Provo Canyon School Info

Provo Canyon School is located in the midst of the scenic locations of Utah. The 242-bed facility was set up in 1971 for treatment of adolescents with learning, emotional and behavioral difficulties. More than 5000 children have been treated at the school over the years. Recreation therapy and the Therapy Without Walls (TWW) are some programs for all students. Experienced teachers and therapists are part of the staff along with the nurses. There are two campuses at the school. The Provo campus is for boys and the Orem campus is for girls. Arranged trips include to areas of Northern and Southern Utah.

Utah is known for its education sector, the large number of colleges and schools. Utah is also the center of many sporting activities, with biking and hiking activities included. Utah is located in western US. 88% of the population lives in the area around Salt Lake City. According to the Ute Indian language, Utah means “people of the mountains”. Utah is largely rocky and is divided in to three different regions. The Colorado plateau, Great Basin and Rocky Mountains form the three divisions of the area. Tourism is one of the main growing industries in Utah. The canyons attract several visitors all through the year. Sporting events like the Utah Summer Games are held at Utah with an atmosphere of great enthusiasm and activity.

Blaming Does Not Solve Problems

When a teen goes astray or becomes "delinquent", and is admitted to Provo Canyon School, parents and staff sometimes engage in the tempting but useless act of blaming and fault-finding as to cause. For example, it would be easy for staff to blame parents for doing a faulty job in raising their child, or sabotaging treatment. It is equally easy for parents to blame staff for not providing appropriate care to their child because their problems aren’t being resolved as quickly or fully as they believe they should. While blaming and fault-finding do not resolve problems, taking appropriate responsibility for our role and actions can.

The following "Ancient Tale" is used with permission of J. Bonner Ritchie:

Long ago in an ancient kingdom there lived a princess who was very young and very beautiful. The princess, recently married, lived in a large and luxurious castle with her husband, a powerful and wealthy lord. The young princess was not content, however, to sit on her throne and eat strawberries by herself while her husband took frequent and long journeys to neighboring kingdoms. She felt neglected and soon became quite unhappy. One day, while she was alone in the castle gardens eating more strawberries, a handsome vagabond rode out of the forest bordering the castle. He spied the beautiful princess and quickly won her heart.
Following a day of dalliance, the young princess found herself ruthlessly abandoned in a distant village by the vagabond. She discovered that the only way back to the castle led through the enchanted forest of the wicked sorcerer. Fearing to venture into the forest alone, she sought out her wise and kind godfather. She explained her plight, begged his forgiveness, and asked for his assistance in returning home before her husband returned. But the godfather, dismayed by her thoughtless behavior, refused forgiveness and denied her any assistance.
Discouraged but still determined, the princess disguised her identity and sought the help of a noble knight of the kingdom. After hearing her sad story, the knight pledged his unfailing aid for a modest fee. But, alas, the princess had no money, and the knight rode away to save other damsels in distress.
"The beautiful princess had no one else from which she could seek help, and decided to brave the great peril alone. She followed the safest path she knew through the forest, but the wicked sorcerer spied her and caused her to be devoured by the fire-breathing dragon."

Who is responsible for the death of the princess? Was it the princess because of her thoughtless and impulsive decision to run off with the vagabond? Was it the lord who insensitively neglected his wife’s needs? Was it the vagabond who put her in danger by his selfish actions? Was it the godfather who could have saved her but condemned her? Should the knight have allowed chivalry be the greater part of valor and helped her without cost? Or was it the wicked sorcerer or the fire-breathing dragon who actually meant her harm?

Perhaps three important morals are found in this story that coach us when dealing with problems in treatment.

The first moral is that blaming, judging, or condemning others does not solve problems, they merely assign blame to someone for a wrong done. The godfather could have helped. Through a little compassionate understanding, he could have helped the princess safely home and helped her take accountability for her actions through honest admission and arbitrating forgiveness. However, he chose to judge and condemn the girl by focusing on the misbehavior instead of the worth of her soul. A subtle difference exists between blaming and holding accountable, and that lies in one’s intent. Blaming ascribes culpability. It loudly proclaims one’s guilt. It says: "You did it. You caused this terrible thing to happen. You are to blame, not me! You should be punished." Holding accountable, on the other hand, is driven by a higher motive: to help the accountable-person learn from their mistakes and not repeat them in the future. Accountability is not blind mercy, but requires that appropriate consequence is meted out. Blame lashes out to hurt back. Accountability seeks to solve problems.

The second moral is that anyone who can help prevent or resolve a problem has some measure of responsibility to do so. In the Ancient Tale, everyone, including the Princess, was partially responsible because each could have helped prevent or resolve the dilemma. The issue is that most people don’t want to acknowledge their responsibility, but proclaim their innocence. The Princess wanted to avoid consequence for her bad choice. The lord could have been a more sensitive husband. The vagabond could have not preyed upon vulnerability. The godfather could have had compassion. The knight could have shown chivalry despite her penniless state. The sorcerer could have let her through the forest. Only the Dragon—being a dumb beast—had a leg to stand on. That’s what dragons did in those days: they toasted people. The problems of our lives and our loved ones have answers as we act in responsible ways to help prevent and resolve them without blame and condemnation. Blaming and complaining simply exacerbate our problems.

The third moral in this story is that each of us has the opportunity to be a force for good or ill in the treatment process. Each of us at one time or another in our life has been subjected to or played the role of princess, lord, vagabond, dragon, sorcerer, godfather, or knight. In essence, we have all found ourselves the victim of our own stupid and bumbling decisions. What seemed to be a good or justified action at one moment, suddenly placed us in horrible jeopardy, and we would have dearly accepted any help to save us from the consequences of our actions. Each of us has neglected instead of been thoughtful; each has preyed selfishly upon another; each has condemned instead of had compassion; each has withheld our help from someone selfishly. Perhaps, we have even been sorcerers and dragons in some way.

What if the Ancient Tale included this as part of the story? Before the princess could return home, her husband discovered her misbehavior and arranged for a man in the village where she was to take her in and care for her, in order to teach her a lesson. The man who was a farmer, reluctantly agreed, but only on the condition that the princess would earn her keep by working and following his rules. The lord happily agreed. Against her will, the princess went with the man to his home and lived with his family. The farmer, being a very pious man, held the princess to strict rules and required her to work. She had to acknowledge her misbehavior to those she hurt, ask for his forgiveness, and change her attitudes and behaviors that had gotten her into trouble with the vagabond. Soon, the princess became unhappy with the daily work and being held responsible by the man and his wife for her lazy and entitled attitude. She expected strawberries every day, and, instead, she had to work and eat vegetables. She became annoyed with the other children and got into arguments and fights with them. Greatly distressed and wishing that she had not come at all, she wrote a note to her husband, explaining that the farmer was abusing her in horrible ways, and that if he had any affection for her at all, he would come and rescue her. If he did not act quickly, she would surely either die or, at least, refuse to be his wife anymore. The lord was intimidated and incensed that the farmer had taken advantage of him, immediately assembled his army and marched to the village where his wife was being held, and forcefully withdrew her. He discredited the man to all the villagers for mistreating the princess and committing all manner of wrong doings.

If this were the ending of the story, what would become of the princess? Would she have learned from her actions? Would she have learned responsible behavior? Would the problem between the lord and the princess ever be resolved? Who would be responsible for what happened to her?

Each client and family of a client coming to Provo Canyon School for assistance should write their own Ancient Tale with them, their family members, peers, and others cast as the princess, lord, vagabond, godfather, knight, sorcerer, and dragon. Each can write their own ending to the story. It does not have to end with the death of the princess or with her being rescued. It can have a positive ending if the family so desires, and if they make the necessary effort.

Often, blaming and finding fault with those who are trying to provide assistance is a means of deflecting responsibility and accountability from own one’s problems. It is easier to point out another’s faults and guilt than take ownership for self. Blaming does not solve problems. Accountability promotes ownership and resolution. These morals to the Ancient Tale can be valuable lessons in obtaining care for a troubled teen.

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Former CEO of Provo Canyon School, Kreg Gillman Speaks

Kreg Gillman has had quite a journey.

•  He first came to Provo Canyon School as a therapist in 1993. After three years, he became a Director of Admissions at 1996, in 1998 he moved to Aspen Achievement Academy and Aspen Ranch, retaining the same post.

•  After three months, in 1998 he was made Executive Director of Aspen Ranch till 2001.

•  Kreg then moved on to SunHawk Academy from 2001-2004 as an Executive Director.

•  In 2004, he was back to where he started his career. Kreg was appointed CEO of Provo Canyon School for both the campuses at Orem and Provo.

•  Kreg believes that success acts as a big morale booster for the student. Any little success caused the students to gain from it, even though the path to success was difficult, the students knew they were on their own and responsible for their actions.

•  Kreg and Tracy have been married for 18 years and have three daughters aged 15, 13 and 6 respectively and a nine-year-old son.

•  Kreg believes been effective parents is difficult, even for people like him who believes that teaching about being good parents is easier than to be one.

•  Kreg's wife Tracy has also worked at a school for some time and knows about residential treatment and other related programs. Tracy takes up her responsibilities at home now.

•  Kreg wants to spread the message that Provo Canyon School is not disciplinary despite it being a residential and protected institution.

•  Kreg state that the Provo Canyon School has been improving its methods over the years. He explains that the improvement has come in the form of better planning.

•  Making teams with lesser number of members has been one of the improvements.

•  The teams consist of 12 students who take part in the school activities together, while playing, eating, and while doing the homework.

•  Staff strength has being increased to help in facilitating individual attention to students.

•  Jeremy Cottle took over from Kreg as the new Provo Canyon School CEO.

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Provo Canyon School: Oppositional Defiance Behavior

Provo Canyon School has treated more than 5000 children in more than three and half decades, and ODD is one of the conditions it treats. The school has a separate ADD / ADHD program for adolescent boys in the 12 to 14 age group. It also treats children who are addicted to alcohol and drugs.

Oppositional Defiance Disorder (ODD) is among the common disorders that children are diagnosed with. 16% is the highest ODD prevalence rate recorded. The rate alters with age.

For instance, the prevalence rate is 2% at the age of seven. In children aged 13, the rate has risen to 5%. In adolescents, the prevalence rate has been similar in girls and boys. Provo Canyon School has treated several adolescents for the disorder.

ODD is different from Conduct Disorder (CD), about 25% of ODD affected boys have been known to be diagnosed with CD. CD is considered a more severe form of ODD.

Most of the mental health services reported cases are due to this disorder. The condition has two main characteristics –aggressive behavior and a habit of irritating others.

Other recurrent symptoms include:

•  Short-tempered.

•  Fiercely argumentative.

•  Disobeying rules set by adults.

•  Blaming others for their behavior and mistakes.

•  Easily annoyed by other people.

•  Resentful and angry.

The symptoms differ according to gender. The boys are more likely to run away from home, while girls may exhibit physical and verbal fighting.

Similar behavior may be observed in young children; only that ODD related occurrences are more noticeable. The reoccurrence factor is a deciding factor for diagnosis. The children are more prone to irregular behavior and resent any authority higher than them.

If untreated, the condition could have serious consequences for the family, the neighbourhood and the community.

Comorbid disorders could be the result of negligence in treatment. Comorbid disorders are not totally related to ADD/ADHD (Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder) symptoms.

Adolescent learning, behavioral and emotional problems have been treated at Provo Canyon School since 1971. The school has two different campuses for girls and boys at Orem and Provo, respectively.

Bringing about attitudinal and behavior change is one of the goals of the school program. This brings us to the matter of change. Change can be defined as a transition from a state to another.

Four assumptions have being made with regard to change:

•  Change is a natural process that is affected and hampered by habits.

•  The family of the adolescent has a major part to play in the parameters of change in an individual. In case of change in living conditions, a family may not be able to adjust itself, resulting in stagnation.

•  Therapeutic change, as experienced at Provo Canyon School, could cause the student to interact using new methods.

•  Changes in behavior, perception, reasoning, judgment and memory could occur in case of a new scenario. Usually, families are so used to following the same method to solve a problem, that after a time period, changing a behavior will not be easy.

Despite the therapist's best efforts, it is up to the student to change. Unless the student doesn't take the initiative, things can't progress. Change can seem disagreeable and difficult at first. The Provo Canyon School structural therapy helps create desire and motivation and disband negative thoughts.

Some therapists have observed that within a group there could be students who are stubborn to change. This attitude can lead to discouragement among other group members. It is rare to find an entire family agreeing on a thing, the same thing applies to therapy.

Though more than 50% of a group may agree with the therapist, early success is not expected. Yes, a steady and gradual shift in the general opinion is possible.

This paper describes a specific clinical case of a young woman with psychiatric and medical diagnoses. The paper identifies social services and health care groups that collaborate with her care. The paper describes the most common situations provided by collaborative care. It then differentiates between nursing diagnoses and collaborative problems. The paper identifies potential barriers to successful collaboration in the case.
Clinical Case
A sixteen-year-old girl admits to the facility with a history of oppositional-defiant disorder, substance abuse, and self-injuring behavior. The referral to the facility was through a school district in California due to the patient's oppositional behavior and truancy. The patient has a history of Osgood-Schlatter's disease, bulimia, and a seizure disorder for which she has a vagal stimulator.
Health and Social Service Groups Participating
The admissions department follows a checklist to ascertain the immediate needs of the patient. They obtain a list of allergies, current and prior use of medications, and a history of assaultive, suicidal, or runaway behavior. A dietician performs a full dietary evaluation within one week of the patient's admission due to her bulimia and history of substance abuse. The dietary department takes the information to ensure all recommendations are included. The nursing staff completes a nursing admission assessment within 24 hours of the admission. This assessment includes a history obtained from the parent, previous facility and the patient. A licensed, independent practitioner, usually an advanced practice registered nurse, performs a complete history and physical, orders routine and individualized lab work based on the findings, and STD testing. Based on the evaluation, referrals to an orthopedic are included to evaluate the Osgood-Schlatter's disease. Referrals to a neurologist are included to evaluate the seizure disorder and prescribe treatment.
A psychiatrist performs a full psychiatric evaluation within five days of admission. Additional psychiatric orders evaluate current diagnoses and admitting medications. A psychologist performs a full psychological evaluation as ordered by the psychiatrist. A therapist performs an evaluation and creates a preliminary treatment plan within 24 hours. The treatment plan includes recommendations for precautions, substance abuse therapy, individual and family therapy, and group therapy according to patient needs.
A recreational therapist obtains an evaluation of current and past needs and compiles a plan. An educational training specialist completes educational testing. Vocational training and assessments are completed to assist with current and future job needs to be included in the education plan. An educational counselor sets up a schedule of classes for the student to ensure credits are complete and progress in senior high school continues in accordance with the IEP. An evaluation of physical fitness requirements individualizes the needs according to the patient's current medical and educational status. A contracted pharmacist evaluates the current medication needs, allergies, and insurance information according to information provided by the medical department. The educational consultant, social worker, judge, or parent involved in financing and sending the patient to the facility are allowed input and given weekly updates on the patient's progress, including monthly evaluations from therapy, medical and educational departments. Common Situations of Collaborative Care
Treatment team is an interdisciplinary panel held twice a week to evaluate the progress of the patient. This is a major opportunity for collaborative care to discuss and share the different perspectives of the patient's progress, and to recommend and formulate any treatment plan changes. “Collaboration involves negotiation and consensus seeking rather than questioning and ordering” (Blais, 2006). During this time, program directives provide information for different departments of important changes or additions to the patient's master treatment plan. Family and group therapy sessions allow parents and other patients to share their observations about the patient's progress with the patient and therapist.
Nursing Diagnoses and Collaborative Problems
Nursing diagnoses would include coping mechanisms and monitoring of behavioral problems due to the oppositional defiant disorder and history of self-injury. Altered nutritional status would be a diagnosis due to her status as an adolescent, history of bulimia, and history of substance abuse. Alteration in comfort would be a nursing diagnosis due to the Osgood-Schlatter's disease and potential for leg pain. Fear of a seizure, noncompliance with treatment, or feelings of powerlessness could exacerbate ineffective coping mechanisms in the patient.
Nursing diagnoses are areas where the nurses are primarily responsible for providing interventions, such as pain relief for Osgood Schlatter's, or magnet treatments for prodromal symptoms of a seizure. Collaborative problems are areas where any number of other staff and departments assist to monitor and give input. Ultimately, all of the staff and patients in the school become part of the collaboration as the patients learn to work together to assist, confront and encourage each other in developing appropriate coping mechanisms to deal with their individual psychiatric diagnoses.
Potential Barriers of Collaboration
Many areas of inquiry and information collection are present, but individuals and separate departments and entities complete each of the assessments and reports. It is imperative to share and discuss information from the individual reports and assessments. Other key members of the team must be aware of ‘the big picture' for cooperation and teamwork to take place for the best patient outcomes. The overall value of the information will be lost if discussion does not take place. If the young woman develops a potential problem, such as a difficult phone session with her parents, other departments need notification in order to best monitor her behavior and potential for self-abuse or self-harm. If prodromal symptoms of a seizure appear during school, the nurses need notification by other teachers and staff in order to perform interventions. A lack of collaboration in these areas could be disastrous.
Conclusion
Collaborative nursing practice is illustrated by the interactions and communication between departments at the facility. The nurse acts as the interdisciplinary facilitator to ensure each aspect of the patient's care is thorough. Therefore, the nurse has an opportunity, a responsibility, and an obligation to assist in synergistic care. This practice goes along with Orem's theory of self-care: “it maintains a focus on what is relevant to nursing” (Dennis, 1997, p. 4), appropriate nursing interventions, and patient outcomes as part of an interdisciplinary team. The nurse is at the core of collaborative practice, ensuring that all disciplines work together to center on the best patient care and outcomes.