Monday, July 13, 2009

Visiting Boystown: A Glimpse of a System of Care

Everyone remembers Spencer Tracy and his role as Father Flanagan in Boys Town, the 1938 Oscar-winning film about a crusading priest who worked with street youth in the early 20th century.  It turns out that the place is still there, outside of Omaha, NE, and that it has morphed into treatment facility for troubled youth of both genders, with a  strong emphasis on the need to create family atmosphere, teach social skills and provide a continuum of care ranging from a therapeutic school to an intensive inpatient unit that can work with children with violent self-destructive outbursts.  Tom Tonniges, the former chief of Community Pediatrics at the AAP, is now in charge of their "Institute for Child Health Improvement", which has a Health Tomorrows grant to develop a transitional program for youth aging out of their system, to insure that they are prepared to manage their own health issues when they leave the place.  Important idea, and it also let me see how a true "continuum of care" could work, and what the challenges are for such a thing in the modern environment.

Boys Town has changed a bit since the founding days when it was a place for street kids from Omaha-  for one thing, it has had girls since 1975.  The focus has changed, from a youth-leadership development model to a Family Home Model, in which the unit is a household of 8 kids (single gender) and a set of house parents (usually a married couple, it seems), living is a large brick house on the campus.  But, in addition to that, Boys Town now provides In-Home Services within Nebraska, an Intensive Residential Treatment milieu on the campus (4 kids with more staff to monitor and manage troubled behaviors) and the ICTU at the University of Nebraska Medical Center, a locked unit.  Oh, and a lot of traditional outpatient therapy.  A kid could theoretically go up and down this continuum of care as ones mental illness required it, getting consistent behavior management throughout, and minimizing that sense of shock and transititon that so complicates things for a lot of SED kids.

In talking to one of  the therapists, however, I learned that this model seldom works;  their managed care "carve-out" provider sees the different levels of care as interchangeable parts, and that, despite having a system that would allow communication and relationship building between agencies as well as with children and families, kids are moved between agencies in such a way as to make it really hard to maintain continuity.  It seems that it is never easy to make systems do what they should.

The transition program is, of course, magnificent;  they hope to hae a manuel of transition training that we can all use soon.  And steak in Omaha just tastes better.   I recommend 36 hours in Omaha, if you ever have the chance.

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