KHK former staff responds to Beacon questions

[Anonymous]

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The Cincinnati Beacon

An Inside Perspective on KHK: Interview with a Former Client and Employee
Tuesday, March 14, 2006

Posted by The Dean of Cincinnati

As part of our continuing coverage on Kids Helping Kids (KHK), The Cincinnati Beacon is proud to bring some new perspectives to bear on our investigation.  In this piece, you will find an interview with an individual (speaking under the condition of anonymity) who was a client at KHK before becoming an employee.

The Dean: Is it true that, during your time at KHK, that the organization prohibited unsupervised contact with parents during the first phase?  If so, why?

KHK Source: KHK did, and still does prohibit unsupervised contact between first phase clients and their parents.  Pathway Family Center (PFC) has more liberal rules governing contact, but I am almost certain it is still supervised.  The reason for this is because pre-compliant clients are expected to manipulate their parents to remove them from treatment.  It is also believed that clients need to focus on themselves in the initial phase of treatment and work through family issues on later phases.  The motivation, at least at KHK, has never been to prevent parents from learning what really happens during treatment.  First phase parents have plenty of contact with parents taking household and thus get a good idea of what happens.  That said, the rules governing first phase client interactions is extremely restrictive, and in my opinion unhealthy.  I was unsuccessful in encouraging change in this policy while an employee, but it is my understanding that PFC will liberalize this policy, though I am not sure how much.

The Dean: If abuse were to occur inside the facility, what access did the clients have to telephones or other communication devices?  Can kids make unsupervised calls to parents to report abuse?  If not, why not?  What structures are available for reporting abuse?

KHK Source: There is an internal grievance policy to report abuse that can theoretically lead to contact with state agencies, but only if clinical staff or the executive director are unable to resolve the grievance.  The clients have no access to communication with the outside on first phase.  While I have never seen abuse during my time at KHK and am certain it would not be overlooked, the clients must rely wholly on the staff?s judgement and cannot therefore effectively report abuse if it were to be disregarded by staff.  Prior to pressure put on KHK by ODADAS, restraint and seclusion were commonplace, though much more-so around the time I was a client.  Clients were never arbitrarily restrained or secluded in my time there, but these practices were certainly overused to the detriment of some clients, and were almost never professionally supervised.  It is safe, however, to say physical abuse never, to my knowledge, took place in the common understanding of the term.  In the past two years restraint and seclusion have almost entirely been eliminated, solely because of outside pressure on KHK.

The Dean: During your time, what method did you use to determine whether a kid had a chronic drug problem, or merely a few experiences with curious experimentation?

KHK Source: For many years the primary method of determining a client?s appropriateness for treatment was based solely on a symptom questionnaire filled out by parents.  Clients could be, and were, released if they did not prove to have a significant using history.  They were, however, regarded with great suspicion and it was an uphill battle once admitted.  I have also seen a handful of clients retained who did not, in my opinion, have the appropriate history, perhaps out of parental pressure on KHK, the assumption that no one would be admitted if they did not need to be, or a reluctance to relinquish a client.  I never saw a client retained who blatantly did not need to be, but the impulse of the clinical staff was clearly to justify retention rather than release a client.  The majority of clients at KHK would be considered by any standard serious drug addicts with demonstrable life consequences.  While it is very unlikely that a client would stay in treatment with no real history of abuse and its consequences, I believe it is difficult to weed out the individuals who had serious pasts but would be able to change without such drastic measures.

The Dean: Did KHK administer drug tests before admitting kids into the drug treatment program?

KHK Source: KHK did not administer drug tests prior to admission for the majority of my time there, but has been doing so at least for the last six months.  Drug testing is sporadic while in treatment to catch transgressors.

The Dean: What do you think about people who have been diagnosed with Post Traumatic Stress Disorder, allegedly due to their time at KHK, or its predecessor Straight, Inc?

KHK Source: It is hard for me to imagine a client at KHK with anything approaching a standard treatment experience to have lasting psychological trauma.  For many years, though, KHK was very persistent in retaining non-compliant clients beyond any reasonable expectation of success.  I believe the rare examples of the clients who graduated after lengthy resistance to treatment motivated this clearly unsound persistence, and any outside professional would be able to recognize that a different course of treatment was needed.  KHK has become much more quick to relinquish clients who are not successful, but there is still a shocking absence of the involvement of professional psychologists in the day-to-day treatment of clients at KHK.  The clinical staff discuss clients with peer staff during biweekly meetings, but at KHK they very rarely meet with individual clients and almost never participate in the group sessions that dominate the clients? day.  Professional involvement has been targeted as a priority, but the clinical staff have yet to become meaningfully engaged in the treatment of clients.  PFC seems to be significantly different from KHK in this regard, and will theoretically increase professional involvement as they take control of operations at KHK.  Unfortunately the clinicians at KHK have resisted these changes thus far, and there is currently effective management at KHK to implement the changes.

The Dean: If KHK really does a good job helping kids get past addiction, wouldn?t that mean there were some long term statistics to demonstrate this effectiveness on a 5, 10, or even a 20 year scale?  Have you ever seen such longitudinal studies?

KHK Source: KHK does have outcome studies conducted by an outside organization demonstrating success rates going back at least ten years, but the questions are written in such a way that the astronomically high success rate is extremely misleading.  They boast something like 70% full-abstinence after two years (I may have this a little wrong, but it is close), but even taking the most charitable view this is a ridiculous claim.  That said, from my experience KHK does seem to be much more effective than other available treatment for adolescents, but I would guess a realistic success rate is closer to 10%.  I have experienced what can be seen as miraculous results for some individuals, including myself.

[ This Message was edited by: Eudora on 2006-03-14 07:42 ]

[Anonymous]

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The Cincinnati Beacon


The Debate Rages: Kids Helping Kids
Saturday, March 18, 2006

Posted by The Dean of Cincinnati


A guest column from an anonymous source (the same one interviewed here)?another piece in our ongoing investigation of Kids Helping Kids.

The following is a response to a small number of the assertions and perceptions that seem to pervade the debate about KHK, as well as my own piecemeal assessment of some general aspects of the treatment model inherited from Straight, Inc, and KHK?s specific application of this model.

I have read in many places that KHK is a money-making scheme; this could not be more untrue.  Though I don?t know what the executive director is paid, the staff at KHK all make considerably less than workers in related fields, and there are no stock-holders making money.  KHK has almost had to shut down a number of times, and has been bailed out by donations on several occasions.  They are motivated by an at times fanatical belief in the righteousness of their work, particularly among the peer staff.  The professional staff seem to enjoy the easy work and are willing to accept meager compensation.  The peer staff genuinely believe in providing the same opportunity they were given to someone else.  I believe the executive director could be considered a true believer as well, though I do not know where this belief stems from.

The charge for treatment has double or tripled, on a sliding scale for different income levels, since Pathway Family Center (PFC) became involved.  To my understanding this increase is motivated by a need to avoid financial crises, and KHK, at least, lost money on every client.

I do not believe allegations of conspiracy are worth discussing.  Though I understand Straight was considerably different, KHK has for a great many years operated in isolation from similar facilities until their recent ties with PFC.  Until this point KHK always appeared to operate in the absence of outside influences or collaboration, in my mind this has been one of its primary defects.

Regarding abuse, I have never seen or heard of clients being physically or verbally abused in my years of involvement in any of the ways described by Straight survivors.  I have seen clients confronted in the group with such pressure that it clearly causes great stress, though never being downgraded or having their person verbally assaulted.  Clients were in the past restrained for disrupting group and refusing to enter seclusion on their own when they did not pose any physical danger to themselves or others.  I believe this is a result of prioritizing the maintenance of a level of order in group at the expense of any best-practices standard of the use physical force only to prevent physical harm.  The verbal intensity of confrontation was greatly reduced by the time I came on staff, as was the use of restraint to maintain order in the group.  Both of these changes were largely a result of the evolution of the peer staff.  Restraint is only used now according to the standards set by, I believe, ODADAS, again because of outside pressure.  KHK was faulted during state audits for the aforementioned restraint and seclusion practices and complied with recommendations.  The absence of abuse at KHK is largely, in my opinion, due to the good fortune that KHK has produced largely self-regulating peer staff.  For all but the last two years the program was one in which unprofessional (though ?trained? by their own recovery experience) peer staff have supervised the group alone and decided when restraint and seclusion were necessary.  Again, restraint and seclusion practices have changed significantly but the absence of professional supervision has not.  While no pattern of abuse would be ignored, it seems very easy to me for a para-professional staff member to commit an act of abuse while unsupervised.  It is, in my mind, only through luck that this has not happened.

Regarding professional supervision.  The average treatment experience for a client at KHK involves almost no professional care.  The peer staff handle nearly all aspects of treatment, which is both KHK?s greatest strength and its greatest weakness.  The clinical (professional) staff at KHK are very uninvolved and do not take part in the regular treatment of clients.  They do shoddy, sporadic, and generic paperwork and have even had peer staff complete their clinical documentation for clients without experiencing consequences when it has been brought to the attention of the executive and program directors.  These practices are particularly egregious when it comes time for CARF certification or a state audit.  Fortunately or unfortunately, this lack of work or professional ethics is a product of laziness, procrastination, and a lack of involvement in treatment rather than a need to be deceptive.  This lack of outside supervision is, again the greatest weakness of KHK and prevents the analysis of current practices and the implication of better ones.  Their is no professional ethic among the clinical staff because there is no accountability and the peer staff do all of the front-line treatment and most of the paperwork.  The internal culture of KHK has also been one in which professional training took a distant second to recovery experience.  This environment seemed to strip clinical staff of their professional training as they were absorbed into the existing framework.  There have been some very involved and successful clinical staff, but this is a product of individuals rather than the institution; a rather fragile framework to build a sustainable professionally run treatment program on.  Again, it is only through good fortune and the general high quality of the peer staff that KHK has done as well as it has.

ODADAS has recently put considerable pressure on KHK to increase professional supervision.  The program director and clinical staff have established Potemkin oversight with, from what I can tell, no real changes.  Fortunately PFC seems to be very different in this regard, but I have little direct experience with them.  I do know that PFC clients have considerable contact with trained professionals, and their groups are always supervised by a trained professional.  I expect that PFC will make significant changes in this area, and they do seem to have incorporated professional psychological care into their institutional structure to some degree.

Another aspect of this treatment model that I find particularly troubling is the coercive nature of the treatment itself.  Clients under 18 are rarely given a choice to be admitted to treatment, and cannot leave once admitted without running away or being withdrawn by their parents.  Now, at least in terms of actually getting away, running away is easy as the program has eliminated belt-looping (ODADAS or CARF deemed it to be client-to-client restraint) and clients can run any time they are outside without being chased.  They are then, however, generally not allowed by their parents to return home.  Coercion in this regard, at least, is more subtle but still clearly present.  The problem for KHK has always been an inability to maintain any desire to continue treatment in such a long program.  This difficulty is the source of many of the rules and restrictions that either seem or are in fact objectionable.  The reason the program exists in the form it does is because of the legal authority parents have over minor children.  While this coercion has always made me uncomfortable, it is hard to imagine any treatment that can reach adolescents without some coercive power over them.  I do think this type of treatment can effect change early in life and prevent later consequences, but ideally one would find a way to reach adolescents without forcing them to participate.  It is in areas like this that I think public criticism and dialogue such as that put forth by KHK?s detractors can be very useful in clearing deadwood and maybe even finding a way to make this treatment work without so many negative aspects.

KHK and from what I can tell PFC are both very insular organizations.  You experienced this when you went into the lobby looking for information.  This insularity is part of their legacy from Straight, as are a number of their questionable practices.  They have been allowed to operate without external supervision and this has prevented their treatment practices from evolving to meet current standards as quickly as they would otherwise.  I do believe that this treatment is effective and helpful for some individuals, but the failure of these programs to operate in the light of day prevents positive change, traumatizes clients, leaves them vulnerable to abuse, and, frankly, creeps people out.  KHK has great institutional weakness that may be corrected in the takeover by PFC, but without pressure from ISAC, ODADAS, and the state KHK has not been motivated to change and improve.  I would recommend finding someone from PFC to give you insight into their organization, as they are who you will be dealing with in Milford from now on.  They seem in many ways to have evolved into a more recognizably modern treatment program than KHK, but have also retained more of the vestiges of Straight due to their being a direct descendent.  Unfortunately, I do not have enough experience with PFC to provide you with more insight.