Since launching All Kinds of Therapy, I have received emails & phone calls from families asking complex questions about transport, such as “will my child forgive me for this?” or “I don’t know if I want transporters or an interventionist” or “my child may not be willing to go.” And so I wanted to have someone clarify what an “assisted enrollment” is and why a family might need one. I came to interviewing Courtney Merrill, LMFT, who was my consultant colleague at School Counseling Group in Washington, DC. Besides four years as a therapeutic placement consultant, she was a clinical director & executive director of a residential treatment facility in UT & a therapist at a wilderness program in AZ. Now, she is the admissions director at a Wilderness Therapy program, True North, in VT.
(Another wilderness therapy program that implements assisted transports is Summit Achievement (ME)
Courtney, you have worked with students in different settings & assisted parents on making the decision to go to treatment. For the purposes of this interview/blog, let’s talk about the process of getting a student to enroll or a family to the process of an assisted enrollment.
How do you define an assisted enrollment?
An assisted enrollment is an enrollment into a program that requires assistance from interventionists. This resembles a traditional transport, when people other than family members come into the home to help the child safely arrive to the program but an assisted enrollment differs from a traditional transport in the following ways:
1. Parents are always involved in the initial intervention in the home. They are responsible for telling their child what is happening. Parents are asked to be simple and concise as they share the plan with their child, but they are also asked to be transparent. They need to let the child know the very basics of the program they will be attending so that the child can understand what is happening. In our case, we ask that parents share at least the following information:
- The program is therapeutic in nature (not just a summer camp)
- The program is outdoors
- The program lasts an average of 10 weeks depending on the work
2. Parents are not expected to convince their child to go to the program, so we also ask that they refrain from a lot of explaining beyond the basics. We also expect them to hold a strong boundary, letting their child know that they have made a decision to enroll them in a program because they care about them, and that they will not change their mind. At True North, we also ask that at least one of the parents come to the program for the enrollment process, even though the child will travel separately with the interventionists. This communicates to the child that the parents are also involved in the process and committed to doing their part.
3. The intervention generally takes place in the morning as opposed to very early or in the middle of the night. This decision is often related to logistics, but there is some flexibility involved in an assisted enrollment, meaning that the interventionists can assess the situation and take additional time if needed in order to help the child to develop some initial buy-in.
4. The child has to agree on a basic level to participation in the program. We are looking for commitment to be in the program. This doesn’t mean they are happy or excited about it. Most of the time it is an understanding that their parents have made the decision and they will need to go along with it because they have limited options.
5. There is some choice involved in the intervention. Generally in our case, the parents have chosen True North as their first choice for their child, but they also have a backup plan. The interventionists will explain that the child is going to a program that day, but they have some choice as to which program they will attend. The secondary program is always one that will accept a child through traditional teen transport, where the child doesn’t have to agree to participation.
Let us generalize for a minute, what type of family or client or situation would you look for when you were recommending an assisted enrollment?
As a consultant, there were two basic things I would look for that would help me determine whether to recommend assisted enrollment or traditional transport.
- The child had a history of being very resistant, particularly to the parents. I would especially be cognizant of children who had previously run away or been aggressive with their parents when boundaries had been held before.
- The parents had a history of having difficulty holding boundaries with the child.
In identifying a child who would be appropriate for an assisted enrollment as opposed to a traditional transport, generally I would look for students who had been resistant with their parents but more compliant when boundaries were held by other adults. If the concern was more about the parents and their ability to hold boundaries, they might also be appropriate for an assisted enrollment because the support of other adults would be conducive to a positive experience.
Now, as the admissions director for True North, there are essentially three pieces that I focus on in this particular process. The first is to determine whether the student is a good fit for True North. We have a specific profile and carefully evaluate each candidate to ensure that they will be an appropriate student for our program. We focus on students who do not have a history of being outwardly oppositional in their interactions with others. We do work with students who can be very resistant toward their parents, but generally they are not as oppositional with other adults outside the home. We rule out students who are at clear risk for running away due to an established history, have demonstrated serious aggression outside of their home, or present with active primary substance addiction. True North students tend to be anxious and/or depressed and we see a lot of avoidant behaviors, including school avoidance, spending a lot of time online, and hiding out in their rooms. Sometimes there is a student who fits this profile well, but their high anxiety, their struggle to cope with difficult emotions related to change and transition, and avoidant behaviors, along with resistance toward parents, will make it difficult for the parents to get them safely to True North.
Once we have determined that the child is a good fit, we will coach the families through the process of bringing their child to the program. Our hope and goal is that as many families as possible bring their child to the program without assistance. Sometimes parents are frightened and anxious but able to communicate their decision and support their child in enrolling. Sometimes the child is likely to be sad and anxious, but willing to attend. In those cases, with the support of the educational consultant, we recommend that they bring the child themselves.
If, in the course of those conversations, it becomes clear that the child is appropriate for our population, but still meets the special criteria above (highly resistant to parents and/or parents are unable to hold the boundary, or have some other circumstance that will make it difficult for them to participate in the enrollment such as a health issue, or special needs related to other family members, or complications related to international students), then with the support of the therapeutic expert we will recommend an assisted enrollment.
Would you know, as a consultant, the type of family when they walked into the office?
Sometimes it would be clear from the very first phone call that a family would require assistance in order to safely enroll their child in treatment. Other times it would be much more difficult to predict. I think sometimes as a consultant there was a temptation to recommend assisted enrollment or transport even when it wasn’t completely necessary because it is the safest option. Parents can be very anxious and very scared in this process and can worry a lot about what will happen when they present the plan to their children. I found that it was very important to address the anxiety and fear and help parents work through some of that, and that it was also important to gather information from other sources (therapists, schools, etc) before making a recommendation about transport. It is important as a professional not to absorb the anxiety and fear from the parents.
What happens if it goes wrong? If there are struggles that are unforeseen, did you as a consultant have a backup plan?
I have always worked with intervention professionals who I trust and who have a very strong reputation. Gratefully, I have had very few experiences where anything went wrong.
I have found, both as a consultant and as an admissions director, that it is essential to build a relationship of trust with the parents prior to this type of intervention and to prepare them for the possible difficulties that may occur. Reputable intervention professionals will also build trust with parents and prepare them for the possibilities. It’s difficult to predict exactly what will happen in these situations, but when we do our best to prepare parents, we can work through unforeseen difficulties. If something goes wrong and it has been forecast as a possibility, parents are much more likely to be able to move forward and work together with me towards Plan B.
As I mentioned, when we are working with an assisted enrollment that requires some buy-in from the student, it is always recommended that the family have a backup plan of a program that does not require buy-in.