The notion of an orphanage in the United States is a bit antiquated these days, but, in Stacia Hornbacher’s view, the Echo Glen Children’s Center in some respects serves exactly that role. This, she says, is a good thing.

“By the time they reach us, these kids are damaged goods,” says Hornbacher, an RN who serves as the facility’s health services administrator. “We provide a stable place where they stay for a period of time and develop relationships with staff and with each other. It’s a family structure with daily routines, something they may not have had before.”

This safe, supportive environment is the backdrop for the innovative work being done to rehabilitate the juvenile offenders at this Washington State facility. Given that many of these youth arrive with significant problems—such as substance abuse, cognitive impairment, criminally violent behavior—they also need intense interventions. That, in fact, is why they are sent to Echo Glen, whose evidence-based cognitive-behavioral therapy (CBT) model is winning accolades across the nation. A component of that model, dialectical behavioral therapy (DBT), even earned NCCHC’s 2006 Program of the Year award.

Radical Model, Real Success
Over the past 10 years, incidence of mental illness among the youth at Echo Glen has risen sharply, from less than 40% to 70%, according to superintendent Don Mead, EdD. In response, the facility piloted and then implemented what was a “radical new approach” at the time. Key features of this approach are as follows:

• It motivates and engages the youth by orienting them to treatment, linking its benefits to their goals and gaining their commitment.

• It teaches the youth new skills and problem-solving techniques, including mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance.

• It provides a supportive environment in which the youth can test and practice their new skills and problem-solving abilities, thus helping to apply them elsewhere.

• It also enhances the motivation and capabilities of the therapists. This increases the effectiveness of their interventions with the youth.

Evaluation of the pilot after one year revealed impressive successes:

• 90% reduction in parasuicidal incidents

• 90% reduction in assault incidents

• 100% more youth keeping a full-time job on campus

• 83% more youth earning a GED on campus

• 83% more youth completing the campus inpatient drug and alcohol treatment program

• 86% more youth successfully transitioning from a mental health cottage to a nonmental health cottage

The treatment also may reduce recidivism, according to a study by the Washington State Institute for Public Policy.

Due to these successes, DBT has become a core component of treatment programs at the other facilities operated by the state’s Juvenile Rehabilitation Administration.

Health Care ... and More
The health staff at Echo Glen also must deal with a full complement of adolescent medical issues, some arising from lack of preventive care earlier in life and many requiring complex medical case management. Most common are chronic problems such as diabetes, orthopedic issues, sports injuries, obesity and ob-gyn needs, according to acting medical director Penny Tronolone, MD.

When a child has a serious special need, such as leukemia, the staff strive to provide routine care on site (just like at home, Hornbacher notes), with trips to specialists as needed. Overall, though, she estimates that up to 90% of the medical, dental and mental health care is provided on-site.

To foster true healing in each youth, programs and services go beyond a narrow definition of rehabilitation. The facility offers treatment for sex offenders, substance abuse treatment and education, gender-specific services, education on healthy lifestyles, programs to nurture family involvement and support, and spiritual growth through the chaplaincy. An extensive volunteer network supports numerous activities, including a “canine connection” program that pairs unwanted dogs with youth who train them for adoption in the community.

 “We do a good job of taking care of these kids physically and mentally,” says Hornbacher, “but feeding the soul is also part of rehabilitation. That’s how we see it in the CBT. If we provide little things they can hook into, it can give a whole new focus to their lives.”

— About the author: Jaime Shimkus is NCCHC’s publications editor. To contact her, e-mail jaimeshimkus@ncchc.org.