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The Troubled Teen Industry / Re: Second post from CALO by Ken Huey
« on: July 16, 2009, 01:14:30 PM »
My original post seems to have generated a lot of response. In sorting through the most apparently sincere posts I have identified what I believe are some main themes of disagreement that many of you might have with CALO: 1) forced treatment, 2) holds, 3) communication, 4) “attack” groups or groups led incorrectly, 5) my work history, and 6) type of student at CALO. I have also come to the conclusion that these issues are in many cases not resolvable. I will still deal with them today but I am beginning to doubt my ability to answer all questions in a final and satisfactory way. With no offense intended, I am afraid there are some who are unwilling or unable to hear my answers. I will talk more about that at the end of this post. For now, let me address the themes named above.
Theme 1--Many have tackled the idea that CALO enrolls kids in treatment against their will. What would we do if a kid ran from CALO? What would we do if a teen refused to go to CALO during a CALO-led transport? Can teens leave CALO when they want?
Response to theme 1—Kids are not given the same rights as adults in the United States. They are not allowed to drink until 21. They are not allowed to vote until 18. They cannot drive until 16 in most states. We all have different age markers based on adult beliefs about what those age groups can handle. I believe that teens should not have complete authority to make any decision about their lives that they wish. They do not have the requisite maturity to take on the world in this way. Especially when a teen is evidencing poor behavioral and emotional regulation, I do not trust that teen to make decisions of, at times, life and death. I believe that adults around such teens are duty-bound to intervene in such cases. In general, that option of adult intervention without permission of the teen ends at 18. That is the partially arbitrary age that many states have set for consent. In general, I agree with that age and support statute and law as currently written. Some teens would refuse to be in treatment even though they do need it. We support that treatment. All things being equal, we prefer to have kids bought-in from the outset but that is not always possible. A suicidal teen does not get to choose death in our program. A kid running from home and putting themselves in dangerous circumstances of all sorts should not be able to continue that misguided behavior. A young person skipping school and huffing gasoline should not have the opportunity to kill enough brain cells to permanently alter their future. Again, we prefer to have kids walk into CALO and desire to stay until they are doing well enough to go home. That is not always possible and we have no moral dilemma with giving minors the care they need to improve their lives—even if it is against their will.
Theme 2—Why Positive Control Systems and why do holds at all?
Response to theme 2--Positive Control Systems uses bent wrist controls if a situation escalates to the extent that a hold is needed. We tried numerous other de-escalation systems before deciding permanently on PCS. We have administration trained in MANDT, CALM, NCI, and one other private facility system that is not publicly available. We moved to PCS because it was nationally certified and recognized, it could be initiated by one staff member in a pinch at the outset (a second staff joins the first staff), it was less traumatizing for our population, and it had a much better track record than other systems. Compared to other de-escalation systems, the statistics bear out that PCS is a much safer intervention. Injuries per hold were much better with PCS. As for the re-traumatization issue, we were not impressed with systems that called for 3 or 4 staff to restrain a kid. Chest compressions can become a problem and just the sheer number of staff involved is frightening. We saw flashbacks with other systems that we do not see with PCS.
Our holds are done for safety. When a teen is a threat to self or others, we de-escalate first and then progress to a hold if necessary. The holds are all documented and are now debriefed with the CEO for training. If you know of a de-escalation system that is superior to PCS I would be very glad to know of it. I mean that sincerely.
Theme 3—Do kids have access to phones to call in a complaint about their treatment? Do kids have their phone calls monitored?
Response to theme 3--We do not provide a phone for students to call in complaints. To date, we have been concerned about frivolous use of such a phone and we have not been able to figure out a way around that problem. As for monitoring calls, we do have a staff member in our large conference room where we have 3 or 4 phone calls going on. The staff member is there for safety as those calls can get emotional at times. Teens are not directed to avoid difficult issues on calls or told to keep ANYTHING secret. They are free to complain if they wish. If a staff member did hear that (sometimes they do but not always) s/he will inform the therapist who can then check in with parents. Parents and students are free to escalate concerns to therapists and administration if desired. I have an open-door policy and on occasion students have taken that opportunity and made complaints about program issues. Those conversations have many times been the genesis of course correction within our organization. I implicitly and explicitly invite these conversations. Such a conversation could and has led to an employee termination. We take allegations of treatment that is not in line with our model very seriously. We even go so far as to tell parents and teens how to file a complaint against us if they don’t feel we are dealing with them in good faith. We have that invitation in written materials for teens and parents and on our web site.
Theme 4—Are groups “attack” based? Are they always led by a therapist?
Response to theme 4--We seem to be getting hung up on semantics with words like “accountability” and even the word “groups.” It is hard to get a clear picture for the reader of what our gatherings (that are not led by a therapist) even look like. They are not psycho-educational when facilitated by coaches. They are just a chance to air out community concerns. Topics like masturbation by a particular teen would not be allowed. Telling another teen he has made a lot of progress with his canine training, airing out a grievance about someone working too slow or not pulling their weight, sharing student-written poems—all these are fair topics of groups. In other settings some who have posted seem to have seen attack groups and that is leading some of you to look for that in our groups. That is not what we are trying to accomplish. Therapists run almost all groups. Shorter gatherings are out in the middle of the living space for all to see. They cannot be hidden. There is never a group held in a closed space that is not facilitated by a therapist. Kids are simply allowed to huddle up in plain view to talk things out in a team group. I don’t know how else to explain it beyond this.
Theme 5—Why did Ken Huey work for Provo Canyon and West Ridge?
Response to theme 5--I learned a great deal from my time at Provo. I got in a lot of fights with residential staff over how I thought things should go. I got written up for the only time in my life at Provo because I was considered too soft. It is fair to say that I wanted Provo to go in a much different direction while I was there. Many people from Provo could testify to that. That was when I began creating what would eventually become CALO and lecturing around the country on relationship-based treatment and the need to put away power and control. There were a lot of very, very good people at Provo. There were also some front line staff with long tenures who I could not convince to change because I didn’t have any direct supervision over them. I left for West Ridge because I had the chance to add something to that organization as a Clinical Director. It was an extremely positive experience. I felt like I was able to contribute to what they were doing. With the help of the Executive Director I was given a great opportunity to help professionalize West Ridge and move people along who could not make necessary changes. I was not at West Ridge 15 years ago but when I was there 3 years ago the program was impressive.
Theme 6—What kind of kid does CALO accept?
Response to theme 6--CALO accepts one in every 11 or 12 kids who apply for enrollment. We take kids with a trauma history and who have acted out in ways significant enough that their future could be compromised. That could mean an event as significant as death or simply a large loss of future relational and job opportunity. I realize that is vague so let me give an example of our low and high ends and you can generalize from those examples. On the difficult end of the spectrum would be a kid who kept getting in fights with mom and dad. Some had gotten physical. Son was dabbling in a number of different drugs. He periodically ran away from home and would be gone for a couple of nights. One night mom woke up with son holding a knife over her. That was the final straw. Parents told the son he was going to CALO and brought him here themselves. He did not want to be at CALO (but now says it has changed his life for the better). On the lower end of a difficulty scale would be a young person who was hoarding food in her room all the time. She would not interact with her adopted family in productive ways. She disobeyed curfew and would sneak out of the house on occasion. She yelled at people for no apparent reason in school. She was failing all her classes. She had a love of animals and believed CALO could help her learn lessons in attachment. She came to CALO of her own volition.
With that I will close this post and ask for an open mind. I have requested that before and been met with skepticism. I think I understand that skepticism but I am beginning to understand that no amount of conversation with me will alleviate all your concerns. In fact, I am a bit of a flashpoint for many and may actually be contributing to the problem by posting on Fornits. I am sorry if that is the case for some. I have no intention of angering anyone or of somehow being disrespectful. I do not believe that there is enough I can say to change a mind if these exchanges have not already done that. I will attempt to avoid stirring up more negative feelings by bowing out of Fornits at this point.
I want to own that I am the one who invited Antigen (Ginger) and Psy (Michael) to come to NATSAP. I think my community needs to hear their arguments. I do not want anyone to believe I am being sneaky about it so I am acknowledging this invitation here. I also want to thank a few of you who have respectfully challenged my thinking. A few of those discussions have directly contributed to growth at CALO. It is a difficult thing to remain open and attentive when the message coming at you is an attack but I have done my best on that front. I feel I have done all I can at this point to hear concerns and be respectful in attending to that feedback. I will now go back to work trying to respectfully encourage our teens to change their own lives. I have a few programmatic items to work on now and some young people to help. My best regards to you all.
Ken
Theme 1--Many have tackled the idea that CALO enrolls kids in treatment against their will. What would we do if a kid ran from CALO? What would we do if a teen refused to go to CALO during a CALO-led transport? Can teens leave CALO when they want?
Response to theme 1—Kids are not given the same rights as adults in the United States. They are not allowed to drink until 21. They are not allowed to vote until 18. They cannot drive until 16 in most states. We all have different age markers based on adult beliefs about what those age groups can handle. I believe that teens should not have complete authority to make any decision about their lives that they wish. They do not have the requisite maturity to take on the world in this way. Especially when a teen is evidencing poor behavioral and emotional regulation, I do not trust that teen to make decisions of, at times, life and death. I believe that adults around such teens are duty-bound to intervene in such cases. In general, that option of adult intervention without permission of the teen ends at 18. That is the partially arbitrary age that many states have set for consent. In general, I agree with that age and support statute and law as currently written. Some teens would refuse to be in treatment even though they do need it. We support that treatment. All things being equal, we prefer to have kids bought-in from the outset but that is not always possible. A suicidal teen does not get to choose death in our program. A kid running from home and putting themselves in dangerous circumstances of all sorts should not be able to continue that misguided behavior. A young person skipping school and huffing gasoline should not have the opportunity to kill enough brain cells to permanently alter their future. Again, we prefer to have kids walk into CALO and desire to stay until they are doing well enough to go home. That is not always possible and we have no moral dilemma with giving minors the care they need to improve their lives—even if it is against their will.
Theme 2—Why Positive Control Systems and why do holds at all?
Response to theme 2--Positive Control Systems uses bent wrist controls if a situation escalates to the extent that a hold is needed. We tried numerous other de-escalation systems before deciding permanently on PCS. We have administration trained in MANDT, CALM, NCI, and one other private facility system that is not publicly available. We moved to PCS because it was nationally certified and recognized, it could be initiated by one staff member in a pinch at the outset (a second staff joins the first staff), it was less traumatizing for our population, and it had a much better track record than other systems. Compared to other de-escalation systems, the statistics bear out that PCS is a much safer intervention. Injuries per hold were much better with PCS. As for the re-traumatization issue, we were not impressed with systems that called for 3 or 4 staff to restrain a kid. Chest compressions can become a problem and just the sheer number of staff involved is frightening. We saw flashbacks with other systems that we do not see with PCS.
Our holds are done for safety. When a teen is a threat to self or others, we de-escalate first and then progress to a hold if necessary. The holds are all documented and are now debriefed with the CEO for training. If you know of a de-escalation system that is superior to PCS I would be very glad to know of it. I mean that sincerely.
Theme 3—Do kids have access to phones to call in a complaint about their treatment? Do kids have their phone calls monitored?
Response to theme 3--We do not provide a phone for students to call in complaints. To date, we have been concerned about frivolous use of such a phone and we have not been able to figure out a way around that problem. As for monitoring calls, we do have a staff member in our large conference room where we have 3 or 4 phone calls going on. The staff member is there for safety as those calls can get emotional at times. Teens are not directed to avoid difficult issues on calls or told to keep ANYTHING secret. They are free to complain if they wish. If a staff member did hear that (sometimes they do but not always) s/he will inform the therapist who can then check in with parents. Parents and students are free to escalate concerns to therapists and administration if desired. I have an open-door policy and on occasion students have taken that opportunity and made complaints about program issues. Those conversations have many times been the genesis of course correction within our organization. I implicitly and explicitly invite these conversations. Such a conversation could and has led to an employee termination. We take allegations of treatment that is not in line with our model very seriously. We even go so far as to tell parents and teens how to file a complaint against us if they don’t feel we are dealing with them in good faith. We have that invitation in written materials for teens and parents and on our web site.
Theme 4—Are groups “attack” based? Are they always led by a therapist?
Response to theme 4--We seem to be getting hung up on semantics with words like “accountability” and even the word “groups.” It is hard to get a clear picture for the reader of what our gatherings (that are not led by a therapist) even look like. They are not psycho-educational when facilitated by coaches. They are just a chance to air out community concerns. Topics like masturbation by a particular teen would not be allowed. Telling another teen he has made a lot of progress with his canine training, airing out a grievance about someone working too slow or not pulling their weight, sharing student-written poems—all these are fair topics of groups. In other settings some who have posted seem to have seen attack groups and that is leading some of you to look for that in our groups. That is not what we are trying to accomplish. Therapists run almost all groups. Shorter gatherings are out in the middle of the living space for all to see. They cannot be hidden. There is never a group held in a closed space that is not facilitated by a therapist. Kids are simply allowed to huddle up in plain view to talk things out in a team group. I don’t know how else to explain it beyond this.
Theme 5—Why did Ken Huey work for Provo Canyon and West Ridge?
Response to theme 5--I learned a great deal from my time at Provo. I got in a lot of fights with residential staff over how I thought things should go. I got written up for the only time in my life at Provo because I was considered too soft. It is fair to say that I wanted Provo to go in a much different direction while I was there. Many people from Provo could testify to that. That was when I began creating what would eventually become CALO and lecturing around the country on relationship-based treatment and the need to put away power and control. There were a lot of very, very good people at Provo. There were also some front line staff with long tenures who I could not convince to change because I didn’t have any direct supervision over them. I left for West Ridge because I had the chance to add something to that organization as a Clinical Director. It was an extremely positive experience. I felt like I was able to contribute to what they were doing. With the help of the Executive Director I was given a great opportunity to help professionalize West Ridge and move people along who could not make necessary changes. I was not at West Ridge 15 years ago but when I was there 3 years ago the program was impressive.
Theme 6—What kind of kid does CALO accept?
Response to theme 6--CALO accepts one in every 11 or 12 kids who apply for enrollment. We take kids with a trauma history and who have acted out in ways significant enough that their future could be compromised. That could mean an event as significant as death or simply a large loss of future relational and job opportunity. I realize that is vague so let me give an example of our low and high ends and you can generalize from those examples. On the difficult end of the spectrum would be a kid who kept getting in fights with mom and dad. Some had gotten physical. Son was dabbling in a number of different drugs. He periodically ran away from home and would be gone for a couple of nights. One night mom woke up with son holding a knife over her. That was the final straw. Parents told the son he was going to CALO and brought him here themselves. He did not want to be at CALO (but now says it has changed his life for the better). On the lower end of a difficulty scale would be a young person who was hoarding food in her room all the time. She would not interact with her adopted family in productive ways. She disobeyed curfew and would sneak out of the house on occasion. She yelled at people for no apparent reason in school. She was failing all her classes. She had a love of animals and believed CALO could help her learn lessons in attachment. She came to CALO of her own volition.
With that I will close this post and ask for an open mind. I have requested that before and been met with skepticism. I think I understand that skepticism but I am beginning to understand that no amount of conversation with me will alleviate all your concerns. In fact, I am a bit of a flashpoint for many and may actually be contributing to the problem by posting on Fornits. I am sorry if that is the case for some. I have no intention of angering anyone or of somehow being disrespectful. I do not believe that there is enough I can say to change a mind if these exchanges have not already done that. I will attempt to avoid stirring up more negative feelings by bowing out of Fornits at this point.
I want to own that I am the one who invited Antigen (Ginger) and Psy (Michael) to come to NATSAP. I think my community needs to hear their arguments. I do not want anyone to believe I am being sneaky about it so I am acknowledging this invitation here. I also want to thank a few of you who have respectfully challenged my thinking. A few of those discussions have directly contributed to growth at CALO. It is a difficult thing to remain open and attentive when the message coming at you is an attack but I have done my best on that front. I feel I have done all I can at this point to hear concerns and be respectful in attending to that feedback. I will now go back to work trying to respectfully encourage our teens to change their own lives. I have a few programmatic items to work on now and some young people to help. My best regards to you all.
Ken