Behrens Study vs. ASTART Debate thread

[Whooter]

Overseen by a third party?   Paid for by Aspen, you mean.  There are plenty of problems with that "study".  So many, in fact, that I thought you had long ago given up on defending it.  Here's a detailed thread on the topic (of which there are many).  Let's keep discussion of the Behrens study to that thread, if we can, as it's closer to the topic than this thread.  Far too many threads have been derailed talking about that study.

The study was funded by Aspen Education, Conducted by Canyon Research and was overseen by a third party.  The 3rd party was WIRB which is an Institutional Review board.  They reviewed and approved the study and looked at areas like the Canyon Research employees previous ties to the industry, if they had any financial ties(other than the current study)during the study etc..  WIRB is also responsible for reviewing the majority of drug submissions to the FDA.  So they are a reputable firm.

This was a study conducted surveying 1,000 parents and graduates of a few programs. The results were presented at the Annual meeting of the APA American Psychological Association.

If my memory serves me well the study showed that up to 80% of the kids who graduated from the programs studied were still doing well after 2 years.  Most people with an anti program bias reject the results, but aside from this small population the study serves as a great piece of information for parents and professionals alike when determining the success of the industry.

The next best thing would be for someone to fund a study who has no ties to the industry and include more programs and track these kids for 2 or more years post graduation.


Review Study here



...

[psy]

And the other side of the argument is here.  I kindly request we drop it here as everything that can be said on the topic likely already has been.

[Whooter]

And the other side of the argument is here.  I kindly request we drop it here as everything that can be said on the topic likely already has been.

Psy, I agree we can leave it here, but, I dont know if you are aware that the other side of the argument, you linked to, was written by ASTART.  If you have ever visited their web site you would find that they are extremely anti-program.  I dont think they could ever give a credible review/assessment of a study conducted on the industry.  If you look at the “parents speak out section” the results are 100% negative.  They lead you to believe not one child has ever been helped.  At least the study states that some kids did well and others did not.  Do you really believe they are posting an accurate account of what they hear from parents or report an accurate review of an independent study?  Or do they print what they feel fills their agenda?

The study was presented in front of the (APA) American Psychological Association. a small obscure website cant be considered credible when deciding if the study is worthy or not.  I think most people would agree.



...

[blombrowski]

In full disclosure I'm a member of ASTART - so feel free to take that into consideration.  However, the following should not be construed as being in any way representing the viewpoints of ASTART

ASTART is a small ad-hoc organization.  And yes it's viewpoints are slanted against entrepreneurial residential treatment, but  I wouldn't call the organization anti-residential.  It has a strong public health orientation.  And a skepticism of the role of the private marketplace to deliver good outcomes when it comes to health care, particularly behavioral health care.

However, the credentials of the individuals who developed the critique of the Behrens study are the kinds of folks who have been asked to keynote conferences, not just provide a poster presentation at them.  Robert Friedman facilitated a mental health research conference for almost 25 years.

The critique stands on its own merits.  You can take from it what you will.  The critique still allows for you to take away from it that parents and youth perceive that the youth has made progress from the time they entered the program to the time that they left the program.  That's not nothing.  For a lot of families it's enough.  As marketing research its something, as public health research it's junk.  It doesn't go far beyond being a satisfaction survey.

Now, if ASPEN or one of their representatives wants to return the favor and critique the quality of some of the mental health outcomes research of it's competitors, they're more than welcome to do that.  The public health research also suggests that the average person should wait to have a mammogram, bases evidence on recidivism rates and not educational outcomes when it holds MST up as a standard, and advocates policies that would inhibit individuals being able to get the very best care that they can afford, but would lead to the best outcomes across the population.

[blombrowski]

http://natsap.org/wp-content/uploads/20 ... I-2013.pdf

The Alpine Academy study I referenced in another thread apparently was just published here.  There is no study here that is as egregious as the Behrens study in terms of establishing conclusions.  And in fact, there is no study that singularly features ASEPN programs - Jared Balmer has left ASPEN to start his own 36 bed program focusing on anxiety disorders in boys.

I want to give NATSAP credit for not engaging in deception with the research that they have peer-reviewed.  But what's left is pretty weak in terms of outcomes.  

In all, what's presented is pretty weak in terms of who they treat, how they treat it, and what the final outcomes are.  And the singular message is, that youth respond to structure and accountability, but the NATSAP programs don't have the power to remake families (well, they could if they actually provided more than parent seminars and actually did some real family work) or society.

[Whooter]

I guess many can argue whether or not the studies covered enough ground (personally I wish they had tracked these kids for longer periods of time), but from the few studies that have been done the result have been positive and encouraging.  As a minimum the studies show that the kids are placed on a good track.  I don’t think we can fault the programs for lack of studies.  Drug trials are typically funded by private donors, the government or the drug companies themselves.  Many here and at places like ASTART do not accept any studies which are funded by the industry even though they are overseen by a 3rd party.  I firmly believe that if the studies had come out negative towards the industry then people here on fornits and at ASTART would embrace the results and the structure of the study would be less of an issue.
 
So that leaves private donations or the Government and I don't think they see any future value in doing this.  Obama care or any other insurance company would never consider any residential treatment beyond 30 days so why invest in a study?  All proceeds will be coming from those who can afford out-of-pocket costs for decades to come and the industry needs to continue reaching out to those who can afford the cost.



...

[blombrowski]

Fair enough, though the problem with the Behrens study was less the study itself, but how it was marketed.  A for-profit company commissioned a study that analyzes and tells the story of the data in such a way that makes the company look good.  Behrens wasn't paid to cook the data, that would be unethical, but she brings her own biases to bear in looking for the best story to tell with the data.

ASPEN presenting the data as a for-profit entity for marketing purposes, is actually less obnoxious than NATSAP presenting the data to make an objective statement about the scientific effects of the treatment that their member programs provide.  But this was back in the Jan Moss era, so I think we can let bygones be bygones.

But as I said, I think the issue has been resolved.  I credit NATSAP, and the member programs that are collecting and sharing data, to try to understand the treatment effects of their programs.  And for showing their hand based on what they're measuring, what is they thing that they're treating.  

Certainly in the case of Montana Academy, that's clear - send your kid to rural Montana so they can mature - never mind why a young person might be demonstrating immaturity (were they sexually abused, are their parents terrible role models when it comes to maturity and narcissism, are they just spoiled brats).  Simple answers, simple solutions, simple analysis.  Not saying it's not well-meaning - but that's how you can both have some real successes in these programs and cause real harm, and it's rather predictable.

[Whooter]

Everyone markets study results and tries to leverage the results to their advantage:

“four out of five dentists recommended sugarless gum for their patients who chew gum".  They may fail to tell you that the fifth dentist recommended that his patients not chew gum at all.  That would be bad for the gum industry.

The people that conduct studies typically have ties to the industry that they are conducting.  Heart studies have heart doctors, drug studies have clinicians and specialists who once worked for private industry and so on.  Its very common and in fact makes the study more viable because the people are familiar with the area being studied and can better direct them.  The problem is if there is money changing hands to sway the results and this is where an IRB comes in.  They approve the study and insure it is done fairly.



...

[blombrowski]

Well yes, glad you agree.  Look I appreciate your vigor in defending your perspective.  

I look at the parent-choice industry as akin to the carbon fuel industry or the gun industry.  Both industries provide a valuable commodity that the people who consume the commodity get utility from.  That there are safer products that produce fewer externalities, that are however less efficient is of no interest to the industry, unless they determine that there is in fact a market for them.  

That an industry that produces such externalities, provokes such criticisms by those who are worried about the effects that are spread over the entire population should not be surprising. With guns it's the suicide rate, with oil it's pollution, and with the TTI it's how the industry reinforces the stigma of behavioral disorders by actively segregating individuals with those behaviors from the community.

These are just some examples of the community impacts from a service or commodity that benefits individuals at the personal level.  It should be obvious to all how it tends to be conservatives who support policies that benefit the individual, and it's liberals who tend to benefit policies whose benefits are distributed across the public.

(I chose to use oil and guns and not tobacco as my comparison point, because I recognize for the right person in the right situation and the right time the use of carbon fuels, and the use of a gun might be the most beneficial thing for society, but it's their overuse, and building of policy around their use, and even poorly thought out laws and implementation of such laws that seek to limit their use, that create preventable harm)

A question directly to Whooter.  Is it too much to ask those who operate and work in programs, and those who refer to programs to think about the broader impact of the services they provide beyond the transactional relationship.  As many of the individuals in the industry are in fact licensed social workers, do they have a responsibility to society that goes beyond their client?  This was an issue that was brought up in a workshop I attended that looked at programs that operate in the public sector who are looking to or have entered the private pay market - and whether it reenforces classism to separate the two populations in two different programs (i.e. Starr Commonwealth/Montcalm Schools as one approach or the combined population at Wediko which is another).   Or is their only responsibility to the client?

[Whooter]

A question directly to Whooter.  Is it too much to ask those who operate and work in programs, and those who refer to programs to think about the broader impact of the services they provide beyond the transactional relationship.  As many of the individuals in the industry are in fact licensed social workers, do they have a responsibility to society that goes beyond their client?  This was an issue that was brought up in a workshop I attended that looked at programs that operate in the public sector who are looking to or have entered the private pay market - and whether it reenforces classism to separate the two populations in two different programs (i.e. Starr Commonwealth/Montcalm Schools as one approach or the combined population at Wediko which is another).   Or is their only responsibility to the client?

My opinion:

We all have a responsibility to society  because we are an intricate part of it but Doctors, nurse, LCSW's etc particularly do not have a responsibility to society when dealing with a person in their care.  

Brombowski, The reason why I think this way is they need to advocate for their patient first and society second.  LCSW’s are trained to work with people one on one (like most medical professionals), not society as a whole.

If your patient is 65 years old and needs a new kidney, should you allow a patient who is 35 to get that kidney because they are younger and would be better served by it and can better contribute to society?  Would you under-treat a patient for pain for fear they would become addicted and may need further treatment for addiction and become a burden on society?  Should a doctor provide expensive intensive care for a newborn who is likely to die or have a terrible quality of life, which would impact society and the cost to care for this child?  Would you breach patient confidentiality if you know the patients’ health status would inflict harm on others in society like communicable diseases?  Would you perform an abortion if the mothers life was in danger if she carried full term even if society decides it is against the law?  or if your personal religion was against abortion? What is the right decision?

LCSW cannot take all of that on, they need to advocate for the patient that they have responsibility for (at that moment in time) and do the best they can to improve that persons quality of life.



...

[blombrowski]

It was an honest question, and that was an honest answer, thanks.

[blombrowski]

And btw, those are all really good examples.  The follow-up then is, when the legitimate care of the individual, interferes with the well-being of the many, or the mores of society, does government have a legitimate role in intervening between the client-helper relationship.  I suppose the answer will depend on where you stand politically and the specifics of the situation.

[Whooter]

I think each case has to be handled individually.  For example individuals should be able to choose if they want to smoke cigarettes or not.  But their decision to smoke will affect society as a whole exposing them to second hand smoke, creating health issues with themselves which will burden society financially when society has to pick up the tab for their long term care.

We, as a society, cannot just make cigarette smoking illegal but we can educate the people on the dangers of smoking and raise the taxes on cigarettes to help pay for the damage they do financially and ease the burden of the non-smokers.  As costs increase so does taxes until smoking becomes too expensive to abuse.

The key, in most cases, is to keep the government as small as possible and out of the decision making process.  A large government is bad for the individual and bad for society as a whole.



...

[psy]

I hope y'all don't mind.  I split the thread and re-titled it to something neutral.  It was either that or bump one of the other old threads and have two competing threads on the same topic going at the same time.  Feel free to quote any of the other posts from other threads if you feel something has been cut off or left out.  I've been on vacation for the past few days so please excuse my lack of participation in this debate.

Drug trials are typically funded by private donors, the government or the drug companies themselves.

But pharmaceuticals are much unlike the industry in that the FDA has to verify, with years of research and mountains of evidence, that a particular drug is safe before it is sold to the public.  The industry has never been held to any comparable standard. It makes it's own rules and you're darned right that who pays for a study and whether or not it's peer reviewed matters.  It's the difference between marketing and science.  If a program controls the data and pays for the "research", there is a good chance that it's going to make the program look good.  They wouldn't very well pay for it otherwise.  Even still, they make mistakes and drugs are recalled. More often than not, programs have to be shut down by the authorities or sued out of existence before they stop doing what they've always done.

Parents should not be trusting their kids with untested techniques regardless of desperation.  The miracle cure of today very often turns out to be the quackery of tomorrow.  People once lined up, voluntarily, to get "ice-pick" trans-orbital lobotomies.  We now consider this barbaric, and those who were subjected to it, victims.  The same is true of those who went through the last generation of programs.  The Seed turned out to be harmful.  Oops.  Next one will be better.  Straight too.  Cedu as well.  Can't forget WWASP.

And now we have Aspen and so forth, all derived from the last generation of programs, and doing more or less the exact same things the previous generation used to do (See Aspen Program MBA's LifeSteps, and how they were IDENTICAL to the Propheets at CEDU/Hilltop, and in the CEDU derived program I was in, down to the french maid outfit).  Yet we're supposed to believe that they've changed, or that they're safe, or that forcing little girls to sexualize and humiliate themselves in front of an audience is somehow a good thing.

You want to tell me that's beneficial?  Well.  Perhaps it works.  In the same way that a trans-orbital lobotomy worked.  They're anxieties and depression -- everything faded away.  The results were there, but so were the scars.  Hollow people with hollow thoughts and no real feelings -- compliant and docile pet humans.  It's for this reason that even if the study is accurate, it mean nothing whatsoever to me.  If the consequence of being involuntarily "healed" is the loss of individuality, is the loss of any sort or rebellion, then that cure comes at the cost of the very thing that makes us human.

Brian has never been in a program so he doesn't know what it's like.  I do.  Data does not matter.  Even if.  Even if your data was accurate and even if the study was independent and peer reviewed.  It would still be ignoring the barbarity of the process.  I've seen the hollow people walking around.  You look into their eyes and you can tell that the spark of life is gone, and even when they leave the program and inevitably snap out of it, they're never quite the same again.  Like a lobotomy or FGM, such a permanent act should never be performed on a person, even a child, without their consent.

I get the ethical dilemma.  What do you do if a kid is shooting heroin or smoking meth or whatever.  Fine.  That's a big problem and maybe in those cases a detox and outpatient therapy are probably appropriate, but most of these kids who are in these programs are there for the "issues" the program targets in the marketing with reads like a laundry list of every behavioral problem known to man -- and they're all treated the same way!  I can't imagine that being successful. If it was, wouldn't these techniques have been adopted by mainstream mental health?  Is there a conspiracy against the techniques the programs use that legitimate therapists would never dare adopt them?  Are programs that far ahead of legitimate science?  I'm not buying it, and even if it were true, it wouldn't make it right.  There are far better ways of treating kids locally, but that's another topic.

[DannyB II]

I hope y'all don't mind.  I split the thread and re-titled it to something neutral.  It was either that or bump one of the other old threads and have two competing threads on the same topic going at the same time.  Feel free to quote any of the other posts from other threads if you feel something has been cut off or left out.  I've been on vacation for the past few days so please excuse my lack of participation in this debate.

Drug trials are typically funded by private donors, the government or the drug companies themselves.

But pharmaceuticals are much unlike the industry in that the FDA has to verify, with years of research and mountains of evidence, that a particular drug is safe before it is sold to the public.  The industry has never been held to any comparable standard. It makes it's own rules and you're darned right that who pays for a study and whether or not it's peer reviewed matters.  It's the difference between marketing and science.  If a program controls the data and pays for the "research", there is a good chance that it's going to make the program look good.  They wouldn't very well pay for it otherwise.  Even still, they make mistakes and drugs are recalled. More often than not, programs have to be shut down by the authorities or sued out of existence before they stop doing what they've always done.

Parents should not be trusting their kids with untested techniques regardless of desperation.  The miracle cure of today very often turns out to be the quackery of tomorrow.  People once lined up, voluntarily, to get "ice-pick" trans-orbital lobotomies.  We now consider this barbaric, and those who were subjected to it, victims.  The same is true of those who went through the last generation of programs.  The Seed turned out to be harmful.  Oops.  Next one will be better.  Straight too.  Cedu as well.  Can't forget WWASP.

And now we have Aspen and so forth, all derived from the last generation of programs, and doing more or less the exact same things the previous generation used to do (See Aspen Program MBA's LifeSteps, and how they were IDENTICAL to the Propheets at CEDU/Hilltop, and in the CEDU derived program I was in, down to the french maid outfit).  Yet we're supposed to believe that they've changed, or that they're safe, or that forcing little girls to sexualize and humiliate themselves in front of an audience is somehow a good thing.

You want to tell me that's beneficial?  Well.  Perhaps it works.  In the same way that a trans-orbital lobotomy worked.  They're anxieties and depression -- everything faded away.  The results were there, but so were the scars.  Hollow people with hollow thoughts and no real feelings -- compliant and docile pet humans.  It's for this reason that even if the study is accurate, it mean nothing whatsoever to me.  If the consequence of being involuntarily "healed" is the loss of individuality, is the loss of any sort or rebellion, then that cure comes at the cost of the very thing that makes us human.

Brian has never been in a program so he doesn't know what it's like.  I do.  Data does not matter.  Even if.  Even if your data was accurate and even if the study was independent and peer reviewed.  It would still be ignoring the barbarity of the process.  I've seen the hollow people walking around.  You look into their eyes and you can tell that the spark of life is gone, and even when they leave the program and inevitably snap out of it, they're never quite the same again.  Like a lobotomy or FGM, such a permanent act should never be performed on a person, even a child, without their consent.

I get the ethical dilemma.  What do you do if a kid is shooting heroin or smoking meth or whatever.  Fine.  That's a big problem and maybe in those cases a detox and outpatient therapy are probably appropriate, but most of these kids who are in these programs are there for the "issues" the program targets in the marketing with reads like a laundry list of every behavioral problem known to man -- and they're all treated the same way!  I can't imagine that being successful. If it was, wouldn't these techniques have been adopted by mainstream mental health?  Is there a conspiracy against the techniques the programs use that legitimate therapists would never dare adopt them?  Are programs that far ahead of legitimate science?  I'm not buying it, and even if it were true it wouldn't make it right.  There are far better ways of treating kids locally, but that's another topic.

Here is the link for an article about Dr.Walter Freeman, AKA "The Showman".   http://psychcentral.com/blog/archives/2 ... -lobotomy/

Excerpt from the article:

"He wanted to find a more efficient way to perform the procedure without drilling into a person’s head like Moniz did. So he created the 10-minute transorbital lobotomy (known as the “ice-pick” lobotomy), which was first performed at his Washington, D.C. office on January 17, 1946.

(Freeman would go on to perform about 2,500 lobotomies. Known as a showman, he once performed 25 lobotomies in one day. To shock his audiences, he also liked to insert picks in both eyes simultaneously.)

According to the NPR article, the procedure went as follows:

“As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. Freeman would then take a sharp ice pick-like instrument, insert it above the patient’s eyeball through the orbit of the eye, into the frontal lobes of the brain, moving the instrument back and forth. Then he would do the same thing on the other side of the face.”

Yes, the industry is evolving and thank god but the motives never evolve. Still the same, GREED!! When money is more important than the safety of people, there is a big problem with society.