Linda Clefisch, 303-674-6681
September 26, 2002
By Loi Eberle, M.A.,
Editor of Woodbury Reports
to road construction that was part of Evergreen, Colorado’s efforts to upgrade their quaint, but rapidly expanding town, I needed
to drive the steeply winding road up the backside of the mountain to visit Forest Heights Lodge. Navigating through what felt
like a friendly, rural neighborhood, at last I arrived at their 10 acre wooded campus that graced the top of the mountain. After a friendly
greeting from Teri in the office, I surmised that it must be quite a journey in the winter. She surprised me, explaining it was not
a problem as the sun quickly melted any snow and ice; quite different from what I encounter during North Idaho winters! Executive
Director, Linda Clefisch, LCSW, and Ray Curtis, MSW, LCSW, Social Service Director at Forest Heights Lodge then gave me
another friendly welcome.
When I verbalized my impression that Forest Heights Lodge specialized in treating children who were diagnosed with Reactive Attachment
Disorder, Linda looked to Ray, knowing that he would want to alter that impression. He explained that most adolescents who were
expressing behavioral or emotional problems have some “attachment issues,” as a result of having experienced some kind of interference
in their process of forming attachments. Thus he felt that the treatment modalities used at Forest Heights Lodge could be applied to
a variety of diagnoses, though he was quick to point out that the techniques used by Forest Heights Lodge were most appropriate for
a younger population. Forest Heights works with 24 boys between the ages of 5 to 14 at the time of admission, who have not “benefited
from previous extensive outpatient psychotherapy and possibly psychiatric hospitalization.” I am aware that some of the techniques used
here are often modified when they are applied to older adolescents in other settings, since developmentally, older adolescents are in
the natural process of separating from their caregivers.
As Social Services Director, Ray demonstrated a tremendous knowledge of the needs of children with attachment issues, and as part of
Forest Heights Lodge’s outreach seminar program, he provides training in various parts of the country, to parents, caregivers and foster
parents. In addition to developing policies and procedures, he is an individual and family therapist and supervisor of graduate students.
He gave me a tremendous overview of their program.
In order to enroll at Forest Heights Lodge, the child must agree to be there, and the parents or guardians must also feel the Lodge
is the appropriate place for the child. If the Lodge also determines that their treatment program can help the child, they begin the
intake process, which includes a visit to the child’s home. Part of this process includes pre- admission discharge planning during the
home visit, which involves interviewing family resources in the community.
Ray explained that he Lodge considers attachment to be the crucial issue when treating emotionally disturbed children. Their treatment
approach encompasses one basic attitude: “WE WILL TAKE CARE OF YOU!” To do this, they have two basic rules, first, they must know where
the child is at all times, and secondly, “No hands on”, both for safety as well as to imply that touch should be an “important part
of meaningful relationships.”
All other rules at the Lodge shift and
change in response to what the staff determines to be best for each child. Having a staff member decide what to do in individual circumstances,
rather just going by the rules emphasizes trust and relationship because the child must relate to adults, rather than “the system” to
have his needs met. This increases the importance of the caregiver. It also discourages manipulation, because the child, rather than
learning to “work the system”, has to deal with a caregiver who assumes responsibility for determining what is best for the child. They
feel their philosophy of limited rules also “permits more effective confrontation of the real issues” that is, “feelings and trust,
not just behavioral issues.” Their view is that “emotional management, relationship skills and conflict resolution are all related to
the basic task of behavioral control. Only when the child feels safe and secure in his environment will he be ready to focus on learning
Forest Heights feels they increase their potential for close and meaningful relationships by keeping the number of direct child care
staff small and using three and a half day shifts, rather than eight hour shifts. This provides consistency of care; for example, whoever
puts a child to bed is there to awaken him in the morning to provide support around issues revealed in his least guarded bedtime hours.
Also, fewer issues are left unfinished. They of course balance this with adequate time off for their staff, and it seemed they experienced
very little turnover, and a well informed staff, where their teachers and therapeutic staff have off as child care workers, growing
into their more responsible roles over a period of years.
Ray explained to me how Forest Heights Lodge recognizes that normal attachment responses, such as praise and encouragement, are not
rewarding to these children. Children with attachment issues desire distance from others and seek to minimize the demands and expectations
of the others. For this reason, behavioral programs don’t work with these children because when consequences are given for undesirable
behavior, it serves to create more distance, thus actually reinforcing a child’s alienation and separation. Nor do consequences help
these children to develop a sense of trust and safety.
The Forest Heights staff has collaborated on the book, Residential Treatment, A Tapestry of many Therapies, edited by
Vera Fahlberg, M.D. It states, “unless we overcome the obstacles for forming primary relationships, behavior controls may be
developed, but they will not be adequately internalized or generalized.” Transferability is an important defining characteristic of
healthy attachment, and it is felt by the staff that “a child who has developed an attachment to a primary caregiver can transfer that
attachment to other important people in his life.”
After a sense of safety and trust has started to be developed, another part of the treatment process involves “taking the lid off” rather
than “keeping the peace”. The child is encouraged to intensely express what he is feeling. When he learns he can do this and yet still
feel that he and others are kept safe, it increases his trust of care. As the Lodge expresses this, “show us your worst; the sooner
you do, the sooner we can prove we can take care of you.”
Kids stay with this program for a number of years, until the treatment team and parents have determined that the child is capable of
developing attachment to other caregivers, and they help the family make this transition.
The attractive and comfortable school has
an upper and a lower school small classroom, and comfortable dorms rooms, with two to a room. It did have a feeling of safety. I watched
the students talking in the large group meeting, then later, eat together in a cozy lunchroom. There seemed to be friendly interactions
between the staff and students, and attractive play areas and recreational options for them.
Although always a difficult decision to have boy this age in out-of-home placement, I feel this is a compassionate environment for them
to be able to ultimately return to their home in a more successful manner.