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Residential Treatment Services as a Vital Part of the Continuum of Care for Children, Adolescents and Young Adults – An Interview with Harvey Newman, CEO of Wellspring Residential Treatment Facility

Wellspring is a residential treatment facility located in Bethlehem, Connecticut. Mental Health News recently met with Wellspring CEO Harvey Newman, MSW to discuss residential care and its benefit to the patients that it serves. In the interview that follows, we learn from Mr. Newman how Wellspring’s residential treatment facility is meeting the ever-changing needs of children, adolescents, and young adults who are experiencing emotional difficulties.

Q: Tell us about the history of Wellspring.

A: Wellspring was started 33 years ago by two therapists from Connecticut, Richard and Phyllis Beauvais. In the beginning, the Beauvais’s took young adults into their home and worked with them in a therapeutic community environment. Being successful at this, demand grew quickly and over the course of its 33-year history, Wellspring has evolved into a multi-faceted clinical facility with 41 beds.

We have a 10-bed residence for young adults, a 19-bed residence for adolescent girls, a 7-bed residence for children, and a 5-bed therapeutic group home, also for children. We also have the Arch Bridge School on our campus, a 51-seat special education facility that serves our residents and community day students who struggle with academic success due to emotional and behavioral issues. Historically, about half the students are Wellspring residents and half day students. The day students travel within a 40-50-mile radius of Wellspring and come as a result of their school system not being able to serve them. We have an outpatient clinic on our campus in Bethlehem, and a larger office located in Middlebury. The Bethlehem campus is located about 90 miles from New York City in the southern part of beautiful Litchfield County. Our campus has farm animals and gardens, both part of the therapeutic work programs. Our residences provide home-like atmospheres that welcome kids and their families in a very special way. Our founders, Richard and Phyllis, are active members of our Board of Directors. I came to Wellspring in 2007 to move the facility from a very personal, small, and quiet program to a more broadly visible facility in the local community and within the professional community. The response to our expanded geographic outreach has been very well received by psychiatric hospitals and schools in the northeast and in local communities, all of whom are seeking our level of care. In the past year, we have served kids regionally from as far south as Princeton, New Jersey, and as far north as Boston – with others from as far as California and England.

We are highly professionalized with a great deal of clinical expertise and run a program that is very clinically intense. We provide over 15 hours of treatment and therapy per week for the children and their families. In our Adolescent program, we require parents to participate in family therapy and to be involved in multi-family group and parent support programs every other week while their children are in residence. Our biggest challenge is to return our kids to their families, communities, and schools, and to make their home and community environment a healthy and permanent place for them. This requires a lot of family involvement, because as the kids get better there needs to be simultaneous changes within the family unit itself.

Q: What is the process of a child being referred to Wellspring for care?

A: Every child who we take into Wellspring has been known to some provider, community institution, or organization that notes their emotional problems and difficulties in living at home. Right now, we get a substantial number of referrals from school systems where the child is not making it because of some emotional issue that is affecting their academic performance. We have a number of referrals on a consistent basis, particularly from Westchester County, New York, and Fairfield County, Connecticut where the school systems feel a need for the child to be enrolled in residential treatment and receive residential education. They select Wellspring for those services. In other instances, we have kids who have been in higher levels of care – be it at a psychiatric hospital, an eating disorder rehab program, or a drug rehab program. After the initial rehabilitation, referrals are made to Wellspring through those institutions or the families. Wellspring works to get at the underlying issues that may have caused the child to develop these problems behaviors.

Q: Are substance abuse and eating disorder the most common diagnoses of the kids that come to Wellspring?

A: We do not view substance abuse or eating disorders as primary diagnoses, but rather as secondary diagnosis. We are seeing kids with primary diagnoses of severe anxiety, depression, bipolar disorder, and personality disorder, along with secondary diagnoses of attempted suicide or self-harm. We treat these problems in a very holistic way. The core of our service is relational. We work with our kids and their families to help them increase their ability to relate to family, community, and school, to become functioning and productive members of their social community. There are often very complicated, sad, angry, and difficult relations between parents and child. Those core relationships with parents are mirrored in the community with other figures at the child’s school. These are difficult situations for the kids to manage, and we work very hard to help them achieve a relational level that permits them to function in these environments.

Q: Once a child arrives at Wellspring, how do they become part of campus life?

A: In addition to schools, we frequently receive referrals from psychiatric hospitals such as New York-Presbyterian Hospital, in White Plains, New York and Silver Hill Hospital in New Canaan, Connecticut. New York-Presbyterian Hospital has residential psychiatric hospital services for children and adolescents, and Silver Hill Hospital has services for adolescents and young adults. Prior to a child coming to Wellspring, a thorough discussion takes place between the referring institution and our admissions staff to make sure the patient being referred is a good match for us. We then get paperwork on the patient from the referring institution and set up a meeting to interview the prospective resident and his or her family. The next steps involve a pre-admission tour of our facility and introductions to therapists and other key personnel who will be working with that child, adolescent, or young adult.

We then set up a date for admission which includes a meeting with our psychiatrist, our nurses, and the psychotherapist who will be assigned to the case. This helps broaden our understanding of the patient and their family.

A new resident always goes through an adjustment period. Along with an orientation program, she is assigned a current resident to act as a mentor. The orientation process introduces the new resident to life at Wellspring, and the mentor works with staff to make the transition easier.

Q: Can you tell us about the campus school at Wellspring?

A: Part of our pre-admission process also involves interfacing with the patient’s school of origin so that we have an acceptable assessment and special education plan that meets the requirements of the sending school system. Our campus school is approved by Connecticut, Massachusetts, New York and New Jersey. Our coursework is accepted by home schools and is credited towards graduation from the school of origin. We maintain ongoing communication with our resident’s school system and try to meet the individual needs of the student and her school. On occasion, we have tutored students in a foreign language and subjects such as advanced calculus so that they can complete the requirements for their home school system. Just recently, we coordinated an advanced placement class for one of our residents who received college credit for that course at a local community college. We get many educationally high-functioning kids at Wellspring and we work to maintain their academic levels and success during their residential stay with us. Our recent state approval process was outstanding, and Wellspring received five commendations along with a five year approval.

Q: Do some of the kids come to Wellspring with a history of harming themselves or a pre-existing flight risk given Wellspring’s open campus environment?

A: As an open and unsecured facility, we have a requirement that our kids have little or no risk of walking off campus, of returning to drugs, of having an active eating disorder or other situations in which a child may be actively involved in any dangerous self-injurious behaviors. This obviously limits the kinds of kids we can serve. We do not serve kids that require a secure locked environment.

Q: What role do medications play in the therapeutic approach at Wellspring?

A: Medications do play a part. Whether it’s a big or a small part in the client’s therapy depends on each individual. One of the things we do with new admissions is to lower dosages or eliminate medications, in the safest possible way, in order to find out who the child is without the blanket of these drugs. Last year, we had a child that came to us on five psychotropic medications. In 14 months, she returned home taking only Flintstones vitamins. It is our goal to reduce, eliminate, change, improve, and test out the client’s medications, so we can work with the real person behind all of the screens that those medications create, and help them access and appreciate their own personal value and giftedness and build a foundation on which they can build stable, creative lives.

Q: Do all the kids attend a general schedule of programs during the day – or are there individualized daily schedules set up for each child?

A: We do have a general program, but within the program are individualized activities designed to specifically meet the needs of each resident. All the adolescents attend school and participate in expressive therapy, art therapy, and our adventure program. In addition, each participates in individual and family therapy sessions. We pay close attention to the type of therapy each client responds to, and structure more time around those modes. For example, some of our kids respond better to nonverbal therapies such as working with our farm animals or art. In these instances, we make sure these specialized activities are added to their schedule. On any day, you might see kids working in the garden, two or three kids working with animals, and another group working on art projects that may be therapeutically directed.

Q: Do you provide vocational guidance for the older kids who are approaching high school graduation?

A: We don’t have a vocational program per se. However, our school staff and therapists work with our students’ college advisors and other educational consultants to prepare for their future. We do have a work program that is related to serving the needs of residents that includes taking care of the house, working in the kitchen, working in the gardens and caring for our farm animals. In that sense, we are preparing kids to return to their homes and community better capable of taking care of themselves. These activities give them needed skills to take charge of their own daily living responsibilities – skills that many don’t have when they come to Wellspring. Many of the parents are thrilled that their kids can cook and care for themselves when they return from Wellspring, and that’s not a bad outcome from a residential stay – in addition to being emotionally healthier.

Q: Do the kids all dine as one group?

A: Yes, everyone dines family style at dining room tables along with therapists and milieu counselors. This creates a real environment with room to engage in meaningful personal and group discussions during mealtime. The dining room tables in our adolescent residence can seat twenty people at a time, along with several side tables. The side tables can be used by a therapist or outside consultant who needs to meet with a child one-on-one, and still be part of the group.

Q: It sounds like you have created an extended family environment for the kids.

A: That’s a good description. We work to create a family environment in Wellspring’s basic philosophy which is “high nurture – high structure.” There is always a lot of verbal support as well as a very structured day and a structured means for developing relationships and communicating within those relationships. We also work with the parents to develop a means for them to carry through a high nurture/high structure kind of environment when the kids are home on passes for weekends and when the kids return home on a permanent basis.

Q: Let’s talk more about the parents. What are some issues that parents themselves come in with when enrolling their child at Wellspring?

A: Each set of parents is unique. Because some of the children who come to Wellspring are approaching young adulthood, many parents have already experienced their child being at one or more inpatient or longer-term facilities, where they might not have had a successful outcome. Therefore, these parents are experienced with having their child at a residential facility. On the other hand, it’s usually a first placement for our youngest population of kids between eight and twelve, so it’s also a first placement for those parents. First time placements are a particularly emotionally wrenching experience. We have found that on a number of occasions – even though we advise differently – the parent doesn’t tell their child that they are going to a residential facility until they actually arrive at the campus or at some point after they arrive on campus. The emotional angst about leaving their child at a residential facility is very high, no matter how competent the staff or comforting the environment. On the other hand, we have had foster care kids who have had 18 previous placements with foster families, psychiatric hospitals, group homes, and other residential treatment facilities with little ongoing parental contact.

In our children’s programs, we have kids who don’t have legal families, as well as kids who have been in foster or adoptive homes. In our adolescent program we require children to have families – adoptive or biological families – or some related adult in their life. In our adult facility where the residents are free to sign themselves out at any point, we almost always have family involvement, and we usually require the resident to permit us to talk with their family and engage their family with them as part of the treatment process.

Q: When you speak about engaging families of Wellspring residents, how does this work for the siblings of residents?

A: One of the most fascinating treatment activities that I found when I came to Wellspring is something we call “multi-family group.” Every two weeks on a Sunday evening, parents and other family members are required to participate in a whole-community therapeutic family group. Each family comes with their own configuration. It can be mom and dad, grandparents, and often siblings of the resident. We often get as many as 15 family units, with 2 to 4 people in each unit participating around a large circle, for a total of as many as 50 people working with two very experienced Wellspring therapists.

We engage the families in public affirmations, identification of issues, concerns and supports that are both inter- and intra-family. Quite often you will hear from a mom whose child has been here for 10 months tell a rookie mom and dad that “It will take a little time to get adjusted to this environment, but in the long run it will become productive – so stay with it.” Or you may hear a dad saying to his daughter, “I am so thrilled with the progress you are making, I have always loved you, but I am so much more comfortable being able to communicate with you in a more positive way.” Those kinds of things are said and discussed in the multi-family group. The kids provide a lot of support for each other in a visible way. Siblings often participate in the group process. The small family groups are part of the larger multi-family group, creating the potential of all groups becoming more cohesive. On occasion we see magical things happening with kids and families in this kind of environment. Parents groups and multi-family groups engage parents to support each other as much as possible.

Q: Is there an average stay at Wellspring?

A: Yes, there is an average stay. For young children it is 12 to 18 months; for adolescents, 9 months to 1 year; and for young adults, 6 to 9 months. However, these numbers do not reflect the real picture. What we look for is an appropriate and flexible length of stay for each individual.

Q: What are your goals for the kids at Wellspring?

A: Our goal is to always return a child to their family, community, school, or work situation. We hope to accomplish this as quickly as possible with mutual agreement with parents, therapists and other facilitators that are involved in each case. We also need to have an assurance that there is a local support system (therapist, home visitors, mentors, etc.), whatever is necessary, to make the return to community permanent. We also must coordinate with the school systems, which are the most important out-of-home activity that children will be engaged in. For that reason, the rhythm of our admissions and discharges are timed to be in sync with the school year. On June 18th, we graduated four residents and two-day students from our campus school who returned home, went on to a new therapeutic school, or on to college.

The Arch Bridge School works closely with the school districts to identify the appropriate time and place for a student to return. Often, that’s a difficult process, because of the limited resources in local schools where they only see one or two kids like ours a year.

Q: When kids return to their homes and communities following a stay at Wellspring, do they encounter any forms of stigma towards them relating to where they have been and what might have caused them to be sent to a residential facility?

A: I am ashamed to say that stigma is still a terrible burden that children with serious emotional issues have to endure. Kids who have been is residential treatment can have a difficult time upon return to their community and school. There are always “bumps” in the road to recovery. Quite often their peers will press them with questions such as: Where were you when you were away? Why were you away? What were you doing? These questions tend to stigmatize the kids that have been in treatment, and so we try to work with the least stigmatizing approach when returning our kids back to their communities. We find that a structured approach to this issue helps. We make sure that the kids’ return to school coordinates with the beginning of the term or school year. This gives them the opportunity to keep up academically and socially. People (neighbors, even school personnel) who don’t understand the depth of the emotional problems our kids have can make it very difficult for the child when they return. We help our kids understand that there will be bumps in the road, no matter how well they are doing when they leave our campus. We try to keep abreast of the kids that we return home without intruding on their home-based support system, so we can provide additional support for them.

This coming October, we’ll be hosting an Alumni Family Day here at Wellspring, and one of the workshops will be called ‘Bumps in The Road,’ to be presented by kids and families who have experienced these bumps firsthand. Our process of addressing stigma is to stress the importance of getting parents to understand what stigma is, how harmful it can be for the kids, and to teach them creative ways to be supportive and to help their kids deal with this issue. For some parents it is very difficult because they feel guilty that their child had an emotional problem and that they might have contributed to their child’s problem.

Q: In closing, would you like to comment on some of the challenges you see in combating the current tide of disfavor that some treatment advocates are promoting against residential treatment facilities?

A: As a CEO of what I believe is a high-quality, open door residential treatment facility, I am very concerned and upset about the flood of advocacy, governmental activity, and literature against residential treatment. This wave of sentiment has reached a point where some advocates feel that residential treatment is not a meaningful part of the continuum of care. In Connecticut, Massachusetts, and New York State, generally speaking, residential treatment facilities are not the dark vision of the Dickens orphanages that the advocates are using in their arguments against residential treatment.

Wellspring is a very thoughtful, deliberate, professional, and experienced service that is a vital part of the community-based treatment system. There are some kids that can’t live in their home community without some form of intensive clinical residential intervention. These kids need our help to temporarily remove them from the tensions they are experiencing in their home community so that they can work with us to figure out and develop the means and competence to return home. Open door residential treatment, in comparison to locked door psychiatric hospitals, is a way back for them into the community. For many of these kids, our campus facility provides the means of making their home and community life more stable. We provide a means for the child to repair and rebuild their damaged sense of family as well as helping them to build their own self-confidence in order to grow and develop into successful and happy young adults.

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