Changes underway in residential schools


David E. Jacobsen, Psy.D., chief executive officer of The Children’s Home in Cromwell, Conn., says that the clinical population has been the biggest catalyst for change within the residential care system. (photo by Tom Croke)

By Phyllis Hanlon

The face of residential care is taking on a new look thanks to advocacy, legislation and stronger input from students and parents.

Alan Chates, Ed.D, director of the FLLAAC (Fitchburg, Leominster, Lunenburg, Ashburnham, Ayer, Clinton) Edu-cational Collaborative and a 20-year veteran of the Office for Children (OFC), now the Office for Child Care Services (OCCS), notes that the focus at residential schools has shifted to behavioral diagnosis and emotional problems.

While with OFC, Chates conducted a two-year study on adolescent presence on adult wards at Worcester State Hospital. Although the report generated considerable controversy, it did lead to reform. Then Massachusetts Governor Michael Dukakis signed executive order 244, which states that no adolescent should be placed on adult wards.

Andrea Watson, founder and president of Parents for Residential Reform (PFRR), a national support group and resource center, indicates that the first residential reform hearing took place in 1999. At that time, rape, drowning, death due to restraint and other acts of violence ran rampant within the residential school system according to Watson. Through PFRR's efforts, Watson says a significant reduction in the number of rapes and institutional deaths as well as a new attitude toward families was realized.

"Parents are now treated as leaders, consumers and with respect. We have a say in treatment," she says. By working with OCCS, PFRR has been able to initiate change and bring awareness regarding dangerous situations, Watson says. PFRR offers tips on finding appropriate schools and different systems of care and connects parents with others for social support.

David E. Jacobsen, Psy.D., chief executive officer of The Children's Home in Cromwell, Conn., notes that the clinical population has been the biggest catalyst for change within the residential care system. Children from various social service agencies as well as the juvenile justice system often find their way into The Children's Home, providing staff with enormous challenges.

Jacobsen says that the school has created a unique and effective way to handle the variety in population. Children's Home relies heavily on input from students before initiating program and policy changes, he states. Students contribute to discussions on various topics that affect them directly. For example, one of the issues the administrative team, board of directors and student representatives have addressed is restraint and seclusion. "There has been a more than 80 percent reduction in the last five years," Jacobsen says.

By involving students in critical decisions, Jacobsen asserts that they gain self-confidence, which helps when they reintegrate into the community. Students also receive a vocational education and credits for working in the community or on the school campus. "This is a good experience and gives kids the skills they'll take with them," he says.

At the Perkins School in Lancaster, MA, "revolutionary changes" have taken place, says Charles P. Conroy, Ed.D., executive director. "It became clear in the 80s that long-term care for kids with mental retardation didn't work," he says. "Mainstreaming was taking hold." Although the recent shift to community-based services is laudable, Conroy points out that the diagnoses upon admission have worsened. "Now, kids are abused, neglected and mentally ill," Conroy says.

Laura Beckman-Devik, M.A., clinical director and COO at Perkins, says, "The depths of mental illness we see for kids is staggering. We're better at diagnosing and recognizing today, but that doesn't account for the increase in the numbers." The age of patients - some as young as five present with bipolar, attention deficit hyperactivity disorder and other behavioral issues - soaring pharmacological requirements and an increased need for high level psychiatric expertise and behavioral therapy presents a bleak picture. "Intervention and prevention have become more critical," she says. "Kids haven't had neurological/biological stimulation to develop social, cognitive and emotional skills."

To address these issues, Perkins instituted a day program six years ago that began with six children and today serves 60. More family therapy programs - both on-site and in the home - have been implemented as well. Beckman-Devik says that residential schools actually work with two populations: the children and their families. "A child didn't become who he is in a vacuum and neither did the family," she says. "We take a strength-based approach and try to focus not on specific problems but on the things they've accomplished," Beckman-Devik adds.

Spurwink in Portland, Maine, provides a different model of residential and day treatment, according to Robert Small, Psy.D., clinical director. Instead of dormitories, Spurwink houses two to four children in one of approximately 50 cottages located throughout south and central Maine. Each location meets specific categories of need with a particular milieu program. "We provide a full biopsychosocial and developmental model," says Small, "with a full multidisciplinary staff, including a speech pathologist, occupational therapist, psychologists, psychiatrists and social workers integrated to one formulation." He points out that changes in the treatment model are due to the evolution in the field. "Total ecology, knowledge and theoretical orientation of behavioral health is more scientific and evidence-based," he says.

As part of its plan to comply with regulatory decrees and licensing guidelines and increase family involvement and accountability for outcomes, Spurwink is making a concerted effort to form stronger partnerships with payers through increased communications and planning, Small says.

In addition, the school is focused on training staff to develop competency-based assessments with a concentration on neurodevelopmental constructs.

Jacobsen foresees increased specialization in the coming years. "There is a need for developing resources to handle severe abuse populations, those with aggressive manifestation or sexually reactive behavior. There are not enough resources for those kids to make a long-lasting recovery," he says. He recommends a tiered residential structure that would allow children who need a certain level of care, without intense psychiatric and clinical care, to access those services.

Of PFRR's work, Watson says, "We have made a lot of progress. We are keeping kids safer. Providers are willing to make changes and be more parent-friendly." Although much progress has been made the work is not yet complete, Watson emphasizes.

Changes underway in residential schools (October 2004 Issue)

Changes underway in residential schools
(October 2004 Issue)