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Expanding our Knowledge of Hospital Based Programs

By Marion Doctor, LCSW

Jan 6, 2010 Back


The concept that pediatric burn centers have a role and responsibility in identifying and providing appropriate intervention for children and adolescents burned as a result of firesetting behavior has only quite recently been acknowledged and acted upon. We, like many other professionals working with youth, tended to see this as an issue for fire departments, juvenile justice, social services or schools. When, in fact, successful identification and intervention with this population requires the combined, coordinated efforts of all of us. The Children’s Hospital (Colorado) Burn Program JFS (juvenile firesetting) staff has not only embraced its responsibility to serve the needs of children who have been burned as a result of their firesetting behavior, but has broadened its referral base to include firesetting youth from the community. The benefits of offering this level of service to the community are many… as are the challenges.

The challenges of providing a comprehensive hospital based JFS program begin first and foremost with funding. The original format for providing JFS intervention services at The Children’s Hospital (Colorado) included a brief assessment and an educational intervention for patients and parents. This intervention was provided by a burn nurse and a clinical social worker at no additional cost to the family. As volume and complexity of cases increased, it became clear that a more comprehensive, specialized program was needed. This was compounded by the decision to accept assessment and treatment referrals from the community. JFS Program staff now consists of four half-time clinicians and one half-time program assistant. Given the number of low income, uninsured, often court ordered patients and limited success with fund raising and grant applications, financial support for this increased level of service continues to be our biggest challenge.

Other challenges to providing a comprehensive hospital based JFS program include continuity and consistency of referrals and parents’ resistance to seek treatment for their child and themselves. Parent participation is a requirement of treatment at The Children’s Hospital Assessment and Treatment Program. Being based in a metroplex with many jurisdictions can at times create a complexity in terms of referrals, reporting and communication. The advantage of working from a pediatric hospital base is the ability to provide treatment across the age range from very young children through adolescence. It is also a neutral, “safe place” for parents and children to share and receive help with those issues that led to the firesetting behavior. An added benefit is access in-house to all levels of mental health services ranging from the emergency department to an inpatient psychiatric admission.

Path to Solutions

I have shared a brief overview of our treatment model with the hope of hearing from my colleagues in other hospital based programs regarding their treatment models, their successes and their concerns. Issues that require our immediate attention and collaborative work are: establishing a national database, completing and reporting outcome studies that include documentation of recidivism rates, as well as a comparative study of different models of treatment and intervention and shared insights regarding funding for hospital based programs. Matchbook provides us with the perfect opportunity to collaborate not only within our own discipline, but to benefit from the knowledge of all disciplines providing services to youth who engage in firesetting behavior.

About The Author

Marion Doctor, LCSW

Marion Doctor has served as a clinician and as a Programs Manger for The Children's Hospital Burn Program and Assistant Clinical Professor, University of Colorado School of Medicine. Marion joined the Burn Team staff in 1978. In that capacity she developed The Children'sHospital Burn Camps Program and The Juvenile Firesetters Assessment and Treatment Program. In 1977, she joined a collaborative effort with Regions Hospital Burn Center in St. Paul, MN and the Shriners Burns Hospital in Galveston, TX to establish a Family Burn Camp in Minnesota and Colorado. In 2001, Marion joined with other burn camp directors to develop the International Association of Burn Camps and was elected as Chairperson. As a result of her contributions, The American Camping Association extended a Special Recognition Award to Marion for Outstanding Service to Organized Camping. Marion has been a member of the Advisory Board for Colorado Safe Kids Coalition, a committee member for the 18th Judicial District Juvenile Firesetter Task Force and Project Staff and Instructor for the Colorado Juvenile Firesetter and Prevention Program. Marion has served as the At-Large Member of the Board of Trustees, the American Burn Association and received the Curtis P. Artz Distinguished Service Award. She currently serves on the Professional Advisory Board for the Zach Burn Foundation and is First Vice President of the Board of Trustees for the Phoenix Society for Burn Survivors. She has served as a member of the Editorial Board and Psychosocial Forum Editor for the Journal of Burn Care and Rehabilitation and has published and lectured nationally and internationally.