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Opinion & Essays - Aug, 1994 Issue #29 

What Do You Think?

In the past few months, I have had several conversations with professionals in emotional growth schools who have been comparing what they are doing now with what they were doing when they started twenty or thirty years ago. This is more than just nostalgia. Among other things, they are asking if they hadn't lost something in the process, or if they are no longer serving the type of kids they used to, or if they really are still in charge of their own program. 

The particular individuals I am thinking of had started youth home/ranch situations about three decades ago. They added therapeutic forms over the years to take advantage of new possibilities of insurance coverage for treatment programs and the growth of the mental health profession with its new techniques and knowledge of treating addictions and mental health disease. 

Part of what is currently causing them to question their evolution in becoming residential treatment centers is the impact they are feeling from the current cost containment emphasis in the insurance industry. Decisions about the cost and length of treatment seem to be increasingly made by distant administrators who have never met the child in question. 

Part of their frustration comes from seeing decisions being made for reasons other than the good of the child. The rest of their frustration comes from seeing their program being squeezed financially, and being forced at times to choose between the good of the program and the good of the child. 

Another comparison is relating to what they put their energy into. In the youth home/ranch situation, the focus of the staff was very directly focused on the needs of each child: developing a work ethic, structure with immediate and appropriate consequences, how to develop positive relationships, and hiring staff who would be good role models and mentors the children would respond to. In a treatment center, those aspects might still exist, but they were joined by IEPs, diagnoses, treatment plans, licensing, credentials, marketing contracts, and conforming to mandates imposed by various agencies or referral sources. In a sense, decisions regarding the services the children received had become shared with people who had never met the child. 

No wonder that some administrators feel that going after insurance money has been a Faustian bargain. Early on the money was good and made possible improvements and an expansion of services that otherwise would have been very difficult if not impossible. It also made possible the provision of services to children who otherwise could never have afforded any residential services. But, later on, when an entity totally removed from the children has to contain a budget, those programs which have become most dependent on that flow of money are going to be the most hurt, and of course ultimately, the children depending on those programs will be the most hurt. 

It seems to be a truism that funding bureaucracies, and especially government bureaucracies, can achieve their mission only while there is an increasing volume of money to spend. When the original source of the money screams "enough," whether taxpayers or premium payers, there will be cost containment decisions, and those decisions will not be made by those who are most familiar with the needs of the intended recipients. 

We have had two or three decades of increasing amounts of government and insurance money being spent on children with troubles, and cost containment time is here. As a result, some programs have closed their doors, and others are scrambling to find ways to survive. The conversations I had were with professionals who are looking to their roots and the basics they started with two or three decades before. They are wondering if the old basics they started with would be the best way to survive the new environment and still provide quality services for children in need. I think their thinking is on the right track, because there are literally dozens of quality programs for children with behavioral/emotional problems all around the country which have been surviving very well without negotiating bargains with insurance companies, or government funding programs, and very clearly spend most of their energy focusing on the needs of the child.

~ LON 

Copyright 1994, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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