Admitting a child to the hospital for any kind of long-term treatment is traumatic for parents. It's a long walk back to the car, and a longer drive home.
When the treatment is related to behavioural problems, there may also be feelings of defeat-of not meet-ing society's expectations for a stable and happy family life.
Cindy Bremner remembers all too well how tough it was for her and husband Darrell to leave their son Cody at the IWK's Children's Response Program in the spring of 2008. But it was better than the alternative. The boy's defiant outbursts and tantrums had brought the couple close to the breaking point.
"We were going nowhere. We were going to a really bad place, and that's scary," recalls Cindy. "We were extremely depressed, my husband and me, trying to cope."
So there was some relief in getting Cody admitted to this residential program that would teach him skills to control his behaviour. And far from cutting off contact with their son, the program gave Cindy and Darrell ample opportunity to work with him constructively, practising new strategies under the guidance of professional staff.
Comprising an entire floor of the APSEA building on South Street in Halifax, the facility is set up as three apartment units, each housing four children up to 12 years old. There used to be 16 beds, but in recent years the program's focus has shifted from residential care to evidence-based clinical treatment of conditions such as anxiety or ADHD (attention deficit hyperactivity disorder). It's still a home-like environment, with daily routines and special activities that mimic family life, but research in the field favours smaller groups, allowing a more intensive, individualized approach. For each child, the objective is successful transition back to his or her real home.
It's now known as the COMPASS program. The full name-the Centre for Collaborative Child and Family Treatment-reflects a broad interdisciplinary approach to mental health, drawing on the expertise of recreational and occupational therapists as well as teachers, psychologists, and psychiatrists. The involvement of parents is also crucial.
"It isn't just the children who benefit from support and treatment; it is that family unit," says program man-ager Barbara Casey. "While they're here, you're attempting to enhance the strengths that the family has. It's not about a cure, it's about increasing capacity."
Referrals to COMPASS may come from anywhere in Nova Scotia. Cindy Bremner says financial assistance for travel expenses made it feasible for she and Darrell to make frequent trips from Chester, on the province's South Shore. With support from program staff, they were active participants in Cody's treatment.
"When we would come in it was great because we could model what they were doing," she says. "They could come out and coach us through it. It was hands-on learning. And every time we went they treated us like family. We sat at the dinner table and had suppers together. It was really nice."
The program is based on a six-month course of treatment, with new admissions on a three-month rotation. After a settling-in period of two weeks, residents go home on weekends. That's a time for children and parents to put what they've learned into practice.
"We do a debrief when families come back Sunday afternoon," says Casey. "We talk about what worked and what didn't."
To keep children on track with their schooling, the staff teacher conducts classes every weekday morning. Afternoons may bring group work, such as anger management or problem solving.
"That's why we do a block intake. All those kids that come in together can start that at the same time," ex-plains Casey.
Physical activities such as swimming and bicycling are considered an important part of the mix, as are music and drumming programs. Outings to the Art Gallery of Nova Scotia or the Discovery Centre serve educational ends while providing an opportunity for the children to be part of the wider community
"The social skills that they're working on, you're giving them a real context. It's a great way for kids to get out, and also you're valuing recreation," says Casey.
Dr. Aidan Stokes, deputy head of Dalhousie University's Department of Psychiatry, is co-leader of the program. He says while research on residential care is tricky because there are so many variables, it's clear that better outcomes are achieved through family involvement, empathetic staff, individualized plans for the development of skills and self-esteem, and ongoing support following the treatment period.
"Success cannot be based on how well the child does in the residential part of the program," he adds, "but on their incremental success at home and in the community, during the time that they are with us and beyond."
Cindy Bremner says when Cody first came home she often spoke to COMPASS staff on the phone, and those pep talks helped smooth the transition. Now 13 years old, Cody is coping much better with school and home life. There are still challenges, but he and his parents have strategies to help them through the rough patches. That difficult decision to admit Cody to the program was a turning point for the family.<
"It was the hardest thing I've ever done in my life," says Cindy. "But it was the best thing, and Cody knew that too."