Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, February 5, 2015

What Is Therapeutic Respite Care? (This Is a Serious Question)

Can anyone define for me what “therapeutic respite care” is, either from a practical or from a legal/licensing viewpoint? I understand respite care, a service provided by foster families or agencies that provide care for a few days for children or adults with special needs, whose families are exhausted with caring for them. I also understand the concept of therapeutic foster care and of special training for resource parents who want to provide a supportive environment for children with physical, cognitive, or emotional disabilities. Organizations or individuals who provide either of these kinds of care are normally licensed by their states, and 
staff  have been subjected to criminal background checks and evaluation of their educational qualifications.

It’s also possible for states to license residential treatment facilities for children and adolescents with chronic emotional, behavioral, or mental health issues. These facilities care for larger numbers of children than would be possible in a foster home, they must have trained professional staff, and they provide educational services as appropriate for each child. They are required to establish treatment plans and goals, rather than simply to “warehouse” children and adolescents whose parents are having difficulty coping.

But therapeutic respite care? Google shows one use of the term to refer to actual brief respite for families with special needs children (www.nvfs.org). Otherwise,  I am not sure there is any such animal under discussion in the conventional world of child and adolescent mental health care. 

When I Google this term, here’s what I see: raisinamazin.com/therapeutic-respite-services, an Oregon outfit that claims to deal with “deep seeded” [sic] problems through the use of chores, journaling (or coloring for younger children), “affirmations and I-statement work”, while keeping the child in the caregiver’s line of sight at all times except when under the surveillance of a video monitor at night. Raisinamazin states that one of the trainers for their staff is Nancy Thomas, of dog-training and holding therapy fame, the lady who has stated that she can tell when parents are good to foster or adopted children because the children still have their heads and arms and legs on. Thomas also advises withholding quantities or varieties of food in response to undesired child behavior--  for example, providing only peanut butter sandwiches and milk rather than regular meals.

Google also shows a 2007 page by the Attachment Therapy/Holding Therapy advocate Deborah Hage, deborahhage.com/articles/respt2rescu.html. In her discussion of therapeutic respite and therapeutic motivational respite ( her term for  a treatment “set up when the child has regressed to such a level that a change of venue is needed in order to motivate him to ‘shift gears’ “), Hage  references practices like those mentioned by the raisinamazin organization and Nancy Thomas, including the use of journaling, chores, and exercise, which “gets oxygen to the brain and enables it to think more clearly”. In addition, the therapeutic respite provider must be eternally vigilant, and “her attention must be so excruciating for the child that he gets the message loud and clear that he never wants to return and be subject to such scrutiny again”. These methods are recommended for use with children whose behaviors Hage attributes to disorders of attachment.

 Google lists a series of providers of therapeutic respite care, including Nancy Thomas, at attachmenttraumanetwork.com/respite.html. This organization attributes unwanted behavior to Reactive Attachment Disorder, and presumably that is the diagnosis considered treatable through therapeutic respite care.

One more: Google shows home4healinghearts.com/about-us/the-support-we-offer/what-is-therapeutic-respite as an entity that offers therapeutic respite care. Such care is intended to make “your child… respectful, responsible, and fun to be around. Your child is expected to work hard to get a strong heart so that he or she can return to the family that loves them. Of course, the duration of the stay will be determined by the adults and specialists involved, but your child will be under the impression [! JM] that they’re earning their way home by exhibiting positive changes in behavior.” Once again, home4healinghearts cites Reactive Attachment Disorder as a major reason for this treatment, but (rather terrifyingly) proposes that children with PTSD and even autism should be subjected to the regimen. This apparently undated site does not describe its founder’s educational background.

I’m not wanting to jump to any conclusions, but it looks to me as if “therapeutic respite care” is a term used almost exclusively by advocates of Attachment Therapy/Holding Therapy and by proponents of the authoritarian practices of Nancy Thomas, Foster Cline, and others. I can see that small groups of this kind could be run under the radar of the law if the caregivers are licensed as foster parents--  or, in fact, if all payment is private, and no complaint is ever brought, whether they are licensed or not. But what about larger facilities, which I know exist? Are these not residential treatment facilities and required to be licensed as such in most states?

Perhaps readers can fill me in on this issue. How often is the term “therapeutic respite care” used in a legitimate way rather than as a description of a small, unmonitored, facility for a very concerning form of treatment? Is there any reader who has experienced such treatment either as a child or as a parent who placed a child?





20 comments:

  1. Have you seen the case out of Arkansas?

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    1. Yes, thanks, I just saw it. These things seem to be coming thick and fast right now-- I hope this means that "authorities" will realize that there are problems that need solving. I'll try to write about this in the near future.

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    2. The family is claiming that the children had RAD but all other indications indicate AD.

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    3. What do you mean when you say AD?

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    4. Attachment disorder. I can send you all the links on the story if that would help. One of them states that one of the girls was punished by having all her things removed from her room and that she had to earn them back. The family is also claiming that a pediatrician and a psychiatrist recommended the informal rehoming. Yet the former foster parents of these two girls recently came out saying that these children did NOT have RAD.

      http://www.arktimes.com/ArkansasBlog/archives/2015/03/07/foster-family-disputes-key-staments-from-justin-harris

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    5. Dear lucreziab, I was afraid you meant "attachment disorder" but I wanted to give you the benefit of the doubt by asking you what you meant.

      I agree that the Harrises seem to have been treating the girls in ways that would be advised by "attachment therapists" who focus on what they call "attachment disorder". But the treatment the girls were given does not mean that they had "attachment disorder" (which I'm not going to reify by calling it by an abbreviation) or even that there is any such thing as "attachment disorder". (If I gave you aspirin, that would not be evidence that you had a headache.)

      The children may well have had behavioral and mood problems that needed treatment-- I have no idea. However, the idea of "attachment disorder" as a mental health problem derived from separation from the birth mother or neglect and abuse, and culminating in rage and serious violent actions, was invented by proponents of Holding Therapy like Foster Cline, Deborah Gray, and Elizabeth Randolph. Randolph created a checklist for diagnosing "attachment disorder" (she said specifically it was not for RAD). She claimed to be able to do this because she herself could diagnose "attachment disorder" when children could not crawl backward on command. (I leave you to think that one over.)

      Proponents of "attachment disorder",like Nancy Thomas, have developed a whole set of parenting actions,like making children "earn" everything, and it does sound as if the Harrises were using these. However, there is no evidence that such parenting practices do anything to correct unwanted behaviors and moods or to "cure" and mental health problem.

      My speculation in this case is that the Harrises were told by therapists and adoption caseworkers that the girls would very likely display a set of serious behavioral problems. This may even have been done in such a way that the girls knew what people expected them to act like. As a result, the parents, and possibly the children, interpreted ordinary child behaviors as "symptoms of attachment disorder" and began to apply the recommended parenting methods, all of which are likely to increase the amount of distress and confrontation between parents and children, and eventually to lead to parents' decision to disrupt the adoption, to "re-home", or to place the children in residential treatment.

      I appreciate your starting the discussion of this egregious case-- but I can't consider "attachment disorder" as an actual part of the problem.

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    6. you have clearly never parented a child with Reactive Attachment Disorder, which is akin to Dr. Bessel Van Der Kolks term, developmental trauma. You probably think he is out to lunch as well?

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    7. I don't think the term "out to lunch" would have occurred to me, but now that you mention it, that seems like a pretty good description of him.

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  2. I've read all the articles on how attachment disorder is quackery so I fully agree with you on that bit. We both know tho that attachment disorder is so offense classified as RAD by people who don't know better and it disturbs me that this aspect isn't being discussed.

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    1. I'm sorry,I'm really confused by what you're saying here, but it doesn't really matter as long as the quackery part is clear. I will be getting together material about the Harris case and writing a post that will connect it with "attachment disorder". Thanks for the link you sent!

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    2. I meant to say that the media and abusive parents use the terms reactive attachment disorder and attachment disorder as if they are totally interchangeable when we both know that is not the case. I apologize if my previous posts I mean comments came through a little weird I am using text to voice on my phone and have a sinus infection.

      I also don't remember if you have ever remembered me commenting before but we have our daughter that was in foster care for nearly 4 years and she does not have any attachment issues at all like everyone said she would but then again we both know it was psychobabble and didn't believe a word of it. if anything we have had a lot of people try to describe her behaviors as being attachment disorder when they are nothing more than normal five year old child issues

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    3. I often have to use the sinusitis defense myself!

      I have to confess I don't remember you, but I'm very glad to hear your statement. If you wanted to tell more specifically about the normal issues that can be misinterpreted, that would be important for people to see--

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  3. A lot of these unregulated homes hide under the banner of religion to do whatever they want to the children in their care. The Child Catchers really illustrates this as well as a series on Tampa teen reform homes and there was another series on Chicago reform homes

    Our daughter is 6 next month. When she first came to live with us last June she gave our cat a "whisker trim". He is a marmalade tabby with intact claws and he just sat there and let her cut off each one. Now I am assuming that he just SAT there but I know for a fact if she was hurting him he would have clawed her severely. She very proudly showed us when my husband got home from work. we had a long conversation with her about why whiskers are important to cats and why she should never do it again and it hasn't been an issue since.

    Then she was caught stealing candy from the bins intended for a school-wide gingerbread house building. Her logic was that we had purchased some of the candy and everybody was going to share the candy for the houses so why did it matter that she took a few pieces before the project? We discussed theft and didn't allow her to participate and picked her up early that day.

    When she misbehaves we will send her to her room to cool down. The amount of time is totally up to her and she will put herself down for a nap. Other times she throws her toys everywhere and in the past if we are in the tv room she would throw things towards us to gain negative attention. That last bit stopped when I informed her that any more toys or books that were thrown into the hallway would be donated to charity.

    Another thing she will do is that whenever she meets new people she will say outlandish things just to see how they react. She reminds me a lot of Louise from Bob's Burgers! LOL our daughter will find whatever buttons she can press and then push every single one just to see how you will react.

    Lastly, she has poor impulse control and very much has an attitude that says I'm going to do what I want when I want and I don't care what you think or what happens to me. at the same time she is still a very loving and caring child and she doesn't expect anything in return when she gives out that love and care.

    many would be thinking that maybe she does have an attachment disorder but the reality is that these are pretty common behaviors for children her age. Her need to test people and to be independent and in charge come completely from her genetic heritage. Both her biological mother and my husband can out stubborn cats. Her temperament is also closely related to theirs.

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    1. Thanks,this is a great addition to what I wrote today-- wish I knew how to move this comment to today's post.

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  4. I'm a mental health provider at a group home that offers therapeutic respite care in addition to our residential and basic respite services. You would not find us with an internet search because we get our referrals directly from the county and thus have no need to advertise.

    Our therapeutic respite stays are generally between 4 and 48 hours. (We do occasionally accept longer stays in family emergency cases but this is unusual.) Eligibility and duration of stay are determined by the county based on the child's and family's level of need.

    While the children are with us, we work on the goals in their existing treatment plan which has been developed cooperatively by their treatment team, including their regular mental health providers, case workers, and in-home service providers.

    The plans are individualized to each child, but their goals generally include things like learning to recognize and manage their mood changes, use coping skills to deescalate, avoid aggressive behavior, interact appropriately with peers and adults, and improve positive communication with their families. We also provide a lot of fun activities to give the kids and their families a break.

    We are very much NOT under the radar. As mentioned, we work closely with the county. We are supervised by our state's Office of Mental Health and receive Medicaid funds, so our facility and our books are regularly audited.

    We are not an attachment therapy program and we do not endorse holding "therapy" under any circumstances.

    Please do not read any defensiveness in this explanation. There are a LOT of awful programs out there that don't take good care of the kids and do more harm than good! Please read my tone as purely informational, since you asked about the different programs are out there. :-)

    My guess is a lot of the better programs have a direct pipeline to a referral source and thus don't advertise.

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    1. Thanks so much for your comments, and your description of a program that sounds excellent.

      I'm still puzzled by the fact that when I Google the term "therapeutic respite care", I see only material related to Attachment Therapy. I've looked at the laws of several states and have not seen licensure or certification using that term.

      Would your organization describe itself as a "therapeutic respite center", or would you simply say that therapeutic respite care is one of your services?

      You don't sound at all defensive, and I hope I am not being offensive. I'm both concerned and curious about places operating as residential treatment centers without being licensed as such, and describing themselves as therapeutic respite care organizations.

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  5. Oh, I think I was misunderstanding you, actually! We don't actually use the *term* "therapeutic respite" in our official documentation, we would use "waiver respite." Since most people wouldn't know what that means because the term isn't very descriptive, we generally explain that the respite is therapeutic, but our licensing would use the term "waiver."

    To answer your other questions, we are primarily a residential program at a community residence (group home) level of care. We just offer the respite as an additional service, mainly for weekends and holidays when many of our residents are on home time.

    Nothing you said was offensive, and I knew it wasn't directed toward programs like ours. I think that providers in legit programs *should* be very concerned about shady or unlicensed programs. I can't go into much detail without being identifying but these programs can negatively affect us and our residents too, so we're totally on the same side here!

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    1. Thanks so much for the clarification-- yes, I believe we are on the same side!

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  6. Ignorance often drives indignation. How many children with attachment disorders has the author of this piece helped? We have adopted 2 children with attachment disorders, and the ONLY thing that has worked for them has been attachment therapy. I will stick with the people who have helped hundreds of children overcome their issues, rather than the critics who do not know what they are talking about.

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    1. Some questions for you:

      1. Who diagnosed your children as having attachment disorders?
      2. What treatments other than attachment therapy did you employ?
      3. What changes in child behavior lead you to say that attachment therapy "worked"?
      4. What is your evidence that the people "have helped hundreds of children"?

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