Thursday, March 22, 2012

Myths about Residential Treatment

Lately it seems to me that more and more people are talking about "finding a placement" for their kids who seem out of control. It's almost an automatic thought now that so many of us are connecting online and know that there are lots of families who have found residential treatment options for their kids. But now it seems that we sometimes head there way too quickly.

As a parent who has had three children in residential setting for a brief period of time, I feel like I should share the reasons why we no longer look at that as a viable option for our kids, even though a couple of the ones at home now are as difficult or more difficult than the ones who ended up in residential 8 years ago.

Before I start this post I want to make something very clear. If you, your other children, or your "out-of-control" child are truly not safe, then finding a placement is your only option. Notice that I did not say that disrupting or dissolving the adoption is an option -- I said finding a residential placement. I am working on some thoughts about disruption and dissolutions for a later post when I get brave enough to address it.

I also want to be clear that this is based on my observations while my kids were in about 7 or 8 different facilities. There may be others that are different and I'd love to hear about that, but this was our experience.

So, here are some myths about residential treatment.

1) Residential treatment will fix a kid. It doesn't happen. The kids sometimes learn a few things -- but, as my friend Kari pointed out when we talked about this today -- children with FASD have difficulty generalizing their learning so they may not be able to apply what they learned in residential to a home setting" In addition, if you haven't figured it out yet, organic brain damage and mental illness can't be fixed.

2) Staff at Residential Treatment Centers are all very educated experts. We often think of these places as being filled with individuals who know all about brain trauma, FASD, and the other issues our kids face. It is possible that there is one, possibly a few, of those people at an RTC, but the people who have daily interaction with the kids often aren't experts at all. Of all the RTCs that our kids were in, the one that was MOST effective had these qualifications for the staff who were supervising the kids: A GED and a Driver's License. (and based on who they hired, preferably big enough to restrain a large teenager). I looked up the hiring qualifications once just out of curiosity. Sure, in order to get licensed the facilities have to have a certain number of professionals there and they do see the kids regularly. But not every staff member is trained and clued into how to help our kids.

3) Residential Treatment Centers have all kinds of new methodologies to help kids. In all actuality, most RTCs have level systems which are very similar to a sticker chart that we have tried to use with our kids for years without success. One of the most disturbing things about some of these places is that it can take a very long time to get up a level, but you can be dropped multiple levels in a day. One of the most difficult things to see was when Mike was in a facility and he was 3 days away from Level 3 having worked for several months to get there. At level three he was finally going to be awarded a home visit. He impulsively grabbed a bottle of conditioner that he saw in a staff members office and found himself back at level zero, looking at three months to get back to where he could have a home visit. What followed that, as you can imagine, was several weeks where he was depressed and not motivated at all to even try to get off level zero and his behaviors plummeted.

4) Residential Treatment is available to adoptive families without a hassle or court or county involvement. Unless you are independently wealthy and can afford the $150 or more a day that these places cost, you will need to have the support of your county and often an open child protection case in order to access this for your child. This can create a very difficult situation that never seems to end. I know very few stories of peaceful and cooperative relationships with counties when a family is trying to access this level of services for a child. Often there is conflict, accusations, investigations, criticism, and the involvement of many people in the life of your family who have varying agendas. It's often not pleasant.

5) You will be an equal and valued member of the treatment team by RTC staff. I could give hoards of examples of how this was not the case when our kids were in treatment. County workers, Guardian ad litems, therapists, and even our kids themselves had more input into the plan for our kids than we did. We are both post-Master's level educated professionals who are articulate and bright, and we were treated as much less than that once we opened our doors to the "system" to get help for our kids.

6) A child or teen will learn to trust you more after being in residential treatment. This certainly has not been our experience. Our kids learned to be incredibly manipulative in order to get their way when it came to placements and they were successful in convincing many people of things that simply were not true. They were empowered to trust us less and rely more on those who they felt could make things happen in their favor.

7) The relationships with peers in residential treatment will be healthy, wholesome, and a part of their healing. Basically RTCs are full of the kind of kids that we don't want our children hanging out with. They form alliances with these kids, and, according to Mike, learn how to be criminals by hanging out with them. He also claims to have been introduced to drugs while there. In addition, he developed a network of individuals across the state that would harbor them when they ran away from home.

8) When a child leaves residential he/she will be grateful to be home and thankful that you gave them the opportunity to heal while away. It's the opposite. Our kids came home angry that we "locked them up" and to day do not recognize that we did it with their best interests in mind. One of them is still very angry and talks about it often.

9) Residential Treatment will help kids learn what they need to learn to function at home and in society. Unfortunately, RTCs are set up to be revolving doors. The expectations are set up and the reward is to go back home. However, just because a kid can function in an RTC doesn't mean they can function the same way in a home setting, so they work real hard to get home... and then within a few weeks they fall apart because they don't have the same amount of structure. That results in them feeling like failures, the family feeling like a failure, and them heading right back to where they came from. Eventually, as our kids have told us, they end up "institutionalized" and jail is the only place they can function as adults.

10) Residential treatment is a better place for some kids than a family. Children and teens need relationships with a completely committed parent. If a child can't be safe at home, than a parent who is very supportive of them in residential is the next best thing. But if there is any way to safely keep a child at home, that is the best place for them.

Many people now are choosing residential for one of two reasons: a) Because they really believe that it is the best place for their child, which as you can see above, I really don't believe it is. or b) because they are tired of dealing with the behaviors that their children are displaying and they want a break from the daily responsibility and drain that a child is on them.

Grant it, I have been there and I am there with a couple of our kids. I would love to have a break from their crazy thinking, their destruction of our home, their threats and verbal abuse, and their oppositional and uncooperative behaviors. I would love to have their siblings be able to enjoy a family meal without an outburst or have a fun family activity without a meltdown. But the bottom line is that our kids are safe and so are we -- and therefore I need to figure out ways to connect with my kids, not send them away with an idealized dream that they are going to get fixed.

Wow, this is harsh. I wasn't intending it to be this way but I guess I have a lot of anger about what our family and our kids went through as we attempted to seek help.

You may feel like I have just dashed your hopes because you were counting on residential to be a solution, so I don't want to leave you without hope or an answer. After my years of experience, I am more convinced (and if you've heard me speak you know that I talk about this every change I get) that as parents we are the ones who need to change in order for our kids to heal. Our responses to them -- choosing not to escalate them or argue with them -- is what will make a difference. Using approaches that are calming and relationship-building instead of consequencing and condemning will go a lot farther than sending them away to get "fixed" by a bunch of "professionals."

Especially those of you who are dealing with younger children -- using a different approach can help you avoid the things we have been through (that I touched on above). Using attachment based models like nurturing heart, or PLACE or empowered to connect, or beyond consequences can make all the difference.

I won't be surprised if there are those who disagree with me and I really hope that is the case. I hope that there are stories out there of families who have kids who were greatly helped by residential and who had positive and helpful relationships with the professionals who were involved. I'd love to hear them.

But for now I am beyond convinced that UNLESS there is a serious safety issue, Residential Treatment is not the answer.


Psycho Mom said...

I so agree with you Claudia. Our daughter is suppose to be going to a RTC within the next week or two. She is not safe in our home, she is too physically violent and we can't get it under control. I have fought with county for group home placement but they want an RTC placement first so she can be "evaluated" and to determine which community placement would be best for her. Whatever. We all know it is because they have no group home placements right now. I am not looking forward to this, I know it will do her no good, but I know even more that she can't continue to live with us, it is breaking my heart. Stupid system

Cyndi said...

Information that is valuable! Can I print this and give it to a county worker who seems to think this is the answer to o everything?

MsMP said...

Thank you for writing this article. I agree with you completely. RTC can’t fix kids. More success is gained by changing the home environment, learning to de-escalate a crisis, getting more in home support, and more attention to parental self-care. It also helps if we can accept our children for who they are and where they are.

My confession, my daughter has had two RTC placements since adoption. Safety has always been the reason for the placement. The treatment plan has varied.

For both placements, I had to prove my credibility and advocate for what our family needed. It was easier in the first setting as they were flexible and had positioned the organization as experts in attachment. I used their own claims to get what we needed. Too bad the RTC closed.

For the first placement, I was the treatment plan. The focus was on attachment. I spent many hours each week (every day during the first months) at the RTC doing attachment focused activities, playing, and “practicing being a family.” I did whatever the group was doing and took the lead with my daughter (the staff took the passive role). We developed a relationship that made it possible to transition home and be safe.

We are now in the fourth month of the second placement. Previous to this placement she was in day treatment, we had a high level of support, and I had a lot of respite care. I tried to keep her home or in short placements in a therapeutic foster home (e.g., 1-4 weeks) until safety was restored.

I did not want another RTC placement, but things just became too unsafe. I tried everything I could to avoid RTC (I really hate it) and as a result, I waited too long for this placement. It is never a good thing for either of us when she has assaulted me.

This RTC is inflexible and very rewards/consequences focused. They say they are family focused but don’t want parents to visit more than twice a week because it interrupts the program. I had to laugh at that...what do they think will happen when she comes home?

I’m slowing proving to them I actually have some skills and they have started to make exceptions to the program and rules to meet our needs. It has taken a lot of energy on my part to build relationships and advocate for our needs. I see her four times a week and focus on keeping things safe.

Safety has been restored during our visits. This weekend, we start home passes to practice bringing safety skills into our home. We will see...

Found myself irritated today when the family therapist suggested that my daughter’s recent commitment to “doing the program” and willingness to talk aoout her traumatic history was a result of their work. Really? Where do they get the nerve to take credit for all the therapeutic interventions my daughter has had in the past eight years? I believe they think more highly of themselves than they ought to think.

She is working hard to come home and it is impossible to know what that means for the long-term. I am recovering from living with violence. We are both practicing skills that keep things safe. I have low expectations and a lot of hope.

Sheri said...

While I agree for the most part, I think it depends on the RTC and the advocacy abilities of the parent. I have no plans to send Dustin to RTC because I know that he will not, with his functioning ability, be able to compete there. But, I know that there are several moms I spoke with in Orlando who have great success with RTC and building behavior and skills. It has been a major blessings for many families. I think it is a dangerous generalization for you to make for parents with HARD kids who are left with no other options to keep them safe.

I used to feel that disruption was wrong. I WAS WRONG. There are instances where disruption is not only necessary but mandatory for the family and the child. It is heart wrenching and horrific for all involved, but sometimes there is no other choice. I feel guilty for feeling that is was always 100% the wrong choice. I have now walked beside families who have had to make that decision and I understand.

DF said...

Spot on, MsMP. And Claudia, I agree with you. RTC can actually cause more harm than good in the long term. It raises the larger questions of what programs need to be developed to help our families work with our children with such significant issues. There is a deep cavern of nothing where there should be a short term stabilization program for our kids.

Jane said...

I don't disagree with you. But the fact remains that our daughter is not safe from herself in our home, and neither are we.

Barb said...

Thanks for the post Claudia. Again you are saying what I am feeling. The one we currently have in RTC is there because of safety issues. But it is killing me that he is there. And, of course, the county is making all sorts of assumptions and forgetting that WE are his parents and WE need to be making decisions. And we have thought about disruption but it would serve no purpose than to haunt me that rest of my days on this earth. Attachment at any level, even a tenuous attachment, is better than no attachment at all.

Claudia said...

Thanks for your comments. I wasn't attempting to cast blame and I hope it wasn't taken that way.

Cyndi -- go ahead and share if you wish. I'm not necessarily telling you can, but this is public information so you can feel free.

Sheri: I tend to make generalizations when I make a point, and I agree that this may be interpreted as me passing judgment on others. I try really hard not to do that -- I was attempting to share MY experience and what WE are choosing to do now, but I'm sure with my annoyingly brash personality it probably came across as judgmental. I really feel like I can't judge anyone if I haven't been in their shoes.

Anonymous said...

There is a gigantic chasm between in-home support and RTC or inpatient crisis treatment. We are relentless advocates for our kids. I spend much of my time calling and calling and calling for therapists and psychiatrists and PCA and MHBA services and more. If I can find someone, they are not qualified, or they are not taking new clients, or they are taking new clients claim to be qualified and totally suck.

Our daughter had to live in a group home for a year because she was hurting our other kids every day. She's in a psych locked ward right now after pulling a knife on my youngest son, age 9, and she is 17. For her, because of her developmental disabilities an RTC wouldn't be appropriate...I didn't even like the group home placement. YET, it went from seeing a psychiatrist once every three months (once a month if I cry and beg each time but with really no med changes or help) to inpatient because there is NOTHING in between. We are fortunate to have supportive county social workers but I know of tons of people who don't have that. Even with supportive workers, there isn't enough other help. We need steps. We have about two steps and then are supposed to jump over this 100 foot crater and rarely do we make it across without getting hurt. I hope this makes sense.

kimberlycreates said...

Harsh, maybe, but I think you're right on. The one thing that bothers me though is this. I've toyed with the idea of some kind of treatment program for one of our kids but I too much of what you say rings true to me. And this child is not dangerous. She's just mentally and emotionally exhausting and I'm just burned out. Maybe I could check MYSELF into a RTC? ;)

Anastasia said...

Wonderful post! I actually work at a private facility that has group homes and RTCs. I'd like to address some of your points from an "insiders" perspective.

To prove your point, while we have to keep up a quota of training hours every quarter, I have a culinary degree and that's it. Every cottage has a therapist of course, but most of the staff is not trained that way. I'm also a mother (the only staff who has any experience with being a parental figure) which I think helps me in my job.

It is not easy to get a placement with the courts, and once you open up your family to the courts and CPS, etc. it is even more difficult to get out of the system. Even if your child is magically better (which we know never happens) they can still barge in and control your lives if they feel like it.

And not only does RTC's not "cure" a child, it can actually cause them to have other issues that they never would have had. We are an all girls facility and a lot of our girls who don't have same sex tendencies get into "relationships" and have inappropriate boundaries with other girls. Which wouldn't have happened if they hadn't been here.

The institutionalized thing is so frustrating to me. Very few of the girls who age out don't make it. They don't know how to function in the real world. To try and combat that, Texas is doing away with the level system and moving away from institutionalized language, like staff, structures, off program that sort of thing. Hopefully it helps a little.

I think you are right. Unless your family or the kid themselves is in physical danger, an RTC should not be an option.

Sorry for the long comment. I just had so much to say!

K said...

We are just beginning this journey, and already I agree 100% with everything you wrote. Thanks for the time and thought that you put into this post. You are a WONDERFUL source of of support for other adopted families.

Kathleen said...

Claudia, I agree with a high percentage of what you've written. RTC did not help our daughter get better, and if I knew then what I know now - we wouldn't have used an RTC.

But that's the POINT - you and I and many others have come a long way and learned better ways to connect with our kids. Many parents are so deep in their mucky trenches, with NO support, and they DO need a break to even be able to implement anything like Beyond Consequences. Their families have become such unhappy, unhealthy places that they can't even conceive of behaving in a loving and affectionate manner towards the difficult child or children they have, and the relationships between the parents themselves, and between the parents and the previously healthy and happy kids (bio or otherwise) have been seriously damaged. Those parents need more than a weekend - or a WEEK - of respite.

A longer term of respite gives those families the opportunity to get their feet back under them. Yes, their child may come back with more anger and more undesirable behaviors, but if they are better equipped then to deal with those behaviors, the outcome may still be better.

And as far as RTC programs go.... The Risking Connections(R) approach by Klingberg Family Centers / Traumatic Stress Institute is AWESOME, very similar to BC, very much what our kids need. :-) (Not where we sent our daughter...)
Also CALO Change Academy Lake Ozark is very attachment based.

For us, Teen Challenge was not especially therapeutic, but it was more affordable than others, and it kept my daughter safe and gave the rest of us a chance to heal.

thanks for the post! :-)


Jen said...

I agree 100% with you. Not to say that RTC is inappropriate for 100% of our adopted kids ... these are two completely different statements.

I am enormously blessed with a behavioral health agency that provides extensive support and treatment to my children on an outpatient basis to help them be more successful at home. My teenager is in a group therapy and behavior management program for three hours a day after school. WHen this ends, a therapist will come to our house 4-6 hours per week to target safety and compliance in our home. We truly get whatever we need from our agency.

I had a scary month or so last year when my son decided he didn't want to live at home anymore. We had a Child Family Team meeting to discuss the possibilities for out of home placements. But it was NOT MY choice. It was his. And it broke my heart into many many pieces. I am glad that is over.

I adopted my children no matter what. They are mine no matter what. I am human and have thought about RTC and disruption and spanking and all of the things that would do devastating damage to my relationship with this mentally ill and attachment disordered teenager. These are just normal thoughts but nothing more. If somebody leaves this house it will be his/her choice or in handcuffs. I am fiercely committed to them no matter what.

Wow, that turned out much more passionate and hurt-filled than I had planned. The point is, if they have to leave due to safety issues, they will. But I am doing EVERYTHING I can to keep them with me so they can learn some family and life skills despite their developmental, mental health, and behavioral challenges.

Mommy Faith said...

Amen. Thank you for writing this post. It wasn't harsh -- it was honest, and much valued.

Psychesick said...

Having been placed in an RTC myself, I can say that I agree with Claudia. I was there for almost 2 years and was the worst experience of my life. I came out a lot worse off than when I went in. The reason they don't want communication between parents and children in the beginning is because there is usually abuse happening and the staff at the RTC don't want the parents to know about it. The first 6 months were pure hell and I never really recovered from the hidden abuses. Juvenile hall and jail were both MUCH better alternatives for me than the RTC. I hated my parents for sending me but looking back, they really weren't allowed to know what was happening to us. For me, i would rather send a chiuld out into the streets than to an RTC...they would at least have a chance. And there is no RTC that I know of that is trustworthy. Any RTC that is restrictive with communication early in the placement is an extremely suspicious red flag that there is abuse.