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.