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RE: Treating Kids with PTSD
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I am a layperson, but I have read research papers (a few years ago) that conclude that level systems are detrimental for youth treated for emotional disturbances, I think in hospital setting. Can't recall what (if anything) it said about RTC. I think there is a huge problem in that the word "treatment" is a very large net, and "residential treatrment" is not much smaller. A Connecticut study concluded that the majority of kids in RTCs studied were there for conduct and attention problems, a smaller number for depressive disorders, a smaller number yet for anxiety disorders, and a final small slice of kids with less-frequently diagnosed conditions such as AS. Reasonable to conclude that programs develop a tradition based on the majority of kids treated. The program may be regarded (especially by courts and agencies) as "appropriate" since it is in use, even though it may be "inappropriate" when carefully judged against the individual child. <BR>
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How are researchers and real-world clinicians looking at PTSD itself? Does diagnosis rely on the existence of an event regarding as traumatic independent of the person's environmental or psychiatric history? Or is it becoming more symptom-based? If the latter, does this lead to inferences that specific traumas have occurred even when they cannot be documented or identified? (e.g. sometimes researchers conclude that PTSD in foster children who are not known to have experienced specific traumatizing events "must have had" exposure to such events in their neighborhoods).<BR>
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Re: self-injury, comment on placing child in program with strong focus on self-injury (e.g. reading fiction about a "cutter" in a residential facility and group discussions about the issue) when the child has no history of self-injury? What possibility this will prompt the child to consider and/or attempt the behavior? (The child having some peers in the program who do have such history, so will learnto some degree about these behaviors regardless.) <BR>
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Sheri McMahon<BR>
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<P class=EC_MsoNormal><FONT face=Arial color=blue size=2><SPAN style="FONT-SIZE: 10pt; COLOR: blue; FONT-FAMILY: Arial">Hi Rob,</SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial color=blue size=2><SPAN style="FONT-SIZE: 10pt; COLOR: blue; FONT-FAMILY: Arial">I'd be interested to understand the source of the question re: level systems and treating kids with PTSD?!?!? </SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial color=blue size=2><SPAN style="FONT-SIZE: 10pt; COLOR: blue; FONT-FAMILY: Arial">I know of no research that suggests that level systems are inappropriate. However, after 12 years of practical experience working with children and adolescents in residential, day treatment, and inpatient treatment settings I can say with some confidence that even the most well thought out point / level system can be mutilated, misused, and/or distorted by the staff who implement the system and supervise the children / adolescents. </SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial color=blue size=2><SPAN style="FONT-SIZE: 10pt; COLOR: blue; FONT-FAMILY: Arial">This depends on a variety of factors related to systemic dysfunction, poor / inadequate / misguided / non-existent clinical supervision, poor staff training schedules, a "criminal justice" philosophical orientation (which tends to be highly punitive), staff burn-out and/or staff psychopathology. </SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial color=blue size=2><SPAN style="FONT-SIZE: 10pt; COLOR: blue; FONT-FAMILY: Arial">Bottom line: point / level behavior management systems MAY become insidiously malignant when left unattended for any period of time. Dysfunctional people / systems tend to engage functional mechanisms in dysfunctional ways. This is why parents, staff, and/or systems that are "issue laden" have difficulty implementing ANY system in a healthy and functional manner.</SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><EM><B><I><FONT face="Times New Roman" size=3><SPAN style="FONT-WEIGHT: bold; FONT-SIZE: 12pt">Kenneth H. Little, MA</SPAN></FONT></I></B></EM></P></DIV>
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<P class=EC_MsoNormal style="MARGIN-BOTTOM: 12pt"><FONT face="Times New Roman" size=2><SPAN style="FONT-SIZE: 10pt"> -----Original Message-----<BR><B><SPAN style="FONT-WEIGHT: bold">From:</SPAN></B> owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu [mailto:owner-CHILD-MALTREATMENT-RESEARCH-L@cornell.edu]<B><SPAN style="FONT-WEIGHT: bold">On Behalf Of</SPAN></B> Longo, Robert<BR><B><SPAN style="FONT-WEIGHT: bold">Sent:</SPAN></B> Wednesday, May 26, 2004 1:15 PM<BR><B><SPAN style="FONT-WEIGHT: bold">To:</SPAN></B> Child Maltreatment Researchers<BR><B><SPAN style="FONT-WEIGHT: bold">Subject:</SPAN></B> Treating Kids with PTSD</SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Does anyone know of any research that suggests that using a "Level System" with Children who are diagnosed with PTSD is 'inappropriate'</SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Thanks,</SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Rob Longo</SPAN></FONT></P></DIV>
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<P class=EC_MsoNormal><FONT face=Arial size=2><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">Robert E. Longo, MRC, LPC</SPAN></FONT></P></DIV>
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