As it celebrates its 25th anniversary this year, many people know the Boys Town Center for Behavioral Health is one of the area's premier facilities for outpatient therapy and treatment for children (and adults) facing serious behavioral and emotional challenges.
Last year, the Center served 4,706 children and adults. And in 2019, for the sixth straight year, the Center was named the "Best of Omaha" in the category of family behavioral therapy.
People also may know the Center has an experienced, dedicated staff, and that many of its clinicians and psychotherapists completed the Center's Postdoctoral Training program and moved into positions at the Center on Boys Town's campus and at behavioral health clinics at Boys Town sites around the country.
They may even be aware of the Center's specialized clinics and programs that help children experience significant improvement in their behaviors and bring welcome stability to their families.
What most people probably don't know is that the idea that led to today's Center for Behavioral Health started with a slide presentation to Boys Town staff on a blustery winter day in late 1993.
The presenter that day was Dr. Patrick Friman, the current Vice President of Outpatient Behavioral Health Services at Boys Town and the Center's director.
At that time, Dr. Friman had been leading research efforts on Boys Town's family preservation and foster care services.
"I wanted more of a presence on campus; those two research jobs were a little sterile," Dr. Friman said in a recent interview. "I asked Dr. Dave Coughlin (then head of Boys Town Youth Care services) if I could do a presentation. The title of the presentation was, 'How to Discipline Children without Raising Your Hand or Your Voice.'"
Dr. Friman hoped to have "a few people" in the audience, as it was a cold, snowy day and he didn't know how much interest there would be in the topic. When he arrived at the Boys Town Headquarters Building, where the presentation was to be held, he found a parking lot full of cars and no spaces available for him.
"I thought they had scheduled something else for that day. I was really angry," he said.
Upon entering the building, however, he discovered that the cars in the lot belonged to staff members who had braved the weather to hear his presentation.
"Nobody knew me; they were there for that title," Dr. Friman said. "The campus was hungry for that type of information at that time. On the strength of that, leadership asked me to start a new department, Specialized Clinical Services…, and that was the beginning of what eventually became the Center."
Getting an Idea Off the Ground
In 1994, the new department set up shop in the basement of the Youth Care building on campus. An office and a few cubicles were built for Dr. Friman and his small staff. Over the next few years, the group continued to conduct research while also providing sessions on child behavior issues – popularly known as "clinic rounds" – to other Boys Town caregivers. Hundreds would sometimes attend these educational sessions, and Dr. Friman was constantly searching Boys Town for hand-me-down chairs and other furnishings to accommodate the participants. Occasionally, his staff provided counseling services to youth from the Omaha community.
In 1999, Dr. Friman left Boys Town to work as a professor at the University of Nevada. In his absence, Specialized Clinical Services continued its research and educational functions. While he loved teaching and the perks that went with it, Dr. Friman said his heart was still with Boys Town and its mission to save kids and heal families.
"None of it compared with being around 'He ain't heavy' and 'There's no such thing as a bad boy.'"
Three years later, in early 2003, Dr. Friman returned to Nebraska and Boys Town.
"When I came back, there wasn't a job for me," he said. "And so Dr. Dan Daly (then the head of Youth Care services) said, 'You've been talking about wanting to open a clinic. Maybe that's the way you can create a job for yourself. I can give you budget and if you can meet the expenses in a year's time and you have a viable operation, we'll keep it going. Of course, I jumped at that. But I didn't have a clinic, and I didn't have resources and I didn't have any referral sources."
That's when Dr. Friman talked to Dr. Pat Brookhouser (director of Boys Town National Research Hospital®) and asked if he could make a presentation to the Hospital's pediatricians.
"The pediatricians heard what they wanted to hear and they started to refer clients right away. And that's how we got started."
After scouring the campus looking for a viable space, the new clinic found a home on the main level of Boys Town's Youth Care Building. While not the ideal location, it was a place to start providing services Boys Town had previously not been in a position of offer.
"We were in a 'rabbit warren' of cubicles," Dr. Friman said. "We were jammed in there like sardines. And the offices (18 in total) weren't soundproofed. You'd sneeze in one and five offices down, somebody would say, 'Bless you.' There was one tiny claustrophobic playroom (for child clients), and one bathroom for all the staff and all the clients."
Besides Dr. Friman, the clinic's staff initially consisted of one psychotherapist and four psychologists, plus support employees.
Slowly, as referrals from Boys Town pediatricians increased, the clinic began to flourish. A new and critical dimension was soon added with the establishment of an internship program. Besides gaining practical experience, the interns also became providers of behavioral therapy and treatment for youth in on-campus Boys Town's Family Home ProgramSM.
"Boys Town was paying outside therapists," Dr. Friman said. "We made a pitch to Dan (Daly) that we could bring that all in-house if we could get our interns licensed as mental health providers. Then treatment could be delivered right here on campus. The interns could coordinate with the communities so there was an integration of services, which is what happened. So, almost all of the clinical services delivered on campus (to Boys Town youth) were delivered by the interns."
A New State-of-the-Art Facility
In 2007, Dr. Daly and Father Steven Boes, who had been named as Boys Town's National Executive Director two years earlier, approached Dr. Friman with a plan to house the clinic in its own new building. But that plan had to be put on hold when the economy suffered a severe downturn the following year and the money that had been designated for construction had to be used elsewhere.
Three years later, though, Dr. Friman and Father Boes revived the idea of a new building as well as a way to pay for it. Boys Town launched its first capital campaign since Father Flanagan's time, with former National Board of Trustees Chair Ken Stinson as the campaign's chairman. Dr. Friman and Father Boes were soon meeting with potential Omaha-area donors, presenting a case for a resource that could help meet an urgent need in the community -- helping kids who needed clinical services for serious behavioral problems. It took time, but the efforts eventually paid off. Private donors generously pledged $10 million, and in 2012, ground was broken for the new building.
The next year, a ribbon-cutting ceremony celebrated the opening of the state-of-the-art Center for Behavioral Health on the Boys Town campus.
Today, the 10,000-square-foot Center offers general therapy and treatment, as well as services through a variety of specialty clinics. It boasts 55 staff members, including 33 clinicians and psychotherapists who conduct therapy sessions in their comfortable, sound-proof offices, in a four-plex of therapy rooms and in a play area. There's also a conference room that seats 65 and a large, welcoming waiting area. (By the way, the building has eight bathrooms.)
A Philosophy of Care Built on Welcoming and Trust
Dr. Friman said he is proud of how the Center and its staff make children and adults feel welcome and, more importantly, feel like they can develop trusting relationships with their service providers.
"We're here to serve those families," he said. "I work with my staff on how the families are greeted, how they're walked back to the office and how we say good-bye when they leave. I want to get across to the families that at last, you're here. I don't know where you've been, where the ill winds blow, but at last you're here and we'll take care of you."
Other dimensions that make the Center's interventions both unique and effective include the science and research that backs up treatment methods, an emphasis on a behavioral approach to helping children get better and a focus on teaching parents how to improve their children's behaviors.
"What make our services special is that there is a limited emphasis on mental health illness and a heavy emphasis on behavioral wellness, and how to perpetuate that," Dr. Friman said. "Our services tend to have a scientific basis and they are delivered in a context of behavioral wellness much more so than in psychopathology. Our preference is to view children's behavior problems as skill deficits rather than forms of mental illness, and parents seem to embrace that and so do pediatricians.
"We target the parents as well as the children, because an hour of time with a child (in therapy) doesn't compare very well with the other remaining 23 hours in that day. So we want to equip the parents with tactics, strategies and perspectives that they can employ during all that other time."
That philosophy has led to steady growth in the numbers of child and adult clients the Center sees every year, despite not actively advertising its services. In 2004, clinicians saw 505 children and families; that number skyrocketed to 4,706 in 2018. Over that 15-year period, 40,211 clients from Nebraska, Iowa and other neighboring states received services at the Center. (About 20% of the Center's clients are adults.)
Internships, the Post-Doctoral Program and Affiliate Site Clinics
Another important component of the Center's work is its Post-Doctoral Program, which provides training and experience for future staff members at the Center and at Behavioral Health Clinics at Boys Town's affiliate sites.
Dr. Friman explained that the path to Post-Doctoral status starts with an internship. Since its inception, the program has trained 160 to 170 interns.
"We hire between six and eight interns a year. They're with us for a year. From that group, we invite the most interested candidates to apply to the Post-Doctoral Program. That's an additional year. Then from that group, we pick the most interested to be staff. All the clinical directors at our affiliate site clinics were formerly interns and post-docs."
The behavioral health clinics that have opened at Boys Town's affiliate sites were a natural extension of the services that were being offered by the Center on Boys Town's home campus. Clinics are currently serving youth at Boys Town Nevada, Boys Town Central Florida, Boys Town South Florida and Boys Town Washington DC.
"The people who run them were trained here in how to deliver clinical services to a community, how to cultivate referrals from pediatricians," Dr. Friman said. "Then they were exported to the sites and just replicated what they learned here, just on a smaller scale."
Dr. Friman said some post-doctoral grads who worked for Boys Town and then left have become well-known and prominent in their areas of expertise. They include Susan Swearer, a professor at UNL who works with Lady Gaga on bullying projects; Doug Woods, who is internationally famous for developing the most effective treatment for Tourette's syndrome; and Ann Davis, one of the most successful researchers of obesity in the United States.
Looking to the Future
The remarkable growth of the Center and its capabilities to effectively serve children and adults can be attributed to the dogged determination of Dr. Friman and his staff to ensure that the Center succeeded, the foresight of Boys Town's leadership and the need for specialized behavioral services in the community. Oh, and a little luck.
"We came out of nowhere as far as the community is concerned, and in very short order we became the primary provider of outpatient clinical services for children, which is no mean feat when you consider that we're competing with (places like) Children's Hospital in Omaha and the University of Nebraska Medical School," Dr. Friman said.
Dr. Friman said he would like to see the Center expand sometime in the future, possibly to include a clinic for treating children with autism. For now, the Center will continue to meet the community's – and Boys Town's needs – as part of Boys Town's bigger mission.
"We're part of something outside of ourselves. It doesn't matter what your job is at Boys Town; you contribute to the mission."
Dr. Friman received his Ph.D. from the University of Kansas. Besides serving as the current Vice President of Outpatient Behavioral Health Services at Boys Town, he is a Clinical Professor in the Department of Pediatrics at the University of Nebraska School of Medicine.