Haven and Hope

When the O-School team meets most parents the first time, they’re somewhere on the continuum between concerned and frightened about their child’s emotional health, behavior and future. Parents seeking professional help for children aren't aware of their options. Often a youngster is falling far behind in school, and has not been able to access the professional help and services he or she needs. Current efforts — provided by the school or privately — aren’t leading to tangible improvements. Everyone is starting to lose hope. The professionals at the O-School believe it’s important to help parents and children make the best choice for their situation. Sometimes that’s the O-School Residential Program or Therapeutic Day School Program, and sometimes it’s another option. To that end, here is a description of the different approaches available, and the types of children they best serve.

Start with Five Simple Choices

Depending on the severity of the challenges facing the child and his or her family, there are five primary options:

• A Home School (meaning their current public or private school) is right for those who are able to learn and may just need more personalized instruction, attention and support through separate special education and/or outpatient programs.
• A Short-Term Intensive Program most often is offered by a hospital (for children in crisis); a diagnostic placement program (typically for 30, 60 or 90 days); or, a wilderness therapy provider (for those who have trouble dealing with everyday life).
• A Therapeutic Day School works when children have difficulties in a traditional classroom setting. This happens because they face mental health or other challenges and are not fully able to access the curriculum.
• A Therapeutic Boarding School is helpful for children who are less acutely distressed, and those who are not considered a safety risk to themselves or others. Children enrolled in this type of short-term program (six months - one year or more) must be highly self-motivated to progress, as much of their time is typically unsupervised.
• A Residential Treatment and School Program is most effective for children who have a hard time learning because of autism, mental health issues and socio-emotional challenges. (That last word is jargon for a person’s experience, expression and management of emotions, and the ability to establish positive and rewarding relationships.)

Here’s a closer look at each.

Research shows that the more interventions a child goes through without success, the harder it becomes to succeed.

Home School-Related Programs

These children are still able to live at home and attend their neighborhood school. They often have an individualized education plan (IEP) that connects them with the resources they need. Outpatient-Based Treatment focuses on the least severe situations. These children are keeping up with their peers at school. While they may be distressed and disruptive, they don’t put others at risk. Rather, they tend to internalize as opposed to externalize their negative feelings. The three most common support services are: 1) Outpatient psychotherapy, 2) Outpatient speech/language therapy, and 3) Outpatient occupational therapy. These usually are provided weekly or every other week. Parents pay for the treatments either through community-based care or privately. Special Education or Multi-Service Outpatient Programs are more intensive. While their child attends the neighborhood school, parents can arrange access to separate Special Education Services, or, enter their child into a more comprehensive outpatient program. These are useful when single-service outpatient treatment hasn’t proven effective enough, or children show an impairment in how they function. There are two benefits: 1) Children get more than one service from the same location, and 2) They are with other children who face similar challenges.

Intensive, Short-Term Interventions

Parents have several choices here. In-Patient Hospitalization / Intensive Outpatient Program / Partial Hospitalization are all options for care that are not related to the child’s home school. The first two focus on 1) getting children through a crisis and 2) connecting them with other longer-term resources. The third provides a respite and promotes problem-solving and relationship-building skills. In all three instances, the child is away from home for some if not all of the time. These options are called for in three situations:

1. Children facing an acute crisis, or recurring dangerous or risky behavior
2. Children who can’t care for themselves to a degree that puts them in danger
3. Children who have stopped functioning

The severity of the child’s condition dictates which of the three interventions works best. In terms of duration of care: In-Patient Hospital stays usually last between a few days to a maximum of a few weeks. Intensive Outpatient Programs vary from weeks to months. Partial Hospitalization allows the child to go home at night and participate in programs (usually skill-building to ensure their safety) during the day. These sessions can also vary from weeks to months. Diagnostic Placement / Short-Term Residential Intervention can be helpful if the origin or extent of a child’s need is unclear. If the child is in danger, then this is covered by private insurance. The goal of a diagnostic program is to complete testing, and diagnose and stabilize their condition. Care is delivered by a multidisciplinary staff for anywhere from two weeks to three months. At the end of this time, next steps for the child are recommended based upon a comprehensive evaluation. Wilderness Programs are designed for children who are overwhelmed and feel lost. This intervention lasts up to six months. The focus is to “unplug” the child from their regular stress-filled life, and allow opportunity to focus inward. The staff observes children and helps them learn to answer questions such as “What am I doing?” and “What do I feel?” Rather than a psychiatric treatment approach, the emphasis is on relationships and friendships with peers, coupled with self-reliance. The education provided centers around the wilderness experience. Many children come out of these programs with an understanding of their needs and recognition that they play a role in their own well-being, and can apply what they have learned to address them.

Therapeutic Day School

Day Schools that provide therapeutic care are a good option when a child may not require full-time care at a Residential Program, but still has difficulty at their normal home school due to mental health or other challenges that may prevent them from accessing the curriculum. Children live at home while attending a regular school day. Available in many locations across the U.S., Therapeutic Day Schools often provide smaller teacher-student ratios, enabling greater individualized attention; a range of therapeutic professionals on staff who assist the teachers and support the students; and fully-accredited classroom instruction. Some programs, like the O-School’s Therapeutic Day School, involve Case Managers to ensure consistency between life at school and life at home. These schools can also help students following a more intensive stay at a Residential Program.

Therapeutic Boarding Schools

Considered a short-term Residential Treatment, children live at a Therapeutic Boarding School between six months to a year (based on the school term’s duration), and occasionally longer. These schools provide group learning for children who experience some distress and are unable to access the curriculum at their home schools, but don’t present an ongoing safety issue to themselves or others. The school — and the residence — are staffed with professionals who are experienced in providing mental health treatments. Children generally aren’t supervised when not attending classes at a Therapeutic Boarding School. Those who have a high level of internal motivation to stay at the school do best here.

Residential Treatment and School Programs

This approach, like the O-School, provides long-term, ongoing therapeutic support in a 24/7/365 residence, combined with an accredited school. Residential Programs are best for children facing one or more of these crises:

1. They have had a serious acute event
2. They take actions that put their lives in danger
3. They have a pattern of repeated hospitalizations
4. They have engaged in supports across the continuum of care, but still have not been able to progress

Children stay in Residential Programs for as long as necessary, but they usually get the most benefit within three years. There are several differences between Residential Treatment Programs and Therapeutic Boarding Schools. In a Residential Treatment Program: Children receive 24/7 monitoring, supervision and in-the-moment treatment. This generally compares with three to six hours a week of treatment in other schools. Clinically trained staff see each child throughout the whole day: in crisis and non-crisis situations; during school hours and afterward. This gives professionals a more accurate picture of each person. It also helps children feel more comfortable and secure that they are cared about. In addition, therapists can encourage children to accept increased challenges. Because therapists see the children over longer periods, they can more effectively support their progress. Children are served by a team that shares information. At the O-School, for example, each child has a team including a special education teacher, a social worker/psychologist, a psychiatrist and a nurse, among others. There is consistent conversation and dialog within the team. For example, teachers know what happened with a student the night before, so are prepared to make any needed adjustments. Families are actively involved. As part of O-School’s commitment to milieu therapy, the professional staff takes a holistic view of the family experience, and works in partnership with parents and other siblings. Issues at home are processed together, giving everyone new insights into and skills for dealing with former problems. This also increases everyone’s chances for a positive transition back home.

Why It’s Important to Make a Good Choice

Research shows that the more interventions a child goes through without success, the harder it becomes to succeed. This is true of many children who walk through the O-School’s yellow door. If only the O-School had been able to care for them sooner, they wouldn’t be struggling as much now. That’s why this list of options is being shared with you -- so you may make an informed decision about the best direction for your child. This can be hard. Sometimes home schools, special education and community-based mental health programs (as well as health insurance companies) view Residential Treatment Programs as the last resort. They direct you to try many other options first. You know your child best. If you aren’t seeing him or her show the positive progress you know is possible, contact Kristin Friesen, LCSW, Director of Admissions, at 773.420.2891, or via email at kfriesen@oschool.org. The O-School will be honest with you. If its programs are not a good fit, you will be directed to other resources. If it looks like the O-School’s programs can help, then Kristen can talk with you about next steps that make sense.

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Pete Myers, Psy.D. is Co-Executive Director of the Sonia Shankman Orthogenic School and the Brooke Whitted Center. In addition, he lectures at the University of Chicago, and is an Advisory Board Member for the Association of Children’s Residential Centers and a Peer Reviewer for the Council on Accreditation. Contact Pete at pmyers@oschool.org.