Best Practices in Residential Treatment

Rodney A Ellis

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780789037886
• eBook ISBN: 9781317993414
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Best Practices in Residential Treatment is a detailed examination of the latest information on empirically tested, evidence-based interventions and procedures across the many dimensions of residential treatment practice. Respected authorities from a broad range of professions provide a truly interdisciplinary look into the various diverse aspects of the treatment of children and youths in a residential setting. The book brings the most current information available on best practices, cultural competence, substance abuse, facility management, medication management, and planning for community reentry. This book provides the latest in research and practical techniques for the unique treatment program. This helpful resource extensively discusses effective counseling interventions, medication management approaches, facility management issues, and aftercare approaches to ensure successful outcomes for children and adolescents leaving a facility. The book's comprehensive nature offers practitioners the most current information on best practices in the residential treatment arena and can serve as a useful resource for future decision-making. This volume is extensively referenced and includes tables to clearly present data. This book is a valuable resource for social workers, psychologists, psychiatrists, counselors, residential program administrators, state departments of children's services, educators, and students at all levels.

This book was published as a special issue of Residential Treatment For Children & Youth.

Introduction

Rodney A. Ellis, PhD, CMSW

This volume was conceived as an opportunity to update practitioners, researchers, administrators, and policy makers on recent advances and trends in child and adolescent residential treatment. Although it remains to be seen what others will learn from it, its editor has learned a great deal. The intent was to solicit papers from experts in specific dimensions of the field, areas like best practices, substance abuse, facility management, medication management, cultural competence, and planning for community re-entry. As I heard from the experts, I learned that many changes have occurred in many areas, yet very little is different in many others.

Another goal for the collection was that it be cross-disciplinary. Some may be surprised to find such diverse fields as psychiatric nursing, recreation, and occupational therapy, and will doubtless be pleased by the contributors they bring. It is easy to become insular, reading only the writings of those easily discerned as our colleagues when, in fact, our circle of colleagues may be broader than we think.

Each article in this volume addresses at least one dimension of residential treatment. The first three articles deal with best practices and promising practices in residential treatment. Eric Yost, PhD and Gary Ellis, PhD, faculty from the field of recreation, both very interested in its application for prevention and treatment, report the results of an outcome study in which self determination theory-based recreational activities were used in a treatment program. That is followed by an article by Carole Lovelle, a practitioner who unites social work and psychology with her MSSW and PsyD. Carole makes a case for using Dialectical Behavior therapy concurrently with Eye Movement Desensitization and Reprocessing to treat adolescents with trauma-related issues. She has dones so in her own practice with great success and points to evidence both empirical and logical of its potential effectiveness. The third article, by two social workers and an educational psychologist (Sam MacMaster, PhD, the current writer, and Tammy Holmes, MA) reports the results of an outcome study of a juvenile drug court and discusses possibilities of combining that intervention with residential treatment. These constitute the contributions to the dimension of treatment.

Culture and cultural sensitivity are increasingly important to residential treatment. Two articles address this topic. One, written by Lori Holleran Steiker, PhD, an associate professor of social work, is a thought-provoking, comprehensive look at the many levels and forms of culture within a facility. The second, penned by Gregory Washington, PhD, Roderick Watts, PhD, and Jerry Watson, PhD (also social workers) reports the results of a single experience with Man Seekers Camp, a residential camping intervention for African American youth.

Advances in treating mental illnesses with psychotropic medication are discussed in the sixth article, written by Julie Worley, FNP, PMHNP. She is in practice as a clinical nurse practitioner working with children and adolescents in both inpatient and outpatient settings. Ms. Worley's article reviews current treatment alternatives for many of the major psychiatric conditions experienced by children and adolescents and describes some of the possible side effects of each.

Two articles consider facility management. The first describes the results of a study by Mike Burford, MSSW (a PhD student), William Nugent, PhD, and John Wodarski, PhD. The study sought to determine whether off-campus passes with an adult mentor or family member helped to decrease the probability of elopement from treatment. The second, by Sam MacMaster, PhD, Lyle Cooper, PhD, and the present writer, discusses issues of facility functioning and survival in a post-managed care era.

The final article focuses on aftercare. Rebecca Estes, PhD, ORT/L, ATP, Claudette Fette, OTR, CRC, the Founder of Denton County Federation of Families, Texas, and Marjorie E. Scaffa, PhD, OTR/L, FAOTA, all occupational therapists, offer a contribution discussing techniques that can facilitate successful reentry for children and adolescents leaving residential treatment.

Hopefully, readers will find the diversity of content interesting, informative, and helpful. It certainly has been to me.

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PROMISING PRACTICES/
BEST PRACTICES

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Effect of Self Determination
Theory-Based Recreation Activity-Staging
on Vitality and Affinity Toward Nature
Among Youth in a Residential
Treatment Program

Erik Yost, MS

Gary D. Ellis, PhD

INTRODUCTION

A major challenge in working with youth who have behavioral, emotional, and learning disabilities is staging environments and activities that fully engage participants in tasks at hand, rather than leaving them detached and disaffected (Skinner, 2002, p. 299; Patrick, Skinner, & Connell, 1993; Wellborn, 1991). Little is known, however, of specific techniques that reliably elicit engagement. The practice of staging experiences that have transformational potential for youth (Pine & Gilmore, 1999; Ralston, Ellis, Compton, & Lee, 2006) remains much more art than science (Long, Ellis, Trunnell, Tatsugawa, & Freeman, 2001; Rossman & Schlatter, 2000). Self-determination theory (Deci & Ryan, 1985; 2002; Reeve, Bolt, & Cai, 1999) suggests a number of principles that might be used by adult activity leaders to elicit target emotional and motivational states among youth. This study thus examined the effect of a recreation activity staged according to self-determination theory principles on situational vitality and affinity for nature of male high school students in a residential treatment facility. The staging strategies were constructed to engage and satisfy psychological needs for autonomy, competence, and relatedness (Deci & Ryan, 2002; Deci, Eghrari, Patrick, & Leone, 1994; Deci, Ryan, & Williams, 1996; Ryan & Deci, 2000) during a snow-shoe tour. The rationale for the investigation follows.

RATIONALE

Engagement refers to “active, goal-directed, flexible, constructive, persistent, focused interactions with the social and physical environment” (Skinner, 2002, p. 299). In contrast, “disaffected actions” are present when individuals are emotionally and behaviorally alienated from participation” in activities (Skinner, 2002; Patrick, Skinner, & Connell, 1993; Wellborn, 1991). Engagement provides an important foundation for learning specific skills, habits, behaviors, and values. It is a necessary condition for the implementation fidelity (Domitrovich & Greenberg, 2000; Duesnbury, Brannigan, Falco, & Hansen, 2003) and thus outcome efficacy of interventions. The ability to apply techniques for eliciting and sustaining engagement is thus an important skill for youth service professionals in a variety of settings.

Self-determination theory (SDT; Deci & Ryan, 1985; Deci & Ryan, 2002; Ryan & Deci, 2000) offers a number of principles that have notable potential for eliciting engagement. Engagement is a function of activation of psychological needs and satisfaction of those needs (Reeve, 2004). SDT proposes three organismic psychological needs that are inherent in all people: the need for autonomy, the need for competence, and the need for relatedness. These psychological needs are assumed to parallel such tissue-deficit needs as hunger, thirst, temperature regulation, and sexual activity in that, like these physiological needs, inattention to psychological needs results in significant and serious dysfunction. Psychological needs are particularly relevant to the challenge of engaging youth in activity, because circumstances that serve to satisfy such needs are experienced as engaging: “When an activity involves our psychological needs, we feel interest [and] when an activity satisfies our psychological needs, we feel enjoyment” (Reeve, 2004, p. 102). Within SDT, the subjective experience of having psychological needs met is called in-situ (state) “vitality” (Nix, Ryan, Manly, & Deci, 1999; Ryan & Frederick, 1997; Kasser & Ryan, 1993).

In addition to in-situ vitality, research has shown that affinity toward nature can create a number of positive outcomes for youth. Affinity toward nature refers to the cognitive value judgment that drives one's emotional response toward nature (Nussbaum, 2001; Solomon, 1988). Among the many benefits that have been found to result from contacts with natural environments are help in counteracting attention difficulties (Kaplan, Kaplan, & Ryan, 1998; Taylor, Kuo, & Sullivan, 2001); alleviating depression, stress, and anxiety (Kahn, 1999; Wells & Evans, 2003); assistance in fostering concentration (Taylor, Kuo, & Sullivan, 2002), promoting growth and development (Moore, 1997), and stimulating creativity (Cobb, 1977; Chawla, 1986).

It is reasonable to propose that in-situ vitality and affinity toward nature may result from situations that engage and satisfy psychological needs for autonomy, competence, and relatedness among youth (Deci & Ryan, 1985; 2002; Reeve, 2004, p. 102). By eliciting in-situ vitality through engagement of psychological needs in natural settings, positive associations between the quality of immediate experiences and the natural environment could be expected to occur. These associations may, in turn, facilitate in-situ affinity for nature. Existing research supports the position that activity staging techniques may successfully be used to engage and satisfy psychological needs. Long, Ellis, Trunnell, Tatsugawa, and Freeman (2001), for example, found that recreation activity staging techniques that are designed to elicit situational feelings of competence elicit enjoyment, self-efficacy, and positivity of affect. Results that are consistent with these occurred in a study that involved experiences staged to engage both competence and relatedness needs (Roark & Ellis, 2007). Other studies have identified effective strategies that can be used to stage experiences that elicit target emotional and motivational states, conceptual learning, and pro-environmental behaviors (Garbarino, 1975; Patrick, Skinner, & Connell, 1993; Koestner, Ryan, Bernieri, & Holt, 1984; Grolnick & Ryan, 1987; Legault & Pelletier, 2000). These studies provide compelling evidence that specific techniques may be used to stage encounters that engage the psychological needs of autonomy, competence, and relatedness that are advanced by self-determination theory (Deci & Ryan, 1985; 2002).

No studies have been completed, however, that directly address the effect of SDT-based activity staging strategies on in-situ vitality and affinity toward nature. The activity staging strategies that have been demonstrated to be effective in other recreation and education settings and contexts may be insufficient to create change in participants' evaluations in the natural environment. The novelties and complexities of the natural environment may be sufficient, in and of themselves, to affect affinity toward nature. Wilson (1984), in fact, proposes that humans possess an innate tendency toward nature. Nature, according to Wilson, is inherent in human beings and nature encounters are naturally pleasing. Individual and cultural differences also play a role in how emotions are construed (Ortony, Clore, & Collins, 1988). These differences may work against any efforts put forth by instructors in executing staging strategies.

Further, it is notable that most students who attend residential treatment programs do so against their will, resulting in a generalized state of either external motivation or amotivation (Deci & Ryan, 2002) among the students. Psychological needs ar...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• 1 Introduction
• Promising Practices/Best Practices
• Culture and Cultural Sensitivity
• Mental Illness/Medication
• Facility Management
• Aftercare/Community Re-Entry
• About the Contributors
• Index