The Child and Family Institute at Mount Sinai St. Luke's features a unique adolescent day program: the Comprehensive Adolescent Rehabilitation and Education Service (CARES). CARES is composed of two tracks, the Adolescent Alternative Day Program (AADP) and the Comprehensive Addiction Program for Adolescents (CAPA). Both programs offer a fully integrated academic experience, which is taught by New York City Department of Education teachers. The programs provide an intensive five-day a week therapeutic milieu from 9 AM to 3:15 PM throughout the academic year. During the summer months (July and August), CARES typically provides summer school classes, continued clinical services, and increased prosocial recreational activities from 9 AM to 1:30 PM.
The CARES educational component is provided directly by the New York City Department of Education. Referred teens must have successfully completed 8th grade and be eligible to work towards their high school diploma or the Test Assessing Secondary Completion (TASC, formerly GED.) All CARES treatment components are designed to address the specific problems that have interfered with each individual patient's academic and social success in the past. CARES teachers and clinical staff work hard to provide the education, life-skills training, and individually focused therapies that patients need in order to reach their goals.
PreCARES and AfterCARES
PreCARES And AfterCARES offer therapeutic services based on the CARES model. An adolescent in PreCARES may not believe they have a problem, even though others in their lives are telling them so. Alternatively, adolescents in PreCARES may be starting to acknowledge concerns about problems, and might consider changing, but are wavering or uncertain. Adolescents and Young Adults in AfterCARES are actively taking steps to make changes in their lives, or have achieved their initial goals and are now working to maintain their gains.
CARES Tracks: AADP and CAPA
Though they share the same educational and treatment resources, each of the two tracks offered by CARES has a distinct focus. The Adolescent Alternative Day Program (AADP) track is designed to help patients whose school performance has been affected most by mental health issues. The word "Alternative" in the AADP title refers to the more focused, individualized, safe, and respectful environment that patients are seeking when they apply here from regular high school settings. AADP, which utilizes a milieu treatment model integrating therapeutic and educational components, provides a unique opportunity to treat adolescents (ages 14-18) with severe emotional problems and school truancy.
The Comprehensive Addiction Program for Adolescents (CAPA) serves adolescents (ages 14-19) who are struggling with substance abuse, either as active users interested in stopping, or as persons in recovery. This program is designed for teens who require a significant level of structure to turn their lives around, but who can continue to live in the community. An integrated substance abuse/mental health model is used to allow for identification and treatment of all relevant issues. The program uses a harm-reduction model to help patients reduce and ultimately abstain from substance use. CAPA is run in collaboration with The Addiction Institute of New York and provides an alternative for New York City teenagers who have just started abusing substances or who have already been in significant substance-related trouble. These co-occurring problems may include: depression and other mood-related disorders, mild to moderate behavior problems (angry outbursts, disrespect, breaking family rules, lying, truancy, early run-ins with the police), school problems and/or legal problems.
CARES Education Component
CARES provides a full-time, diploma-granting high school education curriculum through the New York City Department of Education. In addition, certain patients will be able to opt for a TASC curriculum based upon their needs and preferences. Following New York State Education Department mandates, the diploma program enables patients to earn and accumulate credits as well as prepare for Regents exams. The diploma and TASC educational programs are run through the Re-Start Division of the New York City Department of Education.
CARES Treatment Model
CARES treatment is based on principles of Dialectical Behaivor Therapy (DBT) and the Transtheoretical Model of Stages of Change. CARES provides multidisciplinary therapeutic services to patients whose emotional and/or behavioral difficulties have interfered with their success at school. Clinical staff work together as a team to make an individualized treatment plan for each patient. The different parts of every patient’s treatment plan are described below.
1. Orientation Period
Admission to CARES begins with a 30-day orientation period in which the new patient is expected to arrive for school on time 5 days per week, to attend group and individual therapy meetings, graduate from motivation group, and to participate in family sessions as needed during this month. If these conditions are not met during this 30-day orientation period, CARES may extend orientation but reserves the right to dismiss the new patient from CARES and return clinical responsibility for him or her back to the previous clinicians.
2. Individual and Family Therapy
Patients will be assigned an individual therapist and a psychiatrist, who will monitor their progress on a weekly basis and will meet regularly with patients and their families. Therapists will help patients focus on treatment in order to target personal emotional, behavioral, academic, family and substance abuse goals. Additionally, pregnancy prevention, safer sex practices, and smoking cessation will be addressed in the treatment as needed. Once patients have set treatment goals, they and their therapist will monitor patient progress weekly at minimum. Patients will be required to complete behavioral analyses and weekly diary cards and other clinical measures as needed.
The clinicians at CARES strongly believe that the family has an enormous impact on the progress that each of our patients makes. We believe the family has valuable insight into their teen’s personality, strengths, and interests. Thus, we think it is very important to include the family in the treatment process. In addition to family meetings held at CARES, the CARES’ staff is available to meet with patients and families in the comfort of their home and community.
3. Group Therapy
Like school classes, group therapy sessions form an essential part of the daily learning curriculum at CARES. Every patient is assigned to a particular group schedule. We offer several kinds of groups, such as skills groups (including various creative art therapies), talk therapy groups, wellness groups, DBT groups (see below), and others. A major component of the CARES group program is modeled according to the principles of Dialectical Behavior Therapy (DBT), a highly effective treatment method for teenagers who wish to change from dangerous or self-defeating behavior patterns to more successful responses to stress. Five sets of skills will be taught in rotating periods throughout the year, in coordination with the treatment goals monitored in each patient's individual therapy. These five skill sets are:
Patients for whom drug or alcohol use is an issue will also be assigned to a weekly substance abuse recovery or relapse prevention group. Recovery groups are designed to support patients who are actively in recovery working towards a period of sobriety. Led by clinicians who have years of experience working with people in recovery, patients often find these groups to be a safe place to share their experiences with substance use and to develop specific goals for their own recovery. Relapse prevention groups consist of those patients who have successfully achieved a period of clean time (usually 4 weeks) and who are working hard to maintain their sobriety. Within these groups, patients have found comfort in sharing their feelings about being clean, admitting to any urges to use, and learning alternative ways to cope with new feelings and old habits.
During Orientation, all patients will attend a weekly Motivation Enhancement Therapy Group. Patients will learn about the stages of change, identify what brought them into treatment and areas of their functioning they would like to change, gain an understanding of how their stage of change will help determine their treatment goals, and begin to learn skills to help increase their motivation to achieve their goals.
In addition to the group therapy available to patients, CARES offers two groups for families. The Family DBT Group is open to all CARES patients and their family members after the school day. The five skill sets of DBT are taught to family members and reinforced with patients. In addition, families work together to apply DBT skills to difficulties that arise within their families. The Parenting Group is a support and psychoeducation group open to all Spanish-speaking parents after the school day.
4. Psychopharmacology/Medication Management
All CARES patients are evaluated by a psychiatrist for their medication needs. They must meet with their assigned psychiatrist on a regular basis. Each new patient must provide a written record of a recent physical exam, which will need to be updated at least once per year. Failure to do so can result in an interruption in medication management. Any changes to medication must be discussed with their psychiatrist beforehand. For patients under the age of 18 years old, starting new medications requires the written consent of a parent or legal guardian.
5. Psychological Testing
The service of psychological testing, including psycho-diagnostic evaluations and neuropsychologically-informed evaluations, is conducted for CARES patients when appropriate. Through the testing service patients and their families have the opportunity to better understand underlying brain functioning including cognitive profile, language and executive functioning as well as information processing ability. Patients and families can also ascertain information regarding how psychiatric symptoms affect daily functioning via testing. Families, the clinical treatment team, or school staff can refer a patient for an evaluation.
Patients attend daily academic classes taught by Department of Education teachers. Clinical staff works closely with the teachers each day to ensure that patients are attending their classes, working well with teachers and peers and participating to the best of their ability. On occasion field trips are part of the academic coursework.
7. Milieu Therapy
CARES clinical staff provide an intensive five-day a week therapeutic milieu where they engage in crisis intervention, solution-focused problem solving techniques, and brief counseling, to answer any questions or concerns patients may have about the program, to help reinforce program expectations and offer an opportunity for skills coaching and practice. Interventions in milieu are used as an opportunity to help patients generalize the specific clinical skills they learn in group and individual therapies. Milieu staff typically work outside of the classroom. However, when appropriate they will join teachers in the classroom, implementing behavioral interventions within the classroom that are based on the patient's individualized clinical treatment plan. Milieu staff are instrumental in assisting patients and educational staff in times of distress. Patients needing assistance will be directed to milieu staff or their therapist, and may be required to complete a modified version of a behavioral analysis or other de-escalation approaches before returning to class or community areas. The seamless collaboration between clinical and educational staff on the milieu enables patients to remain successful in the community while working through difficulties.
Each patient is expected to bring all of his or her individual strengths to the community in order to support fellow patients. We expect each community member to take this role of peer support seriously. This is demonstrated in small and big ways, and can include everything from cleaning up after oneself to being a good listener when appropriate. The completion of chores is part of this community involvement and responsibility. Chores are assigned to four patients each day. Chore assignments are posted on the kitchen bulletin board. It is the patients’ responsibility to check the chore schedule and follow through with the completion of his/her chore.
Additionally, community meetings are held on most school days. The Community Meeting provides each patient the opportunity to learn how to negotiate community issues effectively. Both patients and staff share the responsibility for working out any differences of opinion in a safe and respectful manner. Participation in the Community Meeting will keep patients informed about program events, allow patients to contribute to program decisions, and increase patients’ ability to assert themselves in a group situation.
9. Complementary Services
Patients often have additional needs that CARES cannot provide for, which may require involvement of other services. Such services may include AA or NA meetings, case management, waiver program, health home and community organizations including religious groups or after school programs. Participation in such services will be determined by each patient and his or her family with the help of the individual therapist. It may be decided that complementary services are required for a patient to continue in CARES. Case management services are often deemed necessary for patients attending CARES. If a patient does not have case management services, it is likely that the patient’s individual therapist will refer the patient and his or her family for services through C-SPOA (Child Single Point of Access).
Comprehensive Adolescent Rehabilitation and Education Service (CARES)
Department of Psychiatry and Behavioral Health
Mount Sinai St. Luke's Hospital
411 West 114th Street, 2nd floor
New York, NY 10025
To make a referral, please call our Intake Coordinator at (212) 523-3083.
Download the CARES application