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Posted: Mar 28, 2007 15:15

KEEPING UP WITH CHANGE

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By: Lon Woodbury

We live in a fast paced, constantly changing society. Problems that we face now were often unheard of a few short years ago. This is especially true in working with struggling teens. For example, reports of autism or reactive attachment disorder have exploded in recent years. Another example is what is sometimes called computer or Internet addiction. This is a new manifestation of an old ongoing problem. Although experience with drug addiction can give a professional some insight into a case of Internet addiction, intervention or treatment will be effective only when the professional knows something about the Internet. Other examples of new trends are the apparent increase in teen female physical violence, seemingly reduced respect for adults among the young, and other social problems repeatedly examined by the media.

Another change occurring is the explosion of knowledge. For example, brain research and technological based feedback have resulted in new insights and methods for healing that were not even dreamed of a couple of decades ago.

What this says is that working with teens with problems requires constant innovation, and constant adjustment in approaches. In other words, creative approaches will have the best chance of keeping up with changes in knowledge and society in helping young people. The old tried and true methods will gradually become outdated, either because children in our society are manifesting problems in different ways not anticipated by the old methods, or methods of diagnosis and intervention are becoming better and more sophisticated. Those creative enough to recognize and adapt to change will tend be more successful in helping teens.

In working with struggling teens in a residential setting, the trick is to balance experience of old methods with the need to update methods to accommodate expanded knowledge, and changes in our society.

There are three major systems of residential intervention available in this country for at-risk youth: the government through law, the mental health industry through hospitals and RTCs, and the private parent-choice network. Each has its own dynamics with differing strengths and weaknesses. To better serve children, we need to find ways to utilize the strengths of all three systems, the enforcement power of government, the professional skills of mental health professionals, and the passionate whole-child knowledge of parents.

The government contributes through juvenile incarceration facilities, public funded group and foster homes and through regulations to maintain minimum standards of care in both private and public facilities. This system has the advantage of almost unlimited finances through tax resources, and can act as an intervention of last resort for children with no resources, insurance or even family. Regulations can also provide a disinterested third party who has the authority to act if any program is doing the wrong thing. Government intervention seems to have wide public support because much of the public seem to have a faith that government programs are designed by "the best and the brightest," and its employees are relatively objective and fair. The attitude on the part of the public toward offenders is based to a large extent in the public's desire to punish them and "teach them a lesson."

The downside of government intervention is that the primary decisions makers (Legislators) are far removed from the needs of individual children. The system is set up for legislators to think globally, and they are unable to legislate what is appropriate for individual children. The same goes for the civil servants who write the regulations stemming from what the Legislature authorizes, and most of the civil servants who administer these programs. Another downside is the system's foundation is based on politics, that is partisan politics on the part of the legislators and bureaucratic politics on the part of the regulators. Although many people and many facilities are successful in overcoming these dynamics, the system is very susceptible to fads, empire building and hidden agendas. For example, boot camps were soundly rejected by professionals in the private sector after three deaths in Utah private boot camps in the 1990s, but as a result of being pushed by the Clinton Administration, have continued to be popular with public agencies on both the state and federal level even after research has shown them to be ineffective in general, and dangerous to some inmates. Boot Camps for teens are good examples of the resistance public systems have to keeping up with change needed from new knowledge and innovative techniques.

In addition, research indicates the government intervention systems are usually inadequate in hiring adequate mental health professionals. Also, in public systems, parent involvement is at best an option, and only as part of the solution when invited in by the public or public funded programs. From the dynamics mentioned above, government facilities rely primarily on enforcement; all too often downplay treatment, and almost totally ignore contributions parents might be able to make. Since it seems there is always a budget crunch, and budgets often cannot afford proper professional help or adequate staffing, the resulting free time the inmates have are used to "criminalize" or abuse others. The public system dynamics might become even more resistant to innovation and the necessary flexibility if the federal legislation proposed by Congressman George Miller takes the form that some in the industry fear by adding an additional level of bureaucracy. However, on the other hand, if the legislation acts to block bureaucratic resistance to innovation and effective solutions, or find an effective way to reduce existing staff abuse of inmates, it could significantly benefit children.

While Government programs rely mostly on enforcement, mental health residential programs such as Hospitals, RTCs and the like rely mostly on treatment. Some have been very innovative in applying new knowledge from both the mental health field and from other fields such as the parent-choice network in adjusting to changing needs of young people. In these, new knowledge has been applied for their patients, adjusting very well to changing needs, and parents have been brought into the mix as significant players when feasible. In addition, in the mental health field in general, amazing progress has been made in providing relief in treating serious disorders the profession was incapable of doing a few years ago.

Unfortunately, all too many facilities succumb to case load pressures and managed care dictates, and wind up still doing what is sometimes referred to as the "medical model." That is, slap a diagnosis on a child (read label), and carry out prescribed treatment, which too often means multiple medications. Managed Care, which was a product of the Nixon Administration, seems to put cost as a priority over the good of the patient. I've had many psychiatrists and clinical psychologists, as well as hospital administrators, tell me that the pressure to shorten stays to save costs has made it impossible to provide the intervention professional opinion would indicate. Short cuts have too often become standard operating procedure, and relying on medicating a patient frequently becomes the only feasible option.

The upstart in the area of residential intervention is the private parent-choice network this newsletter is devoted to. Only a little over twenty years old, it started as an alternative to mental health treatment and public youth facilities by focusing on a type of whole child education often referred to as "emotional growth." The key was to bring parents actively into the part of the decision making. Since parents arrange for the tuition, the parents have a strong and active vested interest in actively working with the program. For better or for worse, by being responsible for funding the tuition, parents are an integral part of the solution and share in being in the driver's seat, contrary to the standards of government and standard treatment facilities. And, being private, schools and programs are able to innovate, each one applying new knowledge to their programs in ways that can adjust to their population's individual needs. There are several examples of schools and programs that once had a successful program, but by not innovating and adjusting to the changing student needs and new knowledge, eventually closed.

As this private parent-choice network has evolved, many programs have added top quality mental health professionals to merge the healing structure of emotional growth with the knowledge and insights of mental health professionals. This was in response to the knowledge that some children did not respond to structure only, but also needed treatment. In addition, this network has been very active in helping to develop state regulations in an attempt to screen out irresponsible and unprofessional programs from taking advantage of the increasing popularity of parent-choice residential schools and programs.

As a result, if we want to have a national residential child care system that is effective, takes advantage of new pioneering knowledge into human behavior, and adjusts to the changing needs of our youth, we need schools and programs that utilize the passion and support of parents, the treatment skill of mental health professionals, acting under the protective umbrella of government enforcement. Bringing parents into the mix is the key ingredient that has been missing in government and standard mental health systems, and the key to keeping up with change.





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