“Some of these kids come to us so severely traumatized that to them, there is no hope, no future, just pain,” says Bob Sheehan, Program Officer at Four Oaks. He is speaking about children whose cases are deemed “exceptions to policy,” meaning they have behaviors so extreme they typically would be sent out-of-state for treatment at more specialized facilities. Four Oaks began accepting these children into its Psychiatric Medical Institute for Children residential treatment program, or PMIC, in May 2012. Since that time, Four Oaks has overhauled its treatment philosophy and delivery, creating successful outcomes for children with mental health diagnoses who have exhausted all their other options.
Exception to policy children come to Four Oaks having suffered much of the same abuse and trauma as their peers in PMIC, but in addition they have often experienced a string of failed placements—in foster homes, treatment programs, or even placements intended to be permanent—which causes their trauma to become deeply ingrained. Moving from one home to the next, feeling wanted by no one and let down by everyone, becomes a part of the child’s identity.
“It’s tough to face that much failure,” says John Derryberry, Program Coordinator of PMIC. “So we make the commitment to stick with these kids through the intensity of their actions. We tell them, ‘we’re with you for the long haul.’” For children who have made a habit of avoiding their mental health issues by getting kicked out of placements, trust doesn’t come easily. They test the staff by acting out. “The real work begins after all that testing,” Derryberry explains.
The most notable change Four Oaks made in working with exception to policy cases is taking an individualized approach where each child’s treatment plan is driven by their specific trauma, not their behaviors. This new model is called Trauma-Informed Care. It acknowledges that behaviors are a result of trauma, and in order to change the behavior, the treatment has to get at the heart of the trauma the child has faced. A team of specialized Four Oaks staff members achieve this through intensive therapy, play therapy, daily practice of social and communication skills, and other tools as needed.
“The idea that treating mental health is clean and non-emotional has gone out the window,” Derryberry says. “We know that after a child addresses a problem in therapy, that they will probably act out afterwards. But we understand that it’s part of the recovery process.”
This affects the way Four Oaks measures progress, as well. No longer is an absence of negative behaviors an accurate way to measure success. Instead, progress may be based on how many coping mechanisms children are trying, or how well they are using what they’ve been taught to deal with their emotions. It may be their willingness to open up to a therapist about past abuse, or their maturity level when providing input on their own treatment.
Additionally, Four Oaks is looking at ways to measure progress even after the child leaves treatment. Mirroring the comprehensive approach of Four Oaks’ TotalChild initiative, in which staff follow up with a child through age 18, PMIC staff are checking in with families after treatment has concluded. This shows the child, and the family, that they still have a support system at Four Oaks. “Ultimately, it’s about each child finding his own definition of success,” says Derryberry.