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Calming the Explosive Child

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Collaborative problem solving

Now other groups are attempting to confirm those findings. The department of psychology at Virginia Tech in Blacksburg is comparing CPS with traditional parent training in a study of 150 kids with ODD and will also consider whether CPS leads to improvement in specific skills the children may lack. But Ablon and Greene think the most important work on CPS is being done in the real world, at large institutions treating the country’s most troubled children.

The Italian Home for Children in Jamaica Plain, Mass., provides shelter and counseling to children who have been taken from their families because of abuse or neglect. The children are often explosive, and for years they were treated with the rewards and punishments typical of parent training. But when Simona Arcidiaco took over as chief operating officer a few years ago, she began to question whether the system was working. “Unfortunately, a lot of kids were coming back to us,” says Arcidiaco. “Even when behavioral interventions worked here, they didn’t last when the child was discharged into a new environment.”

Arcidiaco had already begun to move away from the standard system of rewards and consequences when she heard about CPS, which was being used successfully at another Boston-area institution, Cambridge Hospital. She went to a CPS workshop given by Greene and began implementing the model in the summer of 2006. Though it’s early yet, Arcidiaco has seen encouraging signs, including the case of a young girl with selective mutism who improved significantly. “When we admitted her, we didn’t demand that she talk,” says Arcidiaco. “That took away some anxiety, and gradually she began doing things such as raising her hand to go to the bathroom, which she had been afraid to do before. Our approach was to acknowledge what she could and couldn’t do at this time and to adjust our interventions accordingly.” Eventually, the girl began speaking to her roommate and one staff member.

Other institutions that have longer track records with CPS have also seen progress. At Cambridge Hospital’s locked, 13-bed inpatient child psychiatry unit, 95% of the kids are admitted for out-of-control behavior and 80% have a history of trauma. In the past, a patient could erupt at any time, punching a nurse or attacking a counselor, and children were being forcibly restrained, often compelled to take psychotropic medication or strapped to a bed. In the nine months before the team at Cambridge Hospital began implementing CPS, there were 281 episodes of restraint and an average of almost 11 staff and patient injuries each month. During the 15 months since implementing CPS, there has been just one episode of restraint and monthly injuries have dropped to 3.3.

The Maine Department of Corrections’ Long Creek Youth Development Center, in South Portland, for 14- to 21-year-olds, many of whom have committed multiple offenses, has also made gains. In 2000 the state began making widespread changes to the juvenile detention system. They started working with Greene and later implemented the CPS model. Long Creek, which in 2000 had more than 100 incidents in which kids had to be restrained, saw that number fall to 38 by 2006, according to Rod Bouffard, superintendent of the center. And as recently as 2005, there were 87 times when a child was put in “observation,” a room for calming down. In 2006 there were only 28 such incidents, and the rate of recidivism in the state’s youth correctional system has fallen to 15%, one of the lowest rates in the country.

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The Plan in Action

Here, an example of a cornerstone in collaborative problem-solving: a parent-child conversation about a problem that regularly causes explosions.

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hed-dossier

1. Treating Explosive Kids, by Ross W. Greene and J. Stuart Ablon (The Guilford Press, 2006). An explanation of the research behind CPS and how psychologists, teachers, social workers and counselors can apply the method in their practices, schools and institutions.

2. “Book Review: Treating Explosive Kids,” by Nicholas Carson, Journal of the American Academy of Child Adolescent Psychiatry, September 2006. Carson takes a critical look at the CPS approach, detailing its psychological roots and assessing whether it is truly the paradigm shift that Greene and Ablon claim. 

3. Opening Our Arms: Helping Troubled Kids, by Kathy Regan (Bull Publishing Company, 2006). Through a series of personal narratives, nurse manager Kathy Regan describes how she applied CPS (among other methods) with surprising results in an inpatient child psychiatry unit at Cambridge Hospital in Massachusetts.

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