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Schools & Program Visits - Sept, 2000 Issue #73

Intermountain Children’s Home and Services
Helena, Montana
406-442-7920/ 800-200-9112
John Wilkinson, MSW, CEO
Tina Johnson, Admissions

Visit Report By Loi Eberle, M.A., on Aug 11, 2000

[Loi is the editor of Woodbury Reports, and works with Lon Woodbury as as an educational consultant. Previously, she co- founded and was a director of a private school for ten years, and taught journalism at CEDU’s Rocky Mountain Academy.]

It was hard not to be overwhelmed by the poignancy of the histories of many of the children who reside at Intermountain Children’s Home. Some were separated from a birth parent at a critical period in their young life (before age 3); others experienced indignities that no human should ever do to another. Its no surprise these children, yes, 4 - 11 year old boys and girls, have not been able to form healthy attachments - bringing pain and chaos to the lives of those who’ve attempted to care for them.

I left this facility deeply encouraged that I have found a place where these kids actually have a chance to heal and ultimately create a life for themselves. The staff were obviously deeply caring individuals, who took time to show me their work, let me experience the kids, and allowed me to ask them in-depth questions. I feel this facility is a tremendous resource for anyone working with this population.

Who is this population? First of all, Intermountain Children’s Home serves children who are much younger than those served by most emotional growth programs, with behaviors and level of emotional disturbance, far more severe. They have found it is necessary to start their work when these children are young, since once they reach adolescence, it is much more difficult to reach this group with the attachment-building techniques used at Intermountain Children’s Home. By the time children with this level of attachment disorder reach adolescence, their issues have blossomed into behaviors that necessitate an even more intense level of intervention; unfortunately, often it is incarceration.

The work they do here is based on attachment theory, developed at Forest Heights Lodge. It was brought to Intermountain Children’s Home by its current Director of Operations, Jim Fitzgerald, MPA, in 1982. The technique, involving a relationship-orientated milieu with distinct clinical underpinnings, has been further developed over the past 18 years to its current high standard and level of integrity. Having trained nationally, Jim serves as a resource in the field.

I spoke at length with the Clinical Director, Dr. Liz Kohlstaedt, who very generously took a good deal of time to discuss the work at Intermountain Children’s Home and Services. She described how they determined who was suitable for their program, only accepting children whom they feel they can reach. This rather lengthy intake process involves a staff member traveling to the child’s home to conduct a psychosocial family assessment, usually prior to admission. Family participation as members of the treatment team, in family therapy and in regular communication with their child both over the telephone and on-site, is essential once the child has been placed.

Essentially the technique involves taking the children through a series of three phases of work, which usually takes two years.

The first phase is engagement, where a sense of safety is developed. In this phase, the child is asked to begin the process of building basic trust with the adults in the program. Each child needs to become dependent upon and trusting of them so that they can allow themselves to rely upon the staff to meet their most basic needs related to care and control.

One method towards achieving this is through the use of “holdings.” A “holding” can occur if a child is not able to have sufficient control to follow verbal instructions, or if his anxiety, fears, or anger are such that he requires assistance in maintaining control or working through issues. Holdings are postured to maintain eye contact, are not punitive, and presented to the child as “I will take care of you until you have regained control.” Holding is done without inflicting pain, and helps the child find that he can be cared for, controlled, and work through issues without being hurt or hurting anyone.

Through development of this trust, as well as through gradual strengthening of adult relationships, the child moves into the next phase, called the “working through” phase. Here is where the difficult work of surfacing their wounds and being in touch with their feelings is done. Generally the children appear to regress in this phase, recreating past trauma within in specific relationships. They also begin to learn new ways to problem solve, and learn that their previous beliefs about the world and their way of responding to it, no longer serve them.

In the final phase of the therapeutic work, called “Separation,” the children begin to generalize trust to others and learn how to solve problems. They also begin the evocative and frightening work of developing positive, healthy, non-conflictual interpersonal relationships in the external world. It is hoped that this extremely difficult work will improve each child’s self- esteem and confidence, will reduce their need to manipulate adult expectations and demands as their means to control their world, and will foster a new view of themselves as a young people with potential, talent and uniqueness.

Aware that the true work of developing healthy attachments has just begun, ICH has created the PATH program for residents who are beginning the slow process of leaving the program and are preparing to go back to the outside world. This program works with the family where the child will go next. Intermountain created this program as a result of recognizing how the child will test the relationships in the treatment family, and that the caregivers will require special skills to work effectively with these children. This program has satellite facilities that work with the treatment families and requires the families to live within ninety miles of them. ICH&S is currently consulting with Dr. Daniel Hughes, an expert in this area, to train psychotherapists to develop strategies specifically for this population. Treatment families may also be encouraged to seek individual or marital counseling at this time, because it has been shown that receiving such a child in the home can be very disruptive to all the family relationships.

Feeling the pain of the place, I asked about staff burn out. I recognized the emotional toil that doing this kind of work on an ongoing-basis must take. To answer my question, the case managers, Dan and Kristen, explained how the therapeutic team works with each child. The team consists of the therapists, the house counselors, the Clinical Director, Liz Kohlstaedt, PhD, and the teachers. Team members help support each other to determine and reinforce the treatment goals, and they also support the members. They hold weekly “family dynamics” sessions, where they address individual staff issues that are observed through the course of the work, and they discuss how their own personal histories are possibly re-activated by certain of the children’s behaviors. This helps them maintain boundaries, develop insight, and provides support for each of them through this very emotionally demanding work of developing attachment with kids. Ultimately, for the growth of the child, these attachments are severed when the child leaves the program. Even so, many of the past residents of the program still remain in touch with the program, years later, sending cards and letters to their former teachers and counselors.

I was told by the staff that the program attributed its strength and success to the fact that everyone involved, at all levels, even support staff, believe in and understand the philosophy of the treatment model, and the therapeutic processes involved in their work with the children.

I was given a very thorough tour of the well-furnished and comfortable schoolrooms and children’s cottages. The children, I felt, were lucky to have such caring and creative teachers, since obviously, education is not usually foremost on these children’s minds. Four cottages each house six to eight students from the residential program. They also have a day program, where students ride the school bus to a special classroom in the main building. The day students do academic work part of the day, and therapeutic work the other part of the time. For example, at the day school each morning is started with students sitting around on couches and comfortable chairs, discussing their emotional issues, before any schoolwork is conducted.

I spent a good amount of time interacting with the children, who alternated between being engaging, charming, distraught, or uncommunicative. I know merely the presence of a new stranger in their midst was disturbing to some of the newer residents, while some seemed happy to have a new person with whom to speak. I witnessed some “holdings,” as well. During these hugging “restraints,” the child is held on a chair, the couch or even the floor, in front of the other children and counselors, using an embrace that protects the child’s head and limbs, while the child rages. While I knew basically what to expect, I was interested in the other children’s reactions. They seemed basically unaffected, with a surprising ability to describe their own process of learning new and better ways of responding to their feelings. One nine-year-old girl told me in very matter-of-fact tone of voice, “When they did that to me, I used to bite everyone and kick very hard - but I don’t do that anymore.” She was the girl who had proudly showed me her room and her stuffed animals (each child has a spacious room and bathroom). I fought back tears later, when her counselor told me her history.

Approximately 60% - 70% of residents are from the state of Montana. However they also take children from all over the country, both from the courts, and private referral sources. The length of time to wait for an opening is usually about six months to one year, but there is some amount of leeway, in critical situations. Generally the children are in the program for two years. Establishing a plan for a permanent placement underlies all discharge options, whether it is to return home, find a new home (such as in PATH), or continue on in some lesser restrictive treatment or boarding school setting.

I left Intermountain Children’s Home sharing the impression that the staff communicated to me: there was a deep sense of mission in their work, as well as a shared commitment by a lot of people, both inside and outside of this program, that enabled this work to occur. I felt so grateful that at least some of the children with this heartbreaking history are being helped.

Copyright © 2000, 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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