ACA Blog

Ryan Thomas Neace
Apr 25, 2011

90-Days to Change: A Forward Thinking Addition to Existing Interventions for At-Risk Youth

90-Days to Change is a comprehensive, Total Life Approach to treating adolescents and young adults, offered by my practice, The Change Group, Central Virginia’s only Total Life counseling agency. Rather than offer an exclusive focus on psychological interventions, it seeks to impact functioning across multiple spheres, including Biological, Psychological, Social, and Spiritual. Interventions in each sphere include (but are not limited to): • Biological: Nutritional Awareness and Diet Coaching, Exercise Training, Yoga • Psychological: Individual and Group Therapy • Social: Group Therapy, Vocational Coaching, Social Cue Coaching, Characterological Development • Spiritual: Yoga, Meditation/Mindfulness, Virtue Coaching, Child/Family-Specific Religious Support Models that integrate various spheres of functioning such as 90-Days to Change dominate the current treatment research, particularly as it regards addiction or substance abuse (DiClemente, 2003) (e.g., Griffiths, 2004), with which many juvenile offenders find themselves struggling. Adolescent addiction help should be of sufficient intensity and duration to achieve maximum changes of attitude as well as behavior, and target to multiple domains of their lives. (Bukstein, 1994; Sanjuan & Langenbucher, 1999) Treatment should address: • Recreational activities (biological) (Bukstein, 1994) • Co-existing psychiatric disorders (psychological) (Bukstein, 1994) • Vocational/educational issues (social) (Bukstein, 1994) • Spiritually sensitive and actively integrated (spiritual) (Bukstein, 1994; Morgan, 1998; Ringwald, 2003; Bubnack, 2007) Non-addiction based research also supports the idea of multimodal and/or integrative approaches, either explicitly or implicitly, particularly for at-risk populations. For example: • Criterion used to evaluate child well-being consistently supports evaluating across multiple planes, such as physical health, psychological health, social health, educational achievement and cognitive development (U.S. Department of Health and Human Services Child and Adolescent Health Measurement Initiative, 2003), and spiritual or religious involvement (Lippman, 2003). • The nonprofit, nonpartisan research center that studies children at all stages of development, ChildTrends, studied 31 comprehensive programs targeted at youth development during the critical transition from adolescence to adulthood. A vast majority of the programs assessed that used skills training designed to improve educational attainment, employment, substance abuse, and delinquency were found effective in at least one outcome. For those programs that intervene with adolescents age 16 or younger, positive impacts on at least one indicator of education or career success were seen. For younger youth, positive impacts were seen in education attainment, school attendance, school engagement, college attendance, employment, earnings, and welfare dependence outcomes (ChildTrends, 2010). • Emotional intelligence and exercise are positively correlated (Tsaousis & Nikolaou, 2005). Yet, adolescents’ propensity to exercise is impacted by their perceived levels of confidence in physical education itself. I.e., In order to exercise, adolescents need coaching to increase their sense of competence (Shen, McCaughtry, and Martin, 2008). • Nearly half of the adolescents in America feel that religion is an important part of their daily lives (Smith & Denton, 2005). Strong religious beliefs and behaviors can enhance personal health and well-being and reduce risk-taking behavior, and thus can potentially strengthen future family functioning for young adults (Hair, Moore, Kuhfeld, & Sidorowicz, 2009; Child Trends, 2002). The above examples but scratch the surface of the available literature suggesting there ought to be more integrative approaches in the treatment of at-risk youth. Ironically, however, we’ve been able to locate precious few programs even attempting such an approach. Thus, it is worth considering the potential outcome of this program on typical at-risk youth. DeShawn: A Hypothetical Vignette DeShawn is a struggling 14-year old African American. His teachers report he was once a good student, but since his father’s incarceration 8 months ago he’s become progressively withdrawn, lethargic, irritable, and rebellious at times. He’s lost interest in basketball because his dad is no longer around to coach him, and doesn’t eat much other than a pop tart in the morning and soda throughout the day. Lately, he has missed an exorbitant amount of school, prompting truancy charges. His mother is his primary caretaker, and she works 2 jobs to support he and his siblings. Though she tries in earnest to work with DeShawn, her efforts are often met with resistance or indifference from him. She cannot motivate him to go to school, and cannot always be home to drive him herself. He has entered the Community Court, a local court diversion program, by his and his mother’s election regarding the truancy charges. The disposition team believes his circumstance could greatly be helped by an integrative approach to DeSahwn’s situation, and assigns him for grant-funded services at The Change Group. 90-Days to Change. Though he’s initially resistant to therapy, DeShawn does respond well to exercise training. He’d always wanted someone to show him how to increase his leg strength to put more “oomph” into his jump shot, but had given up on the idea since his father’s incarceration. He confides in his exercise coach that he quit basketball because he was just too depressed and distracted trying to care for his house while his mother is at work and make sure his siblings do their schoolwork. The exercise coach encourages DeShawn to share this information with his therapist. He reminds DeShawn that the progress he’s made in exercise training is indicative of just how much he has going for him, and that it would be a shame not to get the help he needs. His exercise coach also makes DeShawn’s nutrition coach aware of DeShawn’s increased exercise and need for effective diet, and a meal plan is suggested for him. DeShawn likes the meal plan because he’s “always wanted to know how to cook more stuff!” He and his mother implement it with moderate success, but it is enough to get help DeShawn begin to feel some momentum. DeShawn has learned to trust his exercise coach, so he decides to trust his therapist as well. As they begin treatment for depression, DeShawn is finding his symptoms of lethargy and irritability lessening, and is showing new interest in sports and school. He has more energy and even inquires about what it takes to get into college. Sensing the momentum, DeShawn’s therapist broadens their therapy sessions to include brainstorming sessions regarding the academic, financial, and social requirements to attend college. His therapist suggests that DeShawn and a social coach attend an upcoming college fair, and DeShawn confesses that he gets nervous around large groups of adults. Having primarily interacted with his mother and grandmother for some time now, he explains that he doesn’t really know what to say or how to talk to other adults without “sounding stupid.” DeShawn spends time with his social coach, and they work through a short social etiquette curriculum that prompts DeShawn about appropriate dress, eye contact, and approach with adults. The college fair comes and goes, and though he’s still a bit wobbly, he reports back to his therapist that “it was actually fun!” So fun, in fact, that it reminded DeShawn of the last time he’d really had good interaction in a large group of people – when he attended church with his grandmother. He’d liked going, but had just kind of stopped when his mom began working her second job. At DeShawn’s request, he and his therapist contact his grandmother by phone, and she agrees to start picking him up for youth group. After several weeks, DeShawn reports that he has gotten a few new friends, and is wondering what implications church, religious life, and spirituality have on his behavior. He even wonders what it means about his father’s incarceration, and whether he needs to find a way to forgive him for “leaving me and my mom.” At the end of 90-Days, DeShawn has faithfully completed his program, and teachers are reporting steady class attendance. He still has occasional fits of the blues because of his dad’s absence, but continually receives reinforcement from his youth pastor. DeShawn decided to try out for the YMCA youth basketball team, and made it. His coach is “not like my dad, but still pretty good.” DeShawn’s coach reports that DeShawn has shown other team members some of his leg strengthening exercises, and has even been known to chide them if they drink too much soda. DeShawn’s mother “can’t believe he’s the same kid!” Core to this Total Life Approach is the notion that as functioning in one plane increases, reciprocal positive outcomes are anticipated for its counterparts. E.g., as an adolescent’s sense of social cue mastery increases, so does his psychological functioning via more positive self-talk and self-concept. As self-concept improves, that same adolescent is more apt to try new activities, such as a sport or hobby with which he or she was previously unfamiliar. Physically engaging sport has a double impact as the adolescent reaps the neurochemical rewards of exercise as well as a new found agency for both conquering the unfamiliar and physical agency. All of this leads the individual toward more active social engagement, which leads to involvement in civic or religious community, which starts the whole process over again. Indeed, 90-Days to Change rests on the notion that there is a cascading, recycling progression between interventions and their results that feeds on itself, gaining more and more momentum with each successive stride. Certainly, there will be misgivings, but the sheer volume of support and spectrum of services provided provides an implicit, failure-absorbent cushion that creates a prime environment to understand and grow from mistakes. I will continue to keep you abreast of changes, new developments, growing pains, and success stories as our practice seeks to enrich the lives of those with whom we interact! Let me know what you think, or if there are suggestions you have for us to look at similar programs elsewhere to benchmark! If we are to teach real peace in this world, and if we are to carry on a real war against war, we shall have to begin with the children. --Ghandi

Ryan Thomas Neace is a counselor, professor, and entrepreneur. He is the co-founder and managing director of The Change Group. More at

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