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OHSU's Psychiatric Day Treatment Center Helps Kids Who Struggle in Mainstream Programs

   Portland, Ore.

With an 85 percent successful completion rate, this small program makes a huge difference.

Nowadays Connor runs out the door excited about going to school. A year ago he might have wedged himself in a corner, screamed, kicked, hit or bit his mom, Kathleen, as she tried to get him ready. Once at school, altercations with teachers and fellow students inevitably would erupt, and Kathleen would have to leave work and take him home.

Kathleen has asked that her son's real name, and their last name, not be used to protect her son's privacy.

Last month Connor, 6, reached a milestone. He graduated from Oregon Health & Science University's Children's Psychiatric Day Treatment Center, an intensive, individualized treatment and special education program for children aged 3 to 10 with moderate to severe behavioral and social challenges. Connor struggles with ADHD (attention deficit hyperactivity disorder), bi-polar disorder and speech delay, which cause aggressive behavior and low-impulse control.

After a year on the waiting list, Connor garnered a spot at OHSU's center, and not a minute too soon, according to Kathleen, 36. By that time, Connor had been kicked out of school and every day care facility he had attended. "None of the teachers could handle his outbursts. Normally when a teacher says 'no,' the behavior stops, but with Connor it would escalate to kicking, biting, screaming, hitting. I had to leave work so often that I eventually had to quit."

Despite the yearlong wait, Kathleen acknowledges that her family is one of the lucky ones. According to the surgeon general, 20 percent of children and adolescents in the United States have psychiatric disorders, yet only 1 in 5 of those children receives mental health services. The American Academy of Child and Adolescent Psychiatry reports there are 6,300 child and adolescent psychiatrists in the United States with a need of 32,000. The demand for services far outstrips the supply. In Oregon there are 22 psychiatric Day and Residential Treatment Standards programs, including OHSU's Children's Psychiatric Day Treatment Center, serving 399 children and adolescents, leaving hundreds of children with diagnosable psychiatric disorders without adequate treatment.

The shortage of providers coupled with cuts in federal and state funding have led to the demise of many pediatric mental health programs and services. OHSU's center has not been immune to this problem, according its director Les Busch, M.Ed., L.P.C., assistant professor of psychiatry (child and adolescent psychiatry) in the OHSU School of Medicine, and president of the Oregon Association of Treatment Centers. The center's current grant — co-funded by the Oregon Department of Education and the Oregon Office of Mental Health Services — can accommodate 16 kids and their families. One of the center's treatment teams was eliminated after Measure 28 failed, but may be restored, Busch said. If so, the center could enroll an additional eight children.

Despite these challenges, since its inception in 1970 OHSU's program has successfully graduated more than 400 children, who typically move on to special ed programs in elementary schools and eventually, it is hoped, a regular classroom.

Currently two treatment teams, including a teacher/therapist, two milieu therapists and a senior clinical supervisor assess, plan, implement and evaluate the treatment and education strategy for two groups of eight children and their families. At enrollment, parents commit to weekly counseling sessions, which include child management techniques, individual therapy, marital therapy and play therapy.

"This was the first program that actually focused on treating the family unit as a whole," said Kathleen. "My husband and I were able to meet and discuss our frustrations in a safe, supportive environment. We learned not to react personally to his outbursts, not to automatically get angry. These sessions helped us learn how to talk it through."

In addition to a customized curriculum, OHSU's program incorporates behavioral, social, relationship and physical therapy, something traditional interventional programs don't address, Kathleen said. "These teachers have the training, the medical background and the understanding to work with kids whose brains are wired differently. They know Connor is not acting out on purpose, that he is not trying to make life difficult. Instead of getting involved in a power struggle, they try to look at things from Connor's point of view. They hold him close, help him talk it through. They've taught him to self-regulate, to be self-aware.

"Connor is not fixed," Kathleen said. "He still needs medication and will for the rest of his life. But, a year ago, our 15-year-old daughter couldn't have friends over; and now she can. Our family went to Hawaii this summer, something we never would have considered 15 months ago. Our goal, of course, is for Connor to one day be in a typical classroom among his peers. We have a lot of work ahead of us, but we are well on our way."

The OHSU Children's Psychiatric Day Treatment Center was established in 1970. Children are referred from all over the Portland metropolitan area by public schools, social services agencies, health care professionals, day care centers and parents. Children enrolled in the program receive 230 days of treatment and special education administered by a multidisciplinary treatment team. The average length of stay is 15 months. The OHSU School of Medicine's Department of Psychiatry, Division of Child and Adolescent Psychiatry provides administrative oversight for the program.

OHSU's day treatment center is the only training facility for child psychiatrists, graduating about three each year.

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