The Pitfalls of EBP: A Case for Integrative Rites of Passage
Rites of Passage (ROP) is a term used to describe many major changes in life, such as the beginning or end of adolescence, marriage, having children, elder hood and so on. The term rose from watching indigenous cultures ease their youth through adolescence with as little drama as possible. They are based on merit and performance, rising to the challenge at hand and growing healthily from them. Having let go of ROPs in modern times because many consider them quaint and archaic, we have inadvertently taken the longest running, most successful teen prevention model in history and broken it.
The ROP model basically takes an inherent need to grow and guides the aspects of adolescence we often believe in modern times to be negative into a healthy adult. Since letting go of ROPs in favor of becoming ‘civilized’ we have inadvertently created an entire industry dedicated to trying to fix broken or uncooperative teens. By deciding that ROPs were quaint and archaic, we have come to pathologize adolescence as something to fix, not nurture. Rather than prevent the problem at its source with models and programs based on proven ROP growth dynamics, we now are largely mandated to use Evidence Based Practices with scientific data proving they change uncooperative youth. Rather than preventing the problem as ROPs did for millennia, we attempt to fix them after the problem has manifested. In lieu of using the community for support, we now often send the youth away from his or her community for treatment.
I realize I’m not here to dispute the validity of EBP per se but to put them in perspective as one who has been immersed in those programs for a number of years. Thus I’m not here to argue EBP validity, but to put them in context for you. They are not totally exclusive of each other. A youth who has attended an out-of-state residential treatment program with EBP programming has, in essence, been through a rite of passage.
Rite of Passage specialists struggle to unanimously describe ROPs, but for our purposes an ROP is a community acknowledged effort or challenge that is structured to help youth make developmental jumps forward in a healthy way. While ROPs vary from high school graduation to manhood/womanhood initiations, they use elder mentors to help youth grow from the common struggles of adolescence. Rites of Passage are universal across the globe and throughout history, an impressive statistic on its own.
For those not familiar with the Evidence Based Practice trend dominating youth care right now, many programs working with youth are being essentially forced to use approaches and treatments that have some empirical evidence of success data behind them. For example, probably the treatment with the longest data is Cognitive Behavioral Therapy (CBT). What CBT proposes is common sense to most of us not having major problems in life like so many of the teens I work with. It says that what we think and/or feel affects how we respond to a problem or situation, or our behavior. Then we evaluate the results and reaffirm our beliefs or change them.
One model below is pretty simple after 50 years or so of data. Your thoughts create a feeling, like fear or anger, then your feelings generate some behavior like yelling or punching a wall, and that (inappropriate) behavior further reinforces one’s thoughts especially if there were no consequences for the outburst.
The next model is more detailed. First we need some sort of trigger or situation to get the cycle rolling. This model tends to treat our Thoughts and Feelings as equal partners in creating a responsive behavior, good or bad. Then if we are able, we evaluate our behavior and Think about the outcome. If we get some release, it worked. If we broke a couple knuckles, we may need to rethink our anger outlets. If we don’t change the cognitive belief that punching walls is better than people, we’ll keep hitting walls, for example.
The simplest way to visualize this for me is the graphic below. We can easily imagine what behaviors these feelings might create in teens or anyone else. Some will handle them well and I make a living at the ones who can’t or won’t, two aspects of the same problem.
My issue with Evidence Based Practices like CBT, Aggression Replacement Training (ART) and other canned curricula is twofold. First is more about the prevention of needing these tools in the first place. The Rite of Passage model is about preventing problems such as these, not trying to treat them after the fact. That makes much more sense to me. Secondly, my experience with 13 years of residential treatment settings, six years of probation group homes, and 27 years with at-risk and high-risk teens overall is that EBPs don’t work near as well as everyone hopes.
This is not necessarily a problem with the curriculum, but the delivery. My recent decade with two facilities housing almost 500 teen boys between them is that too often these skills are being taught by untrained, unmotivated staff. Like any curriculum, it is only as good as its teacher. Otherwise we might as just give the textbook or workbook directly to the kid and say, “read this.” Day after day, Positive Skill Development group after another, role modeling without enthusiasm, doing it because it is supposed to be done, obviously detracts from the curriculum’s ability to work as designed. Just because an organization implements an EBP does not guarantee it will work.
There are basically three aspects to problem solving: Prevention, Intervention and Treatment. Preventing a problem in the first place is the easiest, fastest and least expensive way to deal with the problem. If you cannot prevent the problem, then some sort of intervening behavior is required, necessitating more resources, time and money to eliminate the problem. Finally, if you can’t prevent or initially stop a problem, you have to Treat it—the longest, hardest, most expensive way to solve the problem at hand. It is easier to prevent pollution than treat it. Same thing with the hole in the ozone, cancer, oil spills, juvenile delinquency, and so on. This process reminds me of an old quote: Why is there never enough time [or resources] to do it right but always enough time to do it over again?
ROPs are historically and universally known practices that helped older cultures Prevent many of the modern youth behavioral problems we currently deal with. Indeed, my job didn’t exist when I was born, but then neither did pre-school, after-school programs, and so on. Those are modern inventions caused by the breakdown of extended family. The ROP concept is to learn a healthy way to approach challenges and difficulties, guided by elders who have previously walked the same paths, and not become victims to circumstances but grow from them. Below is a simple model of the ROP cycle, first described a century ago by Arnold van Gennep.
Van Gennep initially described a rite of passage as three stages: Separation, (liminal) Transition and Reincorporation. This graphic adds Preparation to help make the youth successful before the challenge. Here is CBT in its infancy within a person, either learning or not how to appropriately respond to negative or difficult stimuli. I’ll assume that from here on out most people reading this article will have a grasp of rites of passage so I won’t bother with more on that for now.
My first real point is that while CBT has a good 50+ years of data behind it as an effective treatment option for many negative thoughts and behaviors, rites of passage have tens of thousands of years in prevention data. What data many will ask? Right now America has what many call the Youth Industry, the sad and huge machine behind trying to get modern teens off drugs, out of gangs, stopping cyber-bullying, and many other antisocial behaviors. America has more youth violence than the next 25 countries combined. A culture should never make an industry of its children.
By ROP prevention data, I refer to the fact that indigenous cultures, dealing with adolescence for millennia, never had to invent juvenile hall, pre-school, after-school programs, residential treatment, group homes, and the rest of America’s multi-billion dollar Youth Industry mechanisms. By effectively preventing most adolescent problems with rite of passage dynamics, our indigenous neighbors never needed to invent major interventions or treatment. Why? Because ROPs were discovered worldwide and historically to help youth cross into adulthood healthily, and indigenous cultures don’t have time or resources to donate to methods that don’t work. But modern youth care seems determined not to look at prevention data because there really is no hard data for ROPs as they didn’t create any problems to document. The ROP cycle, archetypal and universal across the globe, helped teens mature in a healthy way.
My next issue with Evidence Based Practices is, if you take the term literally, that we can no longer be creative, intuitive, adaptive or experimental in our work with youth. If I have to use CBT groups, ART curriculum, Pathways drug curriculum and so on, how will we ever get to see if we can’t find something better than what is currently on the table? The most success I’ve had in 27 years of high-risk teens is with ROP dynamics. Now that I’m forced to use the EBP approved approaches, I feel handcuffed and my kids feel like part of an assembly line, which is what the Youth Industry is. I find it boring for both parties, although I admit some kids avail themselves of the growth opportunity, but I believe that is more of an internal trait than the curriculum breaking down barriers. The longer these curricula run, the older they become and often feel outdated by state-of-the-art teens. Printed curriculum is costly to edit.
Like many, I stumbled across rites of passage model after I’d worked with kids for a while. As a corporate crossover in the late 80s, I did not come into the field with a clue, much less an agenda. I tried everything people suggested like anyone new to a field. After I was luckily exposed to teens from more than 100 countries via half a dozen international youth conferences I facilitated, I started seeing a maturity and responsibility from the initiation cultures vs. modern teens. I pursued that and it worked better than what else I was doing so I adopted it. That simple.
The third problem I have with the modern trend is that to maintain a Youth Industry, we need a never ending supply of youth to “fix” and run through the assembly line of making money at damaged and neglected youth. The CEO of the residential treatment program I just left told me a while back the company was grossing $70 million annually, and he couldn’t wait until they reached $100 million. I tried to do the math on how many hundreds of damaged and traumatized teens that would take, but gave up as too depressing.
There’s an inherent Jungian Shadow piece in any service-based approach. Be it teen residential care, women’s centers, or even cancer surgeons, the problem is that often unconsciously people in these fields are not willing to give up their jobs to fully solve the problem. Residential care needs a stream of wild kids. Women’s centers, God bless them, still depend on battered women and abused children to keep their doors open. Solve domestic violence and child abuse and they go out of business. The dedicated cancer surgeon who tries to extend life must fear, at some level, prevention for cancer.
So for this CEO who claims to be doing everything possible to help disadvantaged youth, is it really in his best interest to find a Prevention or Cure? Sadly, no, so they do enough to meet the requirements of the people paying them but make mostly unconscious choices that inhibit any real, lasting success. For example, having entry level, untrained staff in charge of CBT aspects. The teen that recycles through the facility 3-4 times is the problem to be fixed, and another $40,000 for more EBP.
This is the problem with “programs,” even ROP programs, I’m sad to say. They need more people to come to their programs to stay afloat, offset expenses, pay employees. We keep pathologizing adolescence as something to be fixed, not guided to a healthier outcome. Parents continue to send their wayward youth to wilderness treatment and ROP programs to help refocus these teens. This model completes two of Van Gennep’s stages: Separation (if only for a day or more) and a Transition model to help change them internally. But there is no Reincorporation into their home community without the full ROP model, and this is, in my experience, where almost every program I’ve seen falls short, although more often than not, not in their control.
“Initiating” a teen for a month in Utah is great, and might actually mature and change them, but then we send them home to LA, Chicago, DC, or just an abusive or uncaring family that doesn’t fully embrace the changes. Even if the family sees the change in their son or daughter, the schools will still treat them the same as before their experience, so they have not really been promoted in the community. We don’t need more ROP programs; we need more Community to utilize ROP dynamics.
My final problem with Evidence Based Programs is that often we see the best successes by blatantly ignoring them. For example, think of the most popular of the “idealistic teacher helping resistant youth” movie genre like Freedom Writers, Stand and Deliver, Lean on Me, Gridiron Gang, Remember the Titans, Coach Carter, and most recently Spare Parts. We cheer for the tenacious teacher who resists, who lacks of administrative support and comes up with unique ways to motivate unmotivated students. Rather than pathologizing the teens as many others have already done, these famous teachers and coaches have found creative, out-of-the-box ways to help youth and amaze adults.
If we dissect these movies, we’ll find these creative problem solvers were closer to ROP dynamics than EBP. They came up with a healthy challenge for the youth, got them to try something new and challenging, and supported their growth by creating a community of support with the class or team.
But my real question is this: If we recognize good mentoring when we see it, why don’t parents and other people involved in their children’s lives storm into the principal or superintendent of schools’ office and demand a Freedom Writers teacher? Why not further demand a Lean on Me principal, a Stand and Deliver math teacher or a Gridiron Gang coach? These movies, like the real efforts they portray are powerful enough to make us cry and cheer at the growth and success of resistant kids who now have a stronger sense of themselves for the experience. We need to stop relying on others to make decisions regarding our children. Schools should not be parents. Our government should not become parents. The solution, I believe, will be utilizing more basic ROP dynamics in all youth endeavors to prevent the need for Evidence Based Practices in the first place.
© Bret Stephenson 8/8/2015