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INNOVATIVE CARE CALMS BEHAVIOR
Leo, 7, does schoolwork at Behave 'N Day Center under the eye of Jane Peterson, who started the program. Children attend the center for three months on average. Some are under a psychologist's or psychiatrist's care, and several have a diagnosed mental illness. Leo is taken to a time-out room at Behave 'N Day Center as part of a program to help him deal with his aggressive behavior. The center uses a combination of nearly constant praise, rewards and time-outs. After his time at the center, Leo was able to make a smooth return to his second-grade classroom. By the time Leo was 3 1/2, three day cares had kicked him out. By the time Leo was 3 1/2, three day cares had kicked him out. He hit one teacher hard enough to send her glasses flying and cut her nose. Over the next three years, his aggressive behavior continued. His kindergarten teacher called his mother at work every day. Leo attacked his teacher on one occasion, a student on another. "He would destroy the classroom," said his mother, Kristen Massman. Now 7 years old, Leo has learned to recognize when he is getting upset. He can calm himself instead of going into a rage. Perhaps more importantly, he's made friends. "He never had friends before," his mother said, "because everybody was so afraid of him." Leo's story shows what a difference it can make when several things go right: an alert parent, an early diagnosis, access to appropriate community-based treatment and strong communication among parents, care providers and educators. Kristen first noticed something was wrong when Leo was 2. "I didn't know a kid who could be so angry, aggressive, then loud and happy - all at once," the Ralston mom said. Her pediatrician and other doctors gave her parenting advice. But she knew her only child needed more than strict discipline. Through Internet research, she decided he had symptoms of bipolar disorder, a biologically based mental illness. He would rage for hours, then be deliriously happy. In September 2000, a psychologist confirmed that Leo was bipolar and prescribed mood-stabilizing drugs. But by last January, at age 6, he was so despondent he tried to run in front of a passing car. His mother grabbed him just in time. He continued to struggle, even after a hospitalization. He was placed in Ralston's alternative school but was soon asked to leave because of his behavior. Late last spring, Leo's psychiatrist prescribed lithium, a powerful mood stabilizer. And a respite center told Kristen about a new treatment option. Behave 'N Day Center is the innovation of Jane Peterson, a licensed mental-health practitioner. She works with up to a dozen 2- to 7-year-olds at a time. The children, who have a range of behavior disorders, attend the center for three months on average. There is one caregiver for every three children. Medicaid or school districts pay the $55 daily fee for children they refer. Other parents pay on their own or receive federal Title 20 assistance. After Leo's first day there in late May, Kristen was convinced he would not be welcomed back. "The first day I picked Leo up, he was in the time-out room," she said. "He was back there just cussing and screaming and throwing a fit." But behavior like Leo's is common among the center's children, Peterson said. Many have been expelled from day cares. Some are under a psychologist's or psychiatrist's care, and several have a diagnosed mental illness. "It is nothing for them to pick up a chair and throw it across the room," Peterson said. After a week, a once-wailing, violent child is usually calmer, more attentive and compliant. Leo, one of the older children, took a little longer. "It was several weeks," his mom said, "but Janie really has gotten a hold on his behavior. " The center uses a combination of nearly constant praise, rewards and time-outs. Any mishap - talking out of turn, not asking permission, not following directions - brings an immediate reprimand. "They really need loving but firm structure," said Dr. David Walker, Leo's psychiatrist. "These are not kids that you can expect to structure their own world. You really have to stay on top of things. " Instruction might begin the first time a child takes a toy without asking. After a gentle reminder to ask nicely, the child usually will ask first the next time. "The child is lavished with praise," she said, "and they are grinning from ear to ear." Typically, they begin to understand within days what behavior will produce praise and rewards. Peterson stressed that these children aren't simply the product of bad parenting. "These kids come in with huge rates of aggression and are not your typical child, so typical parenting - even if it is very sound- is not going to solve that," she said. "Normal kids can figure out that if you do something bad at school, the parent gives a consequence at home. They've figured out that they shouldn't do that the next day," she said. "These kids cannot make that connection. These are kids that are wired differently," she said. "They need the booster shot of what they are learning during the day and at home at night to get back on the straight and narrow." Walker is impressed with Leo's progress. "To be honest, I didn't expect a response that quickly," he said. The center provided "excellent feedback" in the form of meticulous notes, he said. "That is the kind of stuff I need to make a clear diagnosis." He also credits Leo's mother. "She was willing to open her eyes and deal with the fact that she is dealing with a child who has emotional needs that need to be addressed," Walker said. "It can be scary for parents, and they have this idea that a psychiatrist will blame the parents." Peterson said her program, rare in this area, needs follow-up care for long-term success. She is opening a second center this month, with the help of a $5,000 state grant. It will offer a program to ease a child's transition back to school or day care. Leo returned to his second-grade classroom in mid-October. Ideally, Peterson said, a therapist would have accompanied him. Instead, several school staff members visited the center to learn Peterson's methods. "His transition back into school went awesome," Kristen said. "I was worried he was going to get there and just fall apart. The minute he began to slip, they reacted quickly. I'm not worried at all now." |
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