P.A.C.T. is a training program for parents. It trains coping skills into the parents of seriously behaviorally involved kids. The P.A.C.T. kid is typically diagnosed with one or more psychiatric conditions; s/he is prescribed medication for those conditions (whether s/he takes it or not); s/he is often known to the police or the courts; and s/he is often in Special Education with a SEM designation. An P.A.C.T. kid also habitually swears at his parents, hits or threatens to hit them; s/he is routinely disobedient and disrespectful; s/he often lies to parents and steals from them; s/he gets in trouble at school, gets in physical fights with siblings at home and throws regular tantrums. P.A.C.T. trains parents to detach from these kids in productive and positive ways. P.A.C.T. resembles Al-Anon in that while learning to detach, parents are also learning to give up the sense of victimization that they often feel. They also give up the need to enable the behavior they say they do not want from their children. The fact that they enable comes as a surprise.

P.A.C.T. became available to the public in 1995. The Willimantic office of the Connecticut State Department of Children and Families (DCF) encouraged its establishment. The area served by the program has subsequently spread over much of the state. Research has reinforced what is accepted in the trenches: that P.A.C.T. can be a highly effective program for the right client. Identifying the right client is best left to the prospective client as they invariably know when they are ready for P.A.C.T....and when they are not. The application procedure contains two informal screening devices which predict success. In a review of outcomes, The Willimantic (CT) Office of DCF found that 80% of parents who completed the entire program reported moderate to significant changes in their seriously emotionally disturbed children's behavior.

P.A.C.T. is clearly not for everyone. Not everyone who needs it wants it; not everyone who needs it can learn it. Parents who enroll in P.A.C.T. are self-selected. They live in situations that are typically dreadful. What makes the P.A.C.T. parent different from the parent who has lived the same life but does not enroll in P.A.C.T. is love for a child or something close to it. Maybe not much love, but enough to keep trying. At a time when everyone else has given up and pleads with DCF to take their kid away, the P.A.C.T. parent is still fighting. It is essentially the same kid in both situations. The wild card is the parent. The P.A.C.T. parent may just be a little bit more anxious about their child's future than the non-P.A.C.T. parent. They may also be a little less resentful of their child than the non-participating parent.

P.A.C.T. is similar to 12 step programs. Parents in recovery find 12 step and P.A.C.T. very compatible. There are differences. The 12 steps are general whereas P.A.C.T.'s 27 steps are highly specific. Thus, many people start 12 step, drop out and may try again in the future. The reverse is true for P.A.C.T.. Most people, who start P.A.C.T., complete and rarely return. But regardless, enrollment in either 12 step or P.A.C.T. represents only a slim fraction of the people who could use either program. The number of eligible folks who get into, say, AA, Ala-teen or Al-Anon is miniscule. Similarly, the number of folks who live with and cope with a seriously emotionally disturbed child is huge. What makes one family select P.A.C.T. and another reject it? Probably misery. Parents who enroll in P.A.C.T. find that they have been transformed. Not everyone is ready to be transformed.

Beware the parent who says, "I'd do anything for my child". Few of us will. Most are likely to believe that the State can do a better job of parenting than they can. Out-of-home placement constitutes the 'anything' that these parents say they will do. It's not much. It certainly does not require much effort on the parent's part. Parents don't phrase it quite like that; they say that they are getting their child the treatment that he needs. But is that true? The common vehicle for these parents is residential placement. Residential placement occurs when a child is removed from the home and placed in an institution with a bunch of other similar kids for a year to a year and a half. In the hands of the affluent, the placement may go on for years. In this period many good things seem to happen for the typical kid. Behaviors calm down. The placement seems to be productive. But it probably isn't. It is very clear that all the kid has done is made up his mind that he wants to go home. He is, after all, in a kind of a jail. He adjusts his behavior accordingly. These kids are not dumb.

Once home, the family experiences a honeymoon. Then old behaviors quickly return. All that parents usually get out of the deal is a kid who is a year older, who has been living with a bunch of kids that his parents would never have approved of back home and who has picked up a skill set of aberrant behaviors that are even worse. Good solid statistics on the effects of residential placement are very hard to come by. But it appears that there is something like a 75% failure rate. Rolling the dice for a 25% chance of change may be better than nothing, but not by much. Incidentally, many residential facilities tell inquiring parents that their facility experiences a 100% success rate. Desperate parents do not question such claims. They just want placement. The number is accurate in one sense: All kids who complete their program experience behavioral success at the time of discharge. This says nothing, however, about what life will be like back home in six months. P.A.C.T. is an alternative to those who seek one. P.A.C.T. happens at a fraction of the cost, too.

BMT had a client who was a social worker for DCF whom we shall call, 'Grandma.' She is a 20 year veteran of DCF. She acquired her granddaughter upon the death of the child's mother, Grandma's daughter. Dad has been in and out of jail for drug related offenses. Mom's death was drug related. The kid was hell on wheels. By the time P.A.C.T. came on the scene, Grandma had been coping badly for years. At the first session, she was asked, "What took you so long?" Her reply is the standard reply: "I wasn't ready." Being ready, unfortunately, means that parents must avail themselves of all programs and find that none of them make a difference in the child's life. No parent comes to P.A.C.T. without a string of disappointments in the form of failed services trailing behind them. This is not to criticize any service. P.A.C.T. does not work with parents who improved as a function of the services they received. It doesn't need to. Yet, Grandma's granddaughter is typical in that miserable kids often do not accept services. Their behavior sets in like concrete. After P.A.C.T. the outcome for Grandma and her Granddaughter was very good. The moral of this story is that even a highly experienced, highly competent MSW can have problems that elude their experiences. Prior to enrolling in P.A.C.T.. Grandma had never sent any of her clients to P.A.C.T.. Now she does.

P.A.C.T. takes about a year to complete. Some can do it in less time. Others take more. P.A.C.T. is mostly in-home although that depends on what part of Connecticut the family lives. The parents are paid...or pay... a weekly visit. An accounting is made of the week and an assignment made from a list of goals. On the return visit the next week, an accounting of the week is again held and the parent either progresses on to the next goal because they did well or reviews the previous goal because they did poorly. In time parents learn that detachment from their kid's awful behavior is essential. Parents learn patience, tolerance and acceptance of a child at his/her worse. These often produce a nice reaction from their child. Parents can learn to furnish a home life for all which is calm. Everyone likes calm. However, this process takes time. Taking control away from a controlling child-so that calm can settle in can happen but it will happen slowly. Hence, a program that lasts about a year.