Riverview Hospital for Children and Youth. Richard J. Wiseman

in November 1969, after giving us the chance to get the lay of the land, the ad hoc subcommittee of the hospital’s Advisory Committee, which had been formed to develop a children’s program, invited the newly appointed co-directors to its meeting. Issues of construction were discussed. The plans called for three phases, each with its own bond issue. The first phase, which had already begun, was the building of three 16-bed cottage-type facilities and renovating the Silvermine Building as an administrative, clinical, and dining facility. The second phase was the construction a new school, and the third was the construction of four additional cottage-type residential units, totaling 112 beds.

      Prior to the meeting, Peter and I surveyed several children’s programs nationally and found there was nearly unanimous agreement that the maximum size of a children’s psychiatric hospital should be no more than fifty or sixty beds. Also, while we supported the cottage-type facilities, we were concerned about the security of the design, especially for the autistic children and for those who might need a more secure setting. We also recognized that there was a need for additional beds but felt that they should be built in two different areas of the state. As a result of this discussion, the commissioner sent a letter to the Department of Public Works to stop planning the additional four residential units but instead to use the money to construct a specially designed facility for children with autism and an intensive care division. Since the latter would obviously take much more time, interim plans had to be revised to accommodate those children. Consequently, we made temporary accommodations in the Silvermine Building. We divided the third floor into an autistic unit and administrative offices, a medical records room, and a conference room. The middle floor became an intensive care unit. We discussed plans for the new school to accommodate up to one hundred children in order to offer a partial hospitalization program.

      Up to this point, children would arrive in an ambulance, without notice, and be automatically admitted by the resident psychiatrist on-call on the basis of “cautious clinical judgment.” We assumed authority to control admissions, which now required a call to the hospital intake staff and a discussion with the referring agency. Our staff discussed each pending transport and assessed with the referring agency the appropriateness of hospitalization. In many cases alternative solutions made more sense. According to the statistics for that year, 324 children had been served, with 225 in residence, 157 new, and 148 discharged. As of the end of June 1970, the census was 74, that is, 59 boys and 15 girls.

      Peter Marshall and I were acutely aware of Marge Stahl’s work to bring some sanity to the Children’s Unit. She had a strong, positive, and loyal relationship with her staff and we were newcomers, taking over her territory. Initially assuming we would have to win her over, we soon learned that this concern was unnecessary. Marge welcomed our help, support, and initiative.

      Thus began a new era and an enormous challenge for all of us.

      Since I had worked previously in the Psychology Department of CVH and the central office of the Department of Mental Health and knew the various departmental heads, it fell upon me to do most of the administrative work, dealing with old friends: Eugene O’Brien, the CVH business manager; Donna Dickson, the personnel director; Dwight Shuman, the director of nursing; and various others at the hospital and central office where I had previously worked.

      Peter would be responsible for the education program, given his experience with boards of education and school operations. Marge reverted to her role as director of residential care. This group, along with Jacqueline Reardon, our secretary, became the administrative staff. Soon, the Yale Child Study came through for us again by assigning as consultants two child psychiatrists, Alan Gurwitt and Norton Garber. They not only gave guidance to our few clinicians but also were enormously supportive of Peter and me. Yale’s Psychology Department assisted by assigning one full-time psychologist and two part-time psychology interns.

      STRUCTURE

      Early in our talks, Peter and I had discussed the importance of milieu therapy, an approach we each had experienced. Milieu therapy embraces the need for the children’s entire environment to reflect a therapeutic mission—the landscape, the buildings, the staff, the policies and procedures, and in particular the residential units, where the children spend a good part of every day and night. To ensure that a milieu approach was taken, we chose to take direct responsibility for this segment of the program and philosophy. The book The Other 23 Hours by Brendtro, Whittaker, and Trieschman became our bible.¹

      One of our first concerns, therefore, focused on the basic structure of the unit. As strong advocates of the other twenty-three hours (meaning the time spent between therapy sessions), we felt it important to devote most of our energy to revamping residential units, recreation, and schooling. There were three residential units. Ward 91 was a twenty-bed, all-girl unit. Peter Marshall, because of his previous extensive work with young adolescent girls, became the coordinator. Because of my previous work with autistic children, I became coordinator of the Autistic Unit, and Peter and I shared coordination of the boys’ ward. Marge Stahl took responsibility for the basic needs of the units, such as scheduling work hours and overtime, supervising staff, organizing medications, and providing all the other daily necessities of group living. Clinical services were provided primarily by social workers and caseworkers, with Marcia Pease-Grant as their supervisor. Additionally, psychology interns and resident psychiatrists were minimally available.

      In our first annual report, we noted new members of the staff. David Hickox, a part-time pediatrician, proved to be an invaluable asset to the program. Each morning he would see any child on sick call, examine new admissions, and generally provide TLC to children and staff. He made himself available in emergency situations from his group practice in Middletown and was our primary liaison with Middlesex Community Hospital. This was a big improvement over a visit to the CVH infirmary serving primarily adult patients, a frightening experience for our kids and staff. We also hired during this period a caseworker for the Autistic Unit, Judith Deras; a psychiatric consultant for the Autistic Unit, Virginia Suttenfield; a behavior modification consultant, Joseph Cautella; two social group workers, David Merry and Roger Wehage; and two nurse clinical specialists, Diane St. Jean and Karen Fredricks. The first fieldwork placement from the University of Connecticut School of Social Work—Esther Adam—and three psychology interns—James Tracy, Margaret Hull, and Peter Bishop—also joined our growing clinical staff.

      As encouraging as it was to welcome new colleagues, serious concerns were also reflected in our annual report:

      By far the greatest problem we have encountered as co-directors of the Children’s Unit has been the great discrepancy between what is expected of our staff and what is possible given the resources available. Further, the coordination of services is often obtained only after interminable delays, unimaginable expenditures of time, energy, skill and paperwork. Even when the proper documents are forwarded to all parties concerned, there is no guarantee that the finances requested will be approved on time, in sufficient amount or at all. Under these circumstances, we understand why there is so much professional resistance to the need for change and a lack of commitment to our program and children; yet we are seeing an encouraging development of openness, of feelings and sharing of advocacy for our children by our staff.

      The great shortage of skilled psychiatrists has made it mandatory for us to use non-medical psychologists, social workers and psychology interns to carry out the major clinical responsibility of diagnosis, treatment and discharge planning. Our psychiatric coverage has been poor, necessitating our decision and need to plan for and develop a Residency Training Program.²

      On the other hand, Arafeh’s superintendent’s quarterly report of July–December 1970 stated: “The autistic program has improved greatly. It can be said that it is now one of the best such programs in the northeast. There is also evidence of improved overall programming This Service has succeeded in recruiting high level and dedicated staff and consultants, and enlisting the cooperation of the Association of Child Psychiatry and the Association of Child Psychiatric Clinics in the state.”³ These encouraging words gave us a significant boost in morale.

      It was clear that the Children’s Unit was viewed by staff as a place for children to stay while a residential treatment center or other childcare facility was sought. There were at this time very few public