Organizations join forces to help teens with severe mental health challenges

Stanford Children’s Health and the Children’s Health Council have launched RISE, an intensive mental health outpatient program for adolescents ages 14-18.

Michele Berk

Stanford Children’s Health and the Children’s Health Council in Palo Alto have launched a joint program to offer intensive outpatient therapy to teens ages 14-18 who are struggling with suicidal thoughts and behaviors, self-harm or other severe mental health challenges.

The program is called RISE, which stands for “reaching interpersonal- and self-effectiveness.” It’s co-led by Michele Berk, PhD, assistant professor of psychiatry and behavioral sciences at the Stanford School of Medicine. Berk brings to the program extensive research and clinical expertise in dialectical behavioral therapy, a specialized intervention for individuals with suicidal or self-harming behaviors, or both. The new program is based on an existing intensive outpatient program at CHC.

According to Antonio Hardan, MD, chief of child and adolescent psychiatry at Lucile Packard Children’s Hospital Stanford, the program is filling a crucial gap in providing a comprehensive continuum of care for teens facing mental health challenges.

“The availability of an intensive outpatient program is critical for teens with different levels of severity of mental health problems,” said Hardan, who is also a professor of psychiatry and behavioral sciences at the School of Medicine. “Stanford and CHC have complementary expertise that make this program truly valuable for patients and families.”

The treatment covers the often overlooked but essential “middle ground” between weekly outpatient therapy and hospitalization, and provides support for patients who are transitioning between the two. The program also offers a critical step-down option for teens who have been discharged and are returning home from psychiatric inpatient or residential stays.

In addition to Berk, child psychologist Stephanie Clarke, PhD, a clinical instructor of psychiatry and behavioral sciences at Stanford, joins licensed clinicians from CHC who were trained through the Linehan Institute to provide all components of a comprehensive dialectical behavioral therapy program for adolescents. (Marsha Linehan, PhD, developed the therapy, a type of cognitive behavioral therapy, to treat borderline personality disorder. Dialectical behavioral therapy is now also used to treat other types of psychological disorders.)

Therapy offered for teens and families

RISE is housed at the CHC’s headquarters in Palo Alto, where participants attend a 12-week course for four days each week after school. After-hours phone coaching is available 24/7. The program includes individual therapy, a multifamily skills group and family therapy. Medication management is also provided by psychiatrists and Stanford child and adolescent psychiatry fellows for the duration of the program.

According to Berk, who was one of the principal investigators of a large clinical trial of dialectical behavioral therapy that was recently published in JAMA Psychiatry, the therapy is currently the only well-established, evidence-based treatment for decreasing self-harming behavior in youth. Hence, Berk said, the collaboration between CHC and Stanford Children’s Health provides “gold standard” treatment for these youth.

In addition to treating young people who have attempted suicide or engaged in self-harming behaviors, the program will also treat those with severe symptoms of anxiety, depression or suicidal thoughts and those who have experienced a significant decrease in functioning at school and at home — e.g., marked decline in grades, school absenteeism — for whom weekly or biweekly outpatient therapy is not effective for symptom reduction and improved functioning.

A hallmark of dialectical behavioral therapy is its inclusion of parents and guardians in treatment. In RISE, parents and guardians join their teens two times a week in a multifamily skills group, where they learn and practice the skills necessary to manage the teens’ symptoms.

“It’s critical that parents and guardians learn the skills and feel empowered to support their teens through a time of crisis,” said Ramsey Khasho, PsyD, chief clinical officer at CHC and the other co-leader of the program. “We are excited and proud to have developed a joint intensive outpatient program with Stanford Children’s Health to provide more teens and families with the best care possible.”

Hardan agreed. “Through CHC’s experience in the development and implementation of intensive mental health and academic programs and Stanford’s expertise in conducting research and providing care for adolescents with suicidal behavior, this program can be transformative for local adolescents who are in need of this level of care,” he said.

The RISE program is accepting referrals. Call (650) 688-3625 or email help@chconline.org to refer a patient.



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