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[ CHAPTER 3 ]

A NEW HOME

…

In 1965 staff moved the children to a relatively new building, Merritt Hall, where they occupied two wards, the boys’ and the girls’. A third room, a large hydrotherapy room tiled from floor to ceiling, was utilized first as an extension for older boys. It eventually became the Autistic Unit.¹

In April 1965 state legislator Marjorie Farmer sent the members of the Children’s Task Force a plan for the organization and operation of the Children’s Unit. Farmer suggested hiring both an administrator and a separate clinical director to enhance the program and to foster a statewide continuum of services. She also recommended short-term inpatient therapy, long-term inpatient treatment, a treatment program for autistic children, a small closed unit for emergency admissions, bed space for evaluations, a day treatment program, and outpatient services. Additionally, she urged that there be a separation administratively and clinically from CVH.²

Finally, in 1966, an architectural firm, Lee Crabtree Associates, was hired to draw up plans for the proposed Children’s Unit. Once again the Yale Child Study Center, according to a report by Melvin Lewis, showed support for the development of a high-quality program for children, emphasizing the need for “a degree of autonomy within the administrative arrangements in the hospital; a full time psychiatrist, improved training, and more suitable facilities.”³

During these years, twenty-five new staff members appeared in the growing Children’s Unit. Some of those hired remained for many years.

Judith Raczkowski McCain started as a summer employee, served as a nurse, returned to school for her master’s degree as a nurse clinician, worked as a cottage coordinator, clinician, and director of group living and, upon retirement in the 1990s, returned as a part-time volunteer through the mid-2000s.

Jerold Langlois, a childcare worker, later became the cottage coordinator and was a “natural.” Wonderfully skilled at working with kids, he was usually called upon to train new employees.

Carl Sundell started as a summer recreation worker. His career spanned more than thirty-five years in a variety of capacities in the Department of Children and Families. He returned as superintendent of Riverview from 1991 to 1997. After retirement, he helped write policy and procedure for the Connecticut Juvenile Training Center.

Sylvia Gracon eventually became the first full-time intake worker. Sylvia specialized in recognizing those children who could best be served in less restrictive settings and elsewhere in the community.

Margery Stahl was one of the first nurses to be assigned to the Children’s Unit. She became nurse supervisor, then director of group living, assistant superintendent, superintendent of Altobello Adolescent Hospital, and finally, superintendent of Riverview following my retirement in 1989. Marge talks about her early days as head nurse on the boys’ unit (Ward 92 in Merritt Hall):

I was hired as the head nurse on the boys’ unit…. There was no training about how to handle these boys programmatically. We walked them to school, but many of the kids never made it to school because of their behavior. The census hovered around thirty, and we slept kids off the wards when we ran out of beds. Many mornings I was alone with the whole crowd. They lined up for meds and walked in a line to breakfast. When the other scheduled staff didn’t show up for work I was offered help from the adult ward staff, but I usually turned it down as [the boys] didn’t want [adult staff] to be there.⁴

In 1967 Mehaden Arafeh accepted the job as superintendent of CVH. Arafeh took a keen interest in improving children’s services. Also in that year, Suzanne Peplow became acting director of the Children’s Unit. Peplow’s quarterly report summary, April 1967, states:

[One] advantage … we have during this quarter is the allocation of specific positions to the unit so that we no longer are unclear as to how many positions we have available to us. Considering the entire year since July 1st, we have made progress in nearly all areas: staffing; programming; structuring and treatment. We still need to continually refine all our programs so that they will more nearly meet patient needs and we most assuredly need to begin research projects, which will help us to chart our future course more effectively on the basis of past experience.⁵

A memo from Peplow to Arafeh questions whether the admission age should be reduced from sixteen to thirteen or fourteen, since there was talk of developing an adolescent unit. There was no reported response to this memo.⁶

In October 1967 the site for the Children’s Unit was dedicated, and the quarterly report indicated that the architectural plans were almost complete and bids would be announced early in 1968. All admitted children were assigned a social worker. It wasn’t unusual for a social worker to carry a caseload of more than twenty children. And then each child was placed on one of four teams, or groups. The psychiatric staff consisted of one half-time psychiatrist and one resident from CVH on a three-month rotation. Most children attended school on the hospital grounds.

In 1968 Margery Stahl became director of residential care when Joyce Aksu resigned. Marcia Pease-Grant acted as senior psychiatric social worker. During these formative years, the clinical staff consisted of a full-time social worker and a few caseworkers. Interns from the CVH Psychology Department would often volunteer part of their time, and psychiatric residents would rotate through the service during their last semester of training. Caseworker Susan Reale describes her experience during these years:

I started in the Children’s Unit as a summer worker in 1965 and 1966 and, along with Carl Sundell, went to Camp Quinebaug when the children were invited out there for two weeks. Upon graduating from college I came back to the Children’s Unit as a caseworker. There were so many kids on the boys’ ward. At one time we had forty kids, and the ward was built for twenty—retarded, emotionally disturbed, conduct disorders, brain damaged, autistic, and so on. All admissions would come through adult services. There were serious language problems because many of the residents were foreign trainees with little English language. It was very scary. As a caseworker I had to try and help communicate. We would be asked what kind of meds to give. When kids got sick we had to send them to the [only] infirmary—along with all the chronic geriatric patients. It was terrifying. In spite of this, however, all the inadequate facilities and challenges, we had a great team. Working together, we did some good things for kids. I remember when I first started. There were pictures of the proposed new Children’s Unit on Suzanne Peplow’s wall [Peplow was the acting director at the time]. That gave us hope.

The philosophy in those times was to rescue kids from their families, but we tried to work with the families and get the kids back home. I remember a girl I was working with. She hadn’t seen her family in several years, so I took her to the address we had. I knocked on the door—no answer. Next door, the neighbor answered. There were a lot of kids there. Someone told me the family had been evicted and was living in a hotel in Hartford. So I went to this hotel—an old run-down place in the North End. Some guy, drunk or on drugs, gave me directions and I finally found the place. They were very happy to see each other.⁷

In an effort to get a better picture of the population and program, T. Wayne Downey, a consultant to High Meadows, published his study “A Comparative Study of Residential Treatment Populations: Children’s Unit of Connecticut Valley Hospital and High Meadows, Hamden, Connecticut.” The article paints a rather dismal picture, describing the patient population similarly reported in other studies (the chronicity of diagnoses such as chronic brain syndrome, childhood schizophrenia, severe behavior disorders, social pathology, mental retardation, and severe, aggressive behavior). In comparing the treatment milieus at High Meadows and the Children’s Unit, he writes about his bias as a consultant to High Meadows and describes his observations:

High Meadows appears to be functioning at near optimal efficiency in terms of its treatment plans and goals, staff morale, and maintenance of physical plant. At the time of [this] study, conditions in the Children’s Unit provided a stark and dismal contrast. The staff was laboring dedicatedly and valiantly under enormous handicaps, inadequate staffing, a deteriorated physical plant both improper and inadequate for the needs of disturbed children, and a lack of high-level professional and administrative support. The school program at Connecticut Valley Hospital seemed the strongest part of the treatment program on the Children’s Unit. In most cases (and in spite of the efforts of an earnest but overwhelmed staff), treatment at Connecticut Valley Hospital consisted of little more than holding the child securely and waiting for time to cool off the crisis situation, allowing for disposition home or to another institution.⁸

In an addendum to the article, Downey expresses his dismay over the mental health system and care for these children:

While some children at Connecticut Valley Hospital would have benefited by long-term intensive treatment in a closed setting, a significant number of children were there as testimony to the glaring lack of acute children’s psychiatric inpatient treatment facilities. Perhaps ten to fifteen percent of the children at Connecticut Valley Hospital and five percent of the children at High Meadows were being “over treated.” These children were not in need of long-term treatment or hospitalization, but were there by accident, default, or artifact. Some children carried the label of psychiatric disorder primarily because no child shelters or domiciles were available in their communities where they could be harbored for the forty-eight to seventy-two hours until the crisis had passed, so that psychiatric treatment and social work intervention could be continued with them and their families in a more meaningful home situation. Certainly the lack of acute psychiatric inpatient facilities serves to perpetuate symptoms in degree and chronicity until separation of a child from home and community under emergency conditions is the only option. The child’s separation from his family then becomes undesirable in terms of what we know about the psychiatric treatment of children and the need for maintenance of family and community ties with individual, milieu and family therapy as modalities to re-establish relationships on a more stable, mature level. This task is infinitely more difficult under the present centralization of child treatment facilities in the state. The twenty-five percent of children in this study from Fairfield County are one to two hours from home, mitigating against consistent close contacts with their families. Acute psychiatric treatment centers for children on a decentralized community basis are called for. Additionally, attention must be given to the special needs of the disturbed, mentally deficient children in the Connecticut Valley Hospital population. They require a special program oriented to the specific needs, capabilities, and tolerances of these children. They require a program, which bridges the gap between their retardation and their emotional disturbance, with special education and therapeutic approaches which a general children’s psychiatric service cannot provide.

A final impression is that many of these deficiencies could be resolved or avoided, were there a central agency or agent charged with and committed to the care and treatment of emotionally disturbed children in the State of Connecticut.⁹

Downey’s analysis clarified the need for massive amounts of help from the government, the community, and the hospital. Arafeh, superintendent of CVH, requested assistance from the Connecticut Council of Child Psychiatrists, asking them to review the Children’s Unit program and make recommendations not only on how to improve its functioning but on how they could help provide psychiatric leadership for the unit.

Partially in response to this request, in February 1969 the Council and the New Haven–Middlesex Chapter of the Connecticut Psychiatric Society submitted a report to the Ad Hoc Joint Committee on the Children’s Unit. In it they reiterate the conclusions of the previous studies and describe their own observations:

The wards have a markedly institutional character, they are cold and generally forbidding, and there is already a sense about them of considerable dilapidation. Clearly they were not designed to withstand use by a fairly active group of children. Some of the rooms are exceedingly overcrowded and there is about them a sense of starkness, which is distressing. There are few personal possessions in evidence and very little sense of any kind of privacy. With one exception, the recreation or public rooms are empty and bare. The one exception is a recently established combined recreation and snack shop which the patients established themselves, which they run, and which has a somewhat more festive, livable and desirable air about it.¹⁰

The report went on to conclude, “The Children’s Unit must have full autonomy. This includes full administrative and program control and in the management of all services with all staff reporting directly to the superintendent of the unit, rather than to the CVH chiefs.” They also recommended a salary level that would attract a qualified person, “optimally a child psychiatrist.”¹¹

Some support came from the judicial side of government with the appointment of a new juvenile court judge, Margaret Brenneman. Judge Brenneman was a strong advocate for children and over the years supported the development of children’s mental health services.¹² Unfortunately, the judicial system changed eventually, and juvenile court judges were replaced with superior court judges who rotated through the juvenile courts, making it difficult to get to know the judges and vice versa.

Early in 1969, Suzanne Peplow resigned, partly because of poor health but certainly out of frustration with not having moved up from the acting-director designation, as well as a sense of futility based on what she perceived as a failure to move more quickly in meeting the needs of the children.

One of Suzanne’s final acts was to recommend an increase in childcare staff from an average of two staff members per shift per ward to an average of just under three staff members per shift per ward. A ward consisted of an average of thirty children. This would raise the number of childcare staff members, including nurses and supervisors, from thirty-seven to fifty-nine, with an average daily census of eighty children on two wards and an “annex” for the autistic kids. This increase would also accommodate the change from a forty- to a thirty-five-hour workweek. Suzanne also recommended an increase in social service staff in order to decrease the caseload of each staff member to fifteen.

Upon Suzanne’s resignation, Margery Stahl, supervisor on the boys’ ward, moved up to acting director of the Children’s Unit, and Marcia Pease-Grant accepted a promotion to senior psychiatric social worker.

Marge Stahl took charge and brought immediate order to a rather dispirited situation. In an interview she describes what it was like at the time:

The hospital really didn’t like the children being there. [The children] broke things, were noisy. We had a child who could pull up a tile in a second. They didn’t like that very much. But basically, the wards in Merritt Hall were very sterile. They had a bed and a locker. And the thing that bothered me most as the nurse on the unit was that the kids had nothing to play with. They didn’t have games, and if they did you were constantly looking to find the pieces. One of the mothers of one of the autistic kids who used to come up to the unit to help with the autistic kids wrote a letter supporting us.¹³

Judy Raczkowski McCain began at the Children’s Unit in 1968 and was assigned to Wards 91 (girls) and 92 (boys) in Merritt Hall. She describes a similar situation:

There were minimal resources for kids. I remember one of the seven-year-olds gravitated towards the autistic kids and began to act autistic because their unit had some toys and he saw that as his way to be able to play with their toys. There would be two people on with forty kids. These children were extremely mad and aggressive. They hated being there. They would say things to me that I didn’t even understand—especially about my mother. But even though I didn’t know what they were saying, I could tell just how upset they always were. For a while there was no recreation for the kids. However, they finally hired recreation workers who organized activities and paid attention to the kids.¹⁴

This frustration soon reached its boiling point. On 23 May 1969, a particularly frustrating day for staff, Marge Stahl remembers going home and sitting on her front stoop and writing a letter to Governor John Dempsey. She pleaded for recognition of the plight of the unit, recounting the various studies cited above without any recognizable results, the promise four years earlier of new facilities, and the immediate crisis of summer approaching, a camp program ready to go, and yet no approval for the necessary staff.

The next day the entire staff of the Children’s Unit signed the letter. On Sunday morning the Hartford Courant headlined the story and Marge received an urgent call from the superintendent, Mehaden Arafeh. He asked Marge to meet him at the hospital. In any case, according to Marge, “for the staff, it formed quite a bond among us at the time and was a catalyst for moving the development of the construction for the new facility.”¹⁵

A search committee—composed of Margery Stahl; Mehaden Arafeh; Charles Leonard, superintendent of High Meadows; Tom Frank, child psychiatrist and consultant for the Department of Mental Health; Albert Solnit, director of the Yale Child Study Center; and Ned Graffignino, director of the Institute of Living’s children’s program—began working to find a permanent director. Following much discussion and failure to find an appropriate or available psychiatrist, two men were approached: Peter Marshall, chief social worker at Highland Heights, a residential treatment center in North Haven, and myself. We were told that the committee was interested in both of us, that we had complementary skills, and that they would like us to get together and decide who would be the clinical director and who would be the administrator. After meetings at our homes, our offices, and atop a raft at Camp Quinebaug, where I was still working, Peter and I clearly felt our compatibility and decided to go for broke. We made several demands, among them to be appointed as co-directors, with equal pay and shared responsibilities, and to become independent of CVH, reporting directly to the commissioner of the Department of Mental Health. These proposals require some explanation:

(1) The concept of co-directors was questionable. We reasoned as follows: There was a very big job ahead of us, and sharing that with someone would make the stress manageable and provide mutual support. We recognized that we could be vulnerable to staff members working one against the other. However, we also recognized that our shared position could work only if we had the utmost trust in each other. We felt we could develop such trust. We would have to define very clearly our separate areas of responsibility, those that we shared, and how we would resolve differences.

(2) It had been the custom at the hospital to pay people according to their professional classification. Thus, the previous administrators had been paid as social worker, psychologist, or psychiatrist, with vastly different salary ranges, even though the expectations of the job were the same. Additionally, since we were going to be sharing the responsibility equally, we felt we should be paid equally. We also knew that a comparable salary level sent a message of equality to others in the state organization.

(3) We decided that it was important to establish that the Children’s Unit was a major program of the hospital and that its leadership be accorded the rights and privileges of other major areas, which were led by psychiatrists. We felt strongly that the philosophy underlying the children’s program must be different and separate from that concerning the adults.

(4) We wanted a voice in the state hierarchy comparable to that shared by the other facilities of the department. This included sitting in on the monthly meetings of the superintendents with the commissioner of the Department of Mental Health.

(5) We needed complete control of all program decisions, with the authority to implement them subject only to the veto of the deputy commissioner for children who would be our direct supervisor.

(6) We wanted to dissociate the children’s program from the stigma associated with adult psychiatric hospitals.

(7) We wanted to make a statement that children’s mental health needs were very different from, but at least as important as, those of adults.

To the credit of the committee and Commissioner Bloomberg, all of our proposals were accepted. While they had some difficulty with the concept of co-direction, they eventually agreed to it with the understanding that we would report directly to the newly appointed deputy commissioner for children’s services, Charles Launi. Charles would work closely with us and would act as arbitrator of any differences we could not resolve ourselves. The second issue caused some difficulty because it meant creating new job specifications rather than using the traditional ones. The creation of new job specifications in a state system is never an easy task, but the committee agreed to pursue it. In the meantime we were placed in “temporary” positions. It was three years later that a position called director of the Children’s Unit was created.

The issue of autonomy from the adult hospital was a very ticklish one that had various emotional and political implications. The separation had been heatedly discussed in various circles between the child advocates and the greater number of mental health professionals who were not in favor, since it implied that children’s needs required special training or programming. We knew, however, that several members of the committee, as well as members of the Connecticut Association of Child Psychiatrists who had strong voices in the state, were outspoken in their endorsement of such separation.

Commissioner Bloomberg, in a letter to Mehaden Arafeh, superintendent of Connecticut Valley Hospital, dated 25 September 1969, officially announced the appointment of the co-directors and clearly spelled out the condition: “Both individuals will have equal and comprehensive authority to operate the children’s services program.” And a separate budget was established. The letter also pointed out that the commissioner had asked the attorney general about the possibility of establishing children’s services as a separate unit of the department. He was informed that it required legislative action and an amendment to the statutes. The letter continues, however, “This amendment will be presented to the 1971 Legislature, and I believe there will be no difficulty in securing approval.”

In the meantime, while legally still a part of CVH, Peter and I would have full responsibility for the program philosophy and implementation and, while reporting to the deputy commissioner for children, would also participate in the CVH administrative staff meetings. This arrangement worked out very well as an interim measure. Arafeh supported our goals and accepted us as members of his administrative staff.