Northern Wisconsin is renowned for its fishing, and Hayward is the home of North America's biggest cross-country ski race - the Birkebeiner. Who would have guessed that these same north woods are home to a gem of a treatment center for at-risk teens and, even more unlikely, home to an assessment center for 6 - 17 year olds that employs three - yes 3 - neuropsychologists on staff?!!

Recently, I drove from Milwaukee to just outside of Hayward (Spooner, actually) to meet Carey Lillehaug, Director of Program Development for the Northwest Passage System. I knew this was a residential treatment program for at-risk teens who were there under a court order - having committed a petty crime (or a series of similar crimes like shoplifting), or being arrested for possession or use of an illegal substance, or because they were part of the foster care system and in a placement that had gone wrong. The kids they treat typically have one or more mental health and/or behavioral disorders.

What I learned during my visit was that this highly competent, unbelievably caring staff has worked with a few private-pay clients over the years and is interested in attracting more. The visit was really a forum for an exchange of information - I learned more about their work and they learned more about educational consultants and the world of private-pay, parent choice schools and programs. I was really excited to learn about their Assessment Center - but let me describe the 3 residential programs first.

• Passage I which opened in '78 is a long-term program for up to 24 adolescent boys, their most severe cases. Using a multidisciplinary approach, the program serves mental needs and offers education and vocational services.


• Passage II and Passage III serve boys and girls respectively. Each program has 10 - 12 beds and uses an outdoor stress challenge model. These programs are 90 days in length and offer family assessment and a weekend retreat. The boys program opened in 1988 and the girls in 2003.

• Restitution - Each student has work time each day - time for which they are paid minimum wage. The money goes to repay any damage they may have done or to pay for things they may have stolen that led to their time at Passage. If they do not have any restitution to make, the student gets a check for the funds earned at the end of the program.


• Education - Passage works closely with each student's home school to keep them on track or to help them catch up in their school work.


• Woodworking - In addition to learning basic skills, the students make and sell outdoor furniture.


• Passage Foundation - To reward the hard work, perseverance and personal risk of successful program graduates, this program offers small stipends and scholarships to help graduates grow and prosper. Monies from woodworking and fundraisers support requests like one from a young man who needed to buy tools to start an apprenticeship program.


• After-care - Three full-time staff travel the state to visit and provide support and guidance to former students for two months following their completion of the program.

While I know there is always great discussion about mixing private pay and public pay kids in the same program - recognizing that it is usually an issue for the parents, not the kids - but the kids that I saw and talked with were certainly not hard-core criminals or gang kids but rather kids that are a lot like those I see in my practice

Half of the students were in school during my visit and I did have a chance to observe -- and to talk to -- some of them about their studies. Most felt they were doing better because they had more individualized attention. The other students were in woodworking, in the gym or doing restitution. As we walked around the three different campuses, I saw the results of students' restitution - lots of stacked wood that had been split and beautifully kept gardens and grounds. I talked with a few boys on a yard crew and they told me they felt good - that the physical aspects of the program were helping them get in shape - or buff, as one young man put it!

Many of these students are from rural areas or small towns - and yet, because so many lack a strong relationship with an adult in their lives, have never gone fishing or hiking. More than one student - even some of the girls - talked about how much they were enjoying the out-of-doors. I saw the woodworking shop in action - and talked to a couple of boys about what they were learning there.

Because I see a number of Midwestern families who always hope to find a quality program closer to home than Idaho, Utah or even New England, I was glad to visit the Passage system. I think the part of the program that most impressed me is their Assessment Center.

Three talented line staff from a mental health hospital in Minneapolis started Passage I almost thirty years ago. Two of the partners are still on board. I had the good fortune of spending time with one of them, Steve Ammend. He has maintained strong relationships with the mental health community in the Twin Cities even though most of their kids come from Wisconsin. Among those relationships is one with the Medical School at the University of Minnesota.

Over the years, the administration realized that many kids were enrolled with incomplete histories and limited (or no) assessment data coming along with them. In building what is now a comprehensive clinical diagnostic assessment and behavioral crisis intervention center providing psychiatric, neuropsychological, individual, family and social assessments for pediatric and adolescent boys and girls in a 30-day model, the founders' connections with the Medical School helped them attract staff - including the three neuropsychologists, a full-time pediatrician on staff and a consulting psychiatrist who is there regularly - doing far more than 15 minute med-checks with kids. They have just hired a board-certified child psychiatrist who will start full-time next summer.

Mark Elliott, the Executive Director, gave me two impressive reports - with the names blacked out for confidentiality. Each has eight sections; Treatment & Placement Recommendations; Case Records Summary; Behavioral; Educational; and Child & Family/Chemical Health Assessments; Neuropsychological Evaluation; Psychiatric Evaluation; and the Health/Medical Discharge Summary and Notes.

Passage has created a report that collects all of the important data on a child in one place - along with the results of their testing - and in a readable format with recommendations for next steps. Jane Doe took eleven tests and John Doe (not her brother) was administered a few more (16 total) in the month or so they were there for observation and assessment.

While a few of the kids may wind up at one of the Passage Programs, by no means is this just a conduit for placement there. Since they test kids from age 6 to 17, the younger kids are not even age appropriate for those programs. Currently, about 10% of the kids being tested are private-pay clients - but the number of private-pay inquiries is increasing each month.

Over a delightful lunch at a little place called the Wren, I met Nick Kalambokidis, the CFO of the organization, and David Ammend, MD, the pediatrician on staff. Carey, Steve and Mark were also there. We wrapped up our meeting with conversations about the rigorous exercise program all the kids participate in and about their plans for an improved nutrition program (to compliment all that exercise!) We also talked about IECA and NATSAP and about how Passage might reach out to other special needs consultants - including some ideas about the IECA meeting that will be in the Twin Cities next spring.

So, if you are headed for northern Wisconsin any time soon, either to fish the summer or to ski in the winter, give Carey a call and go visit. I think you'll be glad you did.