Transport Intervention & Admission Process

The transport intervention and admission process commences once the transport has been confirmed and authorized by the adolescent's parent guardian(s). The following process is applicable to New Start Transports (NST) and its therapeutic transport staff. For guidance and direction regarding the parents' role throughout the transport, please refer to the NST Parent Guide.

NST's therapeutic transport process includes, but is not limited to, the following procedural steps:

Transport Plan:

Our transport coordinator will develop a transport intervention and admission plan based on the communicated needs and requests of the parents, other professionals involved in the placement (e.g., educational consultants, psychologists, therapists, program admission staff), and, perhaps most importantly, the adolescent client. After a suitable plan is formulated, agreed upon, and authorized by the adolescent's parent(s)/guardian(s), a copy of the plan will be forwarded to the assigned therapeutic transport staff. It is important to re-iterate the personalization and assessment that occurs at the planning level of the transport process. NST's transport plans are not rigidly applied to our adolescent clients. Rather, our coordinators collaborate with all those involved in the treatment admission/placement process--parents, family members, mental health professionals, and program admission staff--to ensure that the most appropriate therapeutic plan is devised. Further, our transport plans are always adaptable to each circumstance and situation, meaning that given the dynamic, and sometimes volatile, context of a therapeutic transport, we also account for any unexpected resistance or cooperation in planning a therapeutic transport. In essence, we apply O'Brien and Golding's (2003) Principle of Least Coercion to ensure that our adolescent clients experience the appropriate level of respect and therapeutic support during the entire transport intervention and admission process. A key to ensuring this--an adolescent experiencing increased respect and therapeutic support--is to assess each transport context individually and employ the least amount of coercive methods necessary throughout the entire transport intervention and admission process.

Transport Plan Discussion:

NST coordinators and therapeutic transport staff will always review and discuss the proposed plan, including the travel itinerary and therapeutic transport procedures, with the parents. Importantly, the parents will have the opportunity to confirm their approval and/or (at any time) request revisions. After the transport plan is approved and authorized by all parties, NST will then confirm the travel arrangements and itinerary with the parents, authorize the source of payment, and answer any additional questions.

Prior to Transport:

NST and its employees will make all the necessary travel reservations and preparations before departure to facilitate a safe therapeutic transport.

In-Route to Transport:

NST will contact the parents when its transport staff have left its offices and are in route. At this time, NST will reconfirm the transport details and respond to any additional questions. Parents will also be provided with the therapeutic transport staff's direct company cell phone numbers and will remain in constant contact with our staff throughout the entire duration of the transport admission.

Pre-arrival Call:

If the transport is occurring at the adolescent client's home or place of residence, our therapeutic transport staff will contact the parents approximately five to fifteen minutes before the scheduled time of pick up via cell phone (unless otherwise specified). This will allow our staff a final opportunity to address any more of the parents' concerns and to reconfirm the intervention plan and procedure before entering the home or place of pick-up/intervention.

Arrival to Destination:

After the call, our therapeutic transport staff will meet the parents at the door or outside the home and gather any required paperwork, letters, or approved travel items for the adolescent client. If the adolescent is not asleep or if the parents have any concerns about the adolescent client waking up, NST will collect the approved travel items after the adolescent client is safely seated in the transport vehicle with at least one of our therapeutic staff. Please keep in mind, that when traveling via airplane we do not recommend sending more than a small carry-on bag with the adolescent client. Any additional luggage should be shipped separately, either before or immediately after the transport takes place. This is essential to allowing our therapeutic transport staff to remain completely focused on the adolescent client during all phases of the transport admission and also helps to prevent unnecessary travel delays.

Entering and Locating Child:

Our therapeutic transport staff will follow the parents as they direct them to where their child is located. It is important for NST's therapeutic transport staff to follow the parents to ensure that the adolescent client understands that NST's presence is approved and fully supported by the parents. Additionally, NST understands that its adolescent clients are often (though not always) sleeping at the time its employees arrive. NST does not want an adolescent client misperceiving the intention of our employees. (Please note, that this procedure may vary depending on the assessment of needs determined when constructing the transport plan.)

The Intervention:

(NOTE: Due to the complex nature of the transport intervention process, NST has divided it into sub-categories for discussion purposes. However, because NST personalizes each therapeutic intervention approach to the specific needs of each adolescent client and family context, this represents only a general outline of the intervention process, which has not yet been adapted to the particular needs of the adolescent client and family.)

Wake-up (if applicable)

Parents will wake up their child. To avoid any misconceptions, when the child is adequately conscious and can understand the parents, they will provide a clear and concise explanation about their decision to get him or her help. It is critical that parents avoid being dishonest and to keep their explanation simple and clear. Because anxiety levels tend to be very high at the time of intervention, it may be counterproductive to include too much detail in the instructions given. This can often lead to misinterpretation and overreaction on the adolescent's part. After communicating to the necessary information to the adolescent, parents will then introduce the NST therapeutic transport staff. This process can sometimes vary depending upon how much discussion has transpired between the parents and adolescent regarding the treatment and transport prior to the intervention. Depending on a number of factors, many parents engage in some form of discussion about the decision for treatment, and even transport, before the intervention process actually occurs. Recommendations for what to (and what not to) say are provided on a case-by-case basis and are often best facilitated per the advice and recommendation of a local mental health professionals, educational consultant, or program admission staff.

Introduction

Parents will concisely explain to their adolescent child that in an effort make the travel and transition to the therapeutic program more supportive they have hired a therapeutic transport service to assist. Parents will introduce NST's therapeutic transport staff by name and explain that they will keep him or her safe. Equally, they'll explain that the therapeutic transport staff have their permission to ensure that they safely arrive to the program. Our therapeutic transport staff will attempt to shake the adolescent client's hand during the introduction as a non-threatening and respectful way to approach the adolescent and provide further instruction and information. It is important for both the parents and our therapeutic transport staff to effectively communicate that the parents and family members have made this decision, not as a punishment but rather out of love and concern for the adolescent. From a therapeutic standpoint, individuals are less likely to perceive threat and coercion during the treatment admission process when they perceive and experience that others are acting out of love and they are being treated fairly (Hoge et al., 1993, 2001; Monahan et al., 1995).

Parents’ Departure (if applicable)

Commonly, either because of the adolescent's and/or parents' anxiety, we have the parents excuse themselves from the location of the intervention. If the parents have not already departed, our transport staff will remind the parents that they can be excused. It is much easier for our staff to safely and effectively intervene and de-escalate an anxious adolescent with the parents absent, especially if their presence is contributing to the adolescent's escalation. For example, if conflict or dissonance exists in the parent-child relationship in general (which is often the case), the adolescent may be much more likely to react negatively or resistant to any of the parents' requests, especially while the parents are present. Often in such contexts of parent-child conflict, an adolescent will become very amenable once the parents are absent. However, based on the initial transport intervention plan, it is not uncommon for parents to remain present for the entire duration of the intervention process. Equally, even when parents do need to leave momentarily to allow our therapeutic transport staff to de-escalate the adolescent, parents are often able to come back and give the adolescent a hug and briefly say goodbye depending on the adolescent client's request. In sum, NST's transport intervention process and protocol is contingent on the needs surrounding the adolescent, parents, and family and in particular how the adolescent responds during the process. Because each family and adolescent dynamic is so unique--e.g., differences in personality, symptomology, conflict--whether or not the parents are present is a flexible procedure that occurs (or does not) depending on how the process unfolds and the recommendations of the transport plan.

Intervention

After our staff are introduced to the adolescent client, the transport intervention begins. Our therapeutic transport staff will begin by mediating the decision of the parents, re-clarify parental instructions and intentions, and explain their role in the transport intervention and admission process. While there are some standard details that our therapeutic staff will communicate, their responses are largely dependent upon the adolescent's level of anxiety, resistance, and needs. It is critical that our therapeutic staff do not over or under respond. As each adolescent, and situation, is unique, NST's therapeutic transport staff are trained and prepared to respond and adapt to the specific needs of the adolescent and circumstance. As already noted, our transport staff will make every effort to exhibit care, concern, and respect for the adolescent at this time. Although the initial intervention process can often transpire rather quickly, depending on the situation, our therapeutic staff will validate and respond to any concerns expressed by the adolescent as appropriate. Even subtle factors, such as our staffs' tone of voice and a caring (vs. aggressive) approach can be essential to not only de-escalating and comforting an anxious or hesitant adolescent but also to impacting the adolescent's experience of the overall intervention and admission process. In particular, when adolescents or people in general are not listened to/validated, treated with respect/fairness, and perceive disrespect (vs. care and concern), they are more likely to experience negative and hostile emotions and elevated levels of coercion during the treatment admission process (Fondacaro, et al., 2006; Hardy, 2014; Hoge et al., 1993, 2001; Monahan et al., 1995). Thus, even the seemingly insignificant nuances and subtleties of a transport intervention process can carry important clinical or therapeutic significance.

Transport to Vehicle

Unless otherwise requested by parents or assessed by NST, the interventionists will escort the child to the vehicle with a soft hold upon the adolescent's arms. Because the adolescent's anxiety may still be relatively high and unpredictable, NST has found that an adolescent's level of cooperation/resistance can change at any time especially in the initial stages of the transport admission. Therefore, all precautions are taken to avoid any incidents to the transport vehicle.

Transport to Airport (if applicable)

After NST staff and the adolescent client are safely in the transport vehicle and in route to the airport, our therapeutic staff will begin (if not already) to elaborate the details of the transport. They will also respond to any additional concerns or questions that the child may have. As previously cited, our staff will allow and encourage the adolescent to voice any of his/her concerns about the process and will respond accordingly and with respect. At the moment the transport intervention begins, including during this stage of the transport, our staff strive to establish communication and a rapport with the adolescent. Establishing this relationship early allows the adolescent's anxiety to de-escalate more quickly while increasing their respect and cooperation for our staff and the treatment admission in general.

Airport (if applicable)

While at the airport and in any public area, our staff will remain at arm's length from the adolescent at all times. The adolescent will be given the opportunity for restroom-use, meals, and any approved means of entertainment after clearing the airport security check. Verbal engagement and elicitation is also a critical aspect of this phase in the transport. In particular, how an adolescent does (or does not) respond to our staff can indicate the adolescent's present level of cooperativeness, calmness/anxiety, and alert our staff of any needs or concerns that have perhaps been overlooked. Importantly, by verbally (and sincerely) engaging an adolescent, our staff can help sooth any of the adolescent's anxieties or fears about the program and prevent any anxieties from escalating.

Aircraft (if applicable)

NST's therapeutic transport staff will sit next to the adolescent in the aircraft. Due to last minute purchases, sometimes the reservations cannot select seat assignments next to each other. The NST therapeutic transport coordinator and staff will do all they can to ensure that (at-least) one staff is seated next to the adolescent client. Based on the adolescent's anxiety, additional arrangements can also be made to ensure that both staff members are seated next to the adolescent. Snacks and entertainment will be offered based on the airline used.

Transition to Program

The transitioning process of the transport admission begins the moment the transport intervention commences. However, given the initial anxious, and often volatile, context in which many transport interventions occur, the bulk of the transitioning process tends to occur after the initial intervention phase, when our staff and the adolescent client have left the intervention/pick-up location. Withholding much of the details and complexities until after the initial intervention,or once the adolescent client has fully processed the intervention/placement, is line with numerous crisis intervention models (e.g., crisis prevention institute's nonviolent crisis intervention program) and allows the adolescent to be less anxious and more capable of accurately interpreting and perceiving the details of the situation and treatment. In essence, the transitioning that occurs during the actual intervention phase involves transitioning the adolescent to the next phase of the transport. Once the adolescent has reached the next phase of the transport process, or post-intervention phase, our therapeutic staff will in turn transition or prepare the adolescent for the next phase of the transport. Thus, the transitioning process, per se, is just that--a supportive process that informs the adolescent of what is taking place, but in remaining sensitive to the adolescent's state of anxiety, resistance, and cognitive processing capacity at that moment. Following this trajectory allows for the adolescent to arrive to the program fully aware and transitioned, while experiencing the least amount of trauma and coercion possible, during the process. Being properly informed and transitioned also protects against the adolescent experiencing another state of anxiety or surprise by arriving into treatment with false or unknown expectations. NST will never lie to or intimidate a child. Nevertheless, NST staff will only answer the questions that they know the answers to and will limit the detail of their responses to the anxiety and cooperation demonstrated by the adolescent and the particular stage of the transport admission. Our ultimate goal is for our adolescent client to not experience another, post-transport, anxiety shock, but rather that he or she arrives into treatment open and prepared for the next phase of the admission process, which is usually the program intake/admission process.

Parent Check-In Call

If air transportation is being used, the parents will receive a check-in call from an NST staff member prior to the flight's departure. This call is relatively concise and primarily intended to update the adolescent's parents that our staff and their child/adolescent have successfully made it to the air terminal. If air transportation is not used, NST will call the parents based upon the duration of the drive as discussed in the planning stage of the transport. If any significant changes to the transport arrangements or incidents take place, parents (and the treatment program) will be notified immediately.

Release to Program

Once NST staff and the adolescent have reached the approved release location, or treatment facility, he or she will be relinquished from our care to the program. Most of the adolescent youth we work with will say goodbye with either a handshake or a hug as we wish them the best on their journey. We are able to depart like this because, in most cases, our staff have established respect and a rapport with the adolescent during the transport. While many of the adolescents we support are struggling with family and other issues, most are genuinely good kids and respond well to the dignity, respect, and care that our therapeutic transport staff give them.

Post-Intervention Call

Our therapeutic transport intervention and admission staff will contact the parents and provide a full report of the transport admission. They will also respond to any additional questions the parents may have.

Research & Experience Based:

Our transport admission process is based on the relevant treatment admission research and clinical experience, i.e., procedures that have demonstrated therapeutic utility in both the literature and in actual practice.

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