Interesting Cafety Article

[Che Gookin]

http://http://www.cafety.org/resources/804-redefining-residential-youth-guided-treatment

I decided to post this link here and discuss it here in order to have some basic moderation of the discussion.

I find the items of interest. I'm not a huge fan of fixing programs. However, if I was forced to choose between leaving them alone or enacting the changes suggested by youthmove I'd go with the youthmove/cafety changes. Not sure how popular the reforms would be considering the mania for power and control that infects programs like a sick cancer, but it possibly could do a great deal to address some of the routine issues of abuse and neglect at the hands of programs.

[Whooter]

Quote from above article:


Young people who have been placed in residential settings recognize that residential providers typically operate with the best interests of the young people they work with at heart. However youth are concerned that providers and staff in residential programs are often not open to the idea that their approaches and interventions may not be ideal, even in the most extreme situations when the measures being used upon the young people in their care are abusive. While such cases may not typify the field of residential treatment, they do highlight legitimate and serious practice concerns.

Residential providers often hear the praises of alumni for the help they received. Less often do the criticisms of youth past and present get the same attention. These youth express a variety of concerns that they feel residential providers did not and do not hear. For example:

• Youth have often experienced staff attitudes and approaches that are patronizing and infer that the youth in care do not understand themselves as well as, or better than, the adults; this finds expression in decision making that not only doesn’t include the youth but dismisses the possibility that they might have valuable ideas, perhaps even better than those of the staff.

• Young people often have not experienced meaningful opportunities to discuss or question placement or to be engaged in formulating and carrying out their own treatment plans. They find themselves left with the choice of complying with a set of provisions into which they had no input or complaining, which could jeopardize their privileges or movement toward discharge. They ask that there be “nothing about us without us”.

• Point and level systems used in many residential programs are arbitrary and not responsive to their individual needs or relevant to real-life situations they will be in after discharge.

• Behavior that in many settings would be seen as “normal” is viewed as pathological.

• Staff responses to behavior are at times coercive and induce stress and fear.

• Communication with families and friends is seen by staff as a barrier to treatment.

• Treatment philosophies and approaches don’t always take the values of individual youth nor those of the youth culture into serious consideration.

Residential programs have taken notable steps toward addressing these concerns and implementing youth guided care. While it is probably safe to say that an evolutionary process in this direction has been occurring over the past decade, old habits, especially mental habits, die hard. So despite the evolution that has occurred in the field, there still tends to be collective mindsets in the system and within individual organizations that diminish the importance of meaningful youth involvement. The problem is exacerbated by residential’s typical role as the placement of last resort. Youth entering residential may feel beaten down, cynical, and untrusting due to their experiences thus far, and not receptive to good-faith efforts that may occur to encourage them to participate in their own treatment. Implementing youth-guided care can help mitigate or even eliminate this circumstance.



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[Che Gookin]

Residential programs have taken notable steps toward addressing these concerns and implementing youth guided care. While it is probably safe to say that an evolutionary process in this direction has been occurring over the past decade, old habits, especially mental habits, die hard. So despite the evolution that has occurred in the field, there still te bands to be collective mindsets in the system and within individual organizations that diminish the importance of meaningful youth involvement. The problem is exacerbated by residential’s typical role as the placement of last resort. Youth entering residential may feel beaten down, cynical, and untrusting due to their experiences thus far, and not receptive to good-faith efforts that may occur to encourage them to participate in their own treatment. Implementing youth-guided care can help mitigate or even eliminate this circumstance.

You are going to have to cite a few sources to be taken seriously on these claims. Most programs, in my direct experience, tend to pass off youth involvement as positive peer culture. Which was shown by the very person who invented it as a system being poorly implemented to the detriment of the youth.

So again, specific sources, no program sources either, I'm in a shitty mood and will start deleting woodbury spam on sight.

Likewise to the rest of you vermin, if I hear any crying about what a manwhore the whooter is, I'm gonna go goon city on your ass as well. This goes doubly so to a certain someone's 45 different personalities.

[Che Gookin]

Pbbttt.. I just realized that I called whooter out on a bit that came from the article I posted. Carry on as before...

:facepalms:

[blombrowski]

A few notes about this paper.

1.  It is a paper that was ultimately approved by the board of Youth MOVE, CAFETY, and AACRC.  Two organizations comprised of young people who have been in residential programs (defined broadly), and an organization of residential programs.  To the point about notable steps, this paper in itself is notable.  The recognition by residential providers that they have at times done a shitty job, and aren't calling the youth that are calling them out on doing a shitty job liars and manipulators is progress but...  

2.  While the organization may be progressive (namely the leadership that comprises the board that makes the decisions for the organization), that says nothing about their general membership (i.e. Chris Bellonci, their current President was the provider who testified at the hearing with Kat Whitehead and Jon-Martin Crawford and has been an expert witness in a number of lawsuits involving programs, but if you go through their membership list, there are a number of programs that should pop out as problematic)

3.  One of the programs that has been held out as a residential program that "gets" youth-guided care (and would be considered one of those notable examples), an AACRC member, has a very interesting recent history.  They are an agency that runs all kind of services in the New York City metropolitan area (foster care, group homes, and an RTC in the foster care system, group homes in the foster care and mental health systems, juvenile detention prevention, a clinic, family support, wraparound services, etc)  Their current CEO, who sits on the board of AACRC "gets it".  When he was in charge of their main residential campus, he instituted a number of reforms, like youth running their own treatment planning meetings, holding an agency-wide retreat that includes youth and staff to help make changes to the program, establishing a regular youth council on the grounds, and hiring a youth advocate.  He no longer deals with the day-to-day operations of the facility.  The person in charge of youth development who has been charged to oversee the youth-guided reforms works out of their Bronx office and not on the ground of their Westchester campus.

Recently in a presentation she shared that staff at the residential campus held a meeting where they decided that they were going to re-institute the level system, and neglected to invite her, since they knew that she would insist that the youth on campus would have to be part of that decision.

So you have a CEO who "gets it", a youth development person who "gets it", but staff who are working there day-to-day, basically telling the CEO and the youth development person that they need more "tools" to "control the milleu", namely coercive points and level systems.

This is a program that deals almost exclusively with youth in the child welfare system, many of whom would be placed in our lovely juvenile justice system in New York State if not for this program or be stuck bouncing from foster home to foster home or group home to group home, which happens anyway.

Furthermore, residential treatment is their least profitable division within their agency.  They lose money hand over fist providing residential care (all their funds are through State contracts, which don't cover the costs of operations), and the CEO's time is devoted to fundraising to make up that gap.

So there's the residential providers "meaning well" part.  There's so much more to say on this topic.  And I hope that this can actually be a conversation, particularly around how do you make this kind of situation better?  Because ultimately, this is the kind of program that paper is directed at, not necessarily your average "parent-choice" program.

P.S. - I saw this program do a presentation on youth-guided care on two separate consecutive occasions.  The first one, didn't even have a youth presenter and was a sugar-coated version.  After one of my colleagues called the CEO about how hypocritical the presentation itself was, the next time they did the presentation about a month later, one of their former youth advocates did the presentation with them, and the pure blunt honesty about the current situation came out.

[Pile of Dead Kids]

I'm just lollin' about "Youth-directed". Yeah, the junior staff doing restraints, that's youth-directed treatment all right!

[Che Gookin]

Recently in a presentation she shared that staff at the residential campus held a meeting where they decided that they were going to re-institute the level system, and neglected to invite her, since they knew that she would insist that the youth on campus would have to be part of that decision.

So you have a CEO who "gets it", a youth development person who "gets it", but staff who are working there day-to-day, basically telling the CEO and the youth development person that they need more "tools" to "control the milleu", namely coercive points and level systems.

This is a program that deals almost exclusively with youth in the child welfare system, many of whom would be placed in our lovely juvenile justice system in New York State if not for this program or be stuck bouncing from foster home to foster home or group home to group home, which happens anyway.

Sounds about par for the course. Maintaining such an open environment would take a huge amount of ongoing effort on the part of the youth, staff, and administration. The entire facility would have to be goal driven towards the pursuit of attaining a better outcome for the youths being cared for. That's hard to do when you have the typical power control issues at play thrown in with what I'm guessing are some fairly dynamic residents.

Very difficult indeed.

[Che Gookin]

Residential programs have taken notable steps toward addressing these concerns and implementing youth guided care.

I'd also suggest changing this line to, "Some Residential programs" as the above sentence makes it seem like all programs in general have been taking notable steps.

[Whooter]

Young people who have been placed in residential settings recognize that residential providers typically operate with the best interests of the young people they work with at heart. .........even in the most extreme situations when the measures being used upon the young people in their care are abusive. While such cases may not typify the field of residential treatment, they do highlight legitimate and serious practice concerns.

The above statement indicates that children who have gone to programs realize that programs and staff have the best interest of the children at heart and that although abuse does occur within the industry it is not typical of program practices.  

This runs counter to what many posters here on fornits believe and further shows that the feelings towards programs here on fornits is grossly outdated and they are out of touch with the current kids entering these places.  I think as we bring in more of the current information about programs and let some of the old thoughts and practices of programs like Straight go fornits will be brought more inline with current practices and thinking.



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[Whooter]

Entry phase  -- Most often the decision to place a young person in a residential program is made without any conversation with the youth.
Treatment phase  -- The degree to which youth are engaged in determining their own course of treatment is variable across agencies, but often they are passive recipients, with adults setting their goals set for them based on the reasons for their placement.

Transition phase –- In traditional residential settings graduation from a program is often based on the completion of a step or level program, not necessarily on an ongoing process of evaluating whether the youth is ready to return to the community.

The most critical here, for me, in my experience was the Transition Phase.  Trying to provide a seamless transition form the safety of the program back into the real world is a difficult task, as I had witnessed.  I think more than the other phases this one would benefit the most from the childs input.



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[DannyB II]

(redacted, your focus will be on the topic as well. )

Back to the subject, I read all the 7 pages that were presented, quite a bit of info to digest at one time. Personally I do not believe that the majority of the existing programs would adapt any of the changes set forth here in these pages. There would be a residual atmosphere of philosophies still dictating standards of behavior methods.  We would have to shut them down and start over in order to get any effectual treatment plan going.  
There is a new crop of programs, some have been in existence and others are coming. They are smaller and want to stay that way, there staff are highly schooled and trained. Example; Wisdom Ranch School / http://www.wisdomranch.org/Program.htm.
I am looking forward to this new age of treatment plans, where kids are not necessarily sent away all by them selves for long term, families are demanded to be involved and if not they do not accept your child. They have competent Psychiatrists available for your child with the parent actively involved, staff are educated and trained to deal with children with disorders. Where restraints are not as common for two reasons, one staff are trained to not let incidents escalate and two kids with histories of excess violence are not accepted.
I am not sure what to do with the excessive cases, children with severe anti-social problems, psychotic pathos. I was not one and though I was thrown in with a bunch during my juvenile years, I would not wish this on any kid who does not suffer from these abnormalities.
Just some thoughts I had early on.

[blombrowski]

The most critical here, for me, in my experience was the Transition Phase. Trying to provide a seamless transition form the safety of the program back into the real world is a difficult task, as I had witnessed. I think more than the other phases this one would benefit the most from the childs input.

Which is why if residential treatment is to be used, it should actually resemble the real world as much as possible, because absent that you have the failed transitions that so often happen.  In a well-functioning program, youth and family contact should be frequent (every day or nearly every day from the very start of the residential treatment episode).  The concept of having a community-based program is that the youth can regularly practice what they learn in treatment with their family and their community.  Say Johnny has a temper and get's easily frustrated when he doesn't get his way.  Johnny gets to play on his local basketball team, and if he gets thrown out of the game for punching another player, he gets to go back to the residence and process why he did that, and hopefully the next time he's on the court, he doesn't do that again.  Or let's say Johnny likes to hit his sister when she asks for her Ipod back, Johnny gets to learn how to share with others while he's in the residence and practice those skills when he's at home.

But let's be honest, that would require parents and family to put up with some rather unpleasant behavior from Johnny.  If residential program A is saying we'll take care of everything and in a year your Johnny will be as good as new, we'll just have to figure out how we're going to transition him from our bubble where if he punches people he get thrown down to the ground and restrained, to your home where if he punches people you either do nothing or call us and send him back to the program, and residential B is saying for the next year you'll have to deal with Johnny every weekend, and you'll have to do the hard work of learning what Johnny's triggers are, and putting in the effort, and in the end Johnny is still going to be a rude teenager, but he won't get violent, the typical "program" parent is going to go with A, while maybe the more concerned, more thoughtful, more patient parent might go with B.

And even if program A isn't making girls wear french maid outfits, or putting youth through LGATS, or putting youth in isolation for days at a time, or restraining kids so hard that they break kids' bones, or even if they don't participate in the escort service business, Program A is still problematic because on average it doesn't work past the date that the youth comes home from the program, and if it doesn't work past the date that the youth comes home from the program, what good is it?

Program A describes traditional residential treatment, and most residential treatment programs fit the description.  Bills like H.R. 911 are great for dealing with the programs where easily identifiable and verifiable abuses occur.  But to deal with Program A you need to change hearts and minds.  Hard when the people do it because that's just the way things have always been done.  Nearly impossible when their livelihood depends on doing it the way that they've always been done.    

Last year I was at the AACRC conference and the IECA conference about a month apart.  The folks at AACRC at least give lip service to this kind of transformation, CEOs who want to transform their programs, but who have to basically fire their entire staffs (or spend years retraining those staff) who are comfortable with doing traditional residential care to get anything done.  The folks at IECA were unrepentant about the traditional residential treatment model.

I'll say this again, this isn't about abuse, it's about outcomes.  And the long-term outcomes for traditional residential care are terrible.  This framework for engaging youth and families and communities from the very start of a residential treatment episode has promise (which has the salutary effect of creating an open, transparent program that makes abuse and coercion less likely), but only if people are willing to do it.

[blombrowski]

http://www.aacrc-dc.org/public_policy

For those of you who are interested in reading the seven policy papers.

[Che Gookin]

Young people who have been placed in residential settings recognize that residential providers typically operate with the best interests of the young people they work with at heart. .........even in the most extreme situations when the measures being used upon the young people in their care are abusive. While such cases may not typify the field of residential treatment, they do highlight legitimate and serious practice concerns.

The above statement indicates that children who have gone to programs realize that programs and staff have the best interest of the children at heart and that although abuse does occur within the industry it is not typical of program practices.  

This runs counter to what many posters here on fornits believe and further shows that the feelings towards programs here on fornits is grossly outdated and they are out of touch with the current kids entering these places.  I think as we bring in more of the current information about programs and let some of the old thoughts and practices of programs like Straight go fornits will be brought more inline with current practices and thinking.



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Simply because the statement is made doesn't mean it is a logical or correct one. Many survivors of programs both current and past have had experiences with said programs that lead them to believe the only interests at heart are those of the program's profit margin. You are cherry picking survivor experiences to fit your argument.

The ideas in the article are of merit, however, many of the claims made by this article like the one above ought to be removed.

Not all residential programs are making changes towards Youth based care and very few of them have the best interests of the youth at heart. Again though, the specific ideas of Youth based care are interesting to me, but the exaggerated claims on behalf of all survivors are a bit off putting.

[Whooter]

The concept of having a community-based program is that the youth can regularly practice what they learn in treatment with their family and their community.

I'll say this again, this isn't about abuse, it's about outcomes. And the long-term outcomes for traditional residential care are terrible. This framework for engaging youth and families and communities from the very start of a residential treatment episode has promise (which has the salutary effect of creating an open, transparent program that makes abuse and coercion less likely), but only if people are willing to do it.

I agree that community based programs would be the best option for exactly the reasons you pointed out and this would eliminate the need for any drastic transition program back into the community.  But there will always be those few kids who do not respond well to these programs and need to be exposed to a highly structured environment over the period of several months to a year to modify the childs behavior.  Once this is accomplished there will still be a need to figure out how to transition the child back into society.  So it is important to continue to pursue this research in my opinion.

I think we can all see that the programs are getting better in general, as the article pointed out.  But it is a slow process and many of us have a hard time waiting for the change to occur.  I think what gives us all hope is reading the stories here on fornits, like straight, where the kids were forced to eat rotted food, held in isolation rooms and abused like cattle, no professional counseling vs the programs of today which cater to families with a Vegan, vegetarian or other life style, have no corporal punishment or fences, provide on-site/off-site education and licensed therapists, conduits to the outside world etc.

This article shows that the programs are very open to change and have been listening to their customers and allowed the childrens voices to be heard.  The kids are not saying they were abused but are asking for more input and control over their own lives and the process of healing them.



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