Lake House Academy

[Whooter]

Sure, there are abusers everywhere.  The difference?  Programs have not ever been clinically validated.

I dont think parents will get much comfort if you told them their childs abuser was in a place that was clinically validated.  The education back ground of the abuser doesn't ease the pain at all from the victims point of view or their families.



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[Troll Control]

And nobody said it did.  

The point is that the chances of being abused are much, much greater in a program where abusers aren't disqualified from employment (many programs don't even do background checks at all) and the general culture is to cover up abuse rather than report it, as we have seen with the examples I provided, MBA and Trails Carolina, to name just a couple.

[Whooter]

And nobody said it did.  

Good then we agree on this point.

The point is that the chances of being abused are much, much greater in a program where abusers aren't disqualified from employment (many programs don't even do background checks at all) and the general culture is to cover up abuse rather than report it, as we have seen with the examples I provided, MBA and Trails Carolina, to name just a couple.

No one has established this that I have seen.  I have never seen a study that concluded there is a greater chance of a child being abused in a program.  I never read where either of those programs you mentioned failed to do background checks on their employees.  I dont see any basis for your conclusion.  I think this is your general feeling because of your disdain for programs, but it is not fact based.  Even if 2 programs did forget to do background checks that wouldn't mean they represent the hundreds of other programs.  Do you see what I mean?

Based on the studies and successes "I" have seen and the general structure and how a program is set up I believe they are much safer than any other form of treatment.  But this is my opinion based on personal exposure and experience.



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[Troll Control]

When you're advocating for programs you continually push the idea that even small samples are representative and provide useful data.

I just gave you a small representative sample of the TTI.  Two programs, rife with abuse, with one having an abuse rate of 100% as per the investigation of the state licensing agency.  

How many programs are out there?  Maybe 500 tops?  You can find a rich history of abuse by dozens of programs right here on Fornits, complete with source documents and investigation reports.  So, just right here we could easily identify probably 100 programs listed here as abusive, a rate of 20%.

There are over 100,000 psychologists that belong to the APA alone and over 150,000 social workers that belong to the NASW.  Add those that don't belong to the associations plus psychiatrists, professional counselors and other mental health professionals and that number doubles.  So, out of these some 500,000 mental health professionals, you'd have to find 200,000 cases of abuse just make the comparison you're reaching for.  It just doesn't pass the smell test alone.

Just from readily avaiable anecdotal evidence we can easily see that programs are far more dangerous to the welfare of kids than professional practitioners.  All notwithstanding that there's no proof programs work at all for anyone and cost a hundred times more than traditional treatment.

[Whooter]

When you're advocating for programs you continually push the idea that even small samples are representative and provide useful data.
I just gave you a small representative sample of the TTI. Two programs, rife with abuse, with one having an abuse rate of 100% as per the investigation of the state licensing agency.

When dealing with small sample sizes there are tables that you need to refer to which will tell you how representative your sample may be to the overall population  (i.e. 75%, 90% 99% confidence levels).  I don’t see where I constantly use this as a basis, but statistician do all the time.

How many programs are out there? Maybe 500 tops? You can find a rich history of abuse by dozens of programs right here on Fornits, complete with source documents and investigation reports. So, just right here we could easily identify probably 100 programs listed here as abusive, a rate of 20%.

Many of the abusive programs have closed and new ones have opened.  Some may be abusive while others are not.  I am a firm believer that we cant paint the entire industry with a broad brush.  We need to look at each program individually to determine if they are effective or not.  We also need to separate the cases where the abuse was done by a single individual and not the result of program policy.  So you see we would need to have a study conducted to determine how effective or abusive the industry is as a whole. To my knowledge this has not been done yet.  There have been studies conducted which indicate that groups of programs are highly effective, but no studies to my knowledge have been done to collect levels of abuse present in the various industries or educational segments like private school, programs etc.

There are over 100,000 psychologists that belong to the APA alone and over 150,000 social workers that belong to the NASW. Add those that don't belong to the associations plus psychiatrists, professional counselors and other mental health professionals and that number doubles. So, out of these some 500,000 mental health professionals, you'd have to find 200,000 cases of abuse just make the comparison you're reaching for. It just doesn't pass the smell test alone.

Exactly, a study would need to be done to collect all the abuse occurring in the TTI and then compare it to mental health professions.  Another bit of information may be to compare the public education sector as well.  I think they would produce a lions share themselves.

Just from readily avaiable anecdotal evidence we can easily see that programs are far more dangerous to the welfare of kids than professional practitioners. All notwithstanding that there's no proof programs work at all for anyone and cost a hundred times more than traditional treatment.

I actually see the opposite.  The structure and consistent oversight and low staff to client ratio alone leads me to conclude that programs are much more safer than any other form of in house treatment.

As we debate this it becomes more evident that neither one of us can say that all programs are good or all of them are bad.  It is not as black and white as many here have thought.



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[Pile of Dead Kids]

allows me to maintain the believe

[Whooter]

allows me to maintain the believe

Thanks Pile,  I changed it to : "leads me to conclude"... The other didnt sound right, I agree.



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[Whooter]

"Programs" are not considered a valid treatment modality and this is precisely why insurance companies will not pay for them.

Insurance companies deny coverage based on cost most of the time, DJ.  I am not sure if you are aware of this and don’t mean to pick on your posts specifically.

A patient with lung cancer was prescribed (by his doctor) Tarceva to treat the patients cancer.  The insurance company denied coverage for this expensive treatment.  Traceva is an approved treatment which had undergone and passed clinical trials.  Example Link

The insurance company did respond to this person to indicate that they would cover "palliative care" which includes doctor assisted suicide.

So based on this we can see that insurance companies are not solely driven by what is effective (or best care) for the patient.  Programs could undergo clinical trials and pass with flying colors but it wouldn’t mean that insurance companies would cover their high cost.



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[Ursus]

"Programs" are not considered a valid treatment modality and this is precisely why insurance companies will not pay for them.

Insurance companies deny coverage based on cost most of the time, DJ.  I am not sure if you are aware of this and don’t mean to pick on your posts specifically.

A patient with lung cancer was prescribed (by his doctor) Tarceva to treat the patients cancer.  The insurance company denied coverage for this expensive treatment.  Traceva is an approved treatment which had undergone and passed clinical trials.  Example Link

The insurance company did respond to this person to indicate that they would cover "palliative care" which includes doctor assisted suicide.

So based on this we can see that insurance companies are not solely driven by what is effective (or best care) for the patient.  Programs could undergo clinical trials and pass with flying colors but it wouldn’t mean that insurance companies would cover their high cost.

That was an interesting story, Whooter. While I would hate to be in the shoes of the patient in this case (a MS. Barbara Wagner, btw), here was how the Oregon Health Plan saw it:

Dr. Walter Shaffer, medical director of the state Division of Medical Assistance Programs, which administers the Oregon Health Plan, attempted to defend the health plan's decision.  "We can't cover everything for everyone," he said.  "We try to come up with polices that provide the most good for the most people."  Shaffer then addressed a priority list that had been developed to ration health care.  "There's some desire on the part of the framers of this list to not cover treatments that are futile," he said, "or where the potential benefit to the patient is minimal in relation to the expense of providing the care."[/list]

In this case, according to one of the comments on this article, treatment with Tarceva would have, in all likelihood, extended Ms. Wagner's life by less than two months longer than the placebo group fared. Moreover, Tarceva was apparently not an approved treatment by Oregon at the time; it was then still considered "experimental." Here's that comment, fwiw:

left by John Hrvatska from USA 215 days 6 hours ago.)

at the time of this story (early 2008) Tarceva had yet to be approved by Oregon (and about 20 other states) and was considered experimental.
 
The letter from OHP (Oregon's Medicaid) specifically said they would pay for palliative care and hospice.
 
Tarceva does not cure cancer in any way - what it does, in clinical trials, is extend someone's life 6.5 months instead of 4.7 months people on the placebo averaged.
 
OHP had paid for her previous surgery, chemotherapy, home health nurse, 100%, but denied Tarceva because it was experimental and because they don't pay for drugs that don't have AT LEAST a 5% 5 year survival rate. Tarceva can't even claim that 5% rate for 1 year, much less 5.
 
Is it harsh to ration medical care this way? Yes. On the other hand, if you google the terms "tarceva insurance denied" you'll come up with pages and pages of stories about private firms - and one state - denying Tarceva because of its limited benefit.[/list][/list]

Insurance companies *do* get a little skittish 'bout paying for treatments that are experimental in nature, so this *is* a most appropriate article for the (sub-)topic currently being discussed. Thanks for bringing it to our attention!  

[Whooter]

Thanks, Ursus, we see that the state tried to defend their decision and we can see that insurance companies do not rely on what the doctors prescribe and even though the treatment is acceptable they may rule against it and not cover the cost feeling that prolonging the life of a patient a few months is not worth the expense.

Many professionals in the mental health field show frustration with the present health care coverage of limiting residential coverage to just 30 days.  From the TTI perspective they probably see that even if they had clinical trials done there is no way that the insurance companies would cover the cost of their residential treatment and isnt worth the effort... otherwise they would have started the process.



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[Troll Control]

It's a simple Cost/Benefit analysis for insurance companies.  

Proper clinical treatment costs them a few thousand dollars for provable, measurable results reported by a licensed professional.

Programs would cost them, on average, $60,000 for absolutlely no provable, measurable results.

Let's play your analogy game, shall we?  

You wreck your car and bring it to an unlicensed, fly-by-night body shop who charges you twice the amount for which the car would be totalled.  When you get it back, it's just as wrecked as when you took it in to the shop and is not drivable.  Insurance would not cover the repairs.  

You bring it to a licensed repair shop that charges you 10% of the amount for which it would be totalled and when it comes out it looks fine and is drivable.  Insurance covers the repairs.

It's not that deep.  Until programs are able to provide clinical trial evidence that they are effective, no insurance company would pay for them.  They would be crazy to do so.  It makes no sense from an economic perspective to pay a hundred times more for unproven, experimental treatment than proven, effective treatment.  This is why it's referred to as the "Parent Choice" industry.  Parents can be hoodwinked much more easily than insurance companies.

[Whooter]

It's a simple Cost/Benefit analysis for insurance companies.  

Proper clinical treatment costs them a few thousand dollars for provable, measurable results reported by a licensed professional.

Programs would cost them, on average, $60,000 for absolutlely no provable, measurable results.

Let's play your analogy game, shall we?  

You wreck your car and bring it to an unlicensed, fly-by-night body shop who charges you twice the amount for which the car would be totalled.  When you get it back, it's just as wrecked as when you took it in to the shop and is not drivable.  Insurance would not cover the repairs.  

You bring it to a licensed repair shop that charges you 10% of the amount for which it would be totalled and when it comes out it looks fine and is drivable.  Insurance covers the repairs.

It's not that deep.  Until programs are able to provide clinical trial evidence that they are effective, no insurance company would pay for them.  They would be crazy to do so.  It makes no sense from an economic perspective to pay a hundred times more for unproven, experimental treatment than proven, effective treatment.  This is why it's referred to as the "Parent Choice" industry.  Parents can be hoodwinked much more easily than insurance companies.

Insurance companies try their best not to cover services if they can avoid it... (it effects their bottom line).  Most rehabs are only covered for 30 days..granted some go to 60 or 90.  Programs run for 12 to 18 months and even if they invested their time and money to get their program clinically certified it would take years to convince insurance companies to cover them and even then (as history has shown) they would only cover a small portion of it.

So from the industries stand point there is no payback on investment and the risk of not getting coverage is too high.  Why should they spend the money when their beds are full?  What is the motivating factor?
Do you see what I mean?



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[Troll Control]

Programs run for 12 to 18 months and even if they invested their time and money to get their program clinically certified it would take years to convince insurance companies to cover them...

These programs have been around for forty years or more.  If they worked it would have been documented.  And if it were documented 35 years ago or 30 years ago, they would have been able to accept insurance 25 or 30 years ago.  That argument is a non-starter.

Your business case is better.  They already know a clinical trial will reveal either no change or a worsening (as documented by many youth studies in the past - aggregating distressed teens only makes them worse, as proven by the Surgeon General's report), so they avoid the subject altogether.  

We both know, without a doubt, if these programs could be proven effective, it would already have been done looooong ago.  It would be an absolute and immediate boost to the bottom line and would dismiss efficacy questions in perpetuity.

[Whooter]

Programs run for 12 to 18 months and even if they invested their time and money to get their program clinically certified it would take years to convince insurance companies to cover them...

These programs have been around for forty years or more.  If they worked it would have been documented.  And if it were documented 35 years ago or 30 years ago, they would have been able to accept insurance 25 or 30 years ago.  That argument is a non-starter.

Your business case is better.  They already know a clinical trial will reveal either no change or a worsening (as documented by many youth studies in the past - aggregating distressed teens only makes them worse, as proven by the Surgeon General's report), so they avoid the subject altogether.  

We both know, without a doubt, if these programs could be proven effective, it would already have been done looooong ago.  It would be an absolute and immediate boost to the bottom line and would dismiss efficacy questions in perpetuity.

Ask yourself what would motivate the industry to have all this testing  and studies done.  What motivates the drug companies to spend millions on clinical trials and get FDA approval?  So that they can sell the drug in the United States.  What motivates a person to get a drivers license?  To prove to everyone they are a good driver or because they have to by law.

These programs are not going to spend their good money unless they can see a return on investment or they are forced to by law.  The industry has been growing by leaps and bounds over the past 40 years.  They have plenty of warm bodies to fill the beds.  Why spend money on clinical trials and expensive studies?



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[Anne Bonney]

Ask yourself what would motivate the industry to have all this testing  and studies done.  What motivates the drug companies to spend millions on clinical trials and get FDA approval?  So that they can sell the drug in the United States.  What motivates a person to get a drivers license?  To prove to everyone they are a good driver or because they have to by law.

These programs are not going to spend their good money unless they can see a return on investment or they are forced to by law.  The industry has been growing by leaps and bounds over the past 40 years.  They have plenty of warm bodies to fill the beds.

And that's really what it all boils down to, huh?  How much money they can rake in by scaring the shit out of vulnerable parents.

 

Why spend money on clinical trials and expensive studies?

Because they don't want to hear or publish the results.  It would hurt business.