In more than one way. The possibilities are endless.

In the interest of content, and because this is what I got, I present what I’ve been spending most of my time on the last few days. Testimony I’ll be giving before the Child, Family, Health and Human Services Interim committee this coming Monday. I left out the citations because the formatting was a nightmare. (It’s not short.)

Good morning Madame Chairwoman and members of the committee. My name is Dave Chenault and I am a graduate Social Work student at the University of Montana. I am member of the class which has had the pleasure of working with Chief Adee on a survey of out of state facilities, and have been doing further work on SB 399 as part of another class. Throughout my research I have been fortunate enough to come into contact with many representative of entities both public and private in the state of Montana. I have learned much in the process, and am grateful to all of them.
I also have a substantial professional interest in the residential treatment of adolescents. Working in that field has formed almost the entirety of my professional life. I’ve spent over six years working ten of thousands of hours at five different facilities in four states, in roles ranging from direct service staff to high school social studies teacher. Two of these facilities, at which I spent over three years combined, are currently is use by the state of Montana. Not only do I have some authority to draw on in the matter of residential treatment for America’s youth, I have a deeply personal interest.
Much of the discussion of the issues surrounding SB 399 concern numbers. The number of youth sent out of state in Montana. The number of facilities with whom we as a state contract. The number of dollars spent per bed, per day, per child, annually. The amount of money that might be saved by moving to a wraparound philosophy of care, as SB 399 mandates.
Inevitably I am compelled to think about all of these questions in a different way, because I have seen the faces behind these numbers. I have worked with, day after day, the youth who are sent out of state. I have taught the becoming women and men who often spend substantial portions of the most formative period of their lives sequestered in a separate world. I have spent Christmas day with a young man from Iowa who spent over a year in a residential treatment center struggling to find the strength of self that would allow him to go back to his small hometown and say no to the friends with whom he used to smoke meth. This young mans impoverished parents drove 90 minutes each way every Saturday to visit him. In Arizona I spent Thanksgiving Day with a young woman from Flint, Michigan who, after a year in our care, was returned against her will to her drug-addicted mother because the system provided neither the resources nor the choice for her to do otherwise. Also in Arizona, I spent Easter with a young lady from Missoula, Montana. A young lady with tremendous academic gifts who collected staples and shards of glass, hid them in her socks, and cut quarter-inch deep lines into her thighs and arms for reasons that she could not articulate, and barely seemed able to understand at all.
I say this to you today, madame chairwoman and members of the committee, to highlight what everyone in this room already understands. That the trials of childhood and adolescence provide unique challenges and opportunities, that travailles which would be difficult but recoverable in adulthood can in childhood leave irrevocable, life-long scars, and that therefore the stakes with which SB 399 deals could hardly be higher.1
The youth Montana sends out of state can, irrespective of their diagnoses or behaviors, be divided into two categories. The first can be seen in the young man from the small town in Iowa; those youth who are deeply troubled and have created great difficulties for themselves, their loved ones, and their communities, but who possess communities, and who possess loved ones on whom they can ultimately rely. The professional and academic literature, be it in social work, psychology, or criminology, tells us that recruiting these pre-existing supports in the community-of-origin provides the best hope of giving that youth an independent life.2 Because even the best residential facilities are in their greatest moments a pale shadow of the family experience, an experience which is so crucial for children and adolescents. Research tells us that the longer youth are deprived of a family upbringing, the more serious their problems in the world are likely to become. For these youth residential treatment should be the absolute last resort, and used for as brief a time as possible.3
The second category of youth who end up in residential treatment are epitomized by the young lady from Michigan; it is the category of those youth whose family and community ties are so frayed, poisoned, distant, and thin that they are frighteningly alone in the world. For them too residential placement should be as brief as is practical, but rather than a springboard home, residential placement should be a springboard towards their future as adults. Their opinions and hopes should be consulted at every turn, and programs such as group homes, independent living, and JobCorps should serve as a springboard towards an independent life of their own choosing.
The history of mental health care in the United State supports this.4 The deinstitutionalization of the mentally ill, beginning in the 1970’s, has revealed that conditions as grave as schizophrenia are treatable and recoverable.5 In this we recognize two things: that people are experts in their own lives and are therefore most likely to do well when given the benefit of the doubt and of freedom, and that those youth who make it difficult for their families and communities to support them are not categorically different than anyone else.
This last point is especially important when discussing children and adolescents. By moving away from residential placements and towards a wraparound philosophy of care we are as a state not hoping for the youth in question to no longer experience substantial difficulties. Doing so would be as reasonable as asking for my wife and me to never again disagree about who’s turn it is to do the dishes. We are instead recognizing that all humans, and especially all teenagers, have moments where they are difficult people. Wraparound requires a reallocation of resources that recognizes this, and admits that providing vulnerable individuals and families proactive support, in their communities and on their terms, will get the best results. Research suggests that this is the case, both for the agency and for the community.6
In closing, I must return to the young lady from Missoula with whom I worked in Arizona, because it is she and those like her who will be most challenging to bring home to Montana. There will always be those youth who are all too often unmanageable in their homes and communities, at school, and at the facilities wraparound seems to favor over long-distance and long term residential placement. It is likely that the imperfect world will always call for a level of supervision and an intensity of care that can only be found in certain, institutional, settings. I do know that the young lady in question had been kicked out of a Missoula-area facility because of the severity of her behavior; even if I could recall the facility it would be improper for me to name it.
My suggestion then is to bring all levels of care as close to home as possible. Youth like the young lady I mention are extraordinarily difficult to deal with. They are the least-favored residents of any facility. They are typically the ones responsible for a disproportionate amount of staff time, injury to staff, staff burnout and turnover, and sleep lost to the cause of finding a way to mange and thereby help them. All too often these students are transfered from facility to facility in an effort to mitigate their impact on each facility and staff team, and to hide the fact that few are whiling to take seriously the question of caring for such youth because of the difficulty involved.
In fiscal year 2009, as Chief Adee informed this committee two months ago, Montana sent 127 youth to facilities out of state. While they no doubt exist, it is my professional opinion that of the 127 very few constitute cases as difficult as the one I have lately discussed. My hope for these 127 youth and those who will comes after them is that SB 399 and the work which follows it will lead to most of Montana youth staying close to home; to them being served primarily by the many excellent agencies with which our state is already blessed. It is also my hope that in the very near future Montana will send those of it’s youth who need such care to residential placements which are exclusively in state. This will allow the end hope, integration back into the community and placement on the road towards a normal life in society, within much more direct contact. The young lady from Missoula had a mother in Montana, one who was deeply troubled as a parent and as a person, but who cared very much. Plane tickets, bus rides, and gas to Arizona are expensive. It seems needless that such banal obstacles should become the most significant one places between a mother and her daughter.
Thank you.