Georgetown forum; Disturbed children: Institution or home?

Disturbed children or institution. The topic of the eleven hundred and seventy six consecutive broadcast of the Georgetown University radio forum. Another in a series of educational and informative programs from Washington D.C. The Georgetown forum was founded in 1946. This is Wallace Manning speaking to you by transcription from the Raymond Rice studio on the campus of Georgetown University's historic Jesuit would seat of learning in the nation's capital. Today's discussion will be disturbed children home or institution participating are Mr. Robert de Castello a member of the Academy of certified social workers and executive director of the Christ Child Institute for Children. Dr. William P. Clotworthy clinical director of the Christ Child Institute for Children and Dr. Edwin S. Kessler clinical professor of psychiatry and director of children's psychiatric services Georgetown University

School of Medicine. A quiet dedication to worthy ideals is not often the subject of headlines. And yet in certain areas such as care for the emotionally disturbed great work is being done ripping haps more aware of what is being accomplished for the adult who needs psychiatric therapy. Little is known about the equally important work being done nationally to help emotionally disturbed children. National studies show that three out of every 30 children in a classroom. Are sufficiently disturbed to require some professional mental health intervention and assistance. But these same studies indicate that the number of disturbed children is growing so rapidly in our increasingly complex society that unless we do something about it we may run out of professional resources. Today the Georgetown University forum fulfills an obligation to bring to its listeners and viewers some idea of the magnitude of the problem and what is being done at the Christ

Child Institute to bring professional help to both the children and their parents. And finally how to harness the first strength of government and the private sector to give assistance to a greater number of children. You know we're going to begin this discussion by asking Dr. Castro but now is being done to improve services for the emotionally disturbed child. Not enough at this time. Time really. However three years ago Congress appointed a joint commission on mental health of children to study the mental health needs of children and youth in about one month I report will be out and it will make recommendations on prevention and treatment and the development of very much needed manpower and new services in a way. The commission as a successor to the Joint Commission on Mental health and illness him like it. We hope that it will bring about

some far reaching changes in the organisation and the delivery of psychiatric services for children. Doctor when you see a what is the composition of the group. Well it's not entirely medical. The there is on this commission representation of leading medical welfare educational and scientific organizations dealing in a professional way with the mental health of children with talked about three of 30 children but we're still haven't talked in terms of talking numbers can you give us a figure an estimate of the magnitude of the problem beyond that. There has been a recent study by the National Institute of Mental Health and they estimate that of 70 million children under the age of 18

about need some kind of therapeutic intervention and probably of the about one million four hundred thousand are in need of psychiatric care. Well most are certainly not getting it. Perhaps some kind of therapy is available for about 400000 children which means that really over two thirds of those needing immediate care do not have it available. Now let's get down to a sticky matter of where does or where you determine that a child needs professional help. You should we have said that three out of 30 children in their classroom are stuck with a disturbed to require some professional help now. Now what do we mean. Where do you draw the line as to where they get professional help where you think they should not.

First of all the reports from teachers who've been noticed gross disturbances such as school failure disruptive behavior truancy and recognize obese children many of them have good capacities are not learning. You know as far as which children are emotionally disturbed there are a lot of symptoms that are associated with emotional disturbance. Our fear is stealing bedwetting such things. But what is really important is that the development of a child's potential is interfered with that he is not progressing according to his potential or recorded his chronological age. And when that's blocked then one knows that more trouble is ahead. At a particular term

the stresses that the child is under and the situation that he is in both combine to block further growth and to make him not able to cope very well with the problems that he has to deal with in this environment. It is generally inherent problems are the environmental problems of what could happen to a class. It's really an interaction of things. Child is born with a certain kind of disposition certain kinds of capacities certain kinds of temperament and interacting with his environment may work out well or lead to very severe problems. So so the question then becomes one of whether it would be better to treat such children. And allow them to continue in their home and school environments or whether they should be removed institutions for

her what. What solution should be made. You know this is a very important decision to make because you can't decide it just by the nature of the symptom or the severity. It really has to do with work to read whether something can be offered an institution that can't be at home for instance a child it may be so fixed in a pattern of behavior of suspiciousness and hostility that no matter how hard the parents try to break through this pattern the child feels the only way he can get the attention and the interest that he wants is by being provocative and then the parent is forced eventually to react with retaliation sometimes only by his being in an institution. Can he get out of that cycle and get the help that he needs. Now the Christ Child institution Institute is one whose representatives are with us today and let's hear from them about what

happens when the child comes to such as Christ challenged to turn up. I as the director would like to clarify a point. I don't have to do with how the institution suits this child's age in this child's life. At that point it becomes average about two years so the child average is about two years day where we are in a sense there's an there's an interim Amish child's life trying to do the pharaoh's. And correct types of problems. Dr. Kessler has already referred to but we are not an end in itself we are simply a means to an end and that when a child leaves us it is better that that is not the end. It is really the beginning because in general young children they have a life ahead of them and we have tried to

correct some of the problems that are barely been mentioned earlier. Mr Costello are what age groups do you handle grace shall we have a pre-teen travel age for 2 about 12. This is quite well so I might ask why as well you know but we were I believe I will apparel believe that the condition can be treated better but chances are that there will be a successful doctor plan where you know how early in a child's life can meaningful symptoms be detected. Mr Costello said you have them as young as 4 a cure at your institution. Well one can sometimes tell that something is wrong in the second year of

life say. And generally this wouldn't be so but sometimes the promise won't show up till it goes to school and that would be more commonly the case. What sort of treatment do you give children a Christ child. I want to be there for with different cases. Maybe you could give us an idea of the scope and treatment. We feel that in that place like Christ shall Institute we can offer something beyond what can be offered and they are patient what can be offered in the home. Most of the time when the children come to us the parents are

worn out. He's live that show in a very difficult to live with. Maybe so active so on the go all the time almost climbing the walls. Some of them. That the parents come exhausted and I musta been there so one mediant thing that we can provide is some much deserved relief for them. We have three shifts of staff so it's not a matter of her parents being responsible for 24 hours a day. Nobody has but eight hours at a stretch. This makes it possible of course for the person caring

for the child to be more patient and tolerant. Dr. Kessler has mentioned the fact that just coming in leaving home sometimes breaks out of these fixed patterns of unhealthy interaction between the parents and the child. We like to think that we provide what sometimes call me a new therapy which simply means that as best you can you attempt to make as many of the child's experiences while he's with us. Therapeutic said said whether he's in school with us outside of school or whatever time of day and night it is that the kind of

intervention that we make that in some way it may be useful to him whether it be simply providing as close to our home like atmosphere as possible or where there's warmth and. Whether it's providing an atmosphere of consistency and predictability for a child to feel for any child whether he's with us whether he's a normal child in the home. It's important that the child meet consistency says that he is reasonably able to predict the kind of reactions people around him are going to make sometimes. The families are rather disorganized that the children come from and

sometimes the consistency and predictability of crisis can bring rather immediate kind of relief. Excuse me if you have one if you haven't read your therapy. But this is the psychotherapy. I think maybe some people do feel we provide the more obvious kind of treatments like psychotherapy also such that the parents and they have their priest who helps them understand what it is that is troubling the child. What for instance he might have been born with is made for difficulties what

kind of. Experiences in this young life have made difficulties for him that their parent is as he better understands the child and knows better how to handle him and he continues to visit the child in the chow visits home. And so there's always experiences to discuss as to how best to deal with him. One of the things that has always impressed me so much because I see children only in outpatient therapy in the office is the times when the crises occur when when the real storms happen. I'm not able to be of assistance very often right. Crush I would like to be prepared for these crises.

Can you describe the process. I mean what are you talking about. Crisis now crisis that I have to be something that's happened which upsets the child. Say Frank the instant visitor that he expects came a kid feels frustrated and he gets very upset he may have a temper tantrum or you may try to get everybody mad at him or the like and so ideally one copes with it immediately and whoever is in charge of him at the time takes him aside and encourages him to verbalize whatever it

is that he's feeling. One of the most important things most of our children need to learn is to. Vent their feelings in words rather than action. It's sad when they have acted up so that they have made their lives and the people around them so difficult. You mention regarding the matter of psychotherapy there's course each child has his own psychotherapist also and it's important for him to understand what it is that's happened to him and wanted. What's gone wrong and what may be perpetuating the difficulty. Childhood is not as adept with words as the adult and so that he generally sort of dramatize is

what he has to say through our toys and this and this is interpreted and put into words by his therapist. We also use drugs the lower third of our children are benefiting considerably by the use of the drugs. Is the probability darker that they would have to use drugs for the remainder of their life. No indeed. In a few cases in some small percentage of cases they may have to use drugs for several years. You can pretty well count on that and a lot of cases they won't have to use them much past the age of 12 or so. End of story. Gusto Excuse me doctor Mr Costello or what. What

it is or any figure you can give us on cures are there such things as cures that we've had to study was done over there called follow up studies. I'd like to believe that one over the other in the world says 80 percent of the other will say 60 percent so I have some tracks I guess. What happens afterwards is complicated. Let me tell you about. I'll call him John when John came to life who was too he was obnoxious because he was a byword nobody could standing me get thrown out of the Church throw him out of a really deep religious education they couldn't stand him. His parents couldn't stand me with Biden all the time. And it was pretty hard to take. But in the question of time and particularly one of those educational problems that I have as intelligence was fine but he could

not produce and the dying wish thing was he better hurry up on his medication table if he could do everything else they could not go back and refine a rocket out between a peach or and boom. Parents therapist rep was wrong and he was afraid to exceed his father in the messages that he was claiming from his parents while I was there that which might have been mentioned and so we dealt with us in terms of the parents and they really believe that giving him permission to go ahead and it was shipped no problem. So I replaced him. Then before he was discharged I'm still living with us but he was going home on weekends but he went to school at a local elementary school and he did very well. He was there I'd say for one semester but perhaps when I have and then were able to discharge him back was home altogether and I remember the principal that screwup calling the school he was going to go back to him and he wanted that pencil but it

turned out that this boy is not the same boy that left and they were fed up but when he left. And this is one of the things that Ron has to do with Iraq when the job of a banker and community people remember them were and it's hard for him to get a second chance. It's sort of like we expect you to act different Birkbeck you to accept. And yet when I read we have different expectations because we're not really a current of sick behavior. So sometimes people can like this bunch of them in a room for a child and he did fine. However on the way back home we worked with him for several weeks. His mother his father himself and his sister would call it family therapy and kind of squared away some of the barbs and the bugs in the family

and it was happen his older sister had about his coming home. And this may be coming home much more compatible and he did well. Now not all cases of course end up like this but this is going to happen when the good read with some help from people like the prince but I meant preschool which may not seem like much but it can be very critical. Answer A brushed in passing. Upon another question that occurred to me when the doctor thought when he was talking a seeming paradox and that he said the Christ challenge to it in some cases is trying to provide a home I kept my share for children who have been taken out of their homes. Now could you address yourself to that for a little bit less Are there any with the pollution and we know we are every not a home they were met in the literal sense just to give you some kind of answer let me tell you some of those that we

do we have a developing right now on a par. It's got a couch. It's got to chose to go where the envelope of coffee table television etc.. Now do you use this room have you up to it that not every child is up to using the room because we can have the fur fly across the room that sort of thing so when we're ready for it. We start introducing you that way back into a home like that with Figure 11 children have their own homes of course as well as we can we have them go home for weekends. But there are some instances about nine or 10 of our children will have a total of twenty six that live there and fiber come during the day and about 9 or 10 of the ones that live there really don't have a place to go and immediately. We came on we had people who were trying to develop this program further to give these troubling me

experience or provide some semblance of about the physical aspects of a home in the institution. We tried to provide a step by step return because if you don't give them the opportunity it's very difficult to manage in a home and an institution if you're careful. Now one thing that we have to mention is that therapeutic school we want to speak about what's involved there. Well quickly I'll say that we have three classrooms. There are there's a teacher and a teacher's aide in each classroom. We have a bunch of them out in the classrooms have a maximum of 10 children but rarely do we have that many. So the ratio of teacher to child is rather high. We have what I call a first classroom I mentioned earlier when I talked about the way and when the public school as we care for children who are ready for that and they're ready for

before discharge. And we are licensed especially by the State Education Department to do this kind of work. Did you suggest a moment ago that the total number of children that you have in any given time is about 29 or 30 years or 30 or 32 or something like that. You know I want to ask Dr. Kessler that you were talking about 400000 we're talking about one institution and thirty two. Can you correlate for me. You know I'd like to say that not of course there is a need for many more institutions like like this. In fact there are 15 states that don't have any of any kind. But the importance of this institution is not just the children that are being helped in itself. It's also very important for training of personnel in all kinds of ways including some of my trainees in child psychiatry that spend part of their time working

a crazed child in order to learn the techniques and understand children better where they have an opportunity to be right in the situation where things are going on. This is an invaluable aspect of this kind of. Place I notice you are not Mr gusto at the mention of training personnel. US were proud of that you have such a program. Well Dr. Kass is referring to my biggest bets in the training of Chelsea because back in the training of teachers social workers we are blaming the new future due to psychologists. It keeps us on our toes will make a contribution to the food and there's not the right learning your craft so to speak you know on the job. In addition to the direct training that decent people get we're very proud of that. A discussion of disturbed children home or institution I was thanks to Mr Robert E. cussed ELO member of the Academy of certified

social workers and executive director of the Christ Child Institute for Children. To Dr. William B Clotworthy clinical director of the Christ Child Institute for Children and Dr Edwin s Kessler clinical professor of psychiatry and director of children psychiatric services Georgetown University School of Medicine. If you have attended the weekly discussion program at the Georgetown University radio forum broadcast of which was transcribed in the Raymond Rice studio on the campus of historic Georgetown University in Washington D.C. next week you will hear discussed U.S. commitments to Latin America. A panel at that time will consist of Dr. Thomas Dogg assistant professor of Latin American history and Dr. Norman a ballet professor and chairman department of Latin American Studies at the University of New York at Queen's and research associate Center for Strategic and International Studies at Georgetown University. This program has been presented in the interest of public education by Georgetown University.

You know MODERATOR Well US banning this program was distributed by the national educational radio network.