Search

This open access book describes the theoretical underpinnings and operational aspects of delivering longer-term inpatient psychiatric care to adolescents experiencing severe, unremitting mental illness. The authorship is drawn from the multidisciplinary team that supports the Walker Adolescent Unit, located in Sydney, Australia. The book begins with an account of the planning and development of the unit, an examination of the physical environment, and the adaptations that have been made to ensure its functionality. There follows a consideration of the therapeutic milieu. The book describes clinical processes such as admission and discharge planning, formulation and case review. There is information about the specific roles of professionals and the therapies that they provide. The book describes the steps taken to maintain and enhance the physical wellbeing of patients. There are chapters dedicated to governance, and to training and education. The final chapterdescribes how the unit responded to challenges created by the COVID-19 pandemic.

A gripping chronicle of psychological manipulation and abuse at a “therapeutic” boarding school for troubled teens, and how one young woman fought to heal in the aftermath.At fifteen, Elizabeth Gilpin was an honor student, a state-ranked swimmer and a rising soccer star, but behind closed doors her undiagnosed depression was wreaking havoc on her life. Growing angrier by the day, she began skipping practices and drinking to excess. At a loss, her parents turned to an educational consultant who suggested Elizabeth be enrolled in a behavioral modification program. That recommendation would change her life forever.The nightmare began when she was abducted from her bed in the middle of the night by hired professionals and dropped off deep in the woods of Appalachia. Living with no real shelter was only the beginning of her ordeal: she was strip-searched, force-fed, her name was changed to a number and every moment was a test of physical survival. After three brutal months, Elizabeth was transferred to a boarding school in Southern Virginia that in reality functioned more like a prison. Its curriculum revolved around a perverse form of group therapy where students were psychologically abused and humiliated. Finally, at seventeen, Elizabeth convinced them she was rehabilitated enough to “graduate” and was released.In this eye-opening and unflinching book, Elizabeth recalls the horrors she endured, the friends she lost to suicide and addiction, and—years later—how she was finally able to pick up the pieces of her life and reclaim her identity.

Transforming Residential Interventions: Practical Strategies and Future Directions captures the emerging changes, exciting innovations, and creative policies and practices informing ground-breaking residential programs. Building on the successful 2014 publication Residential Interventions for Children, Adolescents, and Families, this follow-up volume provides a contemporary framework to address the needs of young people and their families, alongside practical strategies that can be implemented at the program, community, system, and policy levels. Using the Building Bridges Initiative as a foundation, the book serves as a'how-to manual'for making bold changes to residential interventions. The reader will learn from a range of inspired leaders who, rather than riding the wave of change, jumped in and created the wave by truly listening to and partnering with their youth, families, advocates, and staff. Chapters provide real-time practice examples and specific strategies that are transformational and consider critical areas, such as family and youth voice, choice and roles, partnerships, permanency and equity, diversity, and inclusion. These methods benefit youth with behavioral and/or emotional challenges and their families and will improve an organization's long-term outcomes and fiscal bottom line.This book is for oversight agencies, managed care companies, providers of service, advocates, and youth/family leaders looking for an exemplar guide to the new frontier of residential intervention. In this era of accountability and measurement, it will become a trusted companion in leading residential interventions to improved practices and outcomes.

Youth residential mental health care is often a last resort after a long time searching for help. Despite engaging with residential care, moving from residential mental health programs to life in the community, many youth still confront disturbing prospects. Incorporating vignettes, chapter summaries, as well as theory and evidence in fields such as education, juvenile justice, child welfare, independent living, supporting families, and positive youth development, this book proposes a template that is both credible and feasible for improving community living outcomes for youth leaving residential mental health programs.

This highly practical resource integrates the powerful dynamics of family into residential treatment and outdoors-based therapy for young people. Recognizing both the family as the systemic base for promoting change in adolescents and the therapeutic potential of the residential/wilderness setting, experts show how aligning the two can enhance the healing value of the program while promoting higher standards for care. Chapters describe innovative, science-based interventions and techniques for treating common behavioral and emotional problems along a continuum of family involvement and separation, to address issues affecting the family as well as the identified patient. With its accessible ideas and compelling case studies, the book ably demonstrates the critical role of family in adolescent patients'successful transition to post-treatment life. Among the topics covered:• A parallel process: home therapy while the adolescent or young adult is in residential care.• Intentional separation of families: increasing differentiation through wilderness therapy.• Emerging family therapy models utilized in residential settings.• Engaging families in Outdoor Behavioral Healthcare.• Research on coping skills used by youth with emotional and behavioral disorders.• Expanding our understanding of the place of family therapy in residential treatment.Family Therapy with Adolescents in Residential Treatment offers novel, exciting, and effective strategies and techniques for practitioners and mental health professionals particularly interested in family therapy with adolescents, and in related interventions and research.

Definitive and wide-ranging, this international review of therapeutic residential child care covers the latest research on how it works, how much it costs compared with the outcomes it delivers and how to deliver this effective form of care for the most troubled children in public care.

Now more than ever there is a need to ensure that best practices are being used in residential programs. As the focus on costs and outcomes increase, residential programs must clearly demonstrate that the interventions provided are efficient and effective. Readers will learn how to: Create strength-based, empowering and healing environments; Better engage and partner with children, adolescents and families, in meaningful ways; Support those who have experienced trauma and loss, and to prevent and eliminate the use of restraint and seclusion; Respect and include cultural indices in practices; Train, mentor, supervise, support and empower staff about how to deliver promising and best practices, and evidence-informed and evidence-based interventions; and Track long-term outcomes, and create funding strategies to better support sustained positive outcomes. This book encourages readers to think strategically about how agencies, communities and systems can identify and implement actions that lead to positive change and how to work more collaboratively to improve the lives of children and adolescents who have experienced emotional and behavioral life challenges and their families.

When Love Is Not Enough relates how a multitude of factors--the competence of staff; the safety, nurturing, and protective elements of the emotional, physical, and political setting; and all overt and covert organizational dynamics--determine whether or not a treatment setting accomplishes its therapeutic aims. Authors in When Love Is Not Enough continue the emphasis on the group-as-a-whole “Group Relation” model of organizational and group processes begun with Wilfred Bion's work at the Tavistok Clinic in London in the 1940s. This model helps those providing services to children and adolescents evaluate their treatment programs and make the necessary changes toward improvement.Chapters in When Love Is Not Enough are dedicated to improving the psychological treatment of children and adolescents in postmodern society, a society in which life in interdependent communities is becoming increasingly important for the health and survival of all persons. Topics covered include: the Tavistok approach to understanding group and organizational behavior the emphasis on group-as-a-whole in problem solving and treatment design narrowing the gap between plan and outcome the dynamics involved in the psychiatric treatment of children issues of staff selection, training, and development in programs designed to treat children countertransference responses in the treatment of children and adolescents revitalizing organizations the subjective experience of school lifeWhen Love Is Not Enough helps organizations realize the ways in which they may, inadvertently, undermine the emotional and cognitive functioning of the staff or the identified patients and set serious limits on the growth of members of the organization, staff and patients alike. It urges organizations to conduct an ongoing self-scrutiny concerning their rational and irrational processes, as this self-examination is crucial to the health and vitality of the treatment offered to others. The book also promotes thinking of the conscious and unconscious dynamics of the group-as-a-whole to more completely inform organizational decisions concerning changes that may enhance the treatment of children and adolescents.When Love Is Not Enough serves as an invaluable guide for mental health professionals who treat children and adolescents, group therapists, hospital and clinic administrators, psychoanalysts, nurses, social workers, psychologists, and psychiatrists.

Here are practical ideas and help for dealing with problems of sexuality in residential treatment settings. On a day-to-day level, difficulties can arise from the need for child care workers to maintain caring and personal relationships with children in the face of the children's and their own sexuality. Children themselves also may have difficulties in properly expressing their sexuality. The Management of Sexuality in Residential Treatment examines a broad range of problems that often occur and describes several treatment programs and strategies for coping with incidents of abuse or alleged abuse.Chapters in the book address issues pertinent for professionals working with children in residential treatment. Authors cover topics such as: residents'needs for love versus sexuality the impact of sexually stimulating materials erotic countertransference in a residential treatment center survey of minor sex problems in the milieu and how to respond to them personal relationships between residents and staffThe book also describes two treatment programs for abused or abusing children. The first is an eight week multimodal therapeutic program for adolescent girls who have been sexually abused, the other a course for sexually abusive boys that includes counseling, sex education, and journal writing. The Management of Sexuality in Residential Treatment is a valuable resource for the staff of residential treatment centers, group homes, residential schools, and hospital pediatric units who wish to understand how to deal more effectively with issues of sexuality and the children for whom they care.

Behavior therapists on child and adolescent psychiatric inpatient units have played an increasing role in the treatment of a wide range of disorders. Indeed, behavioral assessment and treatment strategies in these settings have been applied to a diversity of problems, including depression, mental retardation, autism, conduct disorders, attention­ deficit hyperactivity disorder, anorexia, and bulimia. More recently, the heuristic value of behavioral methods with substance abuse, pediatric pain, and child maltreatment has been documented as well. Because of the multifaceted and complex challenges posed by children and adoles­ cents who reach inpatient units, behavioral clinicians have worked close­ ly with other professionals (e. g., psychiatrists, social workers, psychi­ atric nurses) in an effort to provide broad-spectrum, comprehensive intervention. However, as a burgeoning body of clinical research attests, the significant contribution of behavior therapy to successful treatment outcome is now indisputable. Yet, surprisingly few texts have been published concerning inpa­ tient treatment of children and adolescents. The few extant efforts in this area have not covered the broad array of issues and diagnostic popula­ tions treated, nor have they considered the pragmatic day-to-day diffi­ culties encountered by behaviorally oriented practitioners working in child and adolescent inpatient settings. This text is an attempt to remedy such shortcomings by providing a comprehensive yet practical approach to the functions of behavior therapists on inpatient psychiatric services for children and youth.

This book is written for all mental health clinicians, allied professionals, line staff, social workers, and students whose focus is on the adolescent in residential treatment and the problems facing the aging-out young adult and his transition to independence. Readers will find that the book elucidates upon the fundamentals of assessment, clinical descriptions of theoretical constructs, and the application of technique. All of these domains are regarded as areas of interest and concern for front line staff during their supervision and monitoring of adolescents. This book also addresses the role of the social worker during interventions with families and while conducting group work, and reviews guidelines for treatment staff that will enable them to assess a youth's overall development, self-esteem, and sense of self. Assessments of youngsters include a description of developmental maturation, the level of stability or self-control, and the type of support or structure needed to enhance the youth's life. There is also a comprehensive overview of contextual practice, which details an explicit theoretical basis for understanding the process that brings about change. Of importance for residential staff is to be aware of the effect that expectations within the environment and communication patterns have on youngsters. In this regard the reader will be shown how to approach the youth on his level of understanding and relating, and to recognize which youngsters have learned to survive by not talking. Finally, there is information on how to connect with withdrawn youth, to encourage them to be more open in relationships as well as to deal with their feelings. It will also be of interest to researchers, practitioners, educators, and policymakers who seek to refine their skills and knowledge of residential treatment and to learn specifically about contextual practice.

This book provides a model of care for traumatized children, based on theory and practice experience pioneered at the Lighthouse Foundation, Australia. The authors explain the impact of trauma on child development, drawing on psychodynamic, attachment and neurobiological trauma theories.

'In Residential Treatment of Adolescents, Pazaratz discusses how practitioners can remain emotionally available for the needs of their residents without feeling overwhelmed. Readers will be apprised of ways to deal judiciously with residents who try to circumvent, con, play workers off each other, and even attempt to seduce or manipulate the worker. Each chapter instructs readers to observe their clients and comprehend how they relate to the total environment, in order to determine what the resident is feeling and how he or she makes use of personal resources. This contextual understanding helps to answer questions such as: What are the youngster's goals? What factors obstruct the change process? What are the youngster's defenses and against what? How does the youngster use the milieu (staff and peers) and the community as resources? How can the youngster get significant others to react differently to him or her?'

In Residential Treatment of Adolescents, Pazaratz discusses how practitioners can remain emotionally available for the needs of their residents without feeling overwhelmed. Readers will be apprised of ways to deal judiciously with residents who try to circumvent, con, play workers off each other, and even attempt to seduce or manipulate the worker.Each chapter instructs readers to observe their clients and comprehend how they relate to the total environment, in order to determine what the resident is feeling and how he or she makes use of personal resources. This contextual understanding helps to answer questions such as: What are the youngster's goals? What factors obstruct the change process? What are the youngster's defenses and against what? How does the youngster use the milieu (staff and peers) and the community as resources? How can the youngster get significant others to react differently to him or her?Ultimately, Pazaratz demonstrates that effective treatment staff do not create dependent youth, make treatment oppressive, or enact a role based upon giving consequences. Instead, the reader will learn to integrate diverse intervention strategies into the resident's normal cycle of daily life and how to interact within a team structure.

Integrate psychotherapy with residential treatment to achieve positive results for patients in group care! This book addresses the complex issues that arise in the effort to provide individual therapy in group care settings. It reviews classical case material, presents contemporary case studies, and examines practical and theoretical issues important to the effective delivery of treatment to individuals living in residential care. Noted experts who have been associated with The Sonia Shankman Orthogenic School at the University of Chicago and the Menninger Clinic in Topeka, Kansas, share knowledge garnered from years of real-world experience to help you stay at the leading edge of the field and provide effective individual treatment to your clients in long- and short-term residential care. Psychotherapy in Group Care: Making Life Good Enough includes practical and theoretical chapters exploring important aspects of the group care paradigm. The book: presents a case study that describes vital aspects of the analytic process that emerged in work with an adolescent boy in a group home who felt as though he was a psychological orphan illustrates the role of play as a continuous and basic function in therapy and presents play-themed vignettes from analytic work with two young people in residential care revisits Joey: A Mechanical Boy and Tommy the Space Childclassic case studies from Bruno Bettelheim and Rudolph Ekstienand explores the implications of contemporary relational theory for using the meaning and metaphor of behaviors and communications addresses issues of transference and counter-transference in the psychodynamic psychotherapy of a young girl in residential carewith a discussion of unrecognized rescue fantasies and projective identification, and of the need for residential childcare workers to recognize and work through the difficult feelings evoked in the process of working with seriously disturbed young people examines the structural basis for the integration of psychotherapy and residential treatment, considering the meaning of integration, variables that affect the manner and degree to which integration can be accomplished, and changes in the psychotherapists'roles that can maximize the potential of each variable explores three sets of theoretical issues facing clinicians as they play multiple roles in short-term residential treatment, discussing how conflicts in the roles of therapists and team leaders can be resolved, the implications of such a resolution in terms of confidentiality, and ways in which major approaches to psychotherapy can be adapted to new conditions considers the role of the primary clinician in relation to the residential team and explores the ways in which integration of psychotherapy and residential treatment can be implemented in the early phase of the treatment process

This is one of the books in the Wiley/Department of Health series on residential care. Residential care is an increasingly important topic in social welfare. The series, based on research for the DOH, represents the most up-to-date and authoritative research in this area. This book examines the management of sexually abused and abusing children in foster and residential care. The authors gathered data from a review of 250 carefiles to compare the needs and vulnerability of sexually abused and abusing children with those of non-abused children in care. Drawing on information from their detailed follow-up study of 40 children, the authors explore the management of sexually abused and abusing children inside and outside their placements. They examine the risks these children pose to other residents and foster carers? own children, and the children?s vulnerability to further abuse and exploitation. The authors highlight three different groups of children who have distinctive needs for management and placement: prostitutes; sexualised adolescent girls; and young abusers. The book provides a rich source of essential messages for policy and practice aimed at minimising the risks to these children and others.

Sexual Abuse in Residential Treatment provides comprehensive information on behavioral manifestations of sexual abuse in residential settings and the safety and developmental needs, staff training, and management strategies necessary to protect both residents and staff. Chapters containing vivid case studies that describe problematic episodes, discussions of research projects, and proposals for agency sexuality policies, safe facility management, and staff training contribute to a balanced presentation of the framework in which sexual manifestations are embedded.Professionals in residential treatment will learn how to identify the most common sexual, sexualized, and sexually abusive behaviors and from whence they derive. Sexual Abuse in Residential Treatment provides specific suggestions for policy and program design, recommends operational framework for safe management of treatment facilities, and describes practical staff supervision and training modules. With an emphasis on clinical practice, descriptions of common problems and proposed solutions together with a broad philosophical basis to guide policy setting will benefit professionals in agencies interested in developing customized organizational and treatment plans. Practitioners, policymakers, and decision makers in residential programs, inpatient psychiatric units, community-based group homes, court-related youth shelters, and correctional facilities for the rehabilitation of behaviorally disturbed youth presenting sexual problems will find a wealth of information on a wide range of topics such as: normal, pathological, and abusive sexual behavior in residential treatment staff responses to sexual behavior, training, and supervision needs frequency and quality of sexual behaviors of latency-aged children safe management to prevent toxic manifestations of sexuality management of sex abuse allegations in the residential program recommendations for agency sexuality policies selection criteria and program features for specialized offender treatment the heterogeneity of phenomena classified as “sex abuse” values conflicts involved in the design of programs and policiesSexual Abuse in Residential Treatment provides descriptive commentary concerning sexual behavior of youth in residential treatment from various points of view including development, values, therapeutic milieu, safety, training, and clinical experience. Such a diverse approach makes this a valuable guide for practitioners, as well as program directors, unit supervisors, case managers, staff trainers, faculty in child care studies, and child protective services staff.

First published in 1994. The Sheppard and Enoch Pratt Hospital has been treating severely emotionally disturbed adolescents for a number of years. During this time, they have had the opportunity to build upon the principles and techniques of acknowledged experts and leaders, and have gained a great deal of experience and wisdom ourselves. Our treatment teams had the time to deliver intensive, in-depth treatment, which included three weekly individual psychotherapy sessions, three weekly group therapy sessions, daily activity therapy, and intensive milieu program, daily ward meetings, weekly family therapy, and a daily therapeutic school program. The knowledge and principles described in this book are not only applicable to inpatient facilities but also valuable to practitioners in day hospitals, group homes, and outpatient practice.