Fornits

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An open discussion about the troubled parent industry

Thanks for the fact check.  I was referring to specifically the kinds of circumstances found in the Aaron Bacon and Sergey Blauchstein deaths.  Deaths that could be directly attributed to program design in a "parent-choice" facility.  If we reduce the time frame to three years, the deaths listed are the function of "flukes" i.e. the traffic accident at Sunrise, or deaths in publicly funded group homes/rtcs i.e. Daystar, Leak & Watts.

The restraint deaths were all preventable, but can you just hear Whooter saying "well that's what you get with government funded residential".

Blombrowski, not sure how long you have been posting here, but this is the mentality that has been dominant here on Fornits over the past several years.  Imagine if a child was hit by a car on the way home from public school and a web site similar to fornits with a poster like "Pile of Dead Kids" was trying to spin the accident into the public school system being an abusive environment and wanting to shut down all public schools.  If we applied this same criteria (mentality) to public schools we would have a death list a mile long.  There are  some people who are so anti program that they somehow tricked themselves into believing that any circumstance of death is the responsibility of the program no matter how removed the child was.  Even Psy, who seems very well educated,  attributed a persons relapse into alcohol at age 43 to a program that they attended as a teen when we were talking about Barbara Walters daughter and her recent DUI arrest.

I am glad that you are able to differentiate and see that deaths like restraint deaths are those that we should be focusing on when focusing on the industry, not car accidents or DUI's at middle age.



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"Designed to be abusive" might not be the right terminology - the intent in most programs is not to abuse.  However, my hypothesis is that the CEDU influenced programs are designed in such a way that it should be expected to cause harm.

Lifesteps, raps, etc. were designed to be stressful.  If I take a group of a hundred random people and prepare them for a marathon exactly the same way, some people are going to be successful and be in the best shape of their life.  Some people are going to finish the marathon, but have permanent knee damage.  And probably at least one person will suffer a fatal heart attack, either before, during, or after the marathon.

I like that analogy better myself

The people for whom the CEDU process is successful become its advocates (starting or working in programs, becoming educational consultants, fundraising for the industry).  The people for whom it was not successful are generally silenced (at least until this forum was developed).  It doesn't take away the fact that anyone with a modicum of knowledge about psychology should have known that the CEDU process was likely to cause harm in some of the people who were served by it.

To Mike's point, whether forcing this stress upon a person in an effort to change their behavior, even if objectively it was in their own best interest is an ethical dilemma that I don't care to engage in.

I think the industry has to get better at screening individuals which will do well in a program.  For example, Aspergers kids would suffer inside one of these places and never get anything positive out of it.

What does matter to me, is exposing that these negative outcomes are real, that they exist, and if nothing else raising the bar in what the public considers to be a good outcome.

It isnt natural to expose ones dirty laundry or talk about the failures that one has encountered.  Its not good for business, but it doesn't mean they don't care.  

Kids were dying in programs, not because they were merely accidents, but because there was a pattern of staff not taking health complaints seriously because youth were viewed as being manipulative as a baseline.  I hope that it finally got through to people that, deaths such as these were not acceptable, and that the culture of the industry has changed to at least assume that potential life-threatening conditions are real, before assuming the kid is lying.  3 1/2 years without a parent-choice industry program death.  I sincerely hope that it's not a fluke, and it's result of programs looking at their practices and making the programs safer.  The industry had for years tried to make it seem that deaths were rare compared to other physical activities, and minimize the danger.  Pressure by advocates has changed the calculus to where a program death, particularly one caused by neglect, can put a program out of business.  

I was tracking Death rates in programs vs the public school system for years and posted them here on fornits periodically and it is encouraging that the TTI has seen safer times.  I think awareness and training has a lot to do with the decrease in deaths within the programs.

Similarly, there have been programs that have recognized that the transition from program back to community is challenging, and that there are many youth that experience a J-curve, (I would argue that it's more like a backwards-J curve or at least a U-curve), so a number of programs have developed some kind of after-care program.  The presence of these after-care programs has led to the occasional use of them as preventative-care programs, keeping youth from going into programs to begin with.  

This was a big issue with me at one time.  My daughter did not transition as easily as I would have liked and a more gradual hand-off from program to home life would have prevented a lot of problems and heartache on her part.  They have greatly improved in this area probably due to feed back from parents like myself.

The industry takes a strictly capitalist, individualist, parents' rights model of treatment.  If we assume a highly transparent system (of which the industry is still very opaque, but not nearly as opaque as it was many years ago), where the customer and the consumer are the same (this will never be the case), this model should be expected to lead to good outcomes on it's own - as individuals will cease purchasing a product that they know doesn't work.  This is not an industry where we would expect the free-market to work.  On the other hand, CAFETY for instance, bends socialist, collectivist, youth rights perspective. We can debate ideology, and never get anywhere.  Or we can debate actual outcomes.  What we might be saying here that complicates things, is that the outcomes that matter to the customer (compliant, law-abiding, college educated) are different than the resulting outcomes to the consumer (constantly anxious, loss of identity, loss of community).

First we have to make the point that the internal outcomes that the person who experiences a program, actually exists.  Then the industry has to figure out if they can achieve the first set of outcomes without the second set of outcomes.  Then they have to figure out if it's profitable to do so.

The industry has to continue to do a better job and continue to improve if it is to keep and/or expand its market base.  The industry needs to attract outside agencies willing and interested enough to review their procedures, conduct further studies mirror their polices etc. so that they get more visibility and grow.



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But pharmaceuticals are much unlike the industry in that the FDA has to verify, with years of research and mountains of evidence, that a particular drug is safe before it is sold to the public.  The industry has never been held to any comparable standard. It makes it's own rules and you're darned right that who pays for a study and whether or not it's peer reviewed matters.  It's the difference between marketing and science.  If a program controls the data and pays for the "research", there is a good chance that it's going to make the program look good.  They wouldn't very well pay for it otherwise.  Even still, they make mistakes and drugs are recalled. More often than not, programs have to be shut down by the authorities or sued out of existence before they stop doing what they've always done.

Each side can pick and choose horrible events that occurred in programs or public school systems, college campuses to make their point that they are not 100% safe or that staff and people can be abusive, but the programs themselves are not designed to be abusive as you have indicated.  Giving these kids a highly structured environment has been very successful, psy, and since no outside agency has stepped forward to perform a study the programs themselves have paid for their own studies and tried to distance themselves as best they can from influencing the results by hiring and IRB (Independent Review board)  to oversee the study.  There will always be detractors, like yourself, who try to undercut the studies by saying things like the Framingham heart study is invalid because there were heart surgeons involved in the collection of data, for example, or the head of the study group previously worked in a hospital etc.    therefore the results are invalid!

A lot of work and effort went into these studies and the results are being used to market the TTI as they should be.  I dont think you could present a study that has not been used to market the product that was studied.



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A question directly to Whooter.  Is it too much to ask those who operate and work in programs, and those who refer to programs to think about the broader impact of the services they provide beyond the transactional relationship.  As many of the individuals in the industry are in fact licensed social workers, do they have a responsibility to society that goes beyond their client?  This was an issue that was brought up in a workshop I attended that looked at programs that operate in the public sector who are looking to or have entered the private pay market - and whether it reenforces classism to separate the two populations in two different programs (i.e. Starr Commonwealth/Montcalm Schools as one approach or the combined population at Wediko which is another).   Or is their only responsibility to the client?

My opinion:

We all have a responsibility to society  because we are an intricate part of it but Doctors, nurse, LCSW's etc particularly do not have a responsibility to society when dealing with a person in their care.  

Brombowski, The reason why I think this way is they need to advocate for their patient first and society second.  LCSW’s are trained to work with people one on one (like most medical professionals), not society as a whole.

If your patient is 65 years old and needs a new kidney, should you allow a patient who is 35 to get that kidney because they are younger and would be better served by it and can better contribute to society?  Would you under-treat a patient for pain for fear they would become addicted and may need further treatment for addiction and become a burden on society?  Should a doctor provide expensive intensive care for a newborn who is likely to die or have a terrible quality of life, which would impact society and the cost to care for this child?  Would you breach patient confidentiality if you know the patients’ health status would inflict harm on others in society like communicable diseases?  Would you perform an abortion if the mothers life was in danger if she carried full term even if society decides it is against the law?  or if your personal religion was against abortion? What is the right decision?

LCSW cannot take all of that on, they need to advocate for the patient that they have responsibility for (at that moment in time) and do the best they can to improve that persons quality of life.



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I guess many can argue whether or not the studies covered enough ground (personally I wish they had tracked these kids for longer periods of time), but from the few studies that have been done the result have been positive and encouraging.  As a minimum the studies show that the kids are placed on a good track.  I don’t think we can fault the programs for lack of studies.  Drug trials are typically funded by private donors, the government or the drug companies themselves.  Many here and at places like ASTART do not accept any studies which are funded by the industry even though they are overseen by a 3rd party.  I firmly believe that if the studies had come out negative towards the industry then people here on fornits and at ASTART would embrace the results and the structure of the study would be less of an issue.
 
So that leaves private donations or the Government and I don't think they see any future value in doing this.  Obama care or any other insurance company would never consider any residential treatment beyond 30 days so why invest in a study?  All proceeds will be coming from those who can afford out-of-pocket costs for decades to come and the industry needs to continue reaching out to those who can afford the cost.



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 But most of the harm that those in this community have experienced are context specific.  I think we have to admit that there are some interventions that may have harmed us, that have actually helped others - and that the help and impact are real (leaving aside the question of whether they could have been helped in another way).  But on the flipside, there should be some recognition by those who work in the industry, that there are interventions that they use that are likely to cause harm should they be used on the wrong person.  Given the difficulty that even child protection specialists have with discerning the truth when a parent says one thing and a child says another, it's hard to believe that even in the best of circumstances that a parent will always be a reliable communicator of a child's needs and situation.

Good point, Blombrowski,Personally I maintain that many of these programs should only be used as a last resort.  A time when all other local options have been exhausted.  I agree that many kids do not do well in these programs because they are not suited for them.  I think the programs have evolved over time to better recognize which kids will most likely be successful and which will probably not.  I know for certain that there were many kids who were rejected by ASR because they were not a good fit.. too aggressive, running away etc. If the programs would submit to a 3rd party sign off I think this would further screen out kids who should not be there.



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I'm surprised the industry hasn't tried to buy and pay for more studies given the Miller hearing in which MIller verbally slapped around the NATSAP flunkie Jan Moss on CSPAN. She  just sort of sat there and looked silly while not really being able to respond.

I recall them having that horridly flawed Beherens study that was funded by Aspen, no compromised ethics there of course.. pbbbtt.. lol.

NATSAP really doesnt have any power over the industry.  The Aspen study was solid as I remember.  It was overseen by a third party and showed about an 80% success rate in some areas.



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There are residential programs that can't even get the child to make gains between admission and discharge.  So the pre-post gains are something.  But... without those gains being compared to a control group who didn't have the intervention, or a different intervention, it's hard to make a comparison.

I agree, if they could some how develop a controlled group of kids who are similar, sending half to a program and the other half allow to move forward the best they can on local services or status quo and then follow them a few years past graduation to say age 22 I think that would reveal a lot about the effectiveness (or ineffectiveness) of the program.  Because many here on fornits feel some of these kids will outgrow their problems naturally (mature) over time without such a dramatic intervention as 16 months in a program.

Still reading your previous post....



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