Clinical Guidelines
FamilyLightsm: Successor to Bridge to Understanding
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Our concern about clinical issues is that programs and services make sure they have the competence to treat the issues that arise with the clients they admit.  That seems quite simple and basic, but it is remarkable how many schools and treatment programs are not careful about it. If they have that competence, they should be able to demonstrate that their procedures are consistent with evidence based practices and best practices.  This is not intended to prevent innovation in areas where research has not yet determined what is most effective but it is intended to avoid doing what is known to be inferior.  

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FamilyLightsm is an educational consulting firm specializing in work with families with a young person with behavioral, emotional or psychological difficulties.  We offer in-depth personal guidance to families on a fee basis and free guidance on the internet. FamilyLightsm attempts to be fully objective and accepts no advertising nor referral fees. The only revenue at FamilyLightsm comes from client fees. 

We exempt from these clinical guidelines any school or program that admits and retains only students /clients who have been approved for admission by a licensed clinician who takes responsibility on his / her clinical license for the enrollment of the student/client in a program of change that does not include clinical support. We also exempt conventional (non therapeutic) schools that do on occasion admit students with clinical needs, facilitate access of that student to appropriate clinical support, but make no claim, suggestion, or hint that that the school itself is about change, behavioral correction, or emotional growth apart from the normal growth issues associated with quality education.  However, we do not exempt those schools and programs from the "Treatment or Service Plan guidelines" linked to this page.

We don't have any preference for any particular clinical emphasis, and we don't need to see intense clinical services in programs that serve young people with behavioral problems for whom psychological issues are not significant. They might fit easily into an emotional growth program. The problem is that there aren't many kids with serious behavior problems who have been confirmed to have no significant psychological problems.  

We do want to be sure that every school or program that describes itself as a therapeutic school, residential treatment center, or residential treatment facility (the operative issue being the inclusion of the words "therapeutic" "clinical," or "treatment" or a combination in its name or in a description), we expect that facility to behave as a clinical facility regardless of licensing requirements in that jurisdiction.   That includes that the facility is licensed as a clinical, therapeutic, or treatment facility (unless the jurisdiction has no such license category).

We want to be sure that all aspects of care is subject to the judgment of a person who is licensed as a clinician.  If the program is not in the United States, we want to know that the license is issued in a jurisdiction with effective licensing requirements an addition to the jurisdiction where the program is located. That includes New Zealand and Costa Rica, along with Canada and most western European countries. 

We want to know that there is adequate clinical strength, in schools and programs that make a therapeutic claim. We acknowledge that many people can contribute to healing beyond their credentials, and that not all credentialed people are truly effective.  Specific situations may warrant special consideration.  But normally in a any therapeutic environment making a therapeutic claim,  we see a need for at least one qualified clinician per dozen students /clients, and one to six in a highly intensive environment.  Usually we like to see a doctoral level therapist (not counting any psychiatrists) heading the clinical team.  An especially skilled MSW might be a worthy substitute for Ph. D. psychologist and an especially well trained and experienced team of paraprofessionals might warrant a lower ratio of licensed folk.

We want to know that there is an individual plan for each student's /client's care, therapy and education that individually specifies how the school or program will meet that student's /client's needs.  Procedures in that facility that are not described in each individual plan are described in written protocols that have been authorized by a licensed clinician.

We want to know that care is integrated.  By integrated, we mean that all staff act in support of therapeutic goals at all times and that either a licensed clinician directs the care or a team directs it subject to the confirmation of one or more licensed clinicians on the team.

We also want to know that for each client there is a specific diagnostic formulation and a service plan appropriate to the diagnostic formulation, that includes educational needs.  Then there needs to be a specific approach to provide services according to that plan. 

We need to know that the plan that guides care, regardless of what they plan is called, it is properly written.  It includes goals and/or objectives that meet the definitions of goals or objectives. Goals and objectives are specific as to a point of completion and are not just processes.  For example, "Improve performance on tests," is a process and not a goal or objective. Achieve an average of 95% on all tests over the next three month is a true goal.  (There are no problems with a goal that is by itself somewhat ambiguous as to point of completion, but has associated objectives that break the goal into pieces and are themselves clear as to their points of completion.  

This implies that the program is capable of evaluating and diagnosing disorders or has access to outside facilities for that purpose or it accepts only students with prior in depth diagnostic evaluation.  If the latter is chosen, there must be resources to observe changes in appropriate diagnosis while in school or treatment.

Far too many schools and programs speak loosely about various diagnostic categories. They speak of accepting and working with clients with various diagnoses that require specialized handling.  Most frequently that problem arises with these diagnostic categories:

  • Attachment Issues or Attachment disorder. Incidentally, due to the fact that attachment difficulties are more likely to occur with adopted children than with natural children, people representing programs often speak of adoption issues and attachment issues as if they are the same thing. They are not. Programs that create this confusion probably should not be dealing with either adoption or attachment. Attachment issues are consequence of trauma, not of adoption. There are therapeutic issues that are common among adopted children and frequently occur only as a consequence of adoption.  Attachment difficulties arise from abuse, neglect, and other forms of trauma. 
  • Substance abuse/addiction/12 step work -- see specific guidelines for this category.
  • Sexual issues (sexually reactive or sexually predatory)
  • Eating disorders.

Each of these requires special expertise and methods that might not apply to a general population. Programs should demonstrate specific expertise in each of these areas or not accept clients with these issues and transfer to another facility when these issues emerge.

Our checklist of guidelines is as follows:

  • Each school or program has the capability of resolving any diagnostics not completely resolved prior to admission.

  • Each school or program operates with the competence to serve the needs of all issues and disorders of clients admitted.  This implies that the school or program will deny admission to any person for whom they lack complete competence and will discharge or transfer out a client for whom a diagnosis emerges for which they lack full competence.

  • Each school or program  implements a planning process according to the guidelines for "Treatment or Service Plan" linked to this page.

  • In citing competence in an area each the school or program is citing adherence to  best evidence based practices or innovation anticipated to be an improvement over best evidence based practice when research becomes available. 

  • The school or program demonstrates delivery of best evidence based practice with the following issues or excludes clients with those issues:

    • Eating Disorders

    • Reactive Attachment Disorder or Attachment Issues

    • Sexually Predatory

    • Sexually Reactive

  • The school or program fully complies with FamilyLightsm Guidelines for Substance Abuse Intervention.

Link to Guidelines on Treatment and Service Plans

Feedback is invited. We will publish selected feedback.  Email:  FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last updated 2/28/2009

 
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