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".

Yes, I see what you mean, but it's a poor analogy.  Now, let's use your example, and let's say there was a doctor that was using an untested cancer treatment, that had a very high success rate for remission across a population of women, but within this cohort of women two years out they had a higher rate of relapse than a similar group of women who received traditional radiation and surgery.  As an individual I would be thanking the doctor for the period of remission, but if I got together with the rest of his patients, I might start to wonder why most of us relapsed.

Or, maybe we didn't relapse with cancer, but most of us developed liver damage.  As an individual, I would never attribute my liver damage to a breast cancer treatment, but if most of the other people who got the treatment had the same issue, I'd start asking questions.

For a long time I would have nightmares, and think obsessively about my hospital experience, and I always wondered if it was just me or is this a common experience.  When you're isolated you go about your business and get on with life.  Only after finding out about CAFETY did it dawn on me that there was a whole community of people who had shared experiences (even as different as mine was).

Forgive the following tangent- but where exactly are the community of program parents that are there to provide support to each other.  It's to me the one glaring gap that NATSAP/IECA have in their infrastructure, that presumably would make what they offer better.  Unless, the industry thrives off of the fact that parents of troubled teens are isolated and they prefer to stay that way (and I'm not trying to indicate that the industry does this intentionally, it just is)

And btw, those are all really good examples.  The follow-up then is, when the legitimate care of the individual, interferes with the well-being of the many, or the mores of society, does government have a legitimate role in intervening between the client-helper relationship.  I suppose the answer will depend on where you stand politically and the specifics of the situation.

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?

http://natsap.org/wp-content/uploads/20 ... I-2013.pdf

The Alpine Academy study I referenced in another thread apparently was just published here.  There is no study here that is as egregious as the Behrens study in terms of establishing conclusions.  And in fact, there is no study that singularly features ASEPN programs - Jared Balmer has left ASPEN to start his own 36 bed program focusing on anxiety disorders in boys.

I want to give NATSAP credit for not engaging in deception with the research that they have peer-reviewed.  But what's left is pretty weak in terms of outcomes.  

In all, what's presented is pretty weak in terms of who they treat, how they treat it, and what the final outcomes are.  And the singular message is, that youth respond to structure and accountability, but the NATSAP programs don't have the power to remake families (well, they could if they actually provided more than parent seminars and actually did some real family work) or society.

Dr. Jacob Hess, (PhD), who received his doctorate in Clinical-Community Psychology from the University of Illinois Urbana Champaign

After watching him present, and also observing what his research interests are, and the fact that he has published other peer-reviewed articles, I don't doubt his sincerity or skill as a researcher.  

As for this study, it was a qualitative research study that followed-up with families I believe 2 years post discharge, and the long-term outcomes weren't that great.  But it did establish some patterns as to which of the young women were successful after discharge and what were some of the contributing factors.

When I started writing all of this I didn't see Psy's response with the quote from the Marcus review.  The thing about the TTI and therapeutic communities in general - is that the level of intervention is the community.  The "treatment" effect is the imposition of community norms and community expectations.  

I don't want to lump every single program in one bucket - but as I'm sure has been noted here many times, programs have more in common with religious rites of passage than traditional mental health treatment.  And as everyone here should know, converts make the strongest believers.

To the extent that rites of passage fit within the context of ones culture, and ones expectation of behavior the harm will be less, and the benefit more (stealing this all from Marcus).  Lon Woodbury's daughter probably was actually helped by her experience - she grew up in the industry culture.  While Kat, same program, same intervention was harmed, because of how bizarre and culturally inappropriate the intervention was.  Lon's daughter talks to her parents and her parent's friends about her experience and they're as familiar with the intervention strategy as the liturgy on Sunday.  For Kat, if she talked to most people in her community circle about it, they would treat her like an alien.

As to the way the industry measures these things, and not the human rights advocates, there are some circumstances that should fairly predict whether or not a program will be helpful to an individual youth.  If I practice heart surgery on someone who has a heart condition, that's treatment, if I practice heart surgery on someone who has a kidney infection that's malpractice.  Likewise, a positive peer culture might make sense for a bored and spoiled youth who is getting into trouble with the law, it should be considered child abuse for a rape victim who is acting out because of their trauma.

Obviously there are interventions that are universally harmful.  Whooter, I'd be interested to know exactly what you consider to never be an acceptable intervention.  

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.  

That's really the core issue here. Desperate parents are willing to try anything when they feel like their kids are spiraling out of control and programs are more than willing to sell them a solution. The viability or efficacy of the solution doesn't matter. What matters is that it makes the parents feel good and as far as i'm concerned, that's the number one goal of many of these programs -- not helping the kids. Whooter would argue that by helping the kids, the parents are pleased. I would counter that programs need not actually help the kids. All they have to do is get the kids to believe, and openly profess, that they were helped. If they explode later -- well. It's anybody's fault but the program.

The parents are the customers, there's no doubt about that.  But what if there is full transparency about what the parents were getting for their money, I don't think it would make much of a difference.  The parents who are willing to spend the 100,000 or so, I think they would be satisfied with the dismal long-term outcomes.  Even if we could make the argument that the program doesn't help over the long-term, they might take the trade-off of their kids long-term emotional harm for what a program does provide.  

Then again... I can't find this research paper anywhere except for on the conference agenda where it was presented:

But Does it Really Last? Confronting Hard Questions About Transition
Home and the Sustainability of Change. Lessons from 200 Interviews
with Families Years After Youth Residential Treatment
In our recent study of 125 families years after a youth’s residential treatment, we
observed ?ve external barriers to long-term, sustainable change: 1) A college
party atmosphere glorifying drugs and alcohol, 2) The destructive impact of some
boyfriends, 3) An un-changed home atmosphere of parent habits and overall family
patterns, 4) A relapse into severe depression or anxiety & 5) Instability associated with
changing medication effects over time. This presentation summarizes and elaborates
our subsequent efforts as an agency to better equip youth to face these challenges by
ensuring personal (and family) change goes deeper than behavioral shifts.
Presenters: Jacob Hess, Ph.D., Research Director, Utah Youth Village; Eric Bjorklund,
J.D., Executive Director, Utah Youth Village