I understand and even agree that some kids on a self-destructive track benefit from being handled a bit differently from the way we handle kids on an average, reasonably healthy (for a teen) track.
I honestly don't know, Perri, if you *hadn't* been in a program, if just your experiences that you would have had in daily life, along with time to grow up, would have gotten you to a good place. Nobody can ever know that.
The problem with any treatment for any problem is that it's about numbers: how many people will benefit, how many people will be the same, and how many people will be harmed versus no treatment or some other treatment.
And knowing those numbers is only the *first* step towards responsible treatment of any human medical or mental health or behavioral problem.
The next step is: how do we identify the people who are being harmed by the treatment, how do we identify the people who are not being helped by the treatment.
It is a given that once you identify those people you discontinue that treatment and go to the next kind of treatment option we have, if we have one, or admit you can't do anything for them if we *don't* have one.
If you have an alternate treatment that's also more effective than a placebo, you go through the whole process over again with all the folks who didn't benefit from or were being harmed by the first treatment, and so forth and so on.
That's why I *don't* hit the roof whenever someone brings up the nasty side effects of various drugs. It's because I know that along with those side effect profiles come a list of warning signs to identify when a patient is first beginning to show signs of a bad reaction to the drug and get them safely off of that drug onto something else. If you had a drug for cancer that 60% of people would develop a penicillin-allergy-like rash to and die of, but 40% would be cured, it would *still* be a safe drug if you could watch closely for the signs of a bad reaction and take all those 60% off when all they had was a slight rash. You'd still have a 40% cure rate.
The reasoning behind that example is why I'm perfectly okay with a program methodology that is, hypothetically, disastrous for 80% but life-saving for 20%---IF AND ONLY IF we have a way to separate out the 80 from the 20 before any damage is done and we *do* screen them out so we only have the 20 taking the treatment and being helped, and the 80 get screened out and don't get hurt because we know not to give them the treatment.
My huge, ginourmous, deal-breaking problem with the programs is that they're run in a half-assed flying-seat-of-the-pants, dead-reckoning fashion instead of by the reasoned, scientific approach we apply to medicines or physical therapies or other treatment devices when we're treating people's problems.
By that I *don't* mean that the people running them aren't systematically applying some sort of method with some sort of game plan. They are, just like the pilot that navigates by dead reckoning *is* navigating--just not very well.
I have a huge problem with there being very few long-term studies comparing treatments and placebo-programs for these kids. I have a huge problem with there being little data to predict which kids will be harmed rather than helped by the treatment of being in a program. I have a huge problem with there being no safeguards to ensure that the kids we *know* are likely to have adverse outcomes from a specific kind of program don't end up in that particular kind of program.
It would be fairly easy to set up a placebo program. You set up the sleeping arrangements like a college dorm; the food like a college cafeteria, a regular class schedule; and a bogus non-therapy "therapy"---call it "art group therapy" and give the same group of kids the same time of day access to a room with art supplies and let them paint, draw, model, sculpt, whatever; give the ones on psychiatric care the same psychiatric appointments they'd get if they were outpatient; take them out outside or to a gym to work out on the same schedule as if they were taking PE in high school, plus the teenage daily equivalent of recess; build an allowance into the schedule for phone calls and let them use their phone allowance any way they want; do have the facility locked; do provide suicide watch in a section that works just like regular hospitalization to any kids when and if they need it--or even do the placebo "treatment" in concert with a local hospital and actually hospitalize them when they need it; leave them to clean their dorm rooms or not, to do their own laundry in coin operated machines--with a laundry allowance, and have cleaning staff clean the rest of the place, make the food, do the dishes, etc. This is basically, you're locked in a "safe" little mini-college and given benign neglect. No actual "treatment" distinct from normal outpatient care. A placebo.
Then you have something to contrast with any facility you want.
You could do it quite ethically as a federally funded study and offer the parents service in either facility at one fourth cost (with insurance perhaps picking up some or all of that) so long as they accept that it's random whether the kid goes into the treatment or the placebo facility.
*That* would be *one* way of fairly easily getting the data to start doing teen treatment *right*.
But nobody listens to me......
:-/
Timoclea
