For Providers

What Providers Need To Know

Most common mental health disorders have an onset in childhood or adolescence, with the peak incidence occurring during adolescence. The earlier the intervention, the more successful it will be! If we can get teens help early on, we can avoid the progression of mental illness. Prevention and early intervention are critical to deeply helping individuals with mental health challenges. 

• In the ten years leading up to the pandemic, feelings of persistent sadness, hopelessness, and suicidal thoughts and behaviors increased by about 40% among young people, according to the Center for Disease Control and Prevention’s Youth Risk Behavior Surveillance System.
• Depression is a leading cause of disability in the US. Major depressive disorder (MDD) in children and adolescents is strongly associated with recurrent depression in adulthood; other mental disorders; and increased risk for suicidal ideation, suicide attempts, and suicide completion.
• Suicide is the second-leading cause of death among youth aged 10 to 19. Psychiatric disorders and previous suicide attempts increase suicide risk. 
• According to the 2018-2019 National Survey of Children’s Health, 7.8% of children and adolescents aged 3 to 17 had a current anxiety disorder. Anxiety disorders in childhood and adolescence are associated with an increased likelihood of anxiety disorders and depression in adulthood.

Addressing mental health issues in adolescence is effective in solving acute challenges and may lead to life-long improvements in psychological well-being.

Screening Guide

A mental health screening is a way to catch mental health conditions early. If the screening shows signs of a disorder, more testing is usually needed to diagnose a specific mental health disorder. 

Is it normal teenage angst or a mental health disorder? 

Adolescence is a time of growth and change, so it can be hard to tell if behavioral issues are part of normal development or need to be addressed professionally. According to MOTT Children’s Hospital, 40% of parents struggle to tell the difference between teen depression and normal mood swings. To distinguish between normal mood swings, a clinician will examine three critical areas of concern: 

• Intensity
• Duration
• Domains in which intensity occurs

If a teen has ongoing and intense symptoms, the best course of action is to access a comprehensive mental health assessment from a professional. Early diagnosis and early treatment dramatically improve clinical outcomes. 

Normal Experiences:

• Struggling to make decisions
• Grieving, even when they are glad it’s over
• Feeling stuck
• Confusing outside approval for self-worth 
• Having doubts about a relationship
• Overthinking or worrying
• Feeling shame
• Wanting two opposite things at once 
• Distancing from parents and former friends
• Sleeping and eating a lot

It is developmentally appropriate for teens to experience emotions at a greater scale than any other age group. They are going through intense hormonal changes and do not have the prefrontal cortex development to process that intensity. Everything feels like a big deal to them because everything IS a big deal to them! 

An adolescent may benefit from a mental health screening when they:

• Have lost interest in things that they used to enjoy
• Have low energy
• Sleep too much or too little, or seem sleepy throughout the day
• Spend more and more time alone, and avoid social activities with friends or family
• Diet or exercise excessively, or fear gaining weight
• Engage in self-harm behaviors (such as cutting or burning their skin)
• Smoke, drink alcohol, or use drugs
• Engage in risky or destructive behavior alone or with friends
• Have thoughts of suicide
• Have periods of highly elevated energy and activity, and require much less sleep than usual
• Say that they think someone is trying to control their mind
• Hear or see things that other people cannot hear or see

If you are a teacher or school counselor, you may notice a teen is struggling if they are:

• Frequently sleeping in class
• Spending more time alone and not talking with friends
• Engaging in risky or destructive behavior in school 
• Skipping school frequently or taking extra long bathroom breaks
• Writing about darker personal material in their homework assignments
• Falling behind in class and receiving poor grades, when they used to have good grades

What is included in mental health screenings?

Because we use a transdiagnostic treatment method at Antelope Recovery, we work with many different teens and diagnoses. We start with a generic screening and then do further evaluations depending on the reported symptoms. 

We recommend pediatricians screen annually for depression and anxiety in their teen clients. 

Using these screening tools may increase the effectiveness of identifying mental illness in your clients. (Please note: these assessments may only be conducted by a licensed healthcare professional, with some requiring specialized training):

• Diagnostic Interviews: Diagnostic interviews are structured assessments that gather information about the teen’s symptoms and mental health history. Examples of diagnostic interviews include the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) or the Structured Clinical Interview for DSM-5 (SCID-5).
• Behavioral Assessments: Behavioral assessments gather information about the teen’s behavior and functioning in different settings, such as at home, at school, or with peers. Examples of behavioral assessments include the Child Behavior Checklist (CBCL) and the Behavior Assessment System for Children (BASC).
• Cognitive Assessments: Cognitive assessments measure the teen’s cognitive abilities, such as memory, attention, and problem-solving skills. Examples of cognitive assessments include the Wechsler Intelligence Scale for Children (WISC) and the Delis-Kaplan Executive Function System (D-KEFS).
• Trauma Assessments: Trauma assessments evaluate whether the teen has experienced trauma and assess the impact of trauma on the teen’s mental health. Examples of trauma assessments include the Child and Adolescent Trauma Screen (CATS) and the Trauma Symptom Inventory for Children (TSIC).
• Substance Use Assessments: Substance use assessments evaluate the teen’s substance use and any related problems, such as withdrawal symptoms or legal issues. Examples of substance use assessments include the Substance Abuse Subtle Screening Inventory (SASSI) and the Adolescent Drug Abuse Diagnosis (ADAD) instrument.
• Family Assessments: Family assessments gather information about the family’s history, relationships, and dynamics. Examples of family assessments include the Family Assessment Measure (FAM) and the Family Environment Scale (FES).

How Antelope Recovery Works

Antelope Recovery provides virtual intensive outpatient (IOP) care to teens who are safe at home and don’t need residential treatment, but require more than one hour of therapy a week.

IOP is an intensive type of care, typically for teens who have been to residential or detox treatment and need a strong program that can provide support while they live at home and are enrolled in school. IOP allows them to gain stability while getting the support they need. 

We fill in the gaps in existing models by using a coordinated circle of care within our tight-knit team. Each family has a primary therapist, our nurse coordinator, and our team of group facilitators all working together. 

ACT, CBT, Matrix IOP Model, Motivational Interviewing, Mindfulness 

We are virtual by design. Clients can work with us from the comfort of their homes, for families of all configurations. 

We empower families. Family healing is at the heart of Antelope’s model and through education, groups, and family therapy, each family is enabled to come back together. 

For clients struggling with addiction, we include NA/AA groups, and additional relapse prevention groups. 

Medical Evaluation Guide

If you are a medical provider, look out for certain physical changes in teens. They may be a sign that a teen is struggling. 

• Sudden and noticeable weight changes 
• Dramatic sleep changes. Sleeping all the time or not at all
• Changes in food intake and behavior (food restriction, new diets)
• Signs of increased drug use
  • Very small pupils (a sign of opiate use)
  • Very large pupils (likely psychedelic use)
  • Marks on the teen’s skin where their veins are (usually elbows, wrists, ankles) 
• Signs of self-harm
  • Wearing long sleeves or pants even in very hot weather

Criteria for Medical Stabilization 

We recommend the Society for Adolescent Health and Medicine guidelines for determining if your patient may need admission for medical stabilization. If your patient meets any of the criteria included here, please call your local children’s hospital, local detox center, or medical unit for a consultation. 

• The client is not physically safe and cannot keep themselves safe without someone with them at all times
• The client is in active psychosis or experiencing delusions that significantly interfere with their ability to function and remain safe
• The client is actively suicidal (expressing plan and intent)
• The client is actively homicidal (expressing plan and intent)

We use emergency rooms as a last resort. They are not often trauma-informed, are expensive, and usually cannot keep clients for any sustained period of time. They are really good at providing emergency stabilization, but the stabilization is not permanent or a long-term solution. 

A teen is not a good fit for Antelope’s IOP if… 

• They need to detox for alcohol or illicit drug use 
• They have had active suicidal ideation with a plan within the last week
• They have had homicidal ideation with a plan in the last month
• Active command hallucination or severe thought disorganization
• Moderate to severe intellectual disability
• Neurocognitive disorder with severe memory or functioning difficulties 
• Severe eating disorder or a BMI less than 18 due to an eating disorder
• Severe autism spectrum disorder 

Please come back to us if any of these situations have changed: Severe active eating disorder, active psychosis, active suicidal ideation with a plan, severe active self-harm, or severe active aggression, or no longer is need of detox.

If a teen is struggling with substance use disorder we recommend the following screenings: 

1. Physical exam: A physical exam can help identify any physical symptoms or signs of substance use, such as changes in weight, dehydration, or high blood pressure.
2. Blood tests: Blood tests can check for any underlying medical conditions that may be related to substance use, such as liver damage or infections, sexually transmitted infections (STIs), or bloodborne diseases.
3. Urine tests: Urine tests can detect the presence of drugs or other substances in the client’s system and can help determine the extent of their substance use.
4. Respiratory function tests: Respiratory function tests can evaluate lung health and determine if there is any damage or inflammation due to smoking or vaping.
5. Liver function tests: Liver function tests can evaluate liver health and determine if there is any damage or inflammation due to substance use.
6. Electrocardiogram (ECG): An ECG can evaluate heart health and determine if there is any damage or irregularities due to substance use.
7. Pulmonary function tests: Pulmonary function tests can evaluate lung health and determine if there is any damage or inflammation due to smoking or other forms of substance use.
8. Mental health assessments: Mental health assessments can evaluate the client’s mental health and screen for any co-occurring mental health disorders that may be contributing to their substance use, such as depression or anxiety.

When to give teens a naloxone prescription: 

Naloxone is a medication used to reverse the effects of an opioid overdose. A pediatrician or psychiatrist may prescribe naloxone to a teen client who is using opioids to have on hand in case of an overdose.

Referral to a medication-assisted treatment (MAT) program: MAT combines medication with behavioral therapy to treat substance use disorder. A pediatrician or psychiatrist may refer a teen client who is using opioids to a MAT program that can provide medications like buprenorphine or methadone to help manage withdrawal symptoms and reduce the risk of relapse.

Referral to a detoxification program: A detoxification program can provide medical supervision and support to help a teen client who is using heroin, methamphetamine, or cocaine safely withdraw from the substance.

Contingency management for drug use: We strongly recommend using contingency management as a way to encourage attendance and drug screenings for teens who struggle with substance use disorder. Read more about that here. 

What to Say or Not to Say 

Language is important when talking with struggling teens and their families. Here are some guidelines for when you are working with struggling families.  

Keep it simple

• Use the least amount of words to make your point.
• Have a routine. Make it easy for the teen to predict what will happen during your time together.

Follow through

• Do what you say you will do. 
• If a teen breaks a rule, even if they are usually well-behaved, follow through on the consequence every time.
• Teens will learn that what you say matters and will listen when you speak.

Consistently set context

• Give clear expectations before you do any new activity.
• Before making a transition, clarify what, how, why, and where something is happening
• Is there unstructured time? Let them know what the space should look and feel like during that time. 

Stay on their team

• Make sure the teen knows you have their back. You are on their team. You are not against them. 
• If you feel like you’re not on their team, reschedule or postpone your time with them. 

Be honest. 

• Teens have an incredible “BS” detector. Be honest. Let them know when you don’t know. 

When a teen says, “You don’t get it,” believe them. It is vital for a teen to feel seen. When they feel seen, they begin to trust that they can share honestly. This is important if they need help or find themselves in a scary situation. 

Teens are still learning to express themselves and aren’t very good at it yet. They will need your help in getting it all out. 

Tips: 

• Reflect on what you heard them say, using their exact words
• Ask if there is more they’d like to share
• Don’t share your opinions or boundaries until they’ve gotten it all out
• Use empathy skills such as “I imagine if I were you, I might feel___. Are you feeling anything like that?”
• Share about half of what you want to say. 

Pediatrician Checklist 

Before a client can be admitted into our IOP, we require a visit to their pediatrician, which includes all of the following screenings, labs, and data, to make sure the client is a good fit for our IOP. 

• Drug lab 
• Pregnancy test 

What should I know about medication management during IOP? 

In total, psychiatrists and prescribers have access to 30 antidepressants, 20 antipsychotic medications, 7 mood stabilizers, 6 ADHD medications, and 2 opioid antagonists to treat mental illness.

These are generally effective for the short-term reduction of symptoms. However, symptom reduction often takes days to weeks. A new substance we are learning about is ketamine, which takes hours instead of weeks to reduce symptoms, which is very exciting. 

With medication, we expect clients to respond to the treatment partially. It is not a cure. The goal of using medication is to reduce disability and increase functionality so the client can return to school or have enough resources to access additional services.

Usually, suicide risk is the highest when people regain some functionality after being depressed (this often occurs days to weeks after they’ve started medication). Individuals can become well enough to form a suicide plan and act on it. Often, additional medication will start at this time, as well as longer-term therapy or rehabilitative services. 

At Antelope Recovery, we can help to connect you with an adolescent psychiatrist or prescriber, but we do not do virtual medication management or prescribing in-house. Our nurse on staff is able to support you with finding the appropriate provider and will discuss with you if we have a recommendation for exploring medication changes.