The power of residential treatment
There can be little doubt about the importance of children having strong relationships with competent, caring adults. Such relationships contribute significantly to children’s growth and development. People tend to develop their values and beliefs based on other people who are important to them. People they like or admire, people they want to emulate, groups to which they belong, or groups to which they aspire to belong. Such people also have considerable influence on the goals individuals set for themselves and the expectations the have of themselves. Lack of healthy relationships with adults is likely to be associated with children’s failing to reach, or even to approach, their potential.
Residential treatment programs are in an uniquely powerful position to provide their children with multiple opportunities to experience healthy relationships with adults. First of all, they choose and hire their staff, the adults with whom children spend most of their time. They can provide children with an amazing variety of caring adults — different races, ethnic and cultural backgrounds, different religions, interests, skills, and more. And not only the professionals who relate with the children but also other staff, clerical, dietary, maintenance. These staff are in an interesting position to offer children unconditional positive regard that has little to do with their treatment, discipline, and all that other stuff. They are not paid to work with the children. These are purely personal relationships with purely personal dynamics — you treat me right and I treat you right — or vice versa. Second, programs train and supervise the staff, the adults with whom children have relationships. When residential programs operate the schools their children attend, this influence over the staff extends to school.
More, residential programs can bring in experts in various fields from the outside, for example athletes, musicians, or business people. Or for girls, a model or beautician with expertise in applying and using makeup.
Further, residential programs are in a position to monitor, influence, even to control, many of the interactions children have with other adults. They can determine when and how often children interact with their parents. They can supervise at least some of these interactions, and through family therapy, can exert some influence over them. More, they are in the position to provide support to children both before and after such interactions.
When children attend public schools, residential programs can develop their potential to exert some influence over children’s relationships with the school faculty and administration, provided they are able to develop cooperative relationships with the schools their children attend. They may even be asked to offer advice or possibly inservice training to school personnel.
On the other hand, peer relationships are also important. Peers take on increasing importance as children grow older. For some things, dress, hair style, makeup, and entertainment for example, the influence of peers may be more important than the influence of adults. I suspect few teenagers dress to please their parents. And teenage girls often seem to choose their makeup based on what other girls are doing or telling them rather than what their parents may tell them or what boys actually think. Or how about the generational gap in musical tastes?
Eventually, as children approach adulthood, peer relationships may take on primary importance for other things, as well. When children lack appropriate relations with adults for whatever reasons, their relationships with peers may assume primary importance at a much earlier age.
In my opinion, it is in the realm of peer relations that residential programs have their greatest opportunity to contribute to the development of their children.
First, many programs have some influence over whom they accept into residency. Obviously, programs cannot pick and choose among referrals to select only good role models. All of the children referred have problems. However, when programs have the right to refuse a candidate, they can exercise that right judiciously to avoid accepting children they are not equipped to manage, or children who might pose a danger to other residents.
For example, programs who do not have expertise in treating substance abuse should not accept referrals whose primary problem is with substance abuse. This does not mean that they cannot accept children who have used illegal substances. Apparently, most children have these days. Programs that do not have security or other resources to minimize runaways should not accept children who have a history of running away and staying gone for extended periods of time, especially when their history includes taking other children with them, then abandoning them on the streets. This does not mean programs cannot accept children who occasionally walk off during a tiff with staff or a desire to go to some party. And programs that have limited supervision, especially overnight, should be most wary of accepting both children who have histories of sexual abuse along with children who have histories of sexual activities with others.
Second, programs often have the ability to determine when they admit children. In my experience, admitting two children to the same unit in the same week creates some relationship problems. Children who come into the program at the same time share a common bond of being the new kids. They both feel vulnerable and tend to seek out each other for support. This can lead to their forming unusually strong relationships with each other and interfere with their developing relationships with staff. When one or both are oppositional, this can be especially problematic because it is likely to lead to early conflicts with staff with the support of their peer. Children who enter the program by themselves are more likely to accept support from staff and develop their primary relationship with a supportive staff person.
More, children who come into the program late in the week, i.e., on a Thursday or a Friday, may also be at increased risk for problematic relationships with other residents. They develop their primary relationships with weekday staff during the admissions process, then feel especially vulnerable when those staff are unavailable over the weekend only a day after their admission. The more relaxed atmosphere on weekends along with reduced staffing levels leaves such children vulnerable to approaches from a resident who is not doing well with staff and other residents and who may be looking for an ally.
Finally, and most importantly, program staff are able to supervise virtually all peer interactions at all times. I’m not talking about the type of supervision where staff observe behavior and provide consistent consequences. Rather, I’m talking about supervision that provides staff with the opportunity to monitor peer interactions, to participate and build relationships, to provide guidance, to get involved when conversations become negative. To intervene when ‘war stories’ about past exploits arise. To question when adolescent boys begin to talk disrespectfully about girls and women. To question antisocial beliefs and encourage discussion of appropriate values.
When staff are successful in managing the peer group, they are able to create an environment where peers, for the most part, support treatment objectives. I think of a program in which I worked where this occurred regularly. Where a staff member told me, “I don’t get concerned when they get loud. I just look at their faces. I can tell from their expressions whether the noise is good or bad. When their expression are appropriate, I let them have their fun. When their expressions tell me things are not so appropriate, I step in.” Where kids would tell others, “We don’t use that kind of language in this program.” Or, “We always wear our seatbelts in the van.”
When kids and staff are on the same page as it were, when the kids support the program and pro social values, treatment happens.
And I think of another program in which I worked, a strict behavioral program where the emphasis was on providing immediate consequences with total consistency. Where there was an hour of ‘quiet time’ every afternoon during which children were sent to their rooms while staff did their paperwork and chatted among themselves. Residents also chatted among themselves, with their roommates or those in rooms next door or across the hall, but no one knew what they discussed. The result, an us against them dynamic where the kids and the staff were in frequent conflict. Where kids would cheer on a resident who was having a conflict with staff. Where when the conflict became physical, kids would gang up on staff to ‘help’ the other kid.. Where kids sometimes hatched rather interesting plots that always seemed to catch staff by surprise.
When the residents are supporting antisocial values, values such as theft, aggression, retaliation, or rebellion, when the kids and the staff are on opposite sides, little treatment can occur. Decisive action is required.
The ‘bottom line,’ no matter how effective the relationships that staff establish with children in any group setting — community centers, schools, or residential settings — the results of those relationships can only be enhanced when peers support what adults are teaching, can only be diminished when peers undermine what adults are teaching. Some children are more vulnerable to peer influence than others. Programs can take steps to minimize inappropriate relationships among peers that support counter therapeutic norms and values. More, programs must be prepared to act decisively when unacceptable norms and values arise in the peer group.
I’ll suggest an effective strategy next month for when the norms and values of the group get out of hand.