Although the treatment environment need not be luxurious, it should be well-ordered, inviting, and, if possible, home-like. Local programs that serve local youth and families are preferable to regional programs, which typically obstruct family participation because of travel distances. The treatment staff should include both individuals who are successfully recovering alcoholics and addicts as well as psychologically trained staff with particular expertise in child and adolescent development. Any effective program must have a strong case-management component, so that the activities of agencies, parents, and staff are coordinated and integrated with community resources. Generally, adolescents require intensive intervention, supervision, and treatment for at least 12 months, with ongoing support and supervision for an additional year to establish recovery. All effective programs for children and youth, whether they are out-patient or in-patient, must include highly structured phases that are linked to clearly articulated tasks, privileges, and consequences. Effective programs must also provide individualized treatment planning based on comprehensive assessment; address issues of economic status, race, culture, gender, and sexual orientation; and provide comprehensive medical services that include HIV prevention and treatment of chronic and acute diseases.