Transcript for the Piece Audio version of Cruel Choices Part II

Last week we brought you the story of Dwayne and his daughter Tina.

Dwayne was forced to give up custody of Tina so that she could get the mental health care she needed.
Washington State’s solution for Tina was institutionalization, hundreds of miles away from her father.
Tina continues to struggle with psychiatric problems.
In this follow up to that story, we meet another Washington State family struggling with some of the same mental health issues.
Only this time the family found a program that works.
Heidi Lang brings us the story.
No one ever said raising teenagers was easy.
But Tanya’s daughter Mandy is not your average teenager.
She is dealing with depressive disorder, post-traumatic stress disorder and addiction issues.
At sixteen Mandy attempted suicide.
Not knowing what else to do, her mom tried to get her admitted to a psychiatric institution.
But the state wouldn’t accept her because Mandy didn’t have enough history within the system.
Tanya, a single mom with two other children, was desperate.
She knew Mandy would act out again.
Should she call the police? Child Protective Services?
Would that mean losing custody of her child?
Then she found a program called SWIFT, which stands for the Skagit-Whatcom Intensive Family Team.
Tanya immediately liked the SWIFT approach.
“You know, it was a wrap-around. They were letting us know that they were on board and Mandy needed to set goals and say what she wanted. They were there mainly for her, but it never felt like I was out. They wanted us to say what do you want and it was basically their job to help us figure out how we were going to get there. So we started meeting every week at my house. We started meetings off with what were some goals and what are some things we’re going to celebrate. It was always on a positive note. And we just addressed issues.”

SWIFT is what’s called a wrap-around program.
They are designed to help kids like Mandy in a very different way than traditional institutionalization.
During the wraparound process, a team of individuals who are relevant to the well-being of the child work together to develop a plan of care, implement it and evaluate how it’s working.
Wraparound programs focus on keeping the child in their community.
Most importantly, they include the whole family.
Tanya has her own parent advocate, a woman named Pam.
“There was one night, it was a horrible, horrible – probably the worst time I ever had with her and I was a wreck. Mandy was busting windows and trying to hurt herself very bad. Finally I got Pam on the phone and was like “the police are here” and she came to the house immediately. If I didn’t have Pam I would have completely melted down and I would probably have lost my job by now.”

Last week we heard about a group of families in Washington State that became so frustrated with Medicaid’s failure to deliver mental health services that they decided to sue the state.
Every one of those families has a child with serious mental and emotional disorders like Mandy.
Medicaid is supposed to provide them with intensive home and community-based care.
Instead many end up in the juvenile justice or child welfare system.
Neither system is designed to address children's mental health needs.
So the treatment ends up being ineffective AND expensive.
Alison Barkoff is with the Bazelon Center for Mental Health Law based in Washington DC.
She thinks what’s needed is more wrap-around programs like SWIFT.
“If we are talking about ways to save money and to get better outcomes, we need to focus on getting kids out of institutional care that is extremely expensive and repeatedly found to be ineffective.”

SWIFT began as a pilot project at the University of Washington as part of something called the National Wraparound Initiative.
Eric Bruns is a professor at the UW and directs a group that researches and evaluates wrap-around programs.
He is very clear that the current system isn’t working.
“An ideal system will prevent that first inpatient hospitalization. But even if that first hospitalization occurs, a typical system is going to discharge that youth and just hope it doesn’t happen again. What needs to happen instead is we have a system that is based on these principles of engaging families, of investing in the effort of pulling a team together with a diverse array of resources at their disposal, to do whatever it takes to keep that young person in their home and in their community.”
He admits it’s a very different way of doing business.
“You know, at the system level it requires not necessarily a massive infusion of resources because what we’re looking to do is reduce reliance of other types of costly interventions, such as out-of-home placement, foster home placement, psychiatric hospitalization and redirect it into these community-based treatments. But it really does take a lot of investment of effort at the system level.”

Mandy and Tanya have been in SWIFT a little over a year now.
Mandy has been clean and sober for 8 months.
She is working towards her GED and applied for a job corps program with SWIFT’s help.
Unfortunately, the SWIFT program can only handle 16 families like Mandy’s.
Many more than that need help.
The goal of the lawsuit against Washington’s Department of Social and Health Services is to increase the amount of wrap-around services offered by the state.
That would not only create better outcomes for children and families, it would significantly reduce costs.
Families of kids with severe mental health issues will never have it easy.
But Mandy and Tanya’s experience with SWIFT shows there is hope.
“I mean we are not the same people Pam met a year ago. Period. We’re not. Me and my mother are like best friends again. I mean, we still bicker because we’re so much alike, but we’re healthy. We’re healthy together.”
For One World Report, this is Heidi Lang.