At a Crossroads

Children’s mental health centre offers collaborative approach for troubled youth

When Sarah Tosh*’s six-year-old son Kevin*’s behaviour grew out of control, she had no idea what to do. His erratic tantrums were threatening to rip her family apart.

“He would hijack our family,” said Tosh, who preferred not to use her real name.

At the time, it would take little more than losing at a board game to instigate an outburst. He’d upend the board. He’d throw things. He’d threaten to punch his parents. Sometimes his behaviour became so explosive he’d have to be separated from the family.

“He would become destructive,” said Tosh. “We’d put him in his room to keep him safe. He would become physical with his surroundings and with us and we’d have to put him into his room and just hold the door.”
With his volatile moods, Tosh worried every day about what the evening would bring. She also feared for the relationship between Kevin, who has been diagnosed with Attention Deficit Hyperactivity Disorder, and his two brothers.

“With his ADHD, he’s quite impulsive and so he just wouldn’t be able to control himself,” said Tosh. “He’d get angry and just lash out.

“It just seemed like we couldn’t control him. What we’d do with the other kids just didn’t seem to work with him,” she said. “It was stressful and frustrating. We felt helpless.”

Desperate, Tosh sought help from her family doctor, who referred her to an organization that would change her life: Crossroads, an Ottawa children’s mental health centre that serves children ages 12 and under, who are exhibiting difficulties at home or at school.

Serving about 450 children every year, Crossroads offers a multitude of programs, including a day treatment centre, an under-six program, a program geared towards assessing the risk of fire-setting behaviours and a program called WrapAround, which pulls together support for families while helping them with financial and legal issues.

The wait list is anywhere from nine months to a year; however, Crossroads offers help in the meantime, including therapy, crisis planning and psychiatric consultations.

“In terms of the kids that come to us, most of them are at the moderate level of severity through to the severe end of the spectrum,” said associate executive director Michael Hone.

The statistics bear him out.

According to their most recent program evaluation summary in 2009, Crossroads serves a higher level of moderate to severely troubled children than either the region or the province. Despite this, children at Crossroads see a higher rate of improvement (78 per cent) compared with the region (64 per cent) and province (67 per cent).

Part of the reason is due to Crossroads’ unique in-home counselling program, said Hone.

“A lot of mental health centres will have families come to them, rather than going to the family’s home to work with them,” he explained.

And counsellor Sharon Bell said, “It gives us a chance to see how the families are and to see their interactions with each other.

“So it helps us see how we can help them.”

Bell was Kevin’s counsellor. After visiting Kevin’s parents and hearing their concerns, it was decided she’d visit once a week at dinner time, as this was when Kevin tended to act out.

Crossroads employs a treatment philosophy centred on collaborative problem solving. Other plans tended to lean toward behavioural management; however, collaborative problem solving is based on the idea that children exhibit troublesome behaviour because they lack the skills necessary to handle a given situation.

“A child will do well if they can do well,” explained Hone. If a lagging skill is preventing the child from succeeding, that child may resort to outbursts.

Some of those behaviours can be quite severe, including shouting, using savage profanities and threatening peers or siblings. They may say things like “I’m going to kill you!” or “I’m going to set you on fire!”
The behaviours may evolve into more destructive actions, such as throwing things, shoving people, punching people, banging their heads against walls or the floor, even setting serious fires.

They might not necessarily be trying to hurt someone, Hone noted, they may just be trying to get out of whatever situation they’re in because it’s the only way they know how.

Bell said uncovering the reasons for the behaviour is important, and that empathy and collaborative problem solving are vital tools.

For example, if a child is having difficulty doing homework, she said parents and counsellors will work together with the child to understand why the homework is difficult for the child.

A counsellor or parent might say, “I can see you’re having difficulty with your homework. What’s going on?” From there, they’ll try to deduce what the underlying problem is. Perhaps the child is finding the work too difficult or simply can’t concentrate.

“You’re not blaming the parent for their parenting,” said Bell. “You’re helping them to find a different strategy to deal with their child.”

Bell worked with Tosh’s family for about three months and, by using methods such as role-playing and collaborative problem solving, helped Kevin, now seven, and his family to control his outbursts.

Counsellors will typically follow up with a family for a year after their last session.

There are still occasional problems, but when Kevin threatens an outburst, Tosh uses collaborative problem solving to nip it in the bud.

“If we see he’s getting frustrated with something, we’ll say to him, ‘We can see you’re getting frustrated. Why don’t we take another look at it together?’” said Tosh. “It lets him feel we’re on his side.”

Kevin is now attending school and Tosh said the family dynamic has improved considerably.

“We all get along,” she said. “It’s great.”

*Names have been changed

Author: Chris Hunt