Case Study: Helping Kids In Trouble

The cheerful space in Rhode Island's Bradley Hospital could easily be mistaken for a classroom. Red sweatshirts and SpongeBob backpacks fill a row of cubbies marked with construction-paper name tags. A giant schedule of the day's activities, including "lunch" and "story time," hangs on a center wall, lined with yellow smiley-face cutouts to mark good behavior. But the 14 youngsters who arrive each morning for Bradley's "Pediatric Partial" program aren't ordinary students. They're patients between the ages of nine months and six years with serious emotional and behavior problems. Some hurt themselves; others are violent and many have anxiety, depression and feeding disorders.

According to the American Academy of Child and Adolescent Psychiatry, as many as 12 million children suffer from mental, behavioral or developmental disorders that interfere with their ability to function. They're increasingly being diagnosed at an early age but treatment options typically are limited to admission to an in-patient program or outpatient counseling. "Neither is ideal," says Dr. Elizabeth Wheeler, a child psychiatrist at Bradley who founded the Pediatric Partial program in 1998. Young patients admitted overnight have limited time with therapists, may face medical interventions designed for quick results (like feeding tubes or medication) and endure the added stress of being in an unfamiliar surrounding--an especially significant issue for emotionally fragile kids. Outpatient treatment has its own challenges. Intermittent appointments make it hard for counselors to see the full spectrum of a child's behavior or gain insight into the family dynamics that may be contributing to the problem.

It was with this in mind--and a growing realization that younger and younger children were being admitted to hospitals--that Wheeler created a program that provides patients with intensive, five-day-a-week help without having to spend the night. Each morning for four to six weeks, the youngsters engage in a series of therapeutic activities--painting, reading, singing. A staff of specially trained "milieu therapists" guide the children through meals, outdoor exercise and group activities. "These are emotionally corrective experiences," says psychologist John Boekamp, the program director. "It's rare for these kids to have them." Parents must also attend and learn how to help their children. Also critical are weekly home visits, which give Bradley's staff another opportunity to assist parents. And when a child is ready to "graduate" out to school or day care, a therapist helps with the transition. "There's no other place like it," says Dr. Thomas Anders, president of the American Academy of Child and Adolescent Psychiatry. "In many ways these treatments are prevention services because if [troubled] kids don't get this kind of treatment early, they're going to have more serious problems later on," including teenage pregnancy, substance abuse or violent behavior that lands them in jail.

On a recent afternoon, 10 kids sit in miniature chairs around a tiny table, pigtails and noses bopping in delight as cake and ice cream are served to celebrate a 4-year-old boy's graduation. The small boy, who was admitted to the program after threatening his siblings with knives, had finished four weeks in the program and would be starting at a preschool the following morning. The child's time at Bradley helped end the family's crisis, and hopefully provided new tools that the boy and his mother can use to give them both a new beginning.