Riverview Hospital for Children and Youth. Richard J. Wiseman

were dealt with in ill-equipped emergency rooms, and from there the children were sent to the Children’s Unit with a physicians’ fifteen-day certificate. This gave the hospital permission to accept a child without either the child’s or the parent’s approval. The hospital in turn had to decide whether or not the referral was appropriate. The policy at the time was to use “cautious clinical judgment.” Also, as the on-call physician was likely to be a resident in training with little or no previous training with children, admissions were almost automatic. Because children were sent to the Children’s Unit after failing in other placements, and were generally felt to be untreatable, they often stayed for many months and treatment consisted primarily of trying to hook them up with another program or with a family. The intake process improved when we created a position for our own intake staff.

      A short conversation about a child marked a turning point in treatment philosophy at the Children’s Unit. When the assigned clinician asked, “This child could really benefit from treatment. Where can we send him?”

      I replied, “I thought that’s why he was sent here.”

      Until now, our staff members had thought of themselves as custodial/placement persons rather than as treatment agents, and the excitement they now felt was obvious. From this simple dialogue, a treatment philosophy gradually developed in which the role of the Children’s Unit was to provide extended treatment for children who needed more than a brief stay, and community hospitals, not us, needed to develop emergency, short-term treatment. This enthusiasm fed our goal to develop a milieu program and a residential facility, as we encouraged local hospitals to develop short-term emergency programs. In fact, eventually, we would not accept children unless all community resources had been exhausted. We actively helped local hospitals develop children’s units. At Saint Raphael in New Haven, for example, we helped develop ACUTE, a short-term emergency setting for children and adolescents. We had an understanding that, should they make a referral to us, we would accept it unquestionably because we knew they had done their job. Similar agreements were made with other programs as they developed.

      Our annual report of 1970–1971 reflects this effort: “The reduction in admissions [from 157 in 1970 to 115 in 1971] reflects the new admission policy encouraging admissions of 14 and 15 year old boys to the community hospital serving their town of residence.” This not only reduced direct admissions to the Children’s Unit but improved communications and working relationships with community resources. Our report adds, “The referrals in general are also more appropriate.”⁴

      Interestingly, despite the fewer admissions, a new category of “total children served” shows a significant increase from 324 in 1970 to 447 in 1971, signifying an increase in work with children, families, and family members, including pre-admission interviews and aftercare (a program requiring clinicians to follow up for brief periods after discharge). Part of the 1970–1971 report, “A Philosophy of Treatment and Education,” set forth our commitment to placing greater importance and emphasis on the residential component, or the milieu, and redefining the role of the childcare staff as an integral part of the total treatment program: “Our psychiatrists, doctors and clinical staff must work patiently towards delegating to nurses and aides an important wider spectrum of authority to make decisions than they are accustomed to accepting—or that doctors are accustomed to granting. By the same token, nurses and aides must learn to assume authority they have not had before.”⁵

      Also, we emphasized the importance of including parents in all aspects of the hospital experience—intake, residency, and discharge. To complement our emerging philosophy, Peter and I offered a course called “The Life Cycle” to the entire Children’s Unit staff as well as staff members from CVH, Long Lane School, and the Department of Children and Families.

      We addressed our educational philosophy, too, and modeled it after William Glasser’s Schools Without Failure,⁶ as was our basic principle: No child will be considered too sick emotionally, or too disturbed, or too unmanageable to be deprived of an opportunity to learn.

      Summer school was very limited—half days, with special education graduate students from Central Connecticut State University providing the bulk of the work. Children’s Unit teachers were on a regular school schedule and not necessarily certified in special education. This was the fourth year that Central Connecticut State University provided this service, but the head of the program indicated it could not continue without supervising teachers. Recreation for the summer was equally short staffed. We had hit a hiring freeze and lacked the support of the Service Corps, which had been available the previous five years. Also, Camp Quinebaug was no longer available, because of a new rule that required overtime pay, despite the many staff members willing to give of their time and skills and work more than the mandated eight hours.

      Upon the election of Governor Meskill, everything was put on hold—as is often the case with a new administration—particularly our ability to fill staff vacancies or to hire new employees. The timing couldn’t have been worse for the Children’s Unit, as we could not move forward or continue pursing plans to move to our new facility without the necessary staff. Construction was completed and the Silvermine Complex was officially turned over to the hospital. However, staff shortages, as well as delays in the shipment of furnishings and equipment, postponed the move even further.

      We requested for the new facility fourteen psychiatric aides, one psychologist, and one psychiatrist. There was, at this time, no such title as “child psychiatrist,” and child psychology was not considered a specialty. Also, since CVH’S personnel office was not familiar with hiring people to work with children, there was large turnover of staff. Most had come from adult services. We therefore requested that we handle our own prescreening of applicants and set up our own personnel office. The prescreening was reluctantly agreed to and was cause for a lot of friction over the years between the Children’s Unit and CVH’s personnel office. Also, while the idea of setting up our own personnel office was rejected, CVH assigned one personnel officer to handle our matters, and this greatly improved our relationships with the office. Mehaden Arafeh’s quarterly report optimistically concludes: “[T]he new program structure could not open without the addition of some seventeen direct patient care positions (supportive staff positions are also deemed necessary). The Department of Mental Health was able to obtain a commitment on the addition of some $150,000 to the total hospital budget for this purpose. This is a notable exception to budgetary reductions in other areas, which will have the happy effect of making it possible to use the new structures without delay.”⁷

      The money did not come.

      In the midst of all our frustrations, Governor Meskill, in trying to downsize state government, apparently decided that two heads were not better than one. He declared that one of the co-directors be dismissed. Fortunately, the commissioner fought hard to keep both Peter and me, but he had to compromise by making one of us director and the other assistant director. We were told that we had to “work it out.”

      After many hours of meetings at our homes, looking at our respective duties, trying to find some logical solution, we finally had to agree that the decision must be made by the commissioner. Several days later, Deputy Commissioner Charles Launi met with us to inform me that I had been selected as director. This was a very difficult time. Peter and I had worked hard to develop a trusting, rewarding relationship and cooperative working arrangement. We had taken what we knew was going to be a tough job and made the commitment that no matter what we would stick with it for at least five years. This split changed everything, and we agreed that should Peter be offered a directorship at another facility he would be free to accept it. In fact, it was not long afterward that such an offer was made and accepted and our unique working relationship ended.

      The sense of frustration during this period comes across in the July–September quarterly report:

      This quarter was one of the most difficult and frustrating periods of our experience. We had no idea of what was happening in the Department of Mental Health or the direction of the commissioner…. A great deal of our time was devoted to the many problems of our staff concerning their repeated frustrations in trying to run an effective program with the limitations of staff vacancies, facilities, etc. Although we were repeatedly told that the new positions would be available for the