The Case of the Psychosocial Intervention Program for Adolescents and Young Adults ("Ploes" E.PSY.ME.)[1]
[1] This paper is based on a lecture given at a conference held in October 2024 to celebrate the 30 years of operation of the Family Therapy Unit of the Attica Psychiatric Hospital, and a farewell to the founders of the Unit.
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[keywords: community cultural psychosocial intervention, community approach, adolescence, psychosocial difficulties]
The Psychosocial Intervention Program for Adolescents and Young Adults operates as a network of mental health units, specifically consisting of two community houses, a day center (with a mobile unit of professionals) for adolescents, and a protected housing apartment, to support young adults dealing with psychosocial difficulties. Community-based psychosocial rehabilitation and social and cultural integration are promoted through mental health interventions (individual and group sessions), cultural workshops, community group meetings, etc. An important concern of the program is ensuring continuity of care through the development of an individualized psychosocial intervention plan, with goals related to a) supporting adolescents (formation of social identity, reframing personal history), b) strengthening family relationships, c) empowering the community (supportive network), d) promoting autonomy, and e) providing cultural enhancement, educational support, and pre-vocational training.
Apart from a network of units, the Psychosocial Intervention Program for Adolescents and Young Adults also comprises a developing terrain for research, as the community and cultural psychosocial interventions that are designed and implemented, as well as the scientific hypotheses formulated, require systematic observation and evaluation. Research is applied through monitoring the operational data of the Program itself and its services, but also through investigating data regarding the progress of individual cases.
Simultaneously, the Program functions as a community network. The Day Center for Adolescents and Young Adults operates as an entry point and as a network and monitoring center that facilitates the continuation of care of the adolescents and their families within the community, by proposing and implementing community groups (groups with decision-making processes), community workshops (groups focusing on developing social and political awareness, citizenship, and developing bonds of social solidarity), digital literacy community groups, and collective community actions (cultural workshop festivals, community education programs, community mediation programs).
To this day, over two hundred adolescents and their families have been supported by the Program. By focusing on the level of the adolescent/young adult, the family, and the community, and by following a systemic therapeutic approach that takes into account the socio-ecological dimension, several intervention methodologies have been developed such as: a) collaboration with all family members, b) interconnection between services, c) operation of focused psychosocial intervention groups, and d) reflective groups. These methodologies are based on understanding the complexity of psychosocial phenomena (poverty, neglect, violence), recognizing our positions as professionals (expectations, social representations and biases, social privileges), and recognizing the Other as a subject (bearer of rights, bearer of meaning and knowledge - self - awareness, agency).
Collaboration with the Family
The care of the family is an essential prerequisite for the development of the life course of children and adolescents. Empirical data, in cases of children's removal from the family, show a positive correlation between parents' responsiveness to collaboration and care and the positive outcome of their children's psychosocial goals. In short, collaboration with the family and parents is a facilitating factor in supporting children, even in cases of conflictual relationships between spouses and teenagers with their parents. Family care appears to relieve children by creating the space for focusing on their personal goals related to their differentiation and autonomy.
Collaboration with the family is not an easy goal, as cases of families with psychosocial difficulties face the peril of economic, social, and cultural exclusion, whilst having to deal with Judicial and/or Municipal services (juvenile prosecutor, municipal social service) that intervene in order to remove their children from their care, which in most of the cases imposes further moral devaluation and secondary mistreatment. The Program's initial interventions aim at efforts to restore the family's relationship with services, through mutual recognition of the importance of the parental role, encouragement for family participation in the individual therapeutic plan, information about their rights, and advocacy. The purpose is to integrate parents into community processes of mutual support and all family members into family counseling and therapy sessions, as well as enhancing their access to community resources. The psychosocial interventions do not focus on the adolescents themselves as the epicenter of the problem, but are directed at the relationship of adolescents with significant others, with family members, and their community.
The Functional Interconnection of Mental Health Units
Supporting multi-victimized minors and families requires persistent, continuous, and comprehensive support. It is important that these are processes are undertaken by a group of professionals, by a community network and not by a single support unit. An important aspect of institutional mistreatment is the fragmentation of the support received by families from services, which are not organized horizontally and are not tailor made on the basis of a community support network designed to meet their specific needs (as mental health services should operate), but vertically, in the organizational framework of a political/governmental agency (such as a ministry). The functional interconnection of units and services can allow the emergence of a community network, which facilitates effective prevention and rehabilitation for the Mental Health and Social services recipients and, above all, it can allow continuity of care.
The operation of different units within a horizontal community network also promotes openness and extroversion of the group of professionals (preventing the development of institutionalization practices), facilitates interdisciplinarity (through collaboration of groups of professionals with different specialties), while allowing the adoption of a perspective that does not focus on the symptom or diagnosis of the adolescent, but rather expands to the community, detecting endogenous resources and opportunities to include the family as a whole.
The Focused Psychosocial Intervention Group
In the community approach, collaboration between services and units cannot be organized and function only as an institutional provision and process. The interconnection between services and units presupposes the collaboration of the professionals themselves, who, coming from different services and organizational frameworks, collaborate on the basis of the therapeutic plan for an adolescent. The team that emerges from this collaboration is described as a focused psychosocial intervention group, and consists of the key workers (focal points) of the different services supporting the family. The focused group is formed to support adolescents and the family, and meets regularly, with the aim of defining and monitoring the psychosocial goals that are jointly set.
The focused group is organized as a small-scale support network, with the aim of defending and meeting the best interests of adolescents and the family. Its function as a group allows the interchangeability of professionals' roles in positions of containment and boundary-setting. At the same time, it ensures mutual support among the members of the group themselves, mitigating burnout factors and feelings of frustration, while at the same time functioning as a collective multiplier of the individual efforts of professionals.
The Reflective Groups
The operation of a network through the function of groups, expresses proportionally, the proposition of the community approach for support through and within the community. The groups that need to be formed within a network are as many as the fields of intervention required. The best interest of adolescents and the family is ensured by the focused psychosocial intervention group. The operational framework of the Program is ensured by the staff group meetings of the unit. Supervision group meetings ensure openness and understanding of how the intellectual and emotional dimensions co-exist and interact. Ethics, intervention methodology, professional training, monitoring of the Program's operation, and any other dimension that raises issues for negotiation, requires the formation of a distinct reflection group.
The systemic approach can serve as an organizing principle for the development and operation of community services and networks, but, above all, for the continuous emergence of a perspective that allows reflection on the core functions of the Program and the network. The reflective function of the groups raises questions, concerns, and critical findings about the prospects and orientations of psychosocial intervention.
This function has highlighted the analogy of developmental milestones between adolescents and the Program itself. The autonomy, for example, of adolescents in view of coming of age is directly related to the need for the abolition of constant professional interventions and giving more space and agency to adolescents.
This function has also highlighted the need to support multi-victimized adolescents and families, not by "special services" (such as mental health units for delinquent adolescents), but by specialized networks. Networks that will be able to avoid attributing individual responsibility - expressed as blaming the family, parents, and caregivers for the child's condition - and, instead, accept the part of collective responsibility that concerns the community.
This function can also highlight the historical and cultural dimensions of social and political phenomena, such as child neglect, transitioning from the idea of "saving the child" to the position of "saving their environment, their family, their community".
