Child Study and Treatment Center treats youth with the most complicated and challenging behaviors. Some challenges addressed include psychiatric disorders, attention-deficit/hyperactivity disorder, bipolar disorder, learning disorders, autism, behavior disorders, sexually inappropriate behavior, aggressive behavior, and conditions where there is the potential for self-harm or physical harm to others. Many of the youth have more than one of these challenges. Almost all have demonstrated an increasing potential to be unsafe for themselves and others. This behavior tends to continue to escalate, and without appropriate training and treatment, it poses a clear and ever-present danger. This is where CSTC can and usually does make a positive difference.
- Psychiatric youth counselors
Psychiatric youth counselors are part of the treatment team who help patients each day to reach their goals and implement their treatment plans. Implementation of the treatment plan may include teaching new skills during a soccer game by helping a youth practice controlling their anger when playing with another youth. It may also include helping a youth learn to communicate their needs in a way that others will want to respond to. Psychiatric youth counselors provide patients with coaching when they are having a hard time coping on their own. These counselors also help patients practice the skillful behaviors they learn in therapy groups.
- Nursing
A registered nurse is scheduled to work each shift on each cottage. Nurses are the members of the treatment team who:
- Help with any physical problems patients may have (feeling sick, getting injured).
- Pass out medications (prescribed by medical doctors).
- Schedule and (when staffing allows) take patients to clinical appointments.
- Provide immunizations and basic first-aid or medical assessments.
- Lead patient education groups.
- Provide skills coaching and participate in patient activities.
- Answer patient questions about health or medications.
- Communicate with parents or legal guardians for care coordination.
- Psychiatry department
The Child and Study Treatment Center contracts with the University of Washington Department of Psychiatry for the services of a medical director and an attending psychiatrist for each cottage. Ketron and Orcas cottages have an attending psychiatrist on-site three days a week and available the other two days and after hours. Camano Cottage has an attending psychiatrist on-site four days a week and available the other day and after hours as well. Each patient is under the care of a physician who provides psychiatric services, including evaluation, therapy, medication management, training and oversight. The attending psychiatrist works with the cottage program directors (psychologists) and treatment teams to review progress and ensure that treatment methods are the most effective for the children in their program.
The child psychiatrist is in charge of your medical care while you are on the cottage. They work with you, your parent or guardian, and treatment team to design a treatment plan for you which may include:
- Medications
- Individual therapy
- Group therapy
- Family therapy
- Specialty clinics
Our center uses a variety of different evidence-based practices in our patient care methods. These practices are listed below.
Trauma Focused Cognitive Behavioral Therapy
TFCBT is an evidence based program that can be used in individual therapy for children or adolescents (or adults) who have experienced trauma to such a degree that it impairs functioning of daily life. TFCBT is a tool that can be very helpful in assisting persons who have survived trauma to take some of the intensity out of the memories. This is to say that step one is assessing the (1) most significant trauma, and (2) how the symptoms of it show up in a regular life. Step 2 is to teach specific skills to assist the person in being able to talk about the trauma in a organized way in which perspective is gained. Step 3 focuses on making a narrative of the traumatic experience and taking control of the memories. A checklist can be re-administered throughout the therapy process to measure the decrease in symptoms. While this approach is not used for every child at CSTC, it is a model that has been presented to all CSTC therapists and there is an ongoing commitment from the administration to support the success of this model. Further information and a free training can be found at https://tfcbt.musc.edu/. The primary handbook on this model is by Cohen, Mannarino, and Deblinger (2006) and it is titled "Treating Trauma and Traumatic Grief in Children and Adolescents."
Dialectical Behavior Therapy
DBT is a treatment approach pioneered by Linehan (2001) which combines Cognitive Behavioral therapy techniques for emotion regulation and reality-testing with concepts of distress tolerance, mindful awareness, and acceptance. A Crucial aspect of the therapy is finding a balance between acceptance of a patient just as they are and the need for the patient to change in order to have a "life worth living." One of the major premises of DBT is that patients are doing the best they can, but engage in harmful thoughts and actions because they lack the skills necessary to build a life worth living. At CSTC the DBT approach is used primarily with adolescents to help with handling upsetting feelings and coming to terms with life as it is experienced. Mindfulness, or awareness of one’s feelings, behaviors, and thoughts, is the core component of DBT and is the starting place for teaching the rest of the skills. Both individual and group approaches are used to present DBT to adolescents at CSTC, including DBT Group, individual therapy, DBT skills in the milieu, and special DBT events. Often individual DBT will assist an individual in skill acquisition and use, whereas group settings give the opportunity for processing, trying new skills, and experiencing alternative outcomes. Individual work can also assist in identifying obstacles and patterns that have been problematic in the past. The DBT group focuses mainly on the four key areas of core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills. Adolescents at CSTC have many opportunities to practice these abilities as they develop, whether in Recreation Therapy, on home pass, or on the cottage each of these challenges are present daily. Please do not hesitate to contact the Program Director to ask more about how DBT is used in each cottage program.
Life Space Crisis Intervention
LSCI is one of the many tools in a CSTC staff person’s tool belt. LSCI is an approach assembled by Long, Wood and Fecser (2001) and gives us a framework for looking at "crisis" as a time for growth or opportunity. The work originates from Redl’s (1959) concept of Life Space Interviewing, with some innovations around emergent situations and customized approaches. Life space is defined as a daily experience or the process of going through each day. Many CSTC staff have been to the week long training offered by LSCI instructors. Others have participated in small trainings or staff meeting updates to learn about how specific LSCI tools fit with an individual child or situation. The LSCI model works well in a milieu setting or long-term hospitalization because it emphasizes linking strong emotions and their behavioral expression. Another major component of LSCI is self-regulation, which relates directly to why many children are admitted to CLIP programs. Long et al write "self regulation emerges from understanding people and events in their environment, motivation to change unpleasant conditions, and trust in adults." LSCI brings helpful constructs such as Drain-Off (de-escalate), Timeline (event sequence), Central Issue, Insight, New Skills, and Transfer of Learning. Additionally, LSCI brings irrational beliefs to the surface and teaches about the cycle of conflict. At CSTC we have made posters to prompt staff and clients both with reminders of some of the key ideas of LSCI. The strategies and concepts of LSCI are clearly applicable in our setting, and we encourage you to learn more about the ideas and tools encompassed within this helpful program.
Positive Behavior Support
Child Study and Treatment Center uses a Positive Behavior Support model across campus to support a positive social culture. Through PBS, we identify center-wide behavioral expectations and ensure that everyone knows what they need to do to be successful. PBS is a model that helps everyone focus on the behaviors that are desired and encourages teaching of the skills needed to meet these expectations. In the classroom and on the cottages we work together to reward and encourage the behavior we would like to see increase while working to ignore or discourage behavior we would like to see decrease. We have organized this program around 4 central behavioral expectations: Respect, Responsibility, Commitment, and Safety. Any child/adolescent on campus may earn a PBS card (or feather) for demonstrating positive behavior in one of these 4 areas. Youth can be nominated by peers or staff for a PBS shirt, which is earned by demonstrating progress or role model behavior in one of the four PBS areas. Staff are trained to use PBS language in their interactions with children/adolescents at CSTC and try to use more encouragement than limitation in language. CSTC has a PBS committee that meets weekly to ensure that the model continues with momentum and energy. The PBS committee works together to utilize the model put forth by Horner and others (see reference). Some examples of how Commitment is embraced in the campus-wide PBS program include: supporting students in academic and community matters, improving communication, demonstrating commitment to school program, expectation of adult/staff participation, and staff demonstrating commitment to PBS principles. Some examples of how Safety is embraced in the campus wide PBS program include: maintaining a safe environment, actively engaging youth, being proactive, listening to ideas for a safe community from all members, and modeling safe behavior. Some examples of how Respect is embraced in the campus wide PBS program include: demonstrating supportiveness, modeling expected behaviors, being polite, demonstrating punctuality, making positive verbal statements, using technology in a way that supports a respectful environment, and finding ways to get involved. Some examples of how Responsibility is embraced in the campus wide PBS program include: following the guidelines put forth in the other three PBS areas, planning together in advance, being proactive when there are issues that require attention, and supporting the classroom and cottage environments. The PBS committee welcomes participation from all members of the CSTC community.
Motivational Interviewing
Motivational Interviewing is a goal-directed, client-centered counseling style for eliciting behavioral change by helping clients to explore and resolve ambivalence. The operational assumption in MI is that ambivalent attitudes or lack of resolve is the primary obstacle to behavioral change, so that the examination and resolution of ambivalence becomes its key goal. MI has been applied to a wide range of problem behaviors related to alcohol and substance abuse as well as health promotion, medical treatment adherence, and mental health issues. Although many variations in technique exist, the MI counseling style generally includes the following elements 1) Establishing rapport with the client and listening reflectively, 2) Asking open-ended questions to explore the client's own motivations for change, 3) Affirming the client's change-related statements and efforts, 4) Eliciting recognition of the gap between current behavior and desired life goals, 5) Asking permission before providing information or advice, 6) Responding to resistance without direct confrontation. (Resistance is used as a feedback signal to the therapist to adjust the approach.), 7) Encouraging the client's self-efficacy for change and8) Developing an action plan to which the client is willing to commit.
Psychologists
There is also a full time psychologist on each cottage, also known as the program director. In addition to individual and group treatment, the psychologist also develops the cottage program, the daily schedule and the behavioral programs such as the level system. The psychologist is also responsible to coordinate with the school and the recreation departments. The psychiatrist and the psychologist work together to determine which treatment methods are most effective for the children in their program and both provide training and clinical supervision to the nurses and counseling staff on the cottage.
Professionals in training
While at CSTC, patients may have a chance to work with one or more persons in the final stages of their professional training. Child Study & Treatment Center is very lucky to have many such persons from a variety of accredited universities and hospitals, such as Madigan Army Medical Center, the University of Washington, the University of Puget Sound and others.
Some of these people, such as our psychiatry residents, child psychiatry fellows and developmental pediatric fellows, are licensed physicians whose privileges are authorized underneath the supervision of a member of the active medical staff (i.e., attending psychiatrists). They also can provide individual, group and/or family therapy, perform psychiatric and/or basic pediatric assessments and perform physical examinations. As licensed psychiatric residents under the supervision of the active medical staff, they are authorized to write physician's orders
Our post-doctorate fellows, practicum students and Western State Hospital psychology interns are trainees that will be assisting with forensic evaluations and/or clinical work. They all provide individual, group and/or family therapies, psychological assessments, forensic evaluations, psychological testing and behavior planning.
CSTC also participates with the University of Washington Medical School by allowing fourth-year medical students an opportunity to have an elective class under one of our campus psychiatrists.
- Recreation therapy
The Recreation Therapy Program is designed to help children improve their self-esteem and promote their independent leisure functioning by teaching leisure skills, improving physical fitness, and enhancing social functioning. As members of the treatment teams, recreation therapists design activities to meet these objectives and the therapists help each patient explore a wide variety of healthy and enjoyable activities.
The recreation therapist and the recreation department team teach by example and through participation, and help youth learn and practice skills such as planning, problem-solving, and playing. The team also teaches self-confidence-building through activities such as fishing, hiking, camping, backpacking, writing poetry, rock climbing, expressive arts, life skills, and much more.
The recreation department also serves as a training position for a few select undergraduate recreation students each year. They work closely with our therapists and become a part of the staff while they are here. The department also works with practicum students throughout the year as well as numerous volunteers.
For questions about the program, contact the recreation therapy supervisor at (253)756-2694.