Day

Treatment

offers kids

alternatives

Program seeks to re-integrate

students with mental health problems into

general schools

By KREMENA TODOROVA

Journal Staff Writer

NEW ULM -- Nancy Busse has a few bite marks on her hand and arm -- perhaps an extreme sign of the unending challenge she and her colleagues tackle every day.

Coordinator of the River Bend Day Treatment Program -- commonly called "the principal" by the kids -- Busse heads a team that works with some pretty "unorthodox" children.

Pooled from several school districts in Brown, Sibley and Watonwan counties, the students come to Day Treatment because of a wide range of emotional or behavior problems -- depression, anxiety, attachment or bipolar disorders, schizophrenia. These issues have made it impossible for the students to function successfully in a mainstream school.

Strictly speaking, the kids' troubles are not cognitive or physical -- although inability to focus on academics might in some cases have led to learning gaps, Busse explains. The kids are all of average or above-average intelligence, can use language and know the value of "intrinsic rewards" -- a premise widely relied upon during their stay in Day Treatment. The program seeks to build up what Busse calls the children's "coping skills," with the ultimate goal of sending them back into their former schools.

The children come from all kinds of difficult situations -- dysfunctional families is just one possibility. Sometimes they are on medications -- and those might not be working right, especially combined with the hormonal changes of adolescence. Sometimes the children "shut down." Sometimes they "act out".

"We try to create a structured therapeutic environment in which kids can work out their mental health issues -- whatever those may be," says Busse.

"Academically and emotionally, we try to give them what they need -- through group, individual and family therapy -- and build a safety net around them, so they choose healthier ways of coping."

The children join the program based on recommendations from psychiatrists, public school staff, parents, or county workers. The "average" child stays in Day Treatment for about a year, undergoing a complex, individualized course that, on balance, combines about equal doses of therapy and academics.

The present participants in the program are divided into three age levels: grades 1-5, grades 6-8, and high school (the latter includes one eighth-grader). The three classrooms have, respectively, six, seven, and eight occupants each. The limit is eight kids per classroom.

The students' day flows back and forth between academic pursuits and therapy sessions. Teachers, mental health practitioners, therapists and others take turns to work with each age-based group or else each child.

The curriculum is organized around 45-minute sessions. The children would study a subject, then work on social skills in group therapy, then practice skills during leisure segments, then meet one-on-one with a therapist to focus on an issue or issues -- such as anger management.

As each student progresses closer to the point of returning to his or her regular school, the dosage of the different routines might shift -- for example, academic subjects may take up a larger share of the day.

Each student in Day Treatment has an individual education plan, or IEP -- described by some as a time-consuming, albeit much needed, package of paperwork. This detailed writeup, developed by teachers, mental health workers, county case workers, parents, guardians and/or probation officers, addresses problems, needs and educational techniques on a case-by-case basis. Consequently, each IEP is very different from the next.

An IEP gets reviewed every six weeks. The reviewers assess student progress and evaluate needs for changes in programming and methods.

The children's "evolution" is assessed in various ways -- point sheets that track social skills, behaviors and intervention techniques, data portfolios, weekly classroom meetings, bimonthly meetings with families...

The process of educating the children is one of constant adjustments, and "we have to be very creative," Busse notes.

The ten-year-old program -- which started as a one-room operation to expand to its present eight or so total rooms -- is a cooperative effort of several school districts from Brown, Sibley and Watonwan Counties. The services are co-funded by the counties, which pay for the mental health portion, and the participating schools, which fund the academic component.

In addition to direct work with the children, the program also provides support for the families and programming tips for home school districts.

The Day Treatment facility has several kinds of rooms, all of which modestly-sized by public school standards: the regular classrooms, largely similar in character to any other classrooms with their motivational slogans and student artwork; the group therapy rooms with their muted lighting and cosy nooks; the bare-bones time-out rooms.

Despite the threatening implications, the function of the time-out rooms is not confined to discipline -- sometimes the kids, overwhelmed by a situation, ask to go there themselves. They need to "get away from it all" -- or just finish their math "in peace," Busse says.

In the time-out rooms, kids can do things like bouncing balls or riding a floor scooter -- what might look strange in a general public school is just one of many techniques that help soothe and heal here.

The program employs other innovative approaches as well -- service projects such as planting flowers in parks or delivering "Meals on Wheels"; kids running their own progress reviews; even caring for a "therapy dog."

The Day Treatment program is scoring high with people who benefit from the services or are involved in some other capacity. A poll of about 50 such people conducted last summer puts its approval rating at a high 96 percent.

Staff quality and procedures score especially high -- survey respondents praise the staff's "knowledgeability, effectiveness, competency, professionalism and empathy." They also give high marks to program aspects such as entry procedures, respect for team member values and group therapy programming.

What little dissatisfaction there is, in contrast, focuses exclusively on after-care issues (follow-up plans for home schools and families); or areas outside staff control (facility quality -- no gym).

While no formal program assessment is sought from students, Busse shares an interesting observation. When she joined the program about six years ago, she thought the kids in it might feel negative about being pulled out of their home schools.

She noticed a different reaction -- the kids actually liked it because they felt less different.

"There was less pressure on them -- they were not the odd person," says Busse. "Everyone else here was also in therapy, or had to take meds. It was a sort of relief for them."

Bite marks and all, Busse and her staff harbor no illusions -- they are aware that many student problems will not magically disappear as a result of Day Treatment.

But they see the kids as they come -- "at their unloveliest" -- "stooped over, crabby-looking."

They watch those kids as they change, getting "the bounce back in their step and the color back in their cheeks".

"Even their posture changes," says Busse. "They straighten up, their faces lighten up, they start to glow."

For the professionals on the Day Treatment team, that change is the most important commentary on the work they do.