Blamed and Ashamed: The Treatment Experiences of Youth With Co-occurring Substance Abuse and Mental Health Disorders and Their Families

The Questions

1. Where would you go to get information about substance abuse and mental health services?
2. How would you want information distributed to the community (schools, justice department, etc.) about substance abuse or mental health issues?
3. How has your substance abuse and mental health affected your family and everyday living?
4. Describe your substance abuse and mental health services. What could have made those services better?
5. What was the first residential treatment session you received like? How did you want it to be?
6. How could the initial residential treatment interview have been changed?
7. What kind of residential treatments have you received for your substance abuse and mental health issues? How were your substance abuse and mental health treatments combined? How would you combine them if they weren't?
8. Do you feel that your substance abuse led to your mental health problems or vice versa?
9. What was your aftercare program like? What did you need for a stronger aftercare program?
10. What was more important to focus on when you started your treatment, substance abuse or mental health issues?
11. How did you get into treatment? How did you want to get there?
12. What decisions would you have liked to have made about your treatment that were different from the choices you were given?
13. How were your parents' views on your treatment needs different from your own?
14. Which are you more comfortable with, telling people that you have a substance abuse problem or that you have a mental health problem?
15. If you were to relapse, whom would you tell and why?
16. Did they allow you/invite you to evaluate the services you received?

Responses to Questions

There were hundreds of pages of transcripts from the focus groups and interviews. All were chock full of powerful statements about individual experiences yet each had features in common with many others. The responses to the questions are summarized below and illustrated with quotations from the transcripts.

Where would you go to get information about substance abuse and mental health services?
Youth	Parents
Youth identified many sources where they would seek information. These included professionals or service programs such as school counselors, Narcotics Anonymous, or community mental health centers as well as family members and friends. A few did not know where they would go. In choosing where to go, knowing that the source had experience with the issues and was reliable and trustworthy was important. "I'd go to a friend, or someone with experience, a peer. I'd go to a counselor at school." "I need someone I can go to as an older role model, someone I can trust, a ‘peer advocate’ or someone who has been through this."	Parents did not know where to go other than to agencies and programs that provide substance abuse treatment or mental health services. However, they said the information they got did not help them recognize their son or daughter was in trouble and needing help. "There was essentially no information before our child went to treatment." "I looked at church, youth groups, recreational centers, movies, television, and treatment centers for the right information—nothing fit our situation."

How would you want information distributed to the community (schools, justice department, etc.) about substance abuse or mental health issues?
Youth	Parents
All youth thought other youth were the best source of information and suggested ways their personal strengths and talents could be used to distribute information (i.e., public speaking, writing poetry, rapping, youth crisis and warm lines). They advised that brochures, tapes, public service announcement, and such should be up to date and ‘real.’ They stated that word of mouth, preferably from peers, is effective and suggested door-to-door campaigns and personal testimony at rallies and school meetings. "I think they just have to listen to my story. I can give a lot of information because it's real. I lost everything and have all these health problems that follow and all that kind of stuff." "I think they should offer information about symptoms, services, and programs everywhere, so we can't, our parents can't miss it and will have it when we need it."	Parents thought parents who have been through it should educate other parents. "There needs to be a group of us, of us normal parents, who have children who were in trouble so we can relate to each other and so we can go out and tell other parents they are not alone." About half of them also thought the schools have a role to play and suggested using "parents who have recovering kids to talk to other parents" during drug awareness week and other school based opportunities for parents to share information. They also recommended: "Classroom resource guides so teachers can incorporate discussions." "Internet, school-based health and mental health centers, youth ministries, and parent hotlines and information centers."

How has your substance abuse and mental health affected your family and everyday living?
Youth	Parents
Youth experiences varied. Most reported that family life was really bad when they were using drugs. "It basically tore the family apart." "It's crazy around the house like she doesn't trust me with anything." "I'm fighting hurt feelings. My family turned their backs on me. They gave up on me because of ignorance, pain, and frustration. I am angry about that." "I just kind of quit everything." Some of these young people also acknowledged that their parents' efforts at supervision didn't work. "They tried locking me up in the house to keep me away from guys, keep me off the streets. It didn't work, it made me madder, made me run away." "She wants to keep me off the streets and it don't help. I just keep doing it cuz the weed has control over me right now and I don't listen." "They're trying to help me out, you know. I respect that, but it's my life." Some youth described parental indifference to their substance abuse or complicity with it. "My dad does it too and it's ok as long as I do what I gotta do, he don't really care." "I'm around it every day, since my mom's boyfriend is always getting high downstairs. She doesn't really care because she knows that he gives it to me and my friends sometimes." Youth also expressed specific concern about the impact on schoolwork and especially on younger siblings. "It affected our family in huge ways. I am the bad apple. My mom vows that I will spoil my brothers and sisters. I have." The few youth who felt there was little or no impact on their family attributed it to their family not knowing about their problem. Youth felt punished and abandoned when they were sent away. They felt "put away" as if they didn't belong anymore.	Parents universally reported dramatic changes in their family and in relationships with their son or daughter. "Ripped it apart." "It changes your whole life, it really does. It changes how you talk to people, who you associate with, what you do, what plans you make, and what plans you don't make." "The house is chaotic all the time. We have no life." "It changes every aspect of your life, emotionally, financially, mentally. We're all so busy with my daughter and running her here and there. There's no time and no money left." Some parents stated that their child's substance abuse was actually a symptom of other serious problems in the family and that highlighting the drug problems got them to recognize they all needed help. "I can't say that she tore up the family, but she made the loudest noise and so we started getting some help." Many parents noted the change in their own social lives. "Because you don't know what's going to happen tonight, you don't socialize. You don't have friends over, you don't go other places." Many also talked about added activities and time-consuming responsibilities. "Balancing caring for the family, caring for this child, and protecting other children from getting it is hard." "There are meetings four nights a week. We eat dinner at eleven o'clock at night." Parents described deterioration in relationships with their children. "I just couldn't trust him anymore, for anything. He would lie about the stupidest things, whether he actually brushed his teeth or not. But it seems to be very, very important for him to be able to be in control." Parents recognized the conflict between letting their son or daughter take responsibility for their behavior and doing all they could to support their recovery. "Protecting vs. letting her take responsibility is a push and pull thing." "You try and make it work for them, which we're not supposed to do, I know. But we're the moms. You do what you've got to do to protect them." "I know my daughter has to do it on her own, but she's my kid and I've gone this far to keep her alive. It's hard to just back off." Parents also mentioned that the financial drain, the stigma and shame "were transferred to the whole family."

Describe your substance abuse and mental health services. What could have made those services better?
Youth	Parents
The youth talked mostly about their experiences with counseling—individual and group or family sessions. Their descriptions of these sessions were very powerful and also very negative. Youth felt ‘talked-at’ ignored, ‘set-up,’ blamed, and disempowered by counselors. Generally it was not helpful. "It really sucked!" "The counselor made it seem like ‘Oh it's all your fault. You're the one starting the problem with your father’." "All I know is I didn't like it. My mom and me just sat there fighting the whole time." "If your parents were to talk to them beforehand then they make it seem like everything is against you. It kind of felt like being set up." "They talked to me for like a half hour and then the other half hour they talked to my mom and that didn't work for me because my mom would have a different story than I would. So we need to be in the same room so like we could talk and she could listen and understand." "I guess he was scared of my dad, cuz every time my dad would jump in, he would let my dad take over and say whatever he want. He just had everybody in there and it didn't work. Everybody would talk at the same time; no one would listen to each other. He didn't have control of none of us." "They'll do a family session and they'll have everyone go against me. That's actually a terrible way to counsel somebody. It makes it seem like you're stupid or you're bad." Youth stated that they wanted counselors who listened to them, who could see their strengths, who were not judgmental, and who could advise them about strategies for getting along with parents or working on their problems. "I wanted to be listened to. I needed support. I wanted someone who would hear both sides, mine and my parents'." "The thing you don't want, at first, is to change. You want them to work with you and point out the good points, maybe even be on your side." "I wanted the first session to be where it was just me and him, he would ask me questions, I would tell him how it went. He could like maybe tell me how I could talk to my parents, or whatever." "I needed individual and family counseling to help me explore my problems. Then I needed help working them through with the family." One Youth described a drug abuse class, which she attended for one day. "It was mostly police stuff like what would be different kinds of arrest and what would be a felony and all that stuff about what would happen. It worked but I really didn't want to go." Another described an anger management program. "It was boring though, like an hour and half and I took like ten lessons but I didn't learn anything."	Parents described substance abuse and mental health treatment programs as oriented toward treatment for adults. No program successfully involved families in their son's or daughter's treatment. "The adult substance abuse system is not prepared to deal with interested or involved parents, let alone parent advocates. Adult substance abuse treatments see parents who are involved as ‘enablers.’" "Pure AA systems make individual(s) responsible for actions and consequences. Young people need support from the family to put it together. We need help to figure this out." Parents also objected to the separation of services by the substance abuse and mental health systems. "Substance abuse and mental health need to be addressed as equally important, inextricably linked. Treatment centers don't see them as linked due to system division." "We were told we'd have to enroll our son in one program, finish that, and then send him away to treatment. Our son was away for two years and he did not come home recovered from mental illness or substance abuse. He was a stranger to us." Parents talked about their need for information: to know about treatments, to know what works, to be involved in planning the treatment for their child, to be included, to learn new ways to relate to a family, to know the signs of relapse, to set boundaries. "They treated me like an interloper. They made me feel like it was my fault." "They didn't even talk to us until our insurance ran out. Then he was all ours."

What was the first residential treatment session you received like? How did you want it to be?
Youth	Parents
Youth emphasized the importance of neutrality and strength. They want treatment staff to be fair, focus on the positives (rather than the negatives which was the general rule), and be strong enough to keep all sorts of personalities in balance. "Whoever is facilitating needs to be someone with a strong personality and ‘neutral’ and not give in to the aggressive person in the family." "I want them to make me feel like a person, and not look down on me. It is such a negative thing and so much focus on the negative aspects." Young people also want the atmosphere to be more welcoming and personal and they want their families to participate. "Youth should be allowed to take someone they are comfortable with to the first session." "I was able to continue counseling and therapy that fit my needs. However, my family did not continue their therapy. So it didn't work in the end."	Parents stated that the whole family needs help and it is insufficient to focus solely on one individual—even though that individual may have very great needs. "While the youth is in treatment, the family should be getting special counseling, then everyone should be brought together in joint counseling. It all works hand-in-hand." "Family must participate because family is affected. There needs to be something set up for the youth to go into right after treatment." Parents also recognize that they need help in understanding the treatment. "Parents need to know how to work with their kids and understand them at their level and understand the treatment." As much as parents are committed to full family involvement, they also recognize that sometimes their sons and daughters need some private space. "Allow youth to express issues privately so treatment is more effective in addressing the issues."

How could the initial residential treatment interview have been changed?
Youth	Parents
Youth tended to describe their first interviews as a formal event with a professional asking a lot of questions or someone filling in forms that had to be signed. They would have preferred situations that were more personal. "I felt intimidated, bombarded with repeated questions by the interviewer." "I would have [preferred going] one on one with someone closer to my own age." "I got tired of all the questions." "They didn't ask me how I felt about being there or if I wanted to be there." Young people want to be treated with respect and dignity. "I'd like to be treated like a person not just a case or money. Start with sensitivity, try and get to know us. Be friendly and help." "I was strip searched, psychoanalyzed, and had to take too many tests, too many questions. I want to be treated like a human being."	Parents characterized half of their initial interviews as positive and half as negative. They tended to evaluate the initial interview in terms of how the interviewer approached their son or daughter and/or how truthfully their son or daughter responded. "[My daughter] just danced in circles with them—didn't give them any information, so they didn't focus on what they needed to do." "I was very impressed with him [the interviewer] because he talked on my son's level. He wasn't judgmental or anything. My son really related to him." Parents admitted that they were ‘on guard’ during the intake, fearing they would be blamed or their child would not be admitted if they gave ‘wrong’ answers. "My input was based on the agency's perception of me as a parent. I was afraid they would say it was my fault." "Our input was driven by the need to get the child in treatment and safety rather than our real issues. Treatment occurred before they even talked to us." Parents would have liked the initial interview to be less formal, establish communication, and focus on the real issues that brought them to the facility in the first place. "The interview needs to be more focused on the youth's needs at the time, instead of just admitting to the treatment program."

What kind of residential treatments have you received for your substance abuse and mental health issues? How were your substance abuse and mental health treatments combined? How would you combine them if they weren't?
Youth	Parents
Youth see the inter-relationship between mental health problems and substance abuse. They reported that substance abuse treatment without mental health treatment doesn't work. They recommend getting off drugs and combining medication and working on the "real issues." They value programs that help them find out who they are. "They worked mainly on substance abuse and I think they should split the time between mental health and substance abuse because I really honestly don't know anyone who has a substance abuse problem who doesn't have a mental problem." "I'd first get you off of drugs and then try to figure out what you were covering up with your using and go from there." "I didn't want to hear from someone else, who I was. They basically help you understand. They really got me to look at myself. The treatment I received was pretty sufficient for both mental health issues and substance abuse." "When you're in [substance abuse] treatment you should work on also mental health issues because a lot of your mental health issues have to do with drugs." Some youth mentioned that lack of family participation was a problem. "When I was ordered to treatment, I was forced to get services. My parents were not." "When it was over, I was sent back to an unhealthy environment, back with parents who sometimes use, back with parents who knew nothing about how to help me."	Parents stated that their children needed to be treated holistically as teenagers yet they described a variety of treatment patterns—some separate and some combined. These included counseling, groups, Alcoholics Anonymous, self-medication, inpatient treatment, day programs, private psychologists, and aftercare. Parents talked about the confusion of service fragmentation and how often it was their own efforts that resulted in combining treatment. Yet, they get no credit and much blame. "We need programs that deal with our child as a whole." "It was our responsibility as family members to put the two together, substance abuse and mental health. No one even offered to help us sort this out." "We need access to funding streams that allow us to get services in both areas. We don't know when substance abuse is a problem or is the problem mental health? How are we supposed to know!" All the parents mentioned the lack of family participation.

Do you feel that your substance abuse led to your mental health problems or vice versa?
Youth	Parents
All youth stated that their mental health or emotional problems existed before they got involved with drugs or alcohol. "Ineffective interventions with my mental health symptoms resulted in my substance abuse." "My depression led me to using drugs to try and work my way out of it." "I used substances to forget my problems." Some also recognized that substance abuse exacerbated their mental health problems or brought on new ones. "My emotional feelings led to my drug use, but drug use led to a lot of mental health problems down the road, so it's like that vicious cycle they talk about; one thing leads to another." "My substance abuse fed my mental health problems and made them much worse than they actually were."	Parents generally felt the underlying mental health problems, largely untreated or ineffectively treated, led their child to substance abuse. They saw substance abuse as a form of escape from mental health problems their sons and daughters did not understand. They chided the substance abuse system for refusing to deal with mental health issues. "Untreated mental health problems led to my child's substance abuse." "No one at substance abuse even asked about mental illness."

What was your aftercare program like? What did you need for a stronger aftercare program?
Youth	Parents
About a third had no aftercare program. Comments from those who did were generally positive but for some, "It was the same—I hate going." What works seems to be an individualized approach. "They sent a letter in the mail directly to me rather than my dad or mom, which made me somewhat important. The fact that it was personalized was really cool. Or for that matter, they actually cared enough to write a letter back." "What I personally do, I go to aftercare once a week, I go to a brief one every day. And I have a sponsor who I talked to everyday on the phone and all my friends are clean and they're from my home group." "The sessions were all right, at least this time. The counselor said, ‘Well, you know you got a real bad temper, your father has a bad temper, your sister has a bad temper. I guess it just runs in the family.’ Nothing would have made them better really, me and my dad just never talk." "What I needed, they gave me, they gave me a psychiatrist. I just wish that he would talk longer, that's all. He just asks me common questions about how school is and things like that cause he's on a tight schedule, cause he always synchronizes his watch whenever I speak to him." Youth recommendations for stronger aftercare include more opportunities to make ‘clean’ friends and to "discuss stuff" related to their treatment. They also suggested younger staff and people they could feel comfortable with and trust. "I got to two to four meetings a week, and just going once to aftercare is not enough." "It's easier to talk to people who are around your age." "Reliable peer or case management would help." Youth also mentioned that they needed help from their families to get to aftercare services and this was sometimes difficult.	Parents stated that they did not know what aftercare was. They said there was no such program and described concerns about getting aftercare started but generally were pleased with the services once they began. "Until I find the right one, I'm just kind of holding my breath that she can maintain long enough to get started." They mentioned making new friends and having ‘clean’ fun as being important for their son or daughter. "It's helping more than an intensive program. It's getting them involved with people who've been through the program and who are wanting to stay clean. Because that's the most important thing; they're going to have to have new friends." "Just the camaraderie seems to be helping more than anything." "I'm not sitting in front of a counselor pouring out my guts, I can go have fun." In addition, parents mentioned long waiting periods, little or no connection between residential treatment and aftercare, and the adult treatment model that puts full responsibility on the youth and excludes the family as being obstacles to overcome. "Young people are expected to take full responsibility for themselves. I feel that the service model needs to be revised to support the youth in making aftercare a success." "The parent as participant—family involvement—is not considered favorable in aftercare. Youth need support until they can do it on their own. They are not yet adults."

What was more important to focus on when you started your treatment, substance abuse or mental health issues?
Youth	Parents
Youth were fairly evenly split on whether their mental health or substance abuse issues were more important to focus on at the start of treatment. Those who favored treatment for their substance abuse problems focused on the physical danger they were in or their lack of awareness of their mental health problems. "If I didn't get off drugs the right way, I was gonna die." "I wasn't aware of my emotional problems or anything." "Sometimes it's just overwhelming and you feel like you're just on the verge to do something that might damage you or the others around you." Those who favored treatment for mental health issues attributed their problems to their family background or going "through a stage."	Parents had difficulty choosing one problem over the other and for the most part described how they interacted and both needed to be addressed. "I kind of thought they went hand in hand, that as they worked on his substance abuse, they also worked on his mental health side to understand why he's abusing and how to quit abusing." About half the parents stated that their child's mental health issues were neglected. "I felt like they focused more on the substance abuse, which was a severe problem, but I don't think there was enough focus on the mental health issues, to be honest." "She's got a lot of anger issues and I just wish they would have worked more on that." At the same time, they saw that substance abuse had to be brought under control in order for their son or daughter to make progress with the underlying mental health issues. "She has emotional problems but they couldn't be addressed until she wasn't on drugs and she was on drugs because she had emotional problems. Keeping her structured and in one place was able at least to keep her clean long enough to get to some of the problems."

How did you get into treatment? How did you want to get there?
Youth	Parents
The vast majority of youth were forced into treatment by their parents or a court. They all wished they had gone into treatment voluntarily. However, they acknowledged that they were resisting treatment at the time. "At the time I didn't want to get there but since I had to go I wish I could have made the decision on my own to go." "My mom kept referring and I kept putting it off and finally she had me arrested as a runaway." "Once I got in the group and learned about why I had problems, I wished I had gone on my own. Being forced into it was a good thing for me." "I would have wanted it to be that they were acting upon first detection of behavior they couldn't understand." "I wanted to get into treatment on my own, but I didn't. I wanted to go get help with assistance from someone close to me, like my mother. She is always there for me."	Parents reported three ways their sons and daughters got into treatment: 1) voluntarily (which rarely happened); 2) enrolled by parents; or 3) involuntarily through the courts or social services (sometimes because parents called the police). All parents would have liked their child to enter treatment voluntarily. In addition, parents reported that they did not have sufficient information to recognize or understand the depth of their son's or daughter's problems which made it easy to conceal until they did something that caught the attention of some outside agency (such as the police). "I had no information about how to identify the symptoms of substance abuse. I didn't know there was a problem. When I did get suspicious, there was not enough information to handle the problem. I didn't know what to do or where to go!" Consistently, all parents indicated that they would have liked their child to voluntarily enter treatment.

What decisions would you have liked to have made about your treatment that were different from the choices you were given?
Youth	Parents
The underlying theme in all the youth responses was having choices and having a say in decisions. "There was never an alternative or a choice. Just do it." "I wanted to be a participant in the decision process for my own treatment. My parents, probation officer, etc., made all the important decisions. This caused me to go into the program with a negative outlook." Youth would have liked to choose where they were going to receive treatment and to have a say about the length of their stay and have more information and preparation for transitions and entering new programs. "I would say the decisions I would have liked to have made were all done before I got to treatment." "I would have liked to choose to go somewhere else or had outpatient treatment." "It was difficult to deal with a different group of people from different areas. There should be more preparation for that." Being able decide about taking medication was very important to youth. "I would rather have been given a choice of whether to take medication or not, but no ultimatum, no alternative, they don't even tell that if you don't take it you get restrained." "If I didn't take, then I'd get restrained. They treated people like crazed dogs or animals. They give you no choice." They would also have liked more contact with their families. "My parents could not be involved because of the structure of the treatment. I was told this was my problem." "Families needed to be involved, because once I was treated I returned to my family."	The underlying theme in all the parent responses was having choices and having a say in decisions. Most of the parents felt they had not been given any choice of program—this decision was made by some agency with authority (social services or a court). Those who had a choice of program found it difficult to find reliable information about something that was likely to work for their family. "System information was driven by the provider's needs and not the youth's or family's needs." One parent suggested that choices might not have been a good idea because they were so overwhelmed and could not have made one.

How were your parents' views on your treatment needs different from your own?
Youth	Parents
Youth reported that they did not see eye-to-eye with their parents—especially at first. "She was more for it and I wasn't, see." "My parents took my treatment a lot more serious than me and I'm grateful for that because I probably wouldn't be clean if they hadn't." Youth also described their parents as having expectations that were unrealistic or being over controlling. "My parents thought that as soon as I came out I had to be this new person and it obviously never worked. By the end of the last treatment center, I was ready to make a change and my parents really supported it." "I can't even go outside and smoke a cigarette without them asking where I'm going, what I'm doing. There's like, no trust." "Every time I needed money or something else it was always up to them to get it. So it just caused big problems." Youth described their parents isolating them as ‘the’ problem and denying that there was a family issue to deal with. Involved and supportive families were valued and contributed to the youth's progress and recovery. "My mom and me agreed on everything, and that was one of the biggest factors in getting through my treatment. It helps when someone agrees with your views." "Family support is a strong issue, and they have to be involved in the treatment." "There should be some information for the parents to encourage them to want to be involved. If the child gives up, the parent or support needs to want it for them. It's sad to see the parent give up."	Parents reported that they did not see eye-to-eye with their sons and daughters—especially at first. "In the beginning I think she had an attitude, then she realized that she had to cooperate to get through the program and she accepted it." "I, of course, wanted something that could save my child, so our views were very different. I was willing to make her do anything. She was willing to get out of doing anything and that's kind of where we were." "My daughter thought it [treatment] was way too long. I thought it [treatment] was way too short." "I was there to break down what was wrong, what was going on in order to figure out how to not have it happen any more. He was of the frame of mind that he didn't want to be there, nothing was wrong and he most certainly didn't want me in his face." Parents described how the treatment separated them from their son or daughter and failed to effectively involve the family. "There was no attempt to involve family, which created a sense of isolation." "The program needs to help resolve parent conflict and heal the family."

Which are you more comfortable with, telling people that you have a substance abuse problem or that you have a mental health problem?
Youth	Parents
Youth were universally more comfortable telling people about substance abuse problems. They felt that there is a general understanding of substance abuse and alcoholism but there is limited understanding and great stigma associated with mental health problems. "More people understand what using drugs is about . . . it is more common than mental health issues." "They hear better if you say, 'I'm a weed head; I'm stuck on weed', than 'there's something wrong with my head; I'm going crazy'." "I'm not really comfortable telling people any of those things because to me, people stereotype and put people down if they have a problem." In some cases the youth reported that they did not understand their mental health problems well enough to explain them to others. "Substance abuse would be what I would talk about because I really don't understand why I'm depressed." Youth who were comfortable talking about mental health issues were getting effective treatment for their problem. "First I would only talk about mental health. But I'm pretty open. I feel I can talk about it because it's part of my life. I feel I'm getting help with it, so it doesn't need to be hidden."	Parents said they too were more comfortable talking about substance abuse problems. Most said they would let their children take the lead. "I just have a handful of people that I talk about it with, because she is so complicated." Many parents expressed an active desire to talk about both mental health and substance abuse as a way to educate others. All the parents were willing to reach out to other families to share. "I don't have a problem telling anybody anything because I'm proud of what he did [in treatment] and I would like to be an advocate to parents; you know, ‘Don't do what I did’." Parents also mentioned that confidentiality and legal issues sometimes made it difficult to talk openly. However, they felt it was a family decision—typically led by their son or daughter—whether or not any of them would speak publicly about their experience. "The issue is if the child is comfortable with talking about it, it becomes more comfortable for the family."

If you were to relapse, whom would you tell and why?
Youth	Parents
Most youth reported they would go to family members or supportive and understanding friends. The words they used to describe the individual they would seek out showed they recognized the family members who can be trusted to offer help and support without judgement. They emphasized trust. "It is very important to trust who you are talking to: peer advocates, case managers, and counselors." "If I was real worried about it I'd tell my mom because I know that she would help me come up with some ideas of things I could do." "My best friend, because he would be supportive of me . . . he wouldn't look down on me." "My grandma, because that's the only person who really be trying to help me instead of going behind my back. She be trying to help me, get me to the hospital or something." Youth also would seek out others who shared their experience and had constructive advice about making positive change. "I would tell my best friend because he's been through treatment and he knows what I've been through and where I'm coming from." "I would tell my mom because she would do something and she's gone through this with me and all that."	Parents almost universally said they would go to a professional—typically someone with whom they and their child already had a positive and trusting relationship. Parents were looking for advice and guidance about what they were "supposed to do first to make this curable and fix this?" "I knew Shane was a professional that would know what to do, and I knew that he understood her too." A few parents would go to close friends mostly for "emotional support." One parent was very clear about whom NOT to tell. "I would not tell my husband's parents. They are very closed-minded about what you can do to help." But some families were at a loss as to where to turn. "How do you connect with a community based service when there is no continuing care and no one to talk to?"

Were you allowed/invited to evaluate the services you received?
Youth	Parents
Never	Never

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