What are therapeutic models?
The Toolbox uses the term ‘therapeutic models’ to describes established groups of theory and intervention from psychology, counselling and social work. The therapeutic models featured in this resource are:
- Motivational Interviewing
- Solutions Focused Therapy
- Cognitive Behaviour Therapy
- Adolescent Community Reinforcement Approach
- Narrative Therapy
- Family Focused Interventions
- Dialectical Behaviour Therapy
- Acceptance Committment Theory
Why did we choose these 8 models?
This section describes a set of therapeutic practice approaches or models that may be appropriate for use within youth AOD services. The selection is based on several considerations: evidence of effectiveness; practice wisdom; client characteristics; and the structural characteristics of the Victorian youth AOD service system that may affect the feasibility of implementation.
Seven different therapeutic models are described. Five have a strong evidence base supporting their effectiveness for use in the treatment of youth AOD problems and related difficulties, such as common mental health problems and offending behaviours. Two additional models (Narrative Therapy and Solutions Focused Therapy) are included because they are highly consistent with practice wisdom about the characteristics of effective services and programs for young people, and because they have already received substantial acceptance and implementation within youth AOD services.
The interventions described in this section have been selected based on three main criteria:
- They are well-established, ‘evidence-based interventions’ or ‘evidence-based treatments’ for AOD problems among young people
- They are in published lists of well-established, evidence-based interventions for other behavioural health problems commonly experienced by young people with AOD problems (particularly high prevalence mental health problems and offending behaviour)
- They address needs not fully met by other interventions and demonstrate several characteristics of effective service provision as outlined in Section 3.
All of the therapeutic models considered are consistent with key aspects of established theory about the development and maintenance of AOD and related psychosocial problems among adolescents.
What is a practice element?
A practice element is a discrete component of an active therapeutic intervention applied to the achievement of one or more specific therapeutic aims or intentions. The concept of a practice element is based on the idea that therapeutic interventions or models are comprised of numerous discrete and separable elements that can be combined in various ways.
This resource describes a set of therapeutic practice elements appropriate for use within youth- focused AOD services. These elements may also be appropriate for use in other settings such as youth- focused mental health services, youth justice services, youth and family services, and programs addressing problems such as homelessness, and disconnection from school and work.
Is it OK to use elements without being an expert in the theory?
A key premise underpinning the practice elements approach is that by breaking down complex therapeutic procedures into discrete elements, and defining these elements precisely, workers without specialist training in particular therapeutic models may be empowered to make the use of relevant elements an achievable part of their everyday practice.
This premise does not mean that all practitioners in youth-focused services should be expected to use, or be competent in, all the practice elements endorsed by the organisation. Nor does it mean that specialist training has no place, or that practice elements and modules are of little use for specialists.
Practice elements and modules can be used by practitioners working at various levels in service settings. Individual practitioners can select practice elements to design a wide variety of modules and configure these modules in ways that are individually tailored to the unique needs of individual clients. Agencies can use practice elements to design a limited set of modules that will be endorsed for use with particular client groups. Workforce development such as training and supervision may then focus on this limited set of modules. Supervisors can work with predesigned modules, or design their own modules, and use these to help guide practitioners in working with challenging problems that arise in practice. Specialist expertise in particular approaches is beneficial in the supervisory role, as is insight into the unique challenges of being a generalist.
Why do some elements cover the same areas (eg. Listening, problem solving)?
If therapeutic interventions are to be client-centred, developmentally appropriate and comprehensive, then the Victorian youth AOD service system needs a diverse variety of options ready to deploy.
A single model of therapeutic intervention is not enough to meet the diverse and changing needs of the young people seen in real-world services. Therapeutic practice frameworks must incorporate a high degree of eclecticism, drawing on a variety of different therapeutic models and traditions.
Some of these models cover the same areas of practice, for example, problem solving, as it is an essential area, but different practioners may prefer the language and tools of different models when working with clients.
How does this practice element approach help my clients?
A modular practice elements approach is suited to working with clients who have multiple and complex needs that cannot be met through traditional case work or by evidence-based programs that focus on particular diagnoses or single conditions. It is also useful in a variety of youth-work contexts such as residential settings, outreach and day programs.
Using the practice elements offers these key benefits over the traditional approach to implementing evidence-informed practices in youth-work:
- Easy tailoring to individual client needs
- Sensitive to context
- Ready integration into existing practice
- Amenable to varied modalities
- Cost efficiencies in training and support
- Common language for talking about evidence-based practice and usual care
- Can facilitate description and evaluation of usual care