Study: Institutionalizing Youth in Not Effective

[Troll Control]

I strongly doubt, as Whooter suggests, that any government agency or entity will be studying TTI programs and adopting anything from them. Why?  Because the government must rely upon CLINICAL DATA, as all agencies and professionals must when making treatment recommendations.  Since the TTI is, by definition, NOT CLINICAL and since there has never been a clinical study to assess program effectiveness, the government cannot and will not rely upon any programs as a model until such a time they produce a clinical trial of their methods, which, I think we can all agree, will never happen.

You seem to place an awful lot of faith in our government, DJ. I'm afraid I cannot be half so sanguine. Just what kind of "clinical data" was the government relying on when it was underwriting Pathway Family Center?

Seems to me PFC was just the kind of "community-based alternative" that would appear to fit the bill, according to recommended parameters... Or, maybe I'm just reading them wrong.

It also seems to me the government has been up to their eyeballs in exploring, promoting and perpetrating TC methodologies in both community-based as well as institutional programs from the get go. TC-based methodologies are at the core of much, if not most of the programs featured on fornits. Well, at least the ones which rely on the coercive persuasion of group think.

Finally, with all due respect, what exactly do you mean by the TTI being "by definition, not clinical?" How many folk here have been stashed in a short-term psych unit when juvie proved inconvenient and/or illegal in certain cases? Not to mention long-term psych units? In fact, there's even a forum on fornits for that kinda stuff.

I'm not sure about PFC or what it does, but I thought it was an RTC??  If so, it fails the test of community based outpatient services.  And when you say the govt was "underwriting PFC" what does that mean?

And when you start talking about "TC methodology" I'm not so sure you are speaking about ALL TC's, are you?  I'm familiar with many TC's that don't use any of the methods you describe.  Maybe our definitions of "TC" are different.  Mine is "treatement center,"  but I suspect you might mean "treatment community," which is an entirely different, utterly quackified ballgame, my friend.

I also agree there are many abuses of the existing systems where kids are "misplaced" or locked up for no real reason.  That shouldn't be allowed to happen.  By "not clinical" I mean generally "don't use accepted data-driven clinical practices."

[Ursus]

And when you start talking about "TC methodology" I'm not so sure you are speaking about ALL TC's, are you? I'm familiar with many TC's that don't use any of the methods you describe. Maybe our definitions of "TC" are different. Mine is "treatement center," but I suspect you might mean "treatment community," which is an entirely different, utterly quackified ballgame, my friend.

TC = therapeutic community, that is, neither "therapeutic" nor a "community," lol.

Incidentally... to my knowledge, "community-based" does not necessarily equate with out-patient, at least according to some practitioners...

I'm thinking in particular of Layne Meacham's description of his programs, neither of which lasted very long due in part to a number of abuse claims (and this in Utah). I'm also thinking of the way Jerome Miller characterized some of his recommended proctoring programs when he closed down all of Massachusetts' reform schools in the early 1970s. These programs, along with some study of Miller Newton's KHK program in New Jersey, were essentially what Meacham's programs were based on. Basically a Straight, Inc. model: at program during the day, sleep at an oldcomer's house at night. These were described as "community-based" programs. Could one really consider them "outpatient?" There was 'round the clock, 24/7 intensive behavior modification going on.

[Troll Control]

All good points, Ursus and a good illustration of how the waters are muddied.  It's sometimes difficult to explore the lexicon of therapy because so many quacksters have perverted so many terms that nobody is really sure what they mean anymore.  

Then again, whenever I read program literature, at least to me, it's always a Word Salad Deluxe with Fact-Free Dressing.  But this is also my area of expertise and education and I can see how laypeople get roped in by the truthiness.

[Whooter]

I am not familiar with the "Highfields Treatment Center".  It sounds interesting.


Taking a look at the state of Illinois the cost of one youth was about $6,000 a month in 2005 (Which is in line with the present day cost of a TBS).  The average length of stay for a delinquency commitment was 8.8 months with a mean court eval placed at 3.5 months.

They subsequently adopted a system they called “redeploy” (I believe the "Model for Change" study mentioned this also) which moved these kids from the large state run facilities to local community sites so that the kids would remain in their own county.  These community based facilities were able to show a “reduced cost” and better results (although I haven’t seen a completed study).  So I believe it is doable to shift the lower level offenders to these community sites but they haven’t tried the same thing with the more serious felonies as the “Models for Change” study has suggested, (Yet?)

These community based programs combine therapy with behavior modification, social skills training, cognitive behavioral interventions.

These community based facilities are important for delinquents and their families because it enables the families without access to transportation, on the lower income level, to more easily visit.  Many of the family members could not afford to travel the distances required to be involved with family therapy if the child were placed hundreds of miles away like centrally located state facilities and many of the private institutions.



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[wdtony]

Reading through all of this is all really excellent information/opinions but it has got my head swimming. It's hard to follow in different directions but I will try to keep up.

First, Whooter said that most programs were already short term / under 18 months. When I was in KHK, short term meant a month or less. 18 months was always considered long term and actually anything longer than a month or two was also. So I agree with DJ on this part.

@Ursus, yes, although I don't know exactly what is meant by "community based", I would say that PFC would probably be able to sell itself to the public as a "family oriented program" and try to pretend to be the better alternative due to its weird host-home component.

If "community based alternative" equals "therapeutic community" then that would be a terrible misuse of terminology. But I am not sure that is the case. All of this data reminds me of how KHK/PFC programs as well as many others have claimed an 80 or 90 percent success rate for years without any real data to back up those claims. And we all know that TC's are institutions regardless of what they claim to be. If "you can check out any time you like but you can never leave", then you are not free.

@Ursus, "community based" should ALWAYS equate with outpatient. In my opinion, if a kid can't leave, they are institutionalized which is what this study suggests is a negative. If a kid is out in the wilderness and can't leave or so far away from civilization that leaving is impossible then they are essentially imprisoned. The theme of the study suggests that "locking kids up" doesn't work and isn't effective. If community based alternatives include those that essentially lock kids up, how can we differentiate what is beneficient and what is not?

@ Whooter: Why is it that you seem so very gung-ho with sending kids away. I don't think this is in any way a good idea. I can honestly say that I could have used some time "away" from my family when I went into KHK, BUT I don't think it would have been healthy to have been taken out of my school district or so far away that I couldn't speak with my siblings, parents or friends. What I needed was a little space but I also needed to work things out within my family. I am absolutely certain that I did not need to be extracted or separated from my world at the time. If I had been taken out of state that would have been a huge mistake.

And an interesting bit of info about Illinois: PFC tried to start a program in Illinois but was denied by the state government because they couldn't meet the required criteria for that type of program. In other words, Illinois saw PFC as an illegitimate program and wouldn't let them do in Illinois " what they were doing" in Ohio, Michigan and Indiana. Props to the state of Illinois for stopping the PFC scammers.

@DJ: Fact free dressing = classic.

[Whooter]

@ Whooter: Why is it that you seem so very gung-ho with sending kids away. I don't think this is in any way a good idea. I can honestly say that I could have used some time "away" from my family when I went into KHK, BUT I don't think it would have been healthy to have been taken out of my school district or so far away that I couldn't speak with my siblings, parents or friends. What I needed was a little space but I also needed to work things out within my family. I am absolutely certain that I did not need to be extracted or separated from my world at the time. If I had been taken out of state that would have been a huge mistake.

wdtony, your recap was nicely done.  Here is a response to my piece:


I don’t see myself as gung-ho at sending kids away.  I just finished a post on the benefits of Illinois ”Redeploy” program where they have moved these delinquent kids back into their community for rehabilitation.  I see this as being successful and a model to other states and communities.

If you read enough of my posts know I am for local services as a first step.  If local services are unsuccessful I don’t think that parents should just throw in the towel and let the child continue down a destructive path,(I realize there are many who disagree with me and would tell parents to give up at this point).  But I am a firm believer that when local services fail then the child needs to helped off site.  This thinking is what separates my thinking from many of those on fornits and places me as a proprogram poster ...  (or as the enemy lol).

Many of the TBS’s are far away but the expense includes having the family involved as well.  A trip across the country can be just as difficult as a trip across town if you don’t have the proper funding or transportation,  so distance is relative.  If a child isn’t even attending school anymore and has broken off any constructive communication with their family then what is the difference if they are 10 feet away or 1,000 miles away?  As long as they are receiving help.

Is there a risk associated with sending your child away to a TBS?  Absolutely.  Is there a risk at throwing your hands up and saying we reached the end of the line and decide to do nothing more for your child?  Yes, for sure.  Have kids been abused in Programs?  Yes they have.  Do kids get abused in our public schools?  We all watch the evening news and know they do every day.  So a parent has to make a choice for their child.  Some make a more informed choice than others, but they still need to decide and 100% of the parents do decide either by their action or their inaction.



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[wdtony]

@ Whooter: Why is it that you seem so very gung-ho with sending kids away. I don't think this is in any way a good idea. I can honestly say that I could have used some time "away" from my family when I went into KHK, BUT I don't think it would have been healthy to have been taken out of my school district or so far away that I couldn't speak with my siblings, parents or friends. What I needed was a little space but I also needed to work things out within my family. I am absolutely certain that I did not need to be extracted or separated from my world at the time. If I had been taken out of state that would have been a huge mistake.

wdtony, your recap was nicely done.  Here is a response to my piece:


I don’t see myself as gung-ho at sending kids away.  I just finished a post on the benefits of Illinois ”Redeploy” program where they have moved these delinquent kids back into their community for rehabilitation.  I see this as being successful and a model to other states and communities.

If you read enough of my posts know I am for local services as a first step.  If local services are unsuccessful I don’t think that parents should just throw in the towel and let the child continue down a destructive path,(I realize there are many who disagree with me and would tell parents to give up at this point).  But I am a firm believer that when local services fail then the child needs to helped off site.  This thinking is what separates my thinking from many of those on fornits and places me as a proprogram poster ...  (or as the enemy lol).

Many of the TBS’s are far away but the expense includes having the family involved as well.  A trip across the country can be just as difficult as a trip across town if you don’t have the proper funding or transportation,  so distance is relative.  If a child isn’t even attending school anymore and has broken off any constructive communication with their family then what is the difference if they are 10 feet away or 1,000 miles away?  As long as they are receiving help.

Is there a risk associated with sending your child away to a TBS?  Absolutely.  Is there a risk at throwing your hands up and saying we reached the end of the line and decide to do nothing more for your child?  Yes, for sure.  Have kids been abused in Programs?  Yes they have.  Do kids get abused in our public schools?  We all watch the evening news and know they do every day.  So a parent has to make a choice for their child.  Some make a more informed choice than others, but they still need to decide and 100% of the parents do decide either by their action or their inaction.



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Thanks, I try to keep up at times.

We obviously don't agree on many points and I don't want to waste any time arguing points that are moot.

I would like to bring up another point that you are probably familiar with. You speak about delinquent youth as if they are solely to blame. I don't share this view. When you speak about parents throwing in the towel, you don't mention anything about the parents seeking help for their own failure at parenting. Something that is more widespread and "normal" than teens behaving badly. I don't fault parents for their failure at properly raising their children and needing help. What I do hold them responsible for is dodging responsibility by placing the blame for all problems surrounding the kid's action on the kid. This is a myopic view of the problems that arise in the family when problems should be viewed as a family dynamic issue.

"Kick the dog...The dog bites...Blame the dog for it's behavior" seems to be the troubled teen industry mantra.

I don't see many parents sending themselves away for treatment or even accepting responsibility for family troubles. It is this denial of accountability that probably led to some of the problems with the kid in the first place. But I am being speculative. Of course every situation is different but I think the real "meat and potatoes" of the subject still stands. Family problems ought to be solved with a "family problem solution" which doesn't include the incarceration of only one family member.

[Joel]

Edited: Wednesday, October 06, 2010

[Ursus]

If "community based alternative" equals "therapeutic community" then that would be a terrible misuse of terminology.

Wha??? Where do you read that? I was talking about the TC underpinnings of the TTI. As far as I have been able to make out, therapeutic communities got their start in this country as group counseling or psychodrama programs in jails, thence to reformatories, thence to programs dealing with addiction treatment and behavioral issues. TC-based modalities can be used in institutions and in community-based programs.

"Community based" programs refer primarily to access and scale. That is, they are smaller, more accessible, and generally less restrictive. The Highfields Treatment Center could have been considered to be a community based program and it was an alternative to ending up at Annandale Reformatory. Highfields had a couple of dozen boys, Annandale was one of these monster blocks of concrete with hundreds of cells. Now, that was an institution.

@Ursus, "community based" should ALWAYS equate with outpatient. In my opinion, if a kid can't leave, they are institutionalized which is what this study suggests is a negative. If a kid is out in the wilderness and can't leave or so far away from civilization that leaving is impossible then they are essentially imprisoned. The theme of the study suggests that "locking kids up" doesn't work and isn't effective.

Again, I have no clue where you come up with that. There are both residential as well as nonresidential community based programs. "Outpatient" is a descriptive qualifier and not an equivalency to "community based" here.

Moreover, do I understand you correctly... in that you're saying that... being out in wilderness is equivalent to being institutionalized because, for all intents and purposes, you can't leave? This would be a most erroneous statement to make, IMHO...  

If community based alternatives include those that essentially lock kids up, how can we differentiate what is beneficient and what is not?

By researching them and holding them accountable. Community based programs are not necessarily benign alternatives, although many of them are a saner option. They are simply not institutional programs.

[Whooter]

Thanks, I try to keep up at times.

We obviously don't agree on many points and I don't want to waste any time arguing points that are moot.

I would like to bring up another point that you are probably familiar with. You speak about delinquent youth as if they are solely to blame. I don't share this view.

Delinquent youth is not my term.  I don’t think I have ever used it until this thread.  It’s a term used in the Study referenced by auntie Em in the OP.  The study looked at very severe law offenders and therefore referred to them as Delinquents.  

 

When you speak about parents throwing in the towel, you don't mention anything about the parents seeking help for their own failure at parenting. Something that is more widespread and "normal" than teens behaving badly. I don't fault parents for their failure at properly raising their children and needing help. What I do hold them responsible for is dodging responsibility by placing the blame for all problems surrounding the kid's action on the kid. This is a myopic view of the problems that arise in the family when problems should be viewed as a family dynamic issue.

I think we both agree here.  I have always viewed problems within the family as "family issues", its not just one person or solely the child that is receiving treatment.  Many of the TBS’s see family dynamic change as the solution and look to the family to work on their issues while the child is in the program.  That’s why programs bring the family into the therapeutic process.

"Kick the dog...The dog bites...Blame the dog for it's behavior" seems to be the troubled teen industry mantra.

I don't see many parents sending themselves away for treatment or even accepting responsibility for family troubles. It is this denial of accountability that probably led to some of the problems with the kid in the first place.

I understand completely and this probably happens.  But when a child isn’t responding to local services and has dropped out of school and heading down a bad path then it is a moot point where the blame should be placed.  The child needs to get help and the root cause needs to be identified for sure and changes need to be put in place.  Maybe it is the parents fault in some cases.  But pulling the parents out of the work force and sending them off to a program isn’t going to result in the child going back to school and heading them down a safer path.  I think if it would than that may be suggested in some cases, but we all know this wouldn’t work too well.

I have seen many families change the dynamics at home based on the discussions and findings while the child was in the program to make the home life healthier for everyone.  Change occurs on every facet,not just the child that is in the program.

But I am being speculative. Of course every situation is different but I think the real "meat and potatoes" of the subject still stands. Family problems ought to be solved with a "family problem solution" which doesn't include the incarceration of only one family member.

Agreed, but if local services and family counseling are not affective and the child is still not responding or attending school, and still placing their siblings and themselves at risk then other solutions need to be looked at.  If the whole family could attend for the duration of the stay I think that would result in a better outcome.  I just dont see how many families could afford it.



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[DannyB II]

I would like to bring up another point that you are probably familiar with. You speak about delinquent youth as if they are solely to blame. I don't share this view.

I speak from work experience.  The children I worked with at Eckerd had their problems to deal with.  I can honestly say some of the parents did not have a clue how to raise their child.  The parents I saw, from my perspective, were not consistent with enforcing rules in the household.  They let little things slide and problems became bigger.  There were parents who were more interested in drugs than raising their child.  A child often learns some behaviors from his or her parents.  Obviously some parents pass on bad habits.

I can second that.....
Danny

[Whooter]

I would like to bring up another point that you are probably familiar with. You speak about delinquent youth as if they are solely to blame. I don't share this view.

I speak from work experience.  The children I worked with at Eckerd had their problems to deal with.  I can honestly say some of the parents did not have a clue how to raise their child.  The parents I saw, from my perspective, were not consistent with enforcing rules in the household.  They let little things slide and problems became bigger.  There were parents who were more interested in drugs than raising their child.  A child often learns some behaviors from his or her parents.  Obviously some parents pass on bad habits.

I agree 100%, Joel,just like there are kids who are suffering from emphysema and lung cancer because their parents smoke(d) around them.  But just focusing on getting the parents the help and support they need to quit smoking isn’t going to solve the childs immediate problem.  The main thing is to get the child the help they need and then try to look at the "root cause" and work on the child’s home life before he/she returns.



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[Pile of Dead Kids]

The main thing is to get the child the help they need

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V

[wdtony]

If "community based alternative" equals "therapeutic community" then that would be a terrible misuse of terminology.

Wha??? Where do you read that? I was talking about the TC underpinnings of the TTI. As far as I have been able to make out, therapeutic communities got their start in this country as group counseling or psychodrama programs in jails, thence to reformatories, thence to programs dealing with addiction treatment and behavioral issues. TC-based modalities can be used in institutions and in community-based programs.

"Community based" programs refer primarily to access and scale. That is, they are smaller, more accessible, and generally less restrictive. The Highfields Treatment Center could have been considered to be a community based program and it was an alternative to ending up at Annandale Reformatory. Highfields had a couple of dozen boys, Annandale was one of these monster blocks of concrete with hundreds of cells. Now, that was an institution.

@Ursus, "community based" should ALWAYS equate with outpatient. In my opinion, if a kid can't leave, they are institutionalized which is what this study suggests is a negative. If a kid is out in the wilderness and can't leave or so far away from civilization that leaving is impossible then they are essentially imprisoned. The theme of the study suggests that "locking kids up" doesn't work and isn't effective.

Again, I have no clue where you come up with that. There are both residential as well as nonresidential community based programs. "Outpatient" is a descriptive qualifier and not an equivalency to "community based" here.

Moreover, do I understand you correctly... in that you're saying that... being out in wilderness is equivalent to being institutionalized because, for all intents and purposes, you can't leave? This would be a most erroneous statement to make, IMHO...  

If community based alternatives include those that essentially lock kids up, how can we differentiate what is beneficient and what is not?

By researching them and holding them accountable. Community based programs are not necessarily benign alternatives. They are simply not institutional programs.

I see, so I am misunderstanding some of the meanings here. I will read through it again.

The term (in my opinion) "community based {alternative}" seems to imply that it is an alternative to residential treatment, or being locked up.  Must we have a concrete building to be classified as an institution? I was thinking institutional program meant being physically confined regardless of the means of confinement.

And yes, it is my opinion that being confined by the great outdoors is equivalent to being confined in a building when looking at the impact on the kid. Except I could have probably worded it better...as not being able to escape rather than not being able to leave.

Am I correct in asuming that you believe that community based alternatives are just a tricky term to hide restrictive TC's of the future? I could see this although it could be a mixed bag. If I remember correctly, a few programs had already claimed to be using MST and FFT that were confirmedly abusive last year.

There is no good system in place for this type of family problem. It seems to me that the peeps at CAFETY seem to have the best ideas about creating a real alternative, community based or not.

[psy]

If prohibition creates crime, then why are there so many DUI arrests and deaths? What about all the drunken fights that lead to deaths? Or drunks who take out their rage on their family? So when crack is made available for 99 cents at Walmart, suddenly a utopian society will appear? That's not a world I want to live in.

You imply that the legalization of crack will cause an increase in usage.  Are you that one guy?  You know.  The one who is just dying to smoke crack but won't because it's illegal?  You see my point.  Take a look at this Zogby poll:

http://www.csdp.org/publicservice/zogby2007.htm

Zogby International asked that question of 1,028 likely voters. Ninety-nine out of 100 said "No." Only 0.6 percent said "Yes."1

Drug War advocates have always insisted that addiction would explode if drugs were legalized. But that argument comes apart under the weight of the evidence. While a poll can't predict actual drug use, it clearly shows that most of us avoid hard drugs because of common sense – not fear of arrest.

And that's always been the case. At the beginning of the last century when a virtual free market for drugs existed, use rates were lower than they are today.2 Drug use and addiction – along with crime, violence and corruption – only began to climb after the advent of drug prohibition in 1914.3

Also, like people who blame guns for crimes people commit, you're blaming alcohol itself for DUIs and domestic violence.  The decision to become intoxicated is a choice and a person with violent or reckless impulses knows that he is increasing the likelihood of irresponsible behavior.  Even under the influence, the decision to get in the car or beat on the spouse is a choice.  You might think that prohibition could quickly and easily solve this problem but it can't as history shows.  Making drugs or alcohol illegal simply pushes it underground and makes situations worse by creating a black market supported by violence (eg. Al Capone).  People who do stupid things do stupid things because they make bad choices, and they should be punished accordingly, not given an excuse by blaming it on alcohol or some fictitious "disease".