Doing drugs was part of a slew of problems that had gotten him sent to a Tennessee youth detention center, for six months. Now that he was home, Neko and his mother and two sisters were trying to communicate better. The stakes were high: While Neko was in detention, his baby daughter had been born, and he and his family had primary custody of her.
He’d left their sparsely furnished apartment near the airport in Memphis the night before, even though his mother had expressly forbidden it. He wouldn’t say where he was going.
The next day, standing around the apartment kitchen, Neko, his mom, and his sister talked about what had happened. Or at least they tried.
Mom, her arms folded across her chest and a scowl on her face, was clearly still angry about being disobeyed. And maybe frightened about what could have happened the night before to her 16-year-old son.
Also in the kitchen was Tina Brown, a family intervention specialist with Youth Villages, a nationwide nonprofit dedicated to helping emotionally troubled children and their families. She’d been seeing Neko and his family three times a week since he came home. She brought with her a powerful new tool that’s also a revolutionary way of approaching troubled kids and the conflict they bring to their lives and their families.
It’s called Collaborative Problem Solving, or CPS, and the evidence-based intervention is part of a sweeping rethinking on the part of Youth Villages about what really makes kids act out, get into trouble with alcohol, drugs or sex, or even turn to violence or suicide. Youth Villages has already added CPS to the evidence-based interventions used in its programs in Oregon, Massachusetts, Indiana, Oklahoma, Mississippi and parts of Tennessee. Eventually, the treatment method will spread throughout the organization, which helps more than 22,000 children each year from 20 states and Washington, D.C.
Skill, Not Will
A leading proponent of CPS in the United States is Dr. Stuart Ablon, director of the Think:Kids program at the Massachusetts General Hospital in Boston and an associate professor of psychiatry at Harvard Medical School.
He points out that CPS flies in the face of the conventional wisdom that says children do well only if they want to. If kids don’t follow the rules, conventional wisdom says, they are lazy, unmotivated or defiant. If they disrupt class or kick the door in during an angry outburst or worse, they are just looking for attention.
“So if kids don’t behave,” Ablon said, “they must not want to.”
Ridiculous, he added. “Kids do well if they can. I have yet to meet a kid who prefers doing poorly to doing well.”
Think of it this way: The most challenged kids have delays in brain development from a young age that make it harder for them to learn three critical skills – flexibility, the ability to tolerate frustration and problem solving.
“These deficits come from chronic stress and trauma that is actually toxic to the brain,” explained Ablon. “Toxic stress literally delays brain development.”
Which means that traditional discipline or other interventions don’t build the skills that these kids need, exacerbating their differences, eroding their relationships and “making the kids feel horrible,” noted Ablon.
Enter CPS, which is set up to teach kids – and their families – the skills they need to learn to cope with, what psychiatrists call, dysregulation, but what is commonly known as anger, stress, excitement, temptation, upsetting events…the ups and downs of everyday life.
“It’s one of the few interventions that I know of where the treatment itself is the lever that allows a kid to get better,” said Dr. Tim Goldsmith, chief clinical officer at Youth Villages. “Not only do you get the problem solved and you get better behavior, but also kids’ brains get better at the same time. There aren’t very many things that do that.”
Making a Plan B
At the heart of CPS, said Katherine Peatross, Youth Villages’ clinical program manager, is a decision about what kind of conversation will happen when conflict occurs.
“There are three ways to manage unmet expectations or triggers between a kid and his or her parent or guardian,” she added.
The first is called Plan A, and will sound familiar to traditional disciplinarians: An adult imposes his or her will on a child, basically saying, “Do this because I say so.” Threatening consequences or counting to three qualify as Plan A conversations, too, since the child at the heart of the conflict has no say-so. Youth Villages’ experts are quick to point out that an adult is always responsible for a child’s safety, but usually Plan A conversations aren’t about an immediate physical threat.
The second option is a Plan B conversation, and here’s where CPS actually happens.
“The first step is empathy,” said Peatross, pointing out that Plan B conversations have specific steps, but at its base they are about solving a problem. “Ask the child about the problem using neutral observations. ‘I’ve noticed that … what’s up with that?’”
Here’s where the idea that kids will do well if they can becomes clearer. “You focus on the circumstances around the problem, and get the child’s perspective. Then you have an opportunity to express your concern about a problem and begin to come up with solutions.” The goal is solving the problem for both the adult and the kid. Which means the adult doesn’t get to decide in advance what the solution to the problem might be.
Plan C is not failure it’s an important part of the process -- an agreement to drop the conflict for now, to walk away.
“Plan B conversations are hard,” Peatross acknowledged, “and they don’t always work, you don’t always get to a solution.” But especially for kids who are easily frustrated, quick to anger, and have trouble being flexible, the skills they learn through muddling through Plan B conversations, with either their therapist, parent, guardian or teacher are critical.
“It’s the conversation itself that is the treatment,” said Peatross, compared to other therapies that happen in a therapist’s office, cut off from regular life and problems. “Every back-and-forth may be a dose.” The people who are involved in the problem – both the kids and their family members – are the ones learning to solve it, with everyone sharpening their skills for the next time, and the next.
Yes, it’s messy, Ablon admitted. “If not everyone is on board, if there’s tension all around, that means change is starting to happen.”
For Neko, CPS (with an assist from Brown) became a way to learn how to tell his mother what his real concern was when he bolted from the apartment that night: He was worried they didn’t have enough diapers for the baby, and knew his grandfather would give him the money to buy more. Later in the conversation, though, the talk turned to what Neko would do if he was confronted again with guys trying to get him to do drugs.
“Can I get back to you tomorrow on that?” he asked.
Plan C.
The strategy Neko came up with the next day involved staying away from a particular park at the time he thought the drug guys would be there, and planning to walk away if he saw them again. Problem solved? Maybe not forever, but both Neko and his mother have skills they can use, and hone, when the next problem arises.
“It’s difficult to work with kids,” said Brent Doyle, clinical training consultant at Youth Villages, “but the biggest struggle on the front end is changing the mindset of the adults closest to them.”
In fact, adults are often as much a part of the problem as the kids who are struggling, and for many of the same reasons – toxic stress, drug and alcohol problems, exposure to violence or abuse. CPS, added Doyle, has become the backbone of Youth Villages’ clinical decision making, for all their families across all their programs.
After all, “Adults do well if they can, too.”
Does CPS Really Work?
Implementing CPS across Youth Villages is a major shift in approach, and part of that, in keeping with the organization’s mission, is assessing how CPS is working. In many ways, Youth Villages is set up to do just the kind of cutting-edge research that could keep building momentum for CPS, both across the Youth Villages system and with Think:Kids.
“We have the infrastructure that most of their other partners don’t have to accomplish different kinds of research,” said Sarah Hurley, Ph.D., director of data science at Youth Villages.
The studies that Youth Villages and Think:Kids will collaborate on are focused on two Memphis-area middle schools. They will involve comparing how CPS works in the classroom with classrooms not using it and will also develop a measurement to see how well CPS is working. Finally, the two organizations will work with youth in a Youth Villages residential program in Georgia to measure the brain changes that effective, consistent use of CPS might be making in the kids who learn it.
“It’s a very exciting partnership,” concluded Hurley. “It has brought us a new set of tools to help us assist a population with very difficult problems.”
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