Tuesday, September 8, 2009

Another Piece Disappears

Last week, in our regular e-newsletter, we published a short essay about the closing of OdysseyNH, a residential substance-abuse treatment center for adolescents in Hampton, NH. Here's what we said:

It was with sadness and and a sense of foreboding that we noted, here in New Hampshire, the death of OdysseyNH, an agency providing residential care to troubled adolescents. Odyssey House (later renamed OdysseyNH) opened its doors in 1970, and I first got to know it when I went to work as a local newspaper reporter here in the early '80s. Yet I'd never been inside til last October, when I was preparing a study on the condition of the children's mental health workforce in New Hampshire. It looked a lot like every agency. Maybe a little busier, more chaotic and noisy, but then, the agency's recovery school -- the only one in the state -- had just let out for the day, and vans were crowding the driveway. Some of the kids were headed off to a game somewhere, and shifts were changing. There was lots of laughing and high-fiving.

Things weren't particularly good at the agency -- I knew that -- but then, they weren't good anywhere. Censuses were down at residential programs throughout the state. I sat down with a program director and he told me the agency hadn't anticipated how rapidly funding for residential treatment would deteriorate. Odyssey was expert in treating youth with substance abuse and delinquency issues, and that's all they wanted to do; changing direction in some big and fundamental way clearly seemed almost impossible to them. I asked where the youth were going who used to be referred to Odyssey. The director shrugged and said he had no idea. This seemed incredible to me. He had to know, I thought. Surely, I suggested to him, a clear policy had been articulated at the state level on this transition away from residential treatment; a plan had been laid out and goals had been established. That way, agencies like Odyssey -- the ones who knew the most about troubled youth and what they needed -- would know what to expect and how to adjust. But my question must have struck him as naive, because he just looked at me and smiled.

I came back a couple of weeks later to interview nine front-line staffers. A veteran worker complained about low pay and high turnover, and said he was pushing for change. Younger workers told me they loved the kids but had to work second jobs to make ends meet. Lots of them were going back for advanced degrees; they liked the work, but the pay was killing them. Wht they really needed was a higher-level job, they figured. One staffer who had just finished her master's degree asked if there was anywhere in the state she could work where her student loans would be forgiven; anywhere at all, because she'd be willing to move there. I promised her I'd try to find out.

But despite the obvious stress they were under, the workers at Odyssey were pretty much like the workers at every other agency I spoke to: clear-eyed yet hopeful about their clients, and full of that spirit of jokey camaraderie so common among youthworkers. I liked them, and respected for them doing such a tough job. As we know, the marginalization of residential treatment is a big, complicated story -- one ultimately about economics and philosophy. Outcomes for youth will be similarly complicated. Right now, though, I'm pausing for this one, simple story. Goodbye, Odyssey.

A number of people responded to this article, thanking us for calling attention to the stresses that the field - and particularly residential services - are under. But we have two follow-up questions for our readers:1. In your community, where are the youth who are no longer being referred to your programs actually going? Are they simly being stepped down to a less intensive of care, and if so, what's happening to them there? 2. Given the current climate in the field, where are you seeing INCREASED demand for front-line staff, and where are you seeing DECREASED demand?


  1. In Vermont, we see the youth going to foster homes who struggle with meeting their needs fully or they return to their home communities not receiving the treatment they need. In some cases, they are also in psychiatric hospital placements for longer length of stays because there are not great step down options.

  2. Carole Shomo, Youth Continuum, New Haven, Conn.September 8, 2009 at 8:34 AM

    1. Youth no longer being referred -
    Two categories: Foster youth referred by Dept of Children and Families and DHHS homeless youth
    DCF youth: Approximately 90% of our beds are filled - 10% vacancy has been due to timing of referral process. It is the residential treatment centers that have seen a drastic decrease in their referral rates.
    Homeless youth: We have experienced a 50% increase in requests for assistance from these youth. Many of the referrals are from pregnant and parenting youth. For all homeless youth there is no pattern as to their living arrangements - with friends, relatives, shelters, etc.

    2. We continue to need qualified and experienced direct care staff. We only hire bachelor level or equivalent employees. We prefer a minimum of one year experience. We have recently seen an increase in older experienced applicants who have either retired or have been laid off (from residential treatment centers). Overall, our struggle is the "aptitude" of these employees to provide the quality of care that we expect. Many younger employees (even with bachelor level and experience) do not have the life experience that allows one to interact with adolescents in general, let alone those with a trauma history. You can teach theory, and technique but judgment, self knowledge and "passion" for the work is gathered from maturity.

    Of course, in Connecticut , residential direct care is declining. Employees will need to develop the skills to care for the same acute and troubled youth in lower levels of care - thanks to the ever "efficient" managed care system. Their are many compounding factors and environments that will need to be "tailored" in order to be successful with these youth - school systems, health care, community services and integration into neighborhoods, to name a few. Youth care workers and managers will need to be equipped to navigate all of these on a daily basis.

  3. I work with Catherine in Vt and previously worked at Domus in CT, so it is funny to see the comments from these two very accomplished leaders above.

    I agree with Catherine, that VT places youth into foster homes despite the lack of ability/training for such foster parents to adequately care for such high-needs youth. VT also has the lowest acceptance rate of abuse and neglect calls in the country, with 7 out of 10 callers told in effect, "Sorry but that does not meet our criteria to investigate." So I think we are losing a lot of youth who need help.

    And Carol's comment about the # of homeless youth going up. I told someone recently, "The number of youth in custody may be going down, but the number of homeless teens is booming." We have a perpetual waiting list in our shelter and transitional living residence, this has been the case for over a year now and unprecedented.

    Mark Redmond
    Spectrum Youth and Family Services