The Child and Family Institute at Mount Sinai St. Luke's Roosevelt 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.

CARES Description The purpose of CARES is to provide a safe and therapeutic school environment for New York City public high school students whose previous school performance has been limited by emotional and behavior difficulties, including alcohol or drug problems. CARES provides both educational and therapeutic components, including substance abuse treatment for students who use drugs or alcohol. We help teenagers become motivated, examine and change their destructive behaviors, learn to cope effectively with life stresses, and become abstinent from mood-altering substances.

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 student'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 students need in order to reach their goals.

CARES is a safe and friendly place, and all rules and policies are intended to maintain the respectful community that helps our students to succeed. As members of the CARES community, all students and families must be familiar with the rules and expectations, and all must agree to abide by them in order to participate at CARES. These rules and expectations are described in the CARES Handbook

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 students 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 students 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 students 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 students 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 students 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 students 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 student. The different parts of every student’s treatment plan are described below.

1. Orientation Period
Admission to CARES begins with a 30-day orientation period in which the new student 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 student from CARES and return clinical responsibility for him or her back to the previous clinicians.

2. Individual and Family Therapy
Students will be assigned an individual therapist and a psychiatrist, who will monitor their progress on a weekly basis and will meet regularly with students and their families. Therapists will help students 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 students have set treatment goals, they and their therapist will monitor student progress weekly at minimum.  Students 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 students 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 students 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 student 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 student's individual therapy. These five skill sets are:

  • Mindfulness Skills (to increase awareness of feelings and thoughts experienced through the day)
  • Distress Tolerance Skills (to teach how stress and bad news can be handled)
  • Emotion Regulation Skills (to teach how to recognize and manage difficult thoughts and feelings)
  • Interpersonal Effectiveness Skills (to teach how to make and keep positive relationships)
  • Walking the Middle Path (to teach that there is always more than one way to see a situation and solve a problem)

Students 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 students who are actively in recovery working towards a period of sobriety. Led by clinicians who have years of experience working with people in recovery, students 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 students who have successfully achieved a period of clean time (usually 4 weeks) and who are working hard to maintain their sobriety. Within these groups, students 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 students will attend a weekly Motivation Enhancement Therapy Group. Students 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 students, CARES offers two groups for families. The Family DBT Group is open to all CARES students and their family members after the school day. The five skill sets of DBT are taught to family members and reinforced with students. 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 students are evaluated by a psychiatrist for their medication needs. They must meet with their assigned psychiatrist on a regular basis. Each new student 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 students under the age of 18 years old, starting new medications requires the written consent of a parent or legal guardian.

5. Academic/Education
Students attend daily academic classes taught by Department of Education teachers. Clinical staff works closely with the teachers each day to ensure that students 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.

6. 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 students 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 students 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 student's individualized clinical treatment plan. Milieu staff are instrumental in assisting students and educational staff in times of distress. Students 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 students to remain successful in the community while working through difficulties.

7. Community
Each student is expected to bring all of his or her individual strengths to the community in order to support fellow students. 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 students each day. Chore assignments are posted on the kitchen bulletin board. It is the students’ 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 student the opportunity to learn how to negotiate community issues effectively. Both students 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 students informed about program events, allow students to contribute to program decisions, and increase students’ ability to assert themselves in a group situation.

8. Complementary Services
Students 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, and community organizations including religious groups or after school programs. Participation in such services will be determined by each student and his or her family with the help of the individual therapist. It may be decided that complementary services are required for a student to continue in CARES. Case management services are often deemed necessary for students attending CARES. If a student does not have case management services, it is likely that the student’s individual therapist will refer the student and his or her family for services through C-SPOA (Child Single Point of Access).

Comprehensive Adolescent Rehabilitation and Education Service (CARES)
Child and Family Institute
Mount Sinai St. Luke's Hospital
411 West 114th Street, 2nd floor
New York, NY 10025
(212) 523-7233

To make a referral, please call our Intake Coordinator at (212) 523-3083.
Download a CARES application

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