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The underlying principle in this approach to group treatment is provision of protective limits. In such a model, the therapist is required to operate as a benevolent authority. These children are offered a new view of authority that is firm, consistent, and nonpunitive. As a result, group members come to rely on the safety present in the group experience to develop greater awareness of their feelings and needs. In essence, their emotional needs are recognized and addressed directly, which supports emotional and social development and adaptation. By learning to control their behavior and by understanding their needs, these children can also come to learn how to get along with each other. For these children such achievements represent significant changes in the way they view themselves, as well as the world around them.

This study compares the profiles of two groups of emotionally disturbed female adolescents as measured by two objective personality tests, the HSPQ and the Jesness Inventory. The hypothesis tested was that the unsuccessful girls would score significantly differently on various dimensions of the two tests than the successful girls. Unsuccessful girls were those who did not complete the treatment program; successful girls were those who completed the program. A comparison of the mean scores of the various personality factors on each test showed significant differences upon admission.

Alternate frameworks for a model of residential group care focused on the family have the primary objective of early discharge from group care. The proposals are based on an agency's experience.

In New South Wales, Australia, the Department of Youth and Community Services is empowered by statute to deal with cases of child abuse and neglect. Its child protection services include the Montrose Child Life Protection Unit which is designed to support and complement the work of both the Intake Service, Field Service and most importantly the work of child protective facilities in the community. The service has intake crisis counselling and call out resources; maintains a central register; provides a facility for crisis residential care for children and families, diagnostic assessment, and a day programme. The emphasis in service delivery in New South Wales in the area of child protection is on multidisciplinary intervention. The Department of Youth and Community Services is involved in promoting interagency cooperation and co-ordination. Over and above a philosophy that underlies service delivery is the Montrose Unit's involvement in sensitising the community to the difficult and often demanding role of parenting. Montrose represents an attempt to create an environment where parenting myths can be examined from a reality base and strategies implemented for reeducation.

Techniques previously used to assess the quality of care in large institutions (cf. Raynes, Pratt, & Roses, 1979) were adapted for a similar study of seven small community residences. Five areas were assessed: daily management practices, the physical environment, resident community involvement, staff-to-resident speech, and staff attitudes. Interitem correlations within each scale were generally high, and validity comparisons between the community residences and the larger institutions of Raynes et al. (1979) showed that scores on the measures were generally superior in the group homes. These dimensions of the caretaking environment varied independently of one another, clearly indicating the need for differentiated evaluation techniques.

This study was undertaken to determine whether there were significant differences among three groups of emotionally disturbed children in Massachusetts: children in private residential schools; children in private day schools; and children in special classes for the emotionally disturbed in public schools. The subjects involved in the study consisted of three groups of children who were evaluated as being emotionally disturbed and whose initial enrollments in the respective programs were accomplished during the 1972 to 1973 school year. This represented 129 children enrolled in private day schools, 72 children enrolled in private residential schools, and 309 children enrolled in public school special classes for the emotionally disturbed. Data for these populations were obtained from the records for each of the children on file at the Massachusetts Department of Education, Division of Special Education. This included data on psychiatric diagnosis, IQ, parental separation, geographical location, family income, family social position, and assessment of the child's physical well-being. In addition, two tests were administered to all subjects: The Rutter Child Behavior Scale was completed by each child's classroom teacher, and the Wide Range Achievement Test was administered by the professional having the responsibility for psychometric testing in the respective school.

Many chronically disabled patients need special support systems to help them meet material needs, personal-care needs, and psychosocial needs. The authors propose two guidelines that must be considered simultaneously when deciding what special support system is most appropriate for a particular client. The first is that the system be adequate to meet the client's unmet needs, and the second is that the system not meet needs the client can meet hiself. The authors feel that one should look first to support systems other than special living arrangements, which can easily overprovide services to clients. If a special living arrangement is considered appropriate, the one selected should provide only for those needs the client cannot meet himself.

This is a program description of a short-term residential unit in which whole families are assessed and treated. This unit provides an alternative treatment format for exploring situations where removal of the child appears to be the only remaining option. It also provides an in-depth consultation for agencies who are "stuck" in their treatment of family systems and allows for the teaching of family systems intervention techniques in a non-threatening way. It also allows an opportunity for an external system to reframe, what are, to the involved clinician, impasses with clinical problems. The program, because of its structure, introduces anxiety and tension into systems with chronic mental health problems. It, therefore, serves as, not a panacea, but as an adjunct to more traditional treatment for rigid and resistant systems.

In a study of the patient selection process used in two small, residential, psychiatric treatment facilities for boys aged 12-17, outcome predictions documented by the intake committee at admission were compared with actual outcomes for two and five years after discharge. This comparison allowed researchers to identify documented considerations in the admission decision that were valid, indifferent, or misleading predictors of outcome. The identification and development of valid predictors contributes to the quality and cost-effectiveness of care by improving the selection of patients likely to benefit from the treatment that a facility provides.

The article reports on different components of misplacement as an important problem in the psychiatric care. Basing on a census of all in-patients of the Psychiatrische Universitätsklinik Bern (n = 551) different methods of evaluating misplacement are discussed. Some results of the census: - two thirds of the patients suffer from psychoses, another 13% from oligophrenia: - 46% of the patients are older than 60 years; - 72% have been in hospital for more than one year, 30% even for more than 20 years; - a quarter of the patients need special care. Psychiatrists and nursing staff agree that 198 (= 36%) of the 551 patients do not need any psychiatric treatment or nursing. From this point of view these patients have to be regarded as misplaced in the Psychiatrische Universitätsklinik Bern.

The social climate of four residential alcoholism treatment programs was assessed with the Community-Oriented Programs Environment Scale (COPES). The programs differed in terms of their treatment orientations (aversion-conditioning, milieu therapy) and the sociodemographic characteristics of the patients admitted. Results showed that (1) COPES profiles distinguished between the four alcoholism programs in ways that were consistent with their respective treatment orientations; (2) the type of patient admitted to these programs did not systematically affect their treatment environment; and (3) changes occurring within an alcoholism program resulted in corresponding changes in relevant dimensions of the treatment environment. We also discuss the practical utility of the COPES for assessing alcoholism programs.

Brookside is a second or third tier treatment unit for disturbed adolescents. Most youngsters admitted have been already "treated" by the usual disciplinary measures, simple behavioural techniques, medication and work of different types with them and their families, which have been found to be ineffective. An outline of the philosophy of treatment developed in the unit is described in the paper--a philosophy aimed at dealing with the source of the disturbance and applicable to any type of adolescent problem. A small minority of referrals from our catchment area, the NETRHA has been found unsuitable for this type of work. This unsuitability is not based on the type of problem, but on our assessment of the potential capacities of the individual. Inevitably, in the in-patient setting, the disturbance of the patients affect the staff, and individual and group patient pathology is reflected in staff stress and staff disturbance. Whilst the philosophy of treatment is aimed at benefiting the patient, it is through the understanding and management of staff difficulties, which became of primary concern in the unit, that the pathology of the patients can be unravelled, understood and dealt with. Paradoxically, attempting to care directly for the patients can lead to impossible difficulties, whilst caring for the philosophy of treatment and the staff leads to a solution of most of the problems, and development of both staff and patients. Total patient care is built into the philosophy and management of the unit. Staying with the problem and working as a team has resulted in successful treatment of youngsters considered to have intractable problems whilst periods of poor staff support and difficulties of working together, have led to failures in treatment. The basis of this philosophy was first introduced to the author during his training years at the Northgate Clinic, London NW9.

This study evaluated a program to teach and maintain language training interactions between institutional staff and profoundly handicapped children during a routine care task. Following baseline observations of bath sessions, staff were sequentially taught in multiple baseline fashion to vocalize more during the bath, praise child vocalizations, imitate sounds, and provide sound prompts. Procedures included a brief in-service meeting followed by a series of supervisory prompts and feedback. Results indicated that staff acquired the interaction skills in the bath sessions and that the skills generalized to another direct care task, dressing. The number of days on which components of supervision were implemented decreased from 47% of all days during the experimental conditions to 19% of the days during a 19-week maintenance period with no decrease in staff behavior. The interactions were shown not to interfere with the quality of the direct care task nor to increase the amount of time necessary to complete it. Also, some increases were noted for child vocalization frequencies. The advantages of providing therapeutic interactions during care routines are discussed along with the need for staff management techniques with long-term maintenance value.

In order to be able to realize the cultural care of patients with therapeutic aim the choice of literature and the behaviour of reading of gerontopsychiatric patients were systematicly examined within a two years' programme. In the reading they looked for distraction from the burdening reality, relaxation, but also for the possibility to fill up gaps in the experience by identification. The literature that particularly serves the widening of knowledge found less attention. The reading, which was carried out as a kind of group therapy, proved to be a suitable method to counteract the lack of interest and mental slowness of many gerontopsychiatric patients and through that to make them more capable of the living together in the sense of the therapeutic community.

A therapeutic milieu for children labelled with a diagnosis of early infantile autism is described. This study, in a residential setting near Washington DC, USA, discusses the various procedures adopted for alleviating the problems encountered with these children, such as the formation of social relationships, language formation, and compulsive behaviour.

A relatively inexpensive method for cross-confirming information about the functioning of youths was developed and used in a residential treatment program. With modification, the procedure can be employed in other settings to support and enhance social treatment.

Residential treatment for disturbed, particularly delinquent, adolescents has been described several decades ago by the founders and leaders of institutions. Theoretical considerations in treatment were prominent. The importance of structured milieu and the control of aggression came to acquire recognition. This study describes a structured centre, known to be effective in treating disturbed delinquents, using data gathered over twelve years of clinical work, observation and research. Factors considered essential in defining this institution are isolated and made compatible with the factors indicated by Rutter in his review of the residential treatment of delinquents. These factors are being used in a further study which compares the effectiveness of different types of facilities for a range of diagnostic categories.

During the last decade in Ontario large numbers of patients with chronic psychiatric disorders have been discharged from the mental hospitals and are now scattered throughout other psychiatric facilities. The Homes for Special Care Program offers privately run but government-funded accommodation for severely disabled patients with relatively stable and socially acceptable behaviour, who require residential or nursing care but are thought unlikely to benefit from further hospital treatment. Salient features of the program include the formal discharge of patients from hospital and their legal reinstatement as "persons", the cessation of active psychiatric treatment, and the provision of ongoing care and supervision by largely untrained personnel. Medical care is provided by general practitioners and the program looks to volunteer agencies to provide recreational and other activities for residents.

A follow-up of 46 youthful clients discharged from a therapeutic camp between its inception in 1972 and September 1975 indicates an overall improvement in functioning, especially in the areas of school performance, interpersonal relationships, and household behavior. The one area in which no overall improvement was found was delinquency.