Title: Staff Psychiatrist, Mood and Anxiety Team
Contact Email: mrobb@cheo.on.ca
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