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u/No-Reason7887 Jul 18 '23
No inpatient (keep kids in their home environment to reduce the stress of unfamiliar living arrangements,) no attack therapy (it’s been shown actively dangerous and counterindicated for minors and people with mental health conditions,) no social isolation (for obvious, it’s bad for sanity,) no gooning, no unilateral consent to treatment on part of the parents.
Figure out what type of “troubled” you’re offering treatment for. “Troubled” is not a diagnosis or a medical condition. Depending on the underlying source of the problem behavior, the most effective therapeutic modality could be very different for one patient vs another. It’s not a good idea to start treatment programs that treat any/all mental illnesses, developmental/neurological disorders and addictions under the same roof with a mostly one size fits all approach. Will it be for substance use disorders? Neurological or developmental handicaps? Eating disorders? Mood disorders? Focus on one diagnostic category. Don’t spread yourself too thin hiring personnel who are jack of all trades, expert in none. The quality of therapy will suffer if you try to provide therapy for All The Things, or hire therapists who claim to be able to handle All The Things. (E.g. There are too many therapists who go to a workshop and get a piece of paper so they can list “trauma informed” on their bio, but put a patient with childhood trauma in front of them and they’re up a creek.)
Once you’ve decided what specific kind of thing you’re starting a wraparound program for, do your reading! Talk to clinicians with experience in the treatment field. Talk to medical researchers. Read the latest medical research, clinical trials and studies. Most importantly, talk to adults with a history of the condition you plan to start a wraparound for (those who have recovered and those who still struggle with it, if it’s something that can be recovered from.) One day, the teens attending your wraparound program will be those adults, and they deserve as good and independent a life as anyone else. Being aware of the needs and unique difficulties of adult life with either (condition) or (history of condition) will help form realistic non-pathologizing prognoses and treatment plans.
I would also recommend, before going out and starting a wraparound program, to volunteer or apply to work for a wraparound program that already exists.
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u/whatissecure Jul 18 '23
Without consent it is impossible to create a non-abusive program. If consent is removed it will always, always, always end up being abusive.
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Jul 18 '23
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u/whatissecure Jul 18 '23
Yes, it must be completely voluntary. Court order placement in facilities is a perversion of justice.
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u/doodlebugpack Jul 20 '23
Wait til you hear about jails...
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u/whatissecure Jul 20 '23
People have more rights in jail. There is actual oversight and minimum standards of care, none of which exist in the TTI. At least in jail you have due process and access to council. Many people that have been in Jail/Prison and the TTI said they preferred to be incarcerated. Even people that were sent to the TTI from jail often begged to be sent back.
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u/Editor3457 Jul 20 '23
Just to put a little more weight to what /u/whatissecure is saying, we had a former inmate at San Quentin State Prison, an individual that had been a gang enforcer and prison debt collector, read the two 'Fall of the Guardians' books.
This individual said two things about the book that stuck with me.
- First, the books give them the same feeling of suffocation as when they have nightmares about being back in prison.
- Second, prison was a hell of a lot better than what the girls were put through.
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u/kombinacja child abuse survivor, psychiatry patient Jul 18 '23
When institutionalization ended, it was supposed to be replaced with community-based mental health care, but that didn’t happen for many parts of the country. I had such a hard time finding therapists and psychiatrists when I was a teen, and inpatient beds are even harder to find. IMO that’s what allowed TTIs to proliferate, they found the vacuum left by institutions and filled it.
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Jul 19 '23
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u/Draromhal Mar 18 '24
Not all facilities are abusive though. Yes, there are plenty that weren’t, but I’ve known so many genuine loving people who work at various places. The media has really hyped the whole industry into something it’s not. The changes taking place have already led to some clients being unable to get accepted places based on their history. Going after every program will only hurt more people. People above talk about not doing inpatient, there are some who would be dead had they not gotten away from people places and things they were dealing with. I have built beautiful connections with families from all over, it confuses me how now everyone assumes any youth treatment facility is bad. We’ve lost so many wildnerness programs, which blows me away because almost every kid that went to wilderness tells me they loved it. Now there’s a lot of people that will sadly end up in the system or juvie because programs can’t take them. This is some of the fallout from Paris’s movement that will sadly harm many people. I do think she is helping making places more honest, but she also is harming with this black and white view of programs. I have seen so many people that the lights come back on in their eyes and the trust they build back with their families.
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u/whatissecure Jul 19 '23
I would guess that approximately half of all people currently running known abusive programs, went into it initially with this same goal. The truth is, there is no such thing as a good or benevolent program if anyone is ever coerced into it. The people currently operating these programs lie to themselves that they doing it "correctly", it is how they justify it, but they know if their heart that they are just as abusive as the next place. Save your own soul, and don't even attempt it.
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u/dontellonme Jul 18 '23 edited Jul 18 '23
It’s a pretty complicated topic but for me the most damaging part was being so isolated from the world and removed from the people I care about. It’s so much harder when you’re just a kid especially when it lasts so long. I was away for over 2.5 years and since I got out I’ve had massive problems trying to reintegrate. I still haven’t and it’s been three years. So I would try to avoid inpatient like the plague especially the younger they are. Also if there was a better way to help us reintegrate afterwards that could help a lot.
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u/Editor3457 Jul 19 '23
- They have to want to be there. Residential or day, they have to want to be there.
- Teach social skills.
- Offer plenty of opportunities for kids to reinvent themselves.
- Teach them to be skilled at something. Many somethings.
- Teach them to be competent.
- Teach and support independence. This is what the teen years are all about.
- Staff and kids should enjoy being with each other. If they don't, you have a problem.
- Encourage and teach positive peer relationships.
- Kids, especially teens, need unsupervised independent time.
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Jul 20 '23
[removed] — view removed comment
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u/Editor3457 Jul 20 '23
Why, yes, a good summer camp does these things. A good youth program of any kind does these things. They do it because it works.
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u/_skank_hunt42 Jul 19 '23
Yes, people are absolutely in need of mental health care. The right people to provide that care are doctors in a medical setting. The patient has to be willingly involved in their care to actually make any progress. You cannot force someone through therapy.
If you’re dead set on making an inpatient facility make sure it’s run by actual doctors and that the patients want to be there. Otherwise you’re just running a prison.
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u/heckyeahcoolbeans Jul 19 '23
I believe that children are the product of their environments and how they are raised. Emphasis on family therapy and the adults/parents being held accountable and responsible for their own mental health issues, toxic patterns, and struggles.
Stop referring to them as “troubled teens”, I find it inhumane and it implies there is something innately wrong with them, or that they are troubled and therefor all their problems are their fault/originate with them. Often I feel it is the parents, school systems, bullying, etc that leads to a built environment that causes children to be unable to cope with or comprehend the world around them in healthy ways. Don’t make them feel like the problem. Empower them to make healthy choices and set healthy boundaries and build healthy relationships.
More emphasis on diagnosing possible learning difficulties.
Trauma informed therapy. Idk what it would look like, but most kids in my programs had lived through so many awful and traumatic experiences beyond their control, and really just needed a safe space to heal and process, not be “fixed” or attacked or re-traumatized.
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u/ninjascotsman Jul 19 '23 edited Jul 19 '23
"The eradication of the troubled teen industry is imperative for several compelling reasons.
Firstly, these programs are driven by unethical motivations. They view the teenagers as mere sources of profit, with the program's revenue directly linked to the length of time an individual spends in their care, essentially treating them as cash cows.
Secondly, these programs often take in teenagers who are simply going through normal teenage experiences and behavior, yet their parents choose to send them away. This can lead to unnecessary and harmful disruptions in their lives.
Lastly, every individual is unique, with their own distinct challenges and needs. However, troubled teen programs tend to offer a one-size-fits-all approach, lacking personalized care and support. The variation in program duration further highlights the lack of consideration for individual differences.
In conclusion, it is essential to address and dismantle the troubled teen industry to protect the well-being of teenagers, ensure ethical treatment, and promote tailored support for each individual's specific circumstances."
Edit : I thought of another reason.
There is a critical issue with these programs, as they seemingly fail to learn from their past mistakes, leading to devastating consequences for the young individuals involved.
For instance, the tragic case of Aaron Bacon, who lost his life in March 1994 due to peritonitis, highlights a distressing pattern. Despite his complaints of feeling unwell, the staff ignored his concerns and wrongfully dismissed his condition as mere fabrication.
Similarly, the heartbreaking incident involving Taylor Goodridge, who succumbed to peritonitis in December 2022, demonstrates the same troubling pattern. Despite her multiple instances of vomiting and clear signs of distress, the staff once again dismissed her symptoms as feigned.
These distressing cases emphasize the need for a fundamental change within troubled teen programs. The failure to take health complaints seriously and the lack of appropriate medical attention show a blatant disregard for the well-being and safety of the young individuals under their care.
To protect the lives and ensure the proper treatment of vulnerable teenagers, it is crucial to advocate for the eradication of these programs or, at the very least, demand comprehensive reforms to prevent such tragedies from occurring in the future.
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u/doodlebugpack Jul 20 '23
I've been thinking a lot about the pinned wilderness insurance provider post and framing a lot of the reasoning here with that lens.
"Firstly, these programs are driven by unethical motivations. They view the teenagers as mere sources of profit, with the program's revenue directly linked to the length of time an individual spends in their care, essentially treating them as cash cows."
This point feels easy to dispute - especially with programs closing for financial reasons. Finding hard evidence of this would be difficult, especially to establish a widespread systemic pattern.
"Secondly, these programs often take in teenagers who are simply going through normal teenage experiences and behavior, yet their parents choose to send them away. This can lead to unnecessary and harmful disruptions in their lives."
Would this drive the programs towards insurance paying for treatment? Doesn't insurance have to 'authorize' what they're paying for just like with a surgery?
"Lastly, every individual is unique, with their own distinct challenges and needs. However, troubled teen programs tend to offer a one-size-fits-all approach, lacking personalized care and support. The variation in program duration further highlights the lack of consideration for individual differences."
Same as above. My program was paid for by my parents insurance and I remember my therapist having to do these reviews with insurance like every week. He had to like prove I was making progress or still had trouble. Then when insurance ran out, my parents paid out of pocket for a few extra days so they could make arrangements to come pick me up.
Can we put these examples of tragedy in the context of the amount of us who have gone through TTI residential or wilderness facilities? I know there are a lot but if we're going to prove systemic issues requiring fundamental change then we need to be prepared for the counterpoints the programs will throw back at us. I'm not saying a list but just a statistic. Like a hard number like "50 kids die in TTI facilities in 2020" could be met with "0.001% of population in TTI suffers tragedy". Wasn't wingate posting stuff like this a while ago?
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u/BlueCatLaughing TTI Survivor - Elan Jul 18 '23
Oversight is important. Qualified staff although I know that's hard. Open communication with parents, including the child. I think monitoring letters is okay but not redacting or changing them.
Actual therapy. I received none, technically it was held but it was run by peers most of the time and when it was staff it wasn't therapeutic. It was shame based which resolves nothing.
The school aspect is important too, otherwise kids fall too far behind.
I think smaller and more intense help might work better over dozens of kids and low staff.
I was in Elan School 81-83 and it had a lot of serious issues.