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By Jennifer Brewer
Several new programs in New England recently opened or re-opened
to serve children and adolescents. Walden Behavioral Care reorganized
and re-opened the eating disorders treatment center for teens and
adults at Waltham Hospital in Massachusetts that had briefly closed
because of the hospital's closing. Spring Harbor Hospital in South
Portland, Maine opened a new partial program for teens and their
families after discontinuing a similar program last year. New Hampshire's
Hampstead Hospital opened a new inpatient Development Disabilities
Unit for children ages six to 16 who suffer from behavioral and
psychiatric disorders, mental retardation or autism.
Walden Behavioral Care
The eating disorders treatment center existed 20 years before Waltham
Hospital closed this past summer. For 10 years, it functioned out
of Hahnemann Hospital in Brighton, Mass. then moved to Waltham for
10 more years, according to Clinical Director Dennis Czajkowski,
Ph.D., who has been with the center since its inception. The center
closed for just weeks before its August reopening.
When it became obvious last spring that Waltham was closing, Czajkowski
ap-proached about 20 area hospitals looking for a new home for the
center. Walden Behavioral Care, a private company that has stepped
in when other hospitals closed, contacted Waltham and arranged to
maintain the center almost entirely as in the past. "One of the
things we were concerned about was that we had a staff that works
well with this population, which requires a lot of detail and an
interdisciplinary team working together," says Czajkowski. "Our
treatment team was very good and we needed to make sure we kept
them and that they kept their benefits, especially health insurance.
We were able to retain 75-80% of our staff," he says.
Czajkowski says that Walden has provided excellent leadership,
consultation and structure, without attempting to change clinical
factors, and that the transition has been extremely smooth. "Our
goal is to capture the excellence that was here and continue to
make it grow," he says.
The eating disorders center includes 16 inpatient beds, an eating
disorders partial hospitalization program (seven hours per day)
with no patient limit and an evening program (three hours, three
evenings per week) for 20 to 25 patients, ages 16 and up.
The Waltham campus was bought by Boulder Capital and now exists
as Sterling Medical Center. In addition to the eating disorders
center, Walden targets Nov. 1 for the opening of a renovated 23-bed
inpatient psychiatric unit and expects to open a substance abuse
program by the end of the year.
Spring Harbor
Spring Harbor Hospital's partial hospital program for teens (ages
13 to18) opened in September, after a similar program had been closed
for about a year. According to Communications Chief Gail Wilkerson,
the previous program was dismantled because of staff vacancies and
a desire to "develop a thoughtful, participatory process by which
we could better integrate the partial level of care within our youth
services continuum." The new program offers a wider spectrum of
care, including specific tracks for co-occurring disorders such
as substance abuse and a focus on family treatment.
The partial program is offered to teens that live within 30 minutes
of Spring Harbor and they attend after school (2:30 p.m. to 5 p.m.)
every day for two weeks. Family treatment takes place from 5 p.m.
to 7 p.m. four days per week. The program can serve up to 12 teens
at a time. "These are children with problems at a sub-acute level
- they don't really need hospitalization but their problems are
too much for a typical outpatient clinic," says Carlo Carandang,
M.D., staff psychiatrist. "It eases the burden on inpatient units
for adolescents, where teens are often not discharged because of
disposition and no transition to the community."
This population is best served by addressing specific problems
that teens are having at home and in school, says Carandang. He
feels that if these factors aren't addressed, therapeutic intervention
is more likely to fail. He is confident that the new program's family
focus is going to prove key to its success. "That's something that
partial programs in the past have not really focused on. But we
know that kids don't function as well if family issues aren't addressed,"
he explains. The partial program is currently operating out of rooms
at Spring Harbor Hospital, but is moving toward having its own,
separate facility. Carandang points out that the hospital environment
presents problems for some teens, particularly in creating a stigma
among their peers. "We're trying to make it a different milieu,"
he says.
Hampstead Hospital
Hampstead Hospital's developmental disabilities unit, which opened
in August, is a new offering for children ages six to16 with both
developmental disabilities and behavioral or psychiatric disorders.
Clinical Director Joseph Ricciardi, Psy.D., says that these children
are some of the most likely to become "stuck kids" and are very
difficult to serve in a traditional psychiatric unit.
"It's very complicated," he says. "They have different responses
to medication and learn maladaptive behaviors quickly. Sometimes
a diagnosis of retardation or autism colors people's understanding
of problems such as depression. The field is really struggling with
the issue of co-morbidity in this population."
Ricciardi says that children with developmental disorders are less
likely to respond to traditional activities in psychiatric settings
such as group interaction and recreation. "They don't have the same
social skills or interests, and aren't ready to be asked to play
with other children," he explains.
Most of the eight children currently in the unit, which has a 12-patient
capacity, have come from other medical settings across New England
and lack a traditional family unit. Ricciardi says it is difficult
to predict duration of treatment, which varies widely partially
because of the difficulty of placing these children upon discharge.
"We had one child turn around in less than a week and we are looking
for placements for two others, just six weeks or so since we opened.
We have others who would be ready for the right setting, but it's
hard to find settings," he says.
The unit offers psychopharmacological management and behavioral
therapy and eases children into an on-site special education program.
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