Respectful Adolescent Transports: Principles and Dynamics

By: Kacy Silverstein, M.Ed., NCC & Heather R. Hayes, M.Ed., LPC, CIP, CAI
September 13, 2017

Here’s the nightmare: Something in the family system has gone awry and parents must make the emotional decision that their son or daughter would be better cared for in a treatment program away from home. The family arranges treatment somewhere and decides that their child would be better supported by having transporters assist her on the journey to treatment. So, after much deliberation and agonizing, parents hire transporters to come into their home, wake up their child (usually in the middle of the night or early morning), and whisk them away. Often, this “whisking away” involves force, screaming, attempts at running away, and further fractures in family relationships. This type of transport always involves trauma. Years later, children recount stories of the “big, scary men” who came into their rooms, “gooned” them, and took them out of their homes and forced them into cars for long road trips to an unknown treatment center across the country.

Unfortunately, this nightmare is a reality for many families, who with the best of intentions, hire youth transportation services to facilitate the transport of their child to residential treatment, wilderness programs, or a therapeutic boarding school. So, why do families do this? They recognize that their child needs help and they don’t know what else to do. They trust the websites and voices on the other end of the line telling them that this is the best course of action. They put their faith in a process that they have been promised is in their child’s best interest.

Here’s the other reality. Adolescent transport does not have to look like the scenario shared above. In fact, it can and should look much different. At Heather R. Hayes & Associates, we believe that adolescent transport should be compassionate, safe, and trauma-informed. As a result, we have developed a Respectful Adolescent Transport Protocol ® to support families throughout the transport process. Currently, many adolescents arrive to treatment involuntarily while other agree to go following an intervention or family meeting. Regardless of the circumstances surrounding the decision to have a child enter residential treatment, the transport process should always emphasize a child or adolescent’s self-worth and dignity. A trauma-informed approach to adolescent transport is one in which all parties involve recognize and respond to the impact of trauma and engage in efforts to strengthen resilience. What does this process look like?

Respectful Adolescent Transport Protocol® in action

When a family hires transporters, they should feel confident that the care their child receives is grounded in model that takes into account traumatic stress, adolescent development, and protective factors. The Respectful Adolescent Transport Protocol® involves two trained transporters who are aware of the client’s history, including history of trauma, substance use/abuse, and mental health concerns. An essential element of this protocol is the constant involvement of parents and others in the family support system. Prior to the physical transport, our clinical team prepare the family regarding what to say to their child about the transport process. This preparation includes a meeting with transporters, family, and other loved ones to outline the transport process and coach family on how to speak to their child about the transport. As part of this process, parents and family members are asked to write a letter to the young person being transported. The focus of this letter is two-fold. First, the letter emphasizes the family’s love for their child and their positive qualities, strengths, and resilience. Second, the letter further reinforces that the family has made this decision with their child’s best interest in mind and will not back down from their decision to seek treatment on their child’s behalf. This letter provides a solid foundation for the introduction of our transport service, emphasizing both the family’s love for their child and supporting the family in being accountable for their decision to engage treatment.

Transports are often done in conjunction with an intervention but regardless of whether an intervention has occurred, our team works diligently with families to minimize the risk of traumatizing or re-traumatizing a young person. On a practical level, this means that we do not wake children in the middle of the night and escort them out of the home. This act alone is traumatic and unnecessary. Our protocol respects and supports the dignity of each child being transported, and focuses on parental accountability, building rapport with the young person, and acknowledging their resistance and frustration in a trauma-informed way. In addition, the family is not asked to leave the home while the transporters are speaking with the child. The child’s potential responses are normalized and predicted for the parents. Safety and containment is always the priority and the child understands that this is the decision that has been made by the family. Having the family express their love and reasoning for their decision to send their child to treatment also supports the paradigm of healing and change for the entire family system and well as reduces abduction trauma.

Our transporters understand that trauma can contribute to a slew of behavioral traumatic adaptations and that these behaviors can include physical intimidation, verbal assaults, dissociative behavior, or overly compliant behaviors. How transporters respond to these behavioral adaptations is critical to a successful transport experience, as many adolescents are not excited about the idea of treatment. From a trauma-informed perspective, behaviors are not perceived as good or bad but simply as information. This information allows transporters to tailor their responses to the specific needs of each client.

From the outset, it is the responsibility of the transporter(s) to make the client feel safe. How is this accomplished? The first step involves building authentic relationships. This is accomplished by setting clear, healthy boundaries with the client and engaging in resistance from a place of understanding.

In addition, transporters listen deeply to client’s stories and show genuine curiosity about their lives. Transporters make it a priority to share information with clients about each step of their journey – what to pack, method of transportation (rental car, flight, etc.), who will be traveling, etc. Adolescents, especially those who have experienced trauma, have little to no control over their own lives. In many cases, parents have worked with an interventionist or intervention team to set up treatment and the interventionist and transporters inform the client about this decision. Therefore, it is critical that transporters emphasize what choices are available to clients in order to re-build a sense of self efficacy and personal control. While a client may not get to choose whether or not they go to treatment, transporters can offer simple choices that can help a client feel safe and empowered – food options, movie options for the trip, etc.

Transporters stay with a young person from the moment of introduction until they reach their final destination. Throughout their journey, transporters keep parents informed of their progress and provide updates regarding the emotional and physical well-being of their child. Our Respectful Adolescent Transport Process® underscores a young person’s right to be treated with dignity and respect, while still providing safe transport to treatment programs. In addition, our protocol embraces the following principles as essential to successful transportation of adolescents:

  • A client’s safety and wellbeing is most important during any transport experience.
  •  Transporters are an important part of the client’s treatment team and their actions should support the establishment of safety, relationship building, and mutuality.
  • It is normal for clients to struggle in this process and the job of the transporter is to ease fears, de-escalate crisis, and offer soothing, calming communication and genuine concern.

To learn more about our Respectful Adolescent Transport Process, please email info@heatherhayes.com or call 800-219-0570.