In 2015, Cheryl and Matthew Robben were at a loss for how to help their 9-year-old son they’d adopted from state foster care. But a lack of resources, and his out-of-control behaviors, had them looking for answers from anywhere.
Giving up on caring for a child was never something they fathomed when they started the process to adopt Isaiah. Already parents to two teenagers — Logan and Sarah — they were seasoned parents who had more love to give. But when Isaiah started self-harming and lashing out at others, the couple knew they were in over their heads.
“We were somewhat prepared for behaviors, but not to the extent he had,” Robben said. “He’d attack people, attack animals, attack his siblings. His behaviors would last for three to four hours. We struggled a lot.”
Enter Marcia Ryan and Brook Linenfelser, both clinicians for Illinois-based Chaddock, a licensed and accredited residential treatment program for children who’ve experienced abuse, neglect and trauma during their early development. Chaddock has long specialized in residential treatment, but 10 years ago, the organization decided to make a change in the way it served children and families.
Chaddock administration felt they could better serve struggling children and their families by working with them in the home, before a residential placement became necessary. They created the In-Home Intensive Program, one of a handful of programs in the last few years to address a growing recognition that children are best served in their families and that residential treatment should be avoided if possible.
The effort to keep children out of institutional settings starts with a team of two like Ryan and Linenefelser. Ryan serves as the associate director of client services and is the parent coach when they’re working with families. Linenfelser is the associate director of clinical services and serves as the therapist on the in-home therapeutic team. Their work is what has helped Chaddock emerge as one of a few organizations in the country focused on a somewhat-invisible, high risk population: adoptive families in need of an intervention that can avoid the need for costly residential care or, worse, return to foster care.
With six teams on staff, Chaddock clinicians travel across the country, often times to rural areas where families have few resources available. These teams meet with families one-on-one to help them better understand the impacts of trauma and address the difficult behaviors they’re facing with their child or children.
To date, 75 percent of the families that Chaddock has worked with through the In-Home Intensive Program have been able to maintain their children in their home. The average age of the children served is 12, and 65 percent of them are girls. In the past 10 years, 100 individuals have been served by the program.
“We want to decrease the amount of kids going into residential,” Linenfelser said. “There’s too big of a gap between outpatient counseling and residential.”
Depending on how long families are served by Chaddock’s in-home therapeutic team, the program can cost between $5,000 and $9,000, which is rarely covered by insurance. But that’s drastically less than residential care, which can cost as much as $200,000 annually. The prohibitive expense of such interventions can force some families to surrender their children to foster care, further damaging a child who has already gone through the trauma of separation, abuse or neglect.
When she first shared her challenges with Isaiah, Robben found that other foster and adoptive parents couldn’t relate to the struggles her family was experiencing with Isaiah’s behaviors. They sought out therapists, doctors, psychologists — anyone who could help. After videotaping one of Isaiah’s explosive episodes to show one therapist, Robben was quickly told by the therapist that he could no longer help her and he had no idea who could.
Diagnoses of reactive attachment disorder, oppositional defiant disorder, and an alphabet soup of others began to stack up as the family continued to seek help. Eventually, they found a therapist who specialized in trauma and finally that therapist made a recommendation that would help to change the downward spiral trajectory of their lives.
That recommendation was Illinois-based Chaddock’s In-Home Intensive Program. Robben signed up for a five-day intensive version the organization offered, which Robben credits for ultimately saving her family.
“Oftentimes we get that first call and they’re exhausted,” said Ryan, associate director of Chaddock’s client services. “This is their last-ditch effort before they do residential.”
Chaddock offers two-, three- or four-day intensives, where Chaddock-licensed clinicians and the family spend time in the home with the children and family working very deliberately to address difficult behaviors caused by the child’s early experiences of trauma and the subsequent struggles that often leave the family at a breaking point.
“We know if a child didn’t get held and rocked when they were distressed [that] this is a catalyst for these issues,” Ryan said.
When Robben contacted Chaddock her marriage was strained, as was the relationship she had with her other children. She was physically exhausted from Isaiah’s constant meltdowns and struggling to keep him safe. She was mentally broken because of the lack of support from doctors and therapists, and on the verge of disrupting the adoption.
In desperation, Robben pleaded with the state to support Chaddock’s services. Ultimately, she was able to get the intensive covered by Iowa Medicaid when she shared a warning: “If you don’t help us in the home, we’re afraid we won’t be able to keep him in the home.”
Prior to coming to the Robbens’ home in Iowa, Ryan and Linenfelser talked with Cheryl and Matthew over the phone about Isaiah’s behaviors and the challenges they were facing. The Iowa couple was then tasked with reading articles and books to better help them understand attachment and trauma and how to address those issues with their children. And one of the most crucial pieces of preparation for the intensive included completing assessments of the challenges the family was facing which culminated in a larger assessment of the family’s situation once Ryan and Linenfelser were on site.
In 2015, the clinicians traveled to Iowa to spend those five days with the Robben family, working with them one-one-on for up to 12 hours a day.
“By the time we get there, we know the families very well and we hit the floor running,” Ryan said. “We help them put the pieces together — it’s a lot of psychoeducation.”
While the clinicians were there, they provided private therapy sessions for each of the family members and then collectively worked with the family on various issues they were facing. A lot of time was spent just watching the Robben family interact with each other. Completing the intensive during the summer while the kids were out of school and Cheryl and Matthew took time off from work, really allowed the clinicians to get a feel for the day-to-day interactions of the family.
In between these important therapy and family interaction sessions, Linenfelser and Ryan crafted activities that would naturally create bonding opportunities for them. They also facilitated a number of sensory activities for Isaiah that helped him work through some of his challenging feelings and behaviors.
“We try to identify the struggles in the routine,” Ryan said. “We find things that promote opportunities for bonding in the evening.”
For Linenfelser, this process is actually about giving families the tools to help them get through the tough behaviors and try to make them more manageable. The sensory activities help to regulate the brain with the goal of decreasing the frequency, duration and intensity of the challenging behaviors.
“We work on the attachment of the family system,” Linenfelser said. “We give the parents the tools to decrease the time and intensity of the behaviors. We use Theraplay activities to build and enhance the attachment of the children and families we work with.”
According to Robben, these activities helped provide family members with a better understanding of Isaiah’s triggers and offered them ways to avoid those and work through the problems more quickly.
“They made us understand the broken attachment and how we have to approach things differently,” Robben said. “It helped us put different strategies in place.”
Some of the things the family has implemented since the Chaddock intensive include making sure Isaiah has snacks regularly and trying to always say yes instead of no. So now when Isaiah asks to do something, the response he receives is something like, “Yes, you can do that but after you get your bed made.” The Robbens also give him just a little warning before going places because he was always trying to sabotage activities with his behaviors when he had advance notice.
The clinicians didn’t spend all their time in Iowa just at the family’s home. Chaddock also consults with the family’s regular therapist, educating the child’s school officials about trauma or visiting with other important people in the family’s life who can benefit from learning about trauma. For the Robbens family, that meant creating an assessment report that they easily share with Isaiah’s teachers and school officials so they can have a better understanding of his needs.
“You can’t begin to do this work if you don’t have a solid understanding of how early impacts affect these families,” Ryan said. “There’s a limited number of people with a deep understanding of trauma impacts in children. Sometimes we work with the therapist to give them a crash course.”
Besides the early childhood trauma, the children often have multiple mental health diagnoses including ADHD, FASD, oppositional defiant disorder, and even, in severe cases, reactive attachment disorder. These mental health diagnoses make it challenging to determine if the behaviors are caused by the mental health issues or the developmental trauma the child experienced at a young age.
Wading through the cause of the behaviors and how to address them can be a challenge, but Ryan said, “We’re really good at being able to help sort through that.”
At the end of the intensive, the Robbens received a summary of their work with the clinicians to help remind them of the things they learned and the next steps they needed to take to continue helping Isaiah.
And even after the intensive is complete, the connection between the clinicians and families continues through weekly phone calls and frequent emails.
Three years after their intensive, the Robbens still touch base with Chaddock periodically. For about the first six months, it was pretty regular contact, but now that only happens when something more serious comes up, such as a recent issue with the school.
As a result, the Chaddock therapists were able to reiterate to Isaiah’s teachers and school officials some of the challenges he faces because of his developmental trauma and offered them ways to work through some of the behaviors he has.
Most of the time, the in-home intensive is just what the family needs to set them on a healthier path toward healing. In rare cases, the children do still need more intensive help provided at a residential treatment center. Chaddock has a 48-bed residential facility where children stay for 12 to 24 months. Over time, they’ve also developed a more hybrid model of residential care, where there is more in-home work before and after residential that reduces the amount of time children are out of the home.
“It’s very exhausting work, but it’s very rewarding,” Linenfelser said. “The success you see in a week is about the same as six months of residential.”
The Robbens’ intensive with Chaddock was three years ago. Isaiah’s now a much happier, healthier 12-year-old. The intensive didn’t fix everything, but it gave the Robben family the tools to help Isaiah address his behaviors.
“For us, as a whole family, it was important because his behaviors were tearing us apart at the time,” Robben said. “We were looking for help and we seemed isolated and alone, and nobody understood what we were going through.”
Isaiah still attends therapy regularly but they’ve been able to cut down on the frequency. In addition, the number of medications he takes have been greatly reduced.
“His behaviors didn’t go away,” Robben said. “We’re three years out and we’re still dealing with them, but they’re different. Chaddock helped put all that into play.”
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