Ryther - Healthy Children, Stronger Families

Ryther’s Sub-Acute Residential Treatment Program provides a safe living arrangement for children ages 6-13 struggling to overcome the effects of trauma, violence and mental illness. Ryther’s three cottages, located on our ten-acre campus, each treat twelve children at any given time, employ psychiatry, psychology, evidence-based and experiential therapies as well as parent coaching and shadowing. Most of Ryther’s children (70-90%) show significant improvement in specific behaviors with treatment, such as aggressive tantrums, self-injury, assaultive behaviors, running and others. However, behavioral improvement is not the whole story.

Abuse and neglect can also affect the child’s developing brain and in many realms. In Ryther’s cottages we see relatively high incidences of developmental delays and learning disabilities. Neglect has a profound impact as does in-utero exposure to substances such as alcohol and drugs. Additionally, children who bounced from foster home to foster home tend to have what teachers in Ryther’s on-campus K-8 school call a “Swiss cheese education.”  Because they’ve attended multiple schools sometimes within one school year, they have been taught only pieces of subjects. Every foster home move puts a child approximately 3 months behind in school. On average, a child at Ryther will have moved 9 times before entering one of our cottages.

Ryther’s partnership with the Seattle Public Schools allows children to continue their education while receiving intensive treatment 24/7. The school features 5 classrooms staffed by Special Education professionals and classroom aides, with specific lesson plans tailored to each child’s educational needs. As children get ready to transition out of Ryther, they work on returning to the public school setting as well. First they attend just the morning classes sometimes in a block. If successful they start to stay for another block, lunch and eventually the entire day. This transition accompanies their return to family or relatives, or to a foster home or other long-term living arrangement.

It is promising to see that from 2006 to 2010, the children discharged from Ryther demonstrated substantial academic progress in the following areas:

• 71% saw improvement in their basic reading skills

• 71% saw improvement in their basic math skills

• 88% saw improvement in their reading comprehension skills

In past years, Ryther’s Sub-Acute Residential Treatment Program has seen a steady increase in severity of behaviors in children. Despite this increasing acuity, we continue to see positive outcomes. We also have seen shortened lengths of stay to an average of 9 months. A testament to the children, staff and programs also manifests itself in the six children who will be adopted from within Ryther’s own therapeutic foster home program.

The Sub-Acute Program provides consistently successful therapies for children overcoming traumatic histories.

In recognition of Child Abuse Prevention Month, Ryther Therapist Lindsey Beaky MA, LMHCA offers some insights on how you can do your part to protect children. She explains the often daunting and ambiguous task of when and how to involve Child Protective Services.

Who should report child abuse and neglect?

Professionals who work with children regularly, such as teachers, health care professionals and therapists, are certainly an important part of the recognition and prevention of child abuse. These groups are considered “mandated reporters,” which means they are bound by law to report any signs or suspicion of abuse or neglect of child. While this is April Child Abuse Prevention Month, it’s important to note that most intakes (about 63%) by Child Protection Services are for neglect while 27% are for physical abuse. Whatever the reason, it’s important for all members of our community to understand and take part in this process in order to keep children safe.

You may be a close friend or family member of a child who you suspect is being abused. It’s important to learn to recognize the signs of child abuse and how to approach the child, the parent or both. No matter what, the bottom line is that if you suspect a child is being abused or neglected, it’s vital to call Child Protective Services. Calling CPS does not necessarily mean that a child will be removed from the home. It simply starts a process and creates a record of reports that could, in the end, help the child and family.

How can you recognize child abuse?

In order to recognize potential child abuse, it’s important to understand the different behaviors both parents and children display when abuse is occurring in the family.

Some warning signs that a child is being abused or neglected:

- Her behavior or school performance changes suddenly
- She comes to school early or late, is absent frequently, or does not want to go home
- Medical needs brought to a parent’s attention are not met
- She is watchful or anxious around adults
- She has bruises or injuries that cannot be explained
- She has consistently poor hygiene
- She begs for or steals food or money

Some warning signs that are unique to child sexual abuse include:

- He has difficulty walking or sitting
- He refuses to change for gym
- He reports bedwetting, having nightmares or a sudden change in appetite
- He displays sexual knowledge that is unusual when compared to other kids in his age group

Parents who may be physically or emotionally abusing a child may have these behaviors:

- They offer no explanation, or conflicting explanations, for injuries
- They describe their child in a negative way
- They use harsh physical discipline or are indifferent toward their child
- They abuse alcohol or other drugs
- They refuse offers of help for the child’s problems

Parents who are sexually abusing their child may have the following behaviors:

- They limit the child’s contact with others and are extremely protective
- They are jealous or controlling of other family members
- They are secretive and isolated

Most importantly, if a child reports that they are being physically, emotionally, or sexually abused, or neglected, it is critical that you assume they are telling the truth and that they picked to tell you, as a person who can help them. 

How do you approach the child?

If you believe you have reason to suspect any form of child abuse or neglect, make time to talk to the child about this right away. Find a confidential location and point out what you’ve noticed about their appearance or demeanor. Ask them to tell you about home. Who do they live with? Who are they close to? Are they afraid of anyone? Be aware that if a child is experiencing sexual abuse, he or she may not recognize it as “bad.” When you call Child Protective Services, they will ask for specific information, including: the child’s and parents’ names, birthdate, address, and when an event occurred. CPS and the local police will then take steps to protect the child if he or she is in immediate danger.

How do you approach the child’s parent?

Depending on your relationship with a child’s parent and the nature of the abuse suspected, it may be most helpful for you to assume that the parent is struggling and would accept assistance or support if given to them. Many parents lack the skills, resources, and knowledge to do better, even when they really want to. Approach the parent with care and concern. Find out what the family needs. Provide some resources such as information about parenting classes or counseling, and if you are a family member or friend, offer to take the child for a weekend so that the parents can have a break.

While you do not have to tell them that you are calling CPS, it’s extremely important that you do call CPS, even if you speak to the parents and provide resources and support. If abuse is occurring in a home, Child Protective Services will take additional steps to ensure that parents are connected with services and that children are protected.

What happens next?

Once child abuse or neglect is reported, you may begin to witness serious changes in the family, such as a child being removed from the home or a parent going to jail. Things may get worse for the family before they get better due to separation or sudden involvement with the legal system. Remember, safety for a child is the number one priority, and if your actions meet that goal, the child is ultimately better off than before. Also, if a family is willing and able to change, they will take the steps to do so and may eventually feel thankful for being given the opportunity.

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Notes from Lee Grogg, Ryther Executive Director: Washington’s Children’s Administration periodically sends out reports with data about its activities. You might be interested in what some of that data is.

In the State’s fiscal year 2011 (ending last July 1) there were 77,882 referrals received by CPS reporting alleged abuse or neglect. 37,992 were “screened in” for investigation while 35,772 were deemed for some reason not meeting a standard for further involvement of the agency. In short, about half of all reports made get investigated. If you total the “screened in” and “screened out” figures there is a gap of some 4,118 referrals that is unexplained.

On June 30, 2011, there were nearly 10,000 children in the care of the Children’s Administration. This figure has remained surprisingly stable over the years. Of the 9,987 children in care, 90% (8,966) were in out-of-home care of some kind. A little over a thousand of the children were in State Dependent In-Home care. 3,174 of the children in out-of-home care were placed with relatives. This figure has increased via policy emphasis in recent years. 5,819 (65%) were in foster care or group homes.

The most common reasons for intakes were Negligence or Maltreatment (62.7%), Physical Abuse (27.3%) and Sexual Abuse (4.8%). Assuming that intakes equal the number of children in care in 2011, that means there were approximately 6,562 neglected children, 2,726 physically abused children and 479 sexually abused children in the system.

There were 18 child fatalities in open Children’s Administration (CA) cases of which 11 were due to abuse. At this point the published report seems a bit obtuse. In breaking down the 18 fatalities of kids in open cases they report a line “the number related to child abuse” as being 11 while in the next line they report “abuse-related fatalities in open CA cases” being 7. The wording suggests that, in fact, all 18 fatalities in open CA cases were due to abuse.

April 16-20, 2012 is National Volunteer Week. In appreciation of our wonderful volunteers and to honor their hard work in helping our kids and teens, we are featuring a few of their stories.

From John, a Best Buddy volunteer for a twelve-year-old boy in Cottage D:

“Kingston” and I meet once a week and I have also attended some of his off-site events, which have been amassing fun.

Although I have only been volunteering a few months now, I have seen some changes in my buddy’s attitude.  Kingston looks forward to my visits, as I do, and we have been building a positive relationship.  One day he was so proud of being at Level  1 for good behavior, he had to show me the board where the level system is located. Being on Level  1 means that he had no restrictions, such as being able to go on any outings for the day. On another visit I had lost my coat on Ryther’s play field, and he took me around to all the cottages asking the staff at each if they had seen it.

I believe these visits are special to him because I am not paid staff – I am there, with him every week, because I want to be there and I enjoy spending time with him.  He knows this and I think it makes a difference.  I am sure that building a mentor relationship like this helps complement the tremendous work that Ryther staff do every day.

Volunteering at Ryther has also given me a lot in return.  It has helped me to keep my perspective when life gets too hectic and it also provides an opportunity to give back.  What makes Ryther such a special place to volunteer is easy to answer: the kids.

To learn more about Ryther’s Sub-Acute Care program, visit this page. If you would like to share your story, email clayt@ryther.org.

Lillian Johnson, MSW was hired as Ryther’s Executive Director in 1935 after the Ryther Home closed for a year following Mother Ryther’s passing. Over the next 40 years, she would turn Ryther Child Center into a world-renowned treatment facility with a focus on serving children with emotional or behavioral disturbance. Lillian became the technical and philosophical leader behind Ryther – the first behavioral health center of its kind. All who knew Lillian remembered her unfailing compassion for the children at Ryther.

Ryther’s Board of Directors first hired Ms. Lillian Johnson as Executive Secretary, but soon brought her on as Executive Director. The first five years of Lillian Johnson’s Directorship were tumultuous as Ryther’s staff and Board adjusted to her new and somewhat revolutionary ideas. One of her interesting techniques was to summarize anonymous case histories at Board meetings, Four & Twenty League meetings and public talks. Lillian had a unique ability to make these seem almost too real, and her retellings often had a profound impact on the audience.

Under the oversight of its new director, Ryther Child Center operated as both orphanage and center for emotionally disturbed children until about 1945. At this time Ryther had an active caseload of 277 for their seven employees. Lillian also instituted a new bookkeeping system, an indexing and statistical system that conformed to the state’s requirements, and a new system to record information regarding casework. Lillian brought on five graduate students from the University of Washington to assist with managing the casework.

In addition to deliberately hiring workers of both sexes, Lillian encouraged the child care staff to become more involved in the treatment and therapy of the children. In years past, the child care staff was uninvolved in the therapeutic treatment of the children. Ms. Johnson argued for the inclusion of the child care workers in therapy sessions, with the goal of the child care staff being able to reinforce the treatment strategies of the therapists. Lillian’s approach helped create Ryther’s integrated treatment model—a move that laid the groundwork for today’s Ryther.

Public awareness of Ryther’s success and mission started to grow. Lillian Johnson produced several papers detailing her thoughts and methods regarding treatment of emotionally disturbed children. She wrote that Ryther “has demonstrated that extremely disturbed children not only can be carried successfully within an informal, non-restraint unit, but can be readjusted…. Many people would find this hard to believe unless they saw it in function.”

In 1947, LIFE Magazine featured Ryther prominently with “Bad Boy’s Story,” a pictorial article and success story that chronicled a Ryther boy’s journey from home to Ryther and back again. In response to the LIFE article, Ryther began to receive letters of praise, support, and requests for help with their own children. Even a Hollywood studio approached Lillian with a movie proposal—after careful consideration, Ms. Johnson decided it wouldn’t be in the best interest of the children.

It had been almost 30 years since the construction of the Ryther Child Home on Stone Way, and the organization had outgrown its space. Lillian envisioned a new facility aiming to emphasize a family-style setting. The Four & Twenty clubs, later becoming the Ryther League, raised funds to purchase a ten acre plot of land in North Seattle in 1954 and to build residential, school and administrative buildings by 1957. The new facility was well received, as Lillian wrote shortly after completion:

“We are in our new building and are delighted with it. Everything fell into place: the children slept better, there is less need for … supervision, and everyone is apparently happy as a lark about it.”

Lillian Johnson oversaw quite a unique operation. Ryther’s doors were always unlocked, and Lillian felt that “emotionally disturbed children would thrive in an intimate family-like setting, in which ages and sexes were integrated.” This design was an attempt to create a familial setting which it was thought would aid the children in recovery.

In 1970, Ms. Johnson retired as Director but would continue to work at Ryther as head of Special Projects until her death in December 1977. She would be remembered not only for her ability to inspire others to Ryther’s cause, but for her dedication to improving every aspect of Ryther Child Center, now known as Ryther. She was instrumental in developing Ryther into a leader in behavioral health services, and her efforts to educate other professionals had an impact on a national scale.

A skill you can teach your child today for better tomorrows

How can parents help a child learn to cope with big feelings or a frustrating situation? Well, it takes practice and a plan. And that’s what SODA is. The acronym stands for “Stop, Options, Decide, Act.” The basic steps you can teach your children are listed below. With practice, children can learn self-regulation and problem solving skills. In Ryther’s Sub-Acute Residential program in the cottages, we ask children ages 6-13 to use their SODA skills when they are making everyday choices or faced with a problem.

S.O.D.A. Skills:

1. 1. STOP when a problem is presented
2. 2. Think about their OPTIONS
3. 3. DECIDE on the better option
4. 4. ACT on that option

So what does SODA look like in action?

Tiffany and Zach both want to play together, but they want to play different games and can’t agree. At this point, we teach children to stop before things escalate into a larger problem. Take a step back. Maybe take some deep breaths. Become calm before acting or speaking.

Next, we suggest that they think about their options to solve the problem. We might prompt by saying, “You can compromise and play two games or not play with each other at all.”

Once Tiffany and Zach decide on the option that’s best for them, they then act on that option. You as a parent can commend this behavior.

How do you get the kids to buy in to the program?

We combine the SODA program with an incentive reward program. It’s fairly simple and can be used at home. Each time children demonstrate SODA skills, they get a sticker to place on their chart. When they fill up the chart, they show that they are beginning to master the skills, and staff can reward them with a small toy from the “prize box.” For some kids Pokémon cards are a real motivator and, for others, a half hour later bedtime works.

Start Slow…

When kids first start using SODA, it’s best to guide them through each step. Help them discover options and present only two at a time. Too many options may cause confusion and provoke other issues. The more that children use SODA skills, the more options they’ll discover on their own and the more instinctive and routine using these skills will become. (It could be helpful for adults too!) You’ll have helped them learn a valuable skill.

Contributed by Kristine Joy Culala, BSW, Sub-Acute Care Counselor

An interview with Colin Powers, Supervisor of Cottage A in Ryther’s Sub-Acute Inpatient program, on Gotcha! moments: spontaneous messages of positive reinforcement.

At Ryther, why is it so important to catch kids doing something right?

Our kids have had multiple failed placements and multiple moves. More often than not, they assume that the moves were their fault, the abuse was their fault, and they start to internalize that they’re “bad” kids. It’s important to change this mindset and start teaching them that they are not to blame for everything, and that they do in fact have reasons to feel successful.

How do Gotcha! moments work in the cottage?

The best Gotcha! moments come unexpectedly when a staff tells a child, “I think you had a great day. You should be proud of yourself.” An immediate reward might be given to them, or a message of affirmation might be left on their door overnight so it’s the first thing they see when they wake up. Sometimes it’s just a note that says, “We’re really glad we’re getting to know you.”

What tips do you have for parents who want to try this type of positive reinforcement at home with their own kids?

Spontaneity is the key. It’s easy to catch your child doing something wrong. But if you think about it, it’s just as easy to catch them doing something right. Recognize them, praise them, and tell them what it is specifically that they did that was commendable.

How do tweens or teens respond to this?

It can work with this age group too. Sometimes, a special privilege might be the best reward when they get caught doing something right. It could be getting to stay up later, receiving one-on-one time or a special treat. It is also effective for them when they receive detailed feedback from parents, which serves to help them identify their own strengths. “Thanks for reading to your little brother. You know, we have a lot of little kid books, maybe we should go get you some young adult books this weekend.”

As the Director of our Sub-Acute Care Program I continue to be amazed at the bravery demonstrated by the children in our care.  Most often, our children have been victims of abuse and neglect by those who they have trusted to care for them and keep them safe.  Recovering from that abuse and neglect can be a painful process and the children usually have significant mixed emotions about the people that abused them.  In addition to the pain of recovery, children often worry that they are the only one who may have experienced such trauma at the hands of their care givers and as a result, it is somehow their fault.  While in treatment, the children are able to share what they have experienced with others. 

Ryther’ Survivors group is one way the children are able to start the healing process of the trauma they have gone through.  This group is designed for children who have been sexually abused.  Developed in 2001 to help children cope with the trauma of abuse, the group utilizes a supportive model that uses techniques to build teamwork and trust within the setting.  There are twelve group sessions for one hour a week.  As the sessions progress, the members talk about feelings, learn and practice coping skills, begin to learn about healthy ways and unhealthy ways to think about abuse, and watch videos and listen to different scenarios that help them understand that there are other child abuse survivors.  All these activities are used to help the children gain comfort to eventually be able to share their own story of abuse.    It ends with a graduation party to celebrate the hard work and effort put forth by the children.  To date, there have been over seventy children who have participated and graduated from Survivors Group. 

Children who graduate from Survivors Group find new growth in the healing process

Watching their progression through the group is an amazement.  Most children move from a place of shame and self-blame to a place of pride and a sense of accomplishment upon completion.  They often ask to do group again.  A majority of children who have gone through Survivor’s group have disclosed abuse they have previously not talked about which allows for greater healing and reduction of trauma.  Group therapy appears to be effective due to the peer support, empathy, and common learning in the group.  Our next round of Survivors group starts today, September 29, 2011 for four brave young children.