CHILD AND ADOLESCENT PROGRAM (CAP)

An Intensive Dialectical Behavior Therapy (DBT) Program for Teens and Young Adults, through age 20, with Impulsive and Self-endangering Behaviors

Blaise Aguirre, MD, Medical Director
Janna Hobbs, LICSW, Program Director
Michael Hollander, PhD, Day Hospital Director and Director of Training
Cynthia Kaplan, PhD, Administrative Director, Child and Adolescent Programs

Please call 877.967.7233 or e-mail 3East@mclean.harvard.edu.

3East Brochure (pdf) 3East Consultants Photo Gallery

3East at McLean Hospital is a premier, highly specialized, self-funded treatment program for individuals who are exhibiting self-endangering behaviors and emerging borderline personality traits that may present as depression, anxiety, impulsivity, eating disorders, substance use disorder, post-traumatic stress or self-injury.

The program specializes in intensive dialectical behavior therapy (DBT), a therapy originally developed for adults with borderline personality disorder that has been applied with success to adolescents with similar psychological profiles.

3East now offers three levels of individualized care; enabling patients to fully benefit from ongoing, consistent treatment and support at varying levels of care:

• 3East Residential Intensive. A program for young women, ages 13 through 20.
• 3East Residential Step-down. A program for "graduates" of the "3East Residential Intensive" treatment, ages 13 through 20.
• 3East Day Program. A mixed-gender, non-residential day program, for individuals, ages 13 through 20, who live in the surrounding area or have completed the 3East Residential Intensive program and reside on the 3East Step-down unit.

To learn more about other opportunities that exist for individuals needing support outside of the hospital setting, i.e., work or school, please contact the program at the phone number and email listed above.

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About Adolescent Borderline Personality Disorder

Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, emotions and impulse control. It can be provisionally diagnosed in adolescents when symptoms persist for more than one year. While by nature the personality of adolescents is still developing, the diagnosis of BPD can be made with great care and on the basis of a thorough history and evaluation of an adolescent's thinking style, emotional coping patterns and interpersonal mode of functioning.

Dialectical Behavior Therapy (DBT) has been shown to be one of the most successful and effective treatments for these patterns of behavior. Currently, 3East is unique in offering an intensive, immersion course of DBT in a residential setting to adolescent females. Click here for more information on BPD.

What is Dialectical Behavior Therapy (DBT)?

DBT is a cognitive-behavioral treatment approach that emphasizes the development of four skill sets: mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. DBT was developed initially to treat suicidality in adults with borderline personality disorder; however, it now is being used effectively in adolescents with similar self-harm behaviors as well as other co-occurring psychiatric illnesses. DBT is an empirically supported technique, meaning that it has been clinically tested for its effectiveness in adolescents and adults.

3East Treatment Philosophy

One of the core principles of DBT is the balance of acceptance and change. At 3East, validation strategies and cognitive behavioral protocols are used to help patients stay committed to treatment as they attempt the challenge of changing ingrained behaviors. Staff members work to identify issues that may be reinforcing a patient's unhealthy behavior in order to develop individualized treatment plans and contingencies for long-term benefits.

3East provides the treatment in an intensive form to allow for faster skill acquisition. This structure focuses on the reduction or elimination of the behaviors that are dangerous or get in the way of the teen's capacity to utilize outpatient treatment, while providing new skill sets to support healthier functioning.

Program Components

Treatment components at 3East include classroom-based DBT skills groups, individual DBT, group therapy, skills coaching, and parent guidance. Additional treatment components, at the residential level of care, consist of case management, psychopharmacology evaluation and treatment, milieu therapy and recreational therapies.

Other features unique to the residential program include an all DBT-trained staff and female-only patient population. Throughout each level of care, groups are kept to an intimate size. These benefits, and others, contribute to each individual's sustained improvement.

Admissions

Prospective patients are pre-screened over the telephone. If 3East is an appropriate placement, an in-person interview is scheduled with the patient, her parents and members of the 3East treatment team. The team assesses the patient's appropriateness for admission and provides the patient and her family with an orientation to the goals of treatment. The interview also serves to provide the potential patient with the motivation to fully utilize the treatment.

For information, call 877.967.7233 or e-mail 3East@mclean.harvard.edu

Assessment and Evaluation

Patients receive a thorough evaluation by a highly specialized clinician in consultation with the 3East medical director. The evaluation may entail discussion of both short- and long-term medication treatment options; preferred therapy modalities; family interventions; transitional care planning; and educational recommendations.

If needed, additional specialty consultations are available in the following areas: eating disorders, neurology, trauma, psychopharmocology, educational testing and attention deficit disorder. Following the initial consultation, a multidisciplinary team of clinicians and clinical support staff develop an individualized treatment plan.

Length of Stay and Continuum of Care

Specializing in intensive dialectical behavior therapy (DBT), 3East offers three levels of exceptional care:

• 3East Residential Intensive
  

  The program, for females, ages 13 through 20, is located in newly renovated quarters on the grounds of the world-renowned McLean Hospital. 3East Residential Intensive provides residential 24-hour care and offers extended lengths of stay of 28 days or longer.

  A minimum stay of 28 days is required to complete the DBT curriculum and to glean the full benefits of the treatment. This length of stay enables staff members to determine the most effective way for patients to achieve their goals. It also affords patients and their family members the greatest opportunity to learn the skills and strategies necessary to achieve progress, and to begin to put the skills into practice in their lives.

  Click here to view the "Typical Daily Schedule" for this program's level of care.

• 3East Residential Step-down

  This level of care is for young women who would benefit from longer-term treatment following their completion of 3East Residential Intensive. This residential step-down program is located in newly renovated quarters adjacent to the 3East Residential Intensive program. Access to this less-intensive level of care is offered once the treatment team has determined that the patient is clinically ready for it. The length of stay is determined by the treatment team and is largely based on the patient's treatment goals.

  Residents at this level of care may attend 3East's Day Program or the Arlington School. Arlington School is a nationally recognized accredited high school. The day program and the Arlington School are located on the McLean Hospital campus in Belmont, Mass.

  Click here to view the "Typical Daily Schedule" for this program's level of care.

• 3East Day Program

  The 3East Day Program is a mixed gender program for individuals, ages 13 through 20, who live in the surrounding area or for the females who are attending the 3East Residential Step-down Program. The Day Program runs from 9:00 AM to 3:00 PM, Monday through Friday. The program is open year-round. It is closed on the holidays observed by McLean Hospital. Individuals attending this program benefit from on-going treatment and support from a highly skilled treatment team in the context of a full DBT treatment program.

  3East Day Program is located on the McLean Hospital campus in the "Academic Center Annex" building. Click here to view the "Typical Daily Schedule" for this program's level of care.

Highly Trained and Compassionate Staff

The 3East staff has extensive experience in the clinical application of DBT to adolescents with emerging traits of borderline personality disorder (BPD) and other complex psychiatric diagnoses. Staff members have chosen this patient population as their area of interest and expertise. They pride themselves on the highly specialized and effective treatment they provide to address the often challenging problems presented by this population.

Parental Involvement

Parental involvement is critical to the initial and ongoing success of treatment. Parents are kept in close communication with staff throughout the course of their child's stay. For parents of children enrolled in 3East Residential Intensive, parents participate in the initial evaluation and receive a program orientation. Parents are allowed scheduled visits, and passes are used as opportunities for patients to practice new behaviors and skills.

Because patients consistently make more effective use of treatment if their parents learn the same skills as them, parents of the females in residence are encouraged to attend skills training groups offered at 3East every Monday from 9 to 11 am. Additionally, staff members may be paged anytime for coaching. Family meetings and telephone conferencing further support families in practicing new skill sets.

Discharge Planning

Upon completion of the 3East Residential Intensive program, the treatment team works closely with each patient and their family to develop an appropriate, individualized aftercare plan. Based on a patient's clinical and academic needs, their situation, progress made during treatment as well as the vocational goals in mind for the patient, the treatment team may recommend that continued treatment, at a less intensive level, be provided at McLean Hospital's 3East Program. The continuity of care offered at 3East Residential Step-down and 3East Day Program reinforces the skills learned in a familiar, supportive and caring environment, minimizing disruptions in treatment by allowing the patient to keep the same individual therapist.

Parents can also be provided with referrals to educational consultants who can further assist with the transition of returning to an academic environment outside of the McLean grounds.

Academics

Academic tutoring is available upon request to 3East patients. Program staff works with a patient's home school to assist the family in developing a realistic and appropriate academic plan that may be implemented during treatment and after discharge. Upon completion of the intensive phase of the treatment, patients may elect to attend McLean's Arlington School (www.thearlingtonschool.org), an accredited school for students in grades 7 to 12.

Program Accommodations

3East is located on the bucolic, tree-filled campus of McLean Hospital in Belmont, Mass., which U.S. News & World Report ranks as the nation's top freestanding psychiatric hospital. Though McLean Hospital is located only minutes from Boston, its rural setting offers an idyllic, peaceful environment for patients to focus on their improved mental health.

3East derives its name from its location on the third floor of East House, one of several historic buildings on the hospital campus. The program offers:

• comfortably appointed bedrooms;
• tastefully designed common areas for groups and conversation;
• access to a new, state-of-the-art fitness facility located on the McLean campus; and
• airport transportation.

Overnight Visitor Accommodations

For information on overnight accommodations, please (click here).

Typical Daily Schedules by Level of Care

3East Residential Intensive Typical Daily Schedule
8:00-8:45 am	Morning Routine
8:45-9:00 am	Breakfast
9:00-9:30 am	Daily Goals Group
9:00-11:00 am	DBT Skills Instruction and Acquisition
11:00-11:45 am	Individual Therapy or Core Mindfulness Practice
12:00-1:00 pm	Lunch
1:00-2:00 pm	Relational Dilemmas Group
2:00-3:00 pm	Expressive Therapy
3:00-4:00 pm	Room Time
4:00-5:30 pm	Recreation/Field Trips/Free Time
5:30-6:00 pm	Proctored Homework Time/DBT Tutoring
6:00 pm	Dinner
7:00 pm	Fitness Center
8:00-10:00 pm	Group Activities/Quiet Time
10:30 pm	Lights Out

 

3East Residential Step-down Program Typical Daily Schedule
7:00-8:00 am	Morning Routine
8:00-9:00 am	Breakfast at Cafeteria
9:00 am-3:00 pm	Arlington School or 3East Day Program
3:00-4:00 pm	Room Time
4:00-5:30 pm	Individual Therapy Time
5:30-6:15 pm	Dinner
6:15-7:00 pm	Homework Time
7:00-9:00 pm	Fitness Center Mindfulness Group
9:30-10:00 pm	Free Time and Bed Time Routine

 

3East Day Program Typical Daily Schedule
9:00-10:00 am	Emotion Regulation
10:00-11:00 am	Interpersonal Effectiveness
12:00-1:00 pm	Lunch
1:00-3:00 pm	Skills Focused Academics/Vocational Support

11.2009