Treatment Abuse, Behavior Modification, Thought Reform > The Troubled Teen Industry
Behrens Study vs. ASTART Debate thread
Whooter:
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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blombrowski:
Fair enough, though the problem with the Behrens study was less the study itself, but how it was marketed. A for-profit company commissioned a study that analyzes and tells the story of the data in such a way that makes the company look good. Behrens wasn't paid to cook the data, that would be unethical, but she brings her own biases to bear in looking for the best story to tell with the data.
ASPEN presenting the data as a for-profit entity for marketing purposes, is actually less obnoxious than NATSAP presenting the data to make an objective statement about the scientific effects of the treatment that their member programs provide. But this was back in the Jan Moss era, so I think we can let bygones be bygones.
But as I said, I think the issue has been resolved. I credit NATSAP, and the member programs that are collecting and sharing data, to try to understand the treatment effects of their programs. And for showing their hand based on what they're measuring, what is they thing that they're treating.
Certainly in the case of Montana Academy, that's clear - send your kid to rural Montana so they can mature - never mind why a young person might be demonstrating immaturity (were they sexually abused, are their parents terrible role models when it comes to maturity and narcissism, are they just spoiled brats). Simple answers, simple solutions, simple analysis. Not saying it's not well-meaning - but that's how you can both have some real successes in these programs and cause real harm, and it's rather predictable.
Whooter:
Everyone markets study results and tries to leverage the results to their advantage:
“four out of five dentists recommended sugarless gum for their patients who chew gum". They may fail to tell you that the fifth dentist recommended that his patients not chew gum at all. That would be bad for the gum industry.
The people that conduct studies typically have ties to the industry that they are conducting. Heart studies have heart doctors, drug studies have clinicians and specialists who once worked for private industry and so on. Its very common and in fact makes the study more viable because the people are familiar with the area being studied and can better direct them. The problem is if there is money changing hands to sway the results and this is where an IRB comes in. They approve the study and insure it is done fairly.
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blombrowski:
Well yes, glad you agree. Look I appreciate your vigor in defending your perspective.
I look at the parent-choice industry as akin to the carbon fuel industry or the gun industry. Both industries provide a valuable commodity that the people who consume the commodity get utility from. That there are safer products that produce fewer externalities, that are however less efficient is of no interest to the industry, unless they determine that there is in fact a market for them.
That an industry that produces such externalities, provokes such criticisms by those who are worried about the effects that are spread over the entire population should not be surprising. With guns it's the suicide rate, with oil it's pollution, and with the TTI it's how the industry reinforces the stigma of behavioral disorders by actively segregating individuals with those behaviors from the community.
These are just some examples of the community impacts from a service or commodity that benefits individuals at the personal level. It should be obvious to all how it tends to be conservatives who support policies that benefit the individual, and it's liberals who tend to benefit policies whose benefits are distributed across the public.
(I chose to use oil and guns and not tobacco as my comparison point, because I recognize for the right person in the right situation and the right time the use of carbon fuels, and the use of a gun might be the most beneficial thing for society, but it's their overuse, and building of policy around their use, and even poorly thought out laws and implementation of such laws that seek to limit their use, that create preventable harm)
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?
Whooter:
--- Quote from: "blombrowski" ---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?
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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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