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Turning 18 in Treatment: Where Do You Go – Teen Treatment Option or Young Adult? An interview with Shayna Abraham, M.A.

Shayna Abraham, M.A. is a consultant in the Bay Area who has worked in the Family Choice Behavioral healthcare industry for 16 years. Her company, Prepare To Bloom, assists with families placing their child, teen or young adult in treatment programs around the country — her clients range from ages 8 – 30. I was speaking to her about the variations between teen programs (whose missions is to serve clients under 18) and how to parse out the differences in terms of how they treat and work with treatment goals vs. a young adult program.

Like everything else on this website, we share information about a continuum of care for adolescents and young adults. The treatment programs on this website might look similar in terms of their answers to the All Kinds of Therapy profile, but at the end of the day, what best predicts successful treatment is the sophisticated fit of your teen’s profile and the program’s responsive environment.


Shayna, thanks for talking to me. Let’s start at the beginning before we pull apart treatment approaches. What do most teen residential treatment centers, regardless of the level of care, do for their clients in terms of milieu, therapy (group, family, individual, recreation), education and overall structure? Or even the philosophy of treatment?

The therapeutic work the majority of treatment programs are doing is understanding their emotions, building coping skills for each child and working with the family to help them practice parenting the child they have. The families are involved in weekly family therapy calls and most often quarterly parenting workshops with the goal of enhancing the skills the parents have. This is tied closely to also helping the family system to shift and not just expecting the child to shift.

Educationally the programs are set up to ensure that a child receives the education at the level they need and ideally moving them towards where they are expected, academically. The structure varies, however; the child’s safety is always priority one, regardless of the level of care. And the assumption by the program, academically is they will need more support. This is not always the case with college classes that might be done online though. It is a good question for a parent to ask about before enrolling.

The program models vary with the details but from a high level, they are all working towards teaching their clients how to make the most of their lives and engage in the world around them.


What do you see as the key differences between young adult transitional programs and teen treatment programs?

The main difference I see is switching the ultimate focus from how to prepare a child to return to their family versus preparing a young adult to move into independence. In a young adult program, they are working on understanding the individual’s strengths and challenges in order to create a sustainable plan for them to live independently. There is also a shift in the work done with families, from the perspective of adult to child parenting to adult to adult parenting skills.

Within the world of residential treatment programs for young adult clients, there are a range of services offered. There are young adult programs that offer housing in a home setting, and others that are more independent with apartments. Additionally, there are programs that have multiple phases allowing their clients to practice in a more structured setting and moving towards a less restrictive setting. This allows the young adult to learn about what it takes to run their own lives.This provides the ability to adjust the structure to what the individual and their family need. Programs vary in their length of stay and also the amount of supports they offer.


As a 17 year old ages toward the magic 18th year, and legal majority status, the student knows that it is their legal right to leave involuntary attendance at a program on their 18th birthday. What do you tell families to think about? What types of questions do you consider, as a person who places students nearing this transition??

The government has determined that turning 18 is significant and that it is when one reaches adulthood. Being an adult by the government expectation means that one can now vote and purchase cigarettes. I often highlight for the parents that I am working with that their child turning 18 can be a turning point in their relationship, if the child is ready for it. For the vast majority of the clients I am working with, they are not prepared to enter into young adulthood in a successful manner. The bulk of them have never thought twice about running their own lives and all that will entail in the long run. This creates a lot of fear and uncertainty for parents by not knowing how when or where they will truly be able to launch their young adult.


How do you determine the level of care?

I am looking at what does the individual want for them self moving forward, so I am asking questions around goals.

  • I am also asking about what type of safety concerns might the child bring into the decision.
  • Does the child resonate with being in a city or do they do better in a more rural setting?
  • Do they need access to a college, community college, job, internship, or another experience?
  • What type of therapeutic support to they need (Individual, family, group, particular modality)?
  • What type of psychiatric oversight does the person need? What type of family support does the family need?
  • What depth of responsibility has the person already mastered, what life skills do they still need to learn and work on?
  • What access to family do they need?
  • What are the young adult’s requests for the program?
  • Can they identify what their needs are vs. the wants?


How do you think families should measure success of a placement for a young adult vs. an adolescent program?

Soon after beginning to work with a family, we define the goals that we set out for their child and their family. I think that clarifying where we are headed is so important for each family to make the process their own.

When looking at the adolescent process we are often looking at the child being engaged in their own life, attending school regularly, having a vision of what comes after high school, engaging with appropriate friends, engaging with family activities, completing their educational goals using technology appropriately, respecting the boundaries of the family.

When working with young adults, we are still looking at the individual being engaged in their life, and being able to engage with and eventually, to initiate the supports that they need in order to create the life they would like to have. The hope is that at the end of a young adult program the individual can run their own life in a healthy productive manner.


Is there anything else you want to add?

Yes, thanks. Because the child is the one who leaves the common ground, I think many students (young adults, teens and even pre-teens) don’t understand or recognize that the parents also enter into the psychological therapy. Eventually, they do but I try to have everyone give up the “identified patient” label as quickly as possible so that the entire system can shift and forgive and do some work.

Specifically, here are a few things that I speak to my clients about.

There does not seem to be an understanding that with adulthood comes many more responsibilities and challenges both for the individual as well as their parents.

There are ways parents can begin preparing for this transition early:

  • Give your child age-appropriate responsibilities around the house, including help with food preparation, shopping, yard and vehicle maintenance, pet care.
  • Let them do their own laundry.
  • If you have a housekeeper, do not let them clean your teen’s room. There is no housekeeper in college. Allow your child to feel the consequences of their actions.
  • Talk about money and the cost of food, the mortgage, the car insurance — life is expensive.
  • Ask them to find a job & see how many taxes are taken out.
  • Have the teen define their educational goals, calendar, homework time & agree on what success is in terms of grades.
  • Be curious and ask questions about what your child believes being an adult entails and talk openly about some of the holes you find in their answers.