The Blue
Print for Change
Comprehensive
Mental Health Treatment Services for Children and Adolescents
2011
Focus on the Therapeutic Milieu 3-4
The Sanctuary Program 4
Family Relationships 5
Discharge Planning & Preparation 5-6
Campus Overview 7
Description of Treatment Modalities 8 - 20
Program Description: Intellectual Disability/ 21-22
Autism Spectrum Disorder Unit
Program Description: Female Trauma Unit 23-24
Program Description: Adolescent Male Unit 25
Program Description: Children’s Unit 26
A Safe and Comfortable Living Environment 27
Assessment Tools 28-32
Aftercare Telepsychiatry Services 33
The Blue Print for Change 34
The
Following the Pennsylvania Child and Adolescent Service System Program (CASSP) principles, the interdisciplinary team works diligently to help the child and family reach their greatest potential. In addition to The Bradley Center Team, including Education staff, the referral sources and State or local agencies, are all included in this team approach to treatment.
In order for any treatment intervention to be successful,
effective staff training is critical. At
The Bradley Center, challenging behaviors are safely managed through the use of
the Cornell University Model of Therapeutic Crisis Intervention (TCI). These interventions are completely consistent
with the principles of Trauma Informed Care.
Further, clinical education for staff goes beyond the basics as is
required, and delves into the specific treatment modalities designed for each
Clinical Program within The Bradley Center.
Residential programs at The Bradley Center provide a safe
and therapeutic treatment milieu that creates a structured and predictable
environment by establishing rituals and routines. Therapeutic activities, activities of daily living
and recreational activities take place according to a predictable and
thoughtfully planned schedule. The
schedule, as well as each particular treatment modality, is presented in a
clear, concrete and concise fashion to residents and their families. Individuals are empowered, as they are
expected to take responsibility for their own behaviors and participate in
therapeutic activities (i.e., psycho-educational groups, recreational
activities, activities of daily living, etc.) as is detailed in each resident’s
treatment plan.
The Sanctuary Program
All programming emphasizes a
strength-based approach to treatment. Given that commitment, The Bradley Center
has woven the concept of establishing physical, psychological, social and
ethical safety within its milieus. Research has shown that young people,
particularly those that have failed in traditional treatment settings, develop
pro-social behaviors best by practicing and reinforcing them. The human task of internalizing limits or
developing healthy boundaries, pro-social behaviors and using good judgment is
best fostered by experiential means. The
Sanctuary program, as developed by Dr. Sandra Bloom, teaches young people how
to manage their emotional responses to internal conditions and their external experiences. Within the safe treatment milieu, children
become able to directly deal with issues of loss and change.
The
At the time of admission, a therapist is assigned to the child and her family to serve as the primary contact and provide case management services. Family members are encouraged to become active members of the interdisciplinary team. Family members have a major impact early in their child’s treatment as the therapist seeks their input in the development of the initial treatment plan. Family members attend regular interagency conferences and must be in concert with the psychiatrist’s recommendations regarding pharmacological interventions.
Family members are involved with the therapist and the child
in family counseling sessions on a weekly basis. Sessions occur over the telephone for the
child whose family lives a considerable distance from The Bradley Center. The therapist may have direct contact with
this family should they be able to visit the child and stay at the apartment
that The Bradley Center maintains on campus.
For the child whose family lives locally, counseling sessions take place
on campus or in the family home. A multi-system family focused approach
supports the CASSP principles as services are planned in collaboration with the
family as the primary support system for the child and that services are
planned with all of the child-serving systems involved in the child’s
life.
Disposition planning for the child begins just following the
completion of the admission assessment.
During this process, the treatment team identifies the core issues that
will impact the child’s eventual discharge from the program. Family members and the child are active
members of the team and their wishes and capabilities are given serious
consideration when disposition planning is discussed. External agencies that have been or following
discharge will be involved in the child’s care, are also actively involved in
the process. Representatives from these
agencies join family members and the child in regularly scheduled treatment
reviews. These reviews may include
reports on the child’s behavior during any therapeutic leaves that occurred
during the review period and/or any visits the child made with family members
to the family apartment that is located on campus. This type of planning and preparation helps
the child with progress towards maturation and development of the ability to
self-regulate. The child will then be
able to successfully reintegrate back into her family, school and community and
will not need to revert to the antisocial behaviors that lead to placement in a
residential treatment facility. A
functional assessment, such as the Vineland Adaptive Behavior Scales (VABS),
is completed at the time of discharge.
This is often requested when the child is moving to a less structured
setting, such as a group home. Group
home staff will utilize the results of the assessment to establish a baseline
with which to determine the course of future training.
Campus
Overview
Each Unit
has a capacity of 25 Residents
Unit Description Gender
Intellectual Male & Female 12 – 17.5
Disability/
Autism Spectrum
Disorder Moderate
to Mild
Intellectual
Disability/ Autism Spectrum
composition,
mood
disorders
with history
of
trauma
Adolescent Male Male
Diverse
diagnostic 12
– 17.5
composition,
mood
disorders,
History of
impulse
discontrol
Children’s Unit
Diverse
diagnostic Male & Female 6 - 14
composition,
mood
disorders,
ADHD
Specialized Residential Treatment Services:
The Intellectual Disability/Autism Spectrum Disorder (ID/ASD) Residential Treatment Facility (RTF) is one of the specialized programs at The Bradley Center. The ID/ASD program serves both males and females aged 12 – 17.5 years of age, with a dual diagnosis of a primary Axis I psychiatric diagnosis and an Intellectual Disability or Autism Spectrum Disorder.
Emphasis is placed on community readiness beginning at the
time of admission into the ID/ASD RTF Program.
Skills that are considered critical to independent living are identified
and taught. In order to maximize
learning, teaching takes place in the environment in which the skill is to be
performed. As the child acquires the
skill, she is closely supervised in a structured situation; The primary goal is
to help the child gain the confidence she needs to assume the responsibility
and be able to initiate performing the skill appropriately in the context of
daily living circumstances.
The Skills to Achieve Independent Living (SAIL)
program is utilized to address the teaching of daily living skills in the ID/ASD
RTF Program. The program consists of
skills within four major areas: Personal
Management, Home Management, Applied Academics and Community Access. Within each area, skills are further grouped
into sections. The area of Community
Access, for example, contains four sections.
They are: Leisure Time, Community
Resources, Prevocational and Mobility.
The SAIL curriculum is a teaching program consisting of: (1) Behavioral objectives (life skills); (2) Strategies (to be taught in a
normalized setting); and (3) Mastery criteria on two levels – (a) skill
acquisition and (b) self-initiation. A
Skills Inventory, an annotated checklist, is maintained for each child and
provides a record of the child’s ability on each skill. The inventory can be utilized in planning for
disposition and can help determine whether the child possesses entry-level
skills for a group home placement. The
inventory can then again act as a baseline from which group home staff can
develop their treatment planning.
Individuals with an intellectual disability benefit from the
same individual and group treatment modalities that are made available through
all of the programs at The Bradley Center.
A child residing with the ID/ASD RTF is striving toward similar therapy
goals. However, the manner in which
these treatment modalities are structured, presented and measured is
specialized for the child with an intellectual disability.
Group members are often presented with handouts that provide
each member with an outline of the group (i.e., the structure of the group, the
rules of the group and the group goals).
Similar handouts are distributed in a group of children with an
intellectual disability. However, it is
understood that many of these children have limitations in reading, significant
receptive and expressive language problems and short and long-term memory
problems. Therefore, handouts and verbal
instructions are concise, simple and concrete.
Complex sentences and abstract words are avoided. Written statements are read aloud and each
group member may be asked to repeat the statement or direction in his own
words. Each component or step in a group
presentation has a discrete ending and each group member should be able to
repeat the instruction before proceeding to the next component or step. Each group member brings her handouts with
her when she returns to the next session, so that they can frequently be
reviewed and referenced.
In implementing group approaches in the ID/ASD program at
The Bradley Center, a purposeful effort is made to keep the group size as small
as possible. This is important because
it offers each child more opportunities to practice the particular skill or
behavior being taught within the safe and supportive environment of the group. Numerous repetitions in this context
strengthen the possibility that the child will attempt to incorporate the skill
or behavior into her daily routine.
Because of the limitations in language skills as discussed above, group
approaches with children with intellectual disabilities most often rely heavily
on a modeling component. Modeling is an
illustration or dramatization of “how” the specific skill or behavior is to be
performed. It incorporates all of the
essential verbal and non-verbal components of the skill or behavior. To this end, the use of co-leaders in a group
of children with intellectual disabilities is a very valuable asset. It is essential that the skill or behavior
being taught is modeled correctly from the outset and every time that it is
being demonstrated.
It has been demonstrated that children with intellectual disabilities respond positively to a highly structured, repetitious and concrete group approach. This same structure and routine is equally beneficial with children with complex trauma and issues related to attachment. In many instances, the child begins to experience success for the first time in her life through this type of group experience. She understands what is expected of her and correctly anticipates what is to take place next on the agenda. She actually knows the correct answer or appropriate response and is eager to demonstrate it. She gains confidence and finds herself in a role that she may not before have experienced, as she assumes a position of leadership contributing constructively to the group process and in support of her peers.
Following is a more detailed description of some of the
treatment modalities that are offered.
All are cognitive-behaviorally based.
Pre-Therapy
(Teaching About Feelings)
Sex education, relationship training, anger management training
and social skills training have all been used to deal with feelings but most
begin with an assumption that the child has a basic understanding of feelings.
In developing a curriculum for the active treatment of a child with mental
retardation, it should not be assumed that the individual is able to
effectively recognize, acknowledge and express his emotions or can clearly
identify and label emotional/psychological states in others. Children with complex trauma or a pervasive
developmental disorder have significant difficulty in identifying and
understanding their feelings and the feelings of others, as well as managing
their own feelings. They struggle to
learn how they feel and what is causing them to feel that way and how to handle
their feelings safely.
A pre-therapy, or teaching about feelings, group is taught
in a group format so that the child has the opportunity to hear that many
others have the same feeling experiences. It is a natural beginning for group
counseling. The format and teaching materials are structured so that children
with varying skills can participate. Face drawings of five basic feelings
states (happy, sad, mad, scared and “just okay”) are utilized and various
feeling labels are translated back into these five basic feelings (e.g. I feel
all of the five feelings, sometimes one at a time, sometimes together), are
taught and repeatedly referred to as the group analyses differences and
similarities in each child’s emotional response(s) to common situations. Simple
and enjoyable games such as “The Special Chair”, “The Fan Game”, and “Go Fish”
are utilized to teach and practice these important core concepts and enable the
child to better respond to further counseling.
The concepts outlined in the discussion of teaching about
feelings in a group format are reinforced on an individual basis. Each child is
involved in the self-monitoring of her daily mood. A weekly mood monitoring
form shows five face drawings next to each day of the week; happy, sad, mad,
scared and “just okay.” With the aid of a staff member, the child marks one
face each day to represent her general mood. The child utilizes the weekly mood
monitoring form in the completion of her weekly journal entry and brings these
items with her when meeting with the therapist for individual counseling.
A great deal of space is dedicated in the program description to the discussion of pre-therapy or teaching about feelings. Central to the overall clinical philosophy of treatment at The Bradley Center is the Therapeutic Crisis Intervention System (TCI). TCI is a crisis prevention and intervention model for residential childcare facilities. It assists in preventing crises from occurring, de-escalating potential crises, managing acute physical behavior, reducing potential and actual injury to the child and staff, and teaching the child adaptive coping skills. The TCI model offers a framework for implementing a crisis prevention and management system that reduces the need to rely on high-risk interventions. It provides direct care staff with the skills, knowledge and attitudes to help the individual when she is at her most destructive. It also provides care workers with an appreciation of the influence that adults have with children who are troubled, and the sensitivity to respond to both the feelings and behavior of an upset child in crisis. Strategies in the TCI model emphasize helping the child to explore her feelings, summarize her feelings and the content of the situation and connect behavior to feelings. Therefore, it is important that early treatment interventions through the ID/ASD RTF focus on assessing and enhancing the child’s ability to accurately identify and label her feelings in order to better understand and benefit from TCI strategies.
The outline for a traditional anger management-training
group can be viewed as perhaps too ambitious for an individual with mental
retardation. Over a twelve-week period, relaxation training, the identification
of problem situations, the introduction and discrimination of coping and
trouble statements, role-play, the steps of problem solving and other concepts
are introduced at various points and integrated into the approach. However, the
goal of self-control is maintained as the various components of anger management
are addressed separately through other group experiences. For example, an
initial focus of anger management training, the recognition and identification
of emotions, is dealt with in the pre-therapy group presented above.
Anger management with the more advanced child with complex
trauma recognizes that traumatized children frequently are disconnected from
their own emotional experiences.
Difficulty expressing emotion may lead the traumatized child to be
explosive. Following the onset of
intense emotional states, she may have difficulty calming down and either
remain in a negative affective state for an extended period of time or rely on
maladaptive coping methods (Kinniburgh et al.).
For this child, treatment will follow the approach developed by Millicent
H. Kellner in In Control: A
Skill-Building Program for Teaching Young Adolescents to Manage Anger. The program is based on
cognitive-behavioral principles with its main goal “to help youngsters gain the
awareness and skills to manage the unique, yet malleable dimensions of their
anger (physiology, thoughts, emotion, behavior) so they can achieve
self-control and develop a repertoire of prosocial behavior.”
The In Control Program is made up of a total of ten
anger management sessions with a “connecting activity” to be completed between
sessions. One of the strengths of the
program is that each session follows a similar format that consists of: Goals; Objectives; Materials; Overview;
Leader Script (Review, Session Content and Closing); and Connecting
Activity. The structure is such that
co-leaders of the group can vary throughout the program but consistency is
relatively assured. Because of the
consistent approach, the child may quickly become comfortable with it and
better understand what is being expected of her. In this manner, she can focus more
effectively on the content of the sessions.
Review sheets are utilized at the beginning of the next session to act
as a bridge and demonstrate to the child that there is a “connectedness” to her
treatment. The anger log is
introduced in Session #2 and is the focal point of the program. It is a self-monitoring device and a teaching
tool to reinforce skill development. The
log grows in length and scope as each new topic is introduced until a full version;
the “Final Anger Log” emerges in Session #7. After the anger management group is
terminated, the “Final Anger Log” becomes part of the routine on the unit and
in the classroom. Copies of the anger log
should be kept in clearly designated places. Should an anger-related incident occur, the
staff member would direct the child to take a few minutes to complete an anger
log. This would help with recall and
reinforce key concepts of the program.
The log could be utilized in any debriefing that might be
indicated. In addition, the child’s
therapist should receive any completed logs.
The therapist may wish to incorporate them into the agenda of the next
individual counseling session.
Relaxation training at The Bradley Center will follow the model developed by Cautela and Groden (1978). This is a flexible model for teaching relaxation as a self-control procedure for adaptive behavior. Evidence indicates that it has been shown to be a benefit in decreasing disruptive and aggressive behaviors; as well as being effective in developing attentional skills which results in a decrease in social isolation and an increase in self-help, motor and academic skills. Cautela and Groden’s model also formalizes the adaptation of the relaxation procedures for the child with special needs. A primary concern is developing in the child with mental retardation the ability to generalize learned coping and self-management strategies. To this end, once the children are proficient in some of the relaxation techniques in the group setting, training is moved to the vacant classroom where each child can practice the same techniques while seated at her desk. In this controlled environment, images of stressful academic related situations are introduced as relaxation techniques are being implemented. Other strategies related to anger management, such as coping statements (e.g. “Be cool”, “Stay calm,” and “Think first”) are taught and mastered in a similar fashion.
Social skills deficits have been frequently identified as critical reasons for failure of individuals with mental retardation in competitive employment, sheltered workshops and community living arrangements. Children with complex trauma tend to be attracted to abusive relationships. It is non-abusive relationships that are anxiety producing, confusing, unpredictable and frightening. Children who grow up in abusive relationships tend to treat others with the same callous disregard that they have experienced themselves (Bloom). Any discussions of effective social skills refers to repertoires of social behaviors that, when used in social interaction, tend to evoke positive reinforcement and generally result in positive outcomes. The acquisition of social skills enables the child to competently and effectively participate in diverse aspects of human interaction (e.g. conversational skills, assertive behaviors and leisure-time social interactions skills). Social skills training can also be effective in decreasing the aggressive behaviors associated with arguments and fights. The importance of social skills for interpersonal adjustment, community living and vocational success cannot be overstated.
The
As in relaxation training and other modalities, the issue of
generalization is a primary concern. With social skills training, it is
approached in a similar fashion as described above. The task is somewhat more
difficult in a group setting, as responses to the role model prompt are
inclined to be more generic in nature. However, in an individual counseling
setting, social skills training is closely tied to the child’s specific
deficits and needs. A role-play re-enacts the particular situation in which the
child has reported difficulty. A response is formulated to fit the individual
child’s particular needs and personality. In this manner, the child may find
the response more natural and may be more likely to adopt it into her
repertoire and utilize it in an actual situation.
Group Therapy
MISSION: Group therapy is a process in
which residents gain self-awareness through interactions with others thus
facilitating change in behaviors and improved relationships. The group therapy sessions are conducted in
accordance with all seven commitments in the Sanctuary Model.
The
The
residents attend five group therapy sessions a week. The group format and topics will address
goals and objectives from the individualized treatment plan. All residents will receive a combination of
expressive arts groups, Adventure Based Programming groups, skill based groups
and prescriptive groups. The clinical
team and psychiatrist, family/guardian and referral sources will prescribe
specialized groups for each resident based on their clinical needs and
treatment plan goals and objectives. A
master’s level certified art therapist, a certified music therapist and two
masters’ level mental health therapists will facilitate the groups. Each of the groups is run with two
facilitators and a small group of 4 to 12 residents. The child development
specialists also attend groups to model appropriate group behaviors; provide
proximity control, hurdle help, positive reinforcement, and assist the
therapist in facilitating the group. The
child development specialist can assist the resident in transferring any new
skills discussed in the group sessions into the milieu and community.
1.
Art
Therapy
a. To include displays at the awards
assemblies if resident wishes
b. Purpose/Goal
i.
Safety
(from destructiveness to self and others)
ii.
Symptom
Relief
iii.
Assessment
(strengths and weaknesses)
iv.
Social
Support (Engagement to support, adherence to treatment)
v.
Therapy/Education
(around behavior, treatment collaboration, adherence)
vi.
Exploration
of self concept and family dynamics
2.
Music
Therapy
a. The prescriptive use of music in a
therapeutic fashion to address issues of communication, academics, music,
physical, social, and emotional well-being in a holistic sense.
3.
Psychodrama
a. Residents can write and perform
their own skits or stories in a variety show or play.
b. Residents will prepare scenery,
advertising, marketing, and other productions.
c. Provides an opportunity to express
and process feelings and experiences from their own perspectives and those of
others
4.
Journey
a. David Oldfield program
b. A creative approach to the necessary
crisis of adolescence
5.
Creative
Dramatics
a. Expressing feelings through drama
b. Focus on younger and lower
functioning residents
1. Dialectical
Behavioral Therapy Group
a. Mindfulness
b. Emotion Regulation
c. Distress Tolerance
d. Interpersonal Effectiveness
2. Cognitive Behavioral Therapy
a. Coping Techniques
b. Problem Solving
c. CBT-Event, Thoughts, Feelings,
Behaviors
d. Thought Distortions
3. Social Skills
a. Social Skills Training
b.
c. Interaction Skills
4. Conflict Resolution
a. Peaceworks
approach to teaching conflict resolution to children
5.
Anger
Management
a. Anger styles
b. Triggers
c. Symptoms/effects
d. Coping techniques
6.
Life
Skills/Citizenship
a. Learning about how to be a good
citizen
b. Focusing on independent living
skills such as cooking, shopping, budgeting, transportation, etc.
1.
Drug
and Alcohol Education Group
a. Educate residents who have
experimented with drugs and alcohol.
b. Focus on the various types for drugs
and their effects on the body, brain, behaviors, relationships and overall
functioning in life.
2.
Solution
Focused Process Group
a. Strengths based approach to
identifying behaviors that are not helpful and focusing on what does work.
b. Explore roadblocks to change and
focus on overcoming challenges
3.
Trauma Recovery Group
a. SELF – Sanctuary Model
b. Utilize group process to learn to
manage symptoms of traumatic experiences
c. Indirect use of Dialectical
Behavioral Therapy
4.
Family
Support Group (for residents without identified families and are up for
adoption)
a. The group focused on the
interactions, relationships, responsibilities, discipline, and roles within a
family setting.
b. The group members participate in
family type activities such as playing board games, celebrating holidays and
birthdays, off campus outings, etc.
c. The group would then examine the
different roles within a family in the above mentioned situations.
5.
Relaxation
a. Relaxation exercises
b. Guided imagery
c. Self soothing techniques
6.
Grief
and Loss
a. Identify types of loss
b. Stages
c. Feelings related to grief and loss
d. Recovering from loss
7. Sanctuary Psycho-Education Groups
a. Use
the Sanctuary Psycho-Education Curriculum
b.
Using SELF model (Safety, Emotion Management, Loss, Future)
8. Spirituality
a.
What does spirituality mean to me?
b.
The belief in a higher power
c.
Explore the beliefs of various world religions and their practices
9. Play Groups
a.
Small groups meeting in the play room, outside or the gym.
b.
Directed and non-directed play
9. Resident Internships
a. Residents can be prescribed internships on
and off campus based on their abilities and
emotional stability. The internships
will focus on learning positive job habits and exploring new skills and
experiences.
b. On campus internships consist of working
with the different departments within the facility such as housekeeping,
dietary, maintenance, and clerical.
c. The on campus internships assist residents
in preparing for the world of work. The
assigned tasks can be modified to fit the residents’ strengths and needs.
d. The internships will focus on developing
the following skills:
i.
Ability to stay focused and complete tasks
ii. Initiative – motivation to complete assigned tasks
and take on newly assigned tasks
iii. Ability to cooperate with directions from authority and
accept constructive criticism
iv. Interactions with co-workers (peers/adults)
v. Quality of work,
done correctly, able to correct mistakes, ability to learn from mistakes
e. Residents will be observed and rated on the
above objective by the internship supervisor.
Each resident will also evaluate their own skills using a Likert
scale. Each resident will be provided
supervision on a monthly basis to discuss progress, strengths and needs. A performance improvement plan will be
developed to assist resident in addressing problem areas.
f. The off
campus internships will take place in local businesses such as the Holiday Inn
in
g. All
residents will be supervised by a group therapist, who will remain with the
groups as they are working whether on or off campus.
Adventure Based Therapy
a. Goal –
b. Group initiatives and activities to help develop the
above skills and many more
c. Climbing Wall
Program Description:
Intellectual
Disability/
Autism
Spectrum Disorder (ID/ASD) Unit
The Intellectual Disability/Autism Spectrum Disorder (ID/ASD) Residential Treatment Facility (RTF) is one of the specialized programs at The Bradley Center. The ID/ASD program serves 25 male and female youth, ages 12 – 17.5 years of age, with a dual diagnosis of a primary Axis I psychiatric diagnosis and an Intellectual Disability or Autism Spectrum Disorder.
Individuals
with intellectual disabilities benefit from the same individual and group
treatment modalities that are made available through all of the programs at The
Bradley Center. A youth residing in the ID/ASD
RTF is striving toward similar therapy goals.
However, the manner in which these treatment modalities are structured,
presented and measured is specialized for the youth with an intellectual
disability.
A Stop,
Think, and Go program is utilized on the ID/ASD Unit. The objective of the
program is to provide the youth with concrete, immediate feedback so that the
child can understand the structure and expectations of the unit in order to
help the child develop the ability to better self-regulate. This program
utilizes a stop light system allowing the youth to move between the colors at
different intervals during the day. Each color of the stop light describes the activities
available to the child at each light on the signal, as well as the behaviors
the child should consider and be made aware of at each signal.
Elements of
the SELF Model are included in this program.
Safety issues (physical, psychological and social) are clearly detailed
throughout the program. Handling
feelings without becoming destructive to oneself or others (Emotions) is
underscored. The child has ample
opportunities to learn how to prepare for change (Loss) and re-establish the
capacity for choice (Future). In
addition, the program is cognitive-behaviorally based (CBT) as it emphasizes
steps to get the child to STOP AND THINK before he/she ACTS.
Emphasis is
placed on community readiness beginning at the time of admission into the
Program. Skills that are considered
critical to independent living are identified and taught. In order to maximize learning, teaching takes
place in the environment in which the skill is to be performed. As the child acquires the skill, he/she is
closely supervised in a structured situation.
The primary goal is to help the child gain the confidence he/she needs
to assume the responsibility and be able to initiate performing the skill
appropriately in the context of daily living circumstances. The Skills to Achieve Independent Living
(SAIL) program will be utilized to achieve this goal.
In
implementing group approaches in the ID/ASD program, a purposeful effort is
made to keep the group size as small as possible. Because of limitations in reading skills, receptive
and expressive language skills and short and long-term memory, group approaches
with youth with having intellectual disabilities most often rely heavily on
modeling and role-play. Group approaches
are cognitively based and include; pre-therapy, social skills training, anger
management and relaxation.
Program Description:
Female
Trauma Unit
The Female Trauma Unit at The
Bradley Center is a unit of 25 adolescent girls who have experienced some type
of trauma in their lives. The girls are
placed at The Bradley Center through the mental health, child welfare or
juvenile probation system. Most have
diagnoses of mood disorders with a history of physical or sexual trauma.
The girls will be
involved in milieu therapy focusing on building a safe community where they go
about completing activities of daily living, psycho-educational groups and
structured activities. The girls will
attend five psychotherapy groups a week.
These are small groups that will utilize the Sanctuary Model and The
Westmoreland Posttraumatic Stress Disorder Project. Each girl will be assigned a therapist for
family and individual therapy. Family
therapy will occur one time per week either in person at the
An incentive
program is used on the Female Trauma Unit.
Individual treatment goals are developed each week along with daily
expectations. Each daily expectation is
incorporated with the Seven Commitments of the Sanctuary Model. The incentive program’s week runs from Monday
through Sunday and is tracked by each staff member at the end of each
shift. Each individual goal and daily
expectations are worth one credit point.
The residents can earn a total of 194 credits. Each Sunday a percentage will be totaled for
each resident and this percentage determines what incentive plateau they will
be assigned. There are four different
categories depending on the percentage points: Garage Band, One-hit wonder,
Platinum and ICON. Each plateau has
different incentives and each individual and has the opportunity move to a
different plateau weekly.
In conjunction
with the incentives program, a contract that incorporates the Sanctuary SELF
model will be developed with each resident, their primary staff and their
therapist. The goal of the contract will
be measurable and therapeutically based to meet the needs of the resident. The
contract will provide the resident an opportunity to work towards the goal of
remaining safe and continue this goal upon discharge.
Each resident,
upon entry into the program will complete assessments prescribed by the
treatment team. The assessments will be
repeated as necessary to determine progress and needs. Other indicators of progress may include the
Child and Adolescent Functional Assessment Scale (CAFAS) and baseline
comparisons of the number of passive physical restraints, self-injurious
behaviors, elopement attempts, and other maladaptive behaviors.
Program Description:
Adolescent
Male Unit
The Adolescent Male Unit at the
Treatment interventions follow the cognitive-behavioral
model and Glasser’s Choice/Reality Therapy emphasizing appropriate social
behavior and individual responsibility and problem-solving skills. Having developed a strong internal locus of
control with the ability to identify and solve the mundane problems of daily
living in a prosocial manner, the child will be able to successfully
reintegrate back into his family, school and community and will not need to
revert to the antisocial behaviors that lead to placement in a residential
treatment facility. Social skills
training, relaxation, problem solving, anger management and reality therapy are
included in the approaches that are thoughtfully presented on both an
individual as well as a group setting.
The Adolescent Male Unit places a great deal of emphasis on
staff development and their ability to manage intense affect. Staff recognizes that in order to improve
caregiver-child attunement they must respond to the child’s affect, rather that
react to the behavioral manifestation. A
structured and predictable environment is created by establishing routine and
the use of praise and reinforcement are increased to facilitate the child’s
ability to identify with competencies rather than with deficits.
The Adolescent Male Unit utilizes a Trust-Based Incentive
Program to assist staff in teaching new skills that help each resident to
identify, establish an internal locus of control and to change maladaptive
behaviors. It will help the resident
better understand the relationship between thoughts, emotions and actions. The incentive program will utilize positive
privileges to motivate the young person and encourage positive choices,
behaviors, responsibility and respect.
Program Description:
Children’s
Unit
The Children’s Unit at The Bradley Center is comprised of male and female youths, ages 6 to 14. The unit is divided into two sections, dependent upon age range and level of functioning. One group is co-ed, with the other being male only.
The diagnostic composition being diverse, the Children’s
Unit does specialize in the treatment of Mood Disorders and Attention Deficit
Hyperactivity Disorder (ADHD).
The underpinnings of therapeutic interventions will
incorporate trauma informed principles as well as cognitive behavioral
therapy. In light of the age group, play
therapy and social skills training will be incorporated into individual, group
as well as family treatment sessions.
A Stop,
Think, and Go program is utilized on the Children’s Unit. The objective of the
program is to provide the child with concrete, immediate feedback so they can
understand the structure and expectations of the unit in order to help the
child develop the ability to better self-regulate. This program utilizes a stop
light system allowing the child to move between the colors at different
intervals during the day. Each color of the stop light describes the activities
available to the child at each light on the signal, as well as the behaviors
the child should consider and be made aware of at each signal.
All residents and staff will receive ongoing education as to
the beneficial and therapeutic use of the diversion room. Relaxation techniques, Anger Management
training, as well as Adventure Based Therapy will facilitate the treatment
needs of this age and diagnostic group.
A Safe and Comfortable
Living Environment
At The
Bradley Center the young people are permitted to decorate their bedrooms with
child friendly items. These items can be
from their home, or can be provided and purchased by The Bradley Center. Items that are permitted are: appropriate family photos, appropriate
drawings that the child has completed, arts and crafts projects, posters that
are child friendly, incentives posters, Sanctuary Safety Plans and Unit
expectations.
Items that
are not permitted are those depicting pornography, violence, drugs/alcohol or
those with demeaning or degrading messages.
Decorative
items may be secured to the wall with the use of masking tape, blue poster
tack, double sided tape or removable mounting squares. Items may not be attached to the walls with
staples, duct tape, nails or push pins.
Clinical Assessments:
The AD/HD Rating Scale IV
uses the actual diagnostic criteria for Attention-Deficit/Hyperactivity
Disorder as listed in the DSM-IV-TR as the basis for the scale. It is used for both younger children and
adolescents. The
There are a total of 18
items to be evaluated by the teacher, with a scale range of “never” to “very
often.” Items on the questionnaire
include: organization, activity level, disruption to classroom, listening and
inattention.
Administration Schedule: Baseline and then every two weeks during the
school year.
The Child Depression
Inventory (CDI) is a 27-item self-rated symptom oriented scale
suitable for children and adolescents aged 7 to 17 years. The scale discriminates children with the
psychiatric diagnosis of major depressive or dysthymic disorder as opposed to
those with other psychiatric conditions or non-selected “normal” school
children. It is sensitive to changes in
depression over time and is an acceptable index of the severity of the
depressive disorder. The CDI quantifies
a range of depressive symptoms including disturbed mood, hedonic capacity, vegetative
functions, self-evaluation, and interpersonal behaviors. It can be completed in 15 minutes or
less. The CDI can be scored and
profiled in less than 10 minutes.
Administration Schedule: Baseline and then monthly.
The Obsessive-Compulsive Disorder Checklist (OCDC) includes
elements of checklists/inventories developed by Vitiello (1989), Gedye (1992)
and Leyton (2001). It is understood that
compulsive behaviors tend to occur in categories and this checklist contains
categories of ordering, completeness/incompleteness, cleaning/tidiness,
checking/touching and deviant grooming.
The content of a compulsion may change over time, although the type of
category tends to persist. This
checklist also recognizes the difficulty that children and adolescents have in
describing the underlying anxiety and subjective discomfort related to an
obsession and the repetitive behavior.
The Obsessive-Compulsive
Disorder Checklist utilizes traditional
DSM-IV criteria but places emphasis on objective, observable behavior and
practical daily consequences, rather than on inner conflicts and anxiety. Compulsive behavior and its severity are
described from an external, objective point of view that could be filled out by
an observer. The checklist should be
suitable for children unable to read, articulate thoughts or even speak. The severity scale should be useful in
evaluating effectiveness of any treatment tried.
Administration
Schedule: Baseline and then monthly.
The Revised Children’s Manifest Anxiety Scale (RCMAS) is a 37-item self-report inventory
used to measure anxiety in children and adolescents aged 6 to 19 years. Each item is purported to embody a feeling or
action that reflects an aspect of anxiety.
It is a relatively brief instrument which can be administered and scored
in about 20-30 minutes. Each item is
given a score of one for a “yes” response, yielding a Total Anxiety score. Three empirically derived Anxiety Subscales
scores (Physiology, Anxiety, Worry/Oversensitivity, and Social Concerns/Concentration)
and Lie Scale scores can be calculated.
The Lie scale is best thought of as a social desirability scale as it
does not directly and conclusively detect “lying.”
Administration
Schedule: Baseline and then monthly.
The Trauma Symptom Checklist
for Children (TSCC) is utilized to evaluate acute and
posttraumatic symptomotology in children and adolescents who have experienced
traumatic events (e.g., physical or sexual abuse, major loss, disaster, witness
to violence).
The 54-item TSCC is a self-report
measure that includes two validity scales (Under responsive and Hyper
responsive) and six clinical scales (Anxiety, Depression, Anger, Posttraumatic
Stress, Dissociation and Sexual Concerns).
The instrument can be administered in 15-20 minutes and can be scored in
just a few minutes. The TSCC has
been described as probably the most widely used measure of children’s PTS
symptoms. For many purposes, the TSCC
sub-scales can be used in the place of additional measures.
Administration Schedule: Baseline and then quarterly (at time of
treatment plan review)
The Vineland Adaptive Behavior Scales (VABS) were designed to assess handicapped and
non-handicapped persons from birth to adulthood in their personal and social
functioning. Following Edgar Doll’s
original conceptualization of adaptive behavior as multidimensional in
structure and his measurement of the behaviors by areas, the VABS is organized around four Behavior
Domains: Communication, Daily Living Skills, Socialization and Motor Skills.
Administration
Schedule: At time of discharge.
Yale Global Tic Severity Scale
(YGTSS) is a semi-structured, clinician-rated instrument of motor
and phonic tic severity. A separate,
one-item impairment rating is also included that captures distress and
impairment in interpersonal, academic and occupational realms due to all
endorsed tics.
Administration Schedule: Bi-weekly for a period of time specified by
the psychiatrist.
3. Child and Adolescent Functional
Assessment Scale (CAFAS)
Residents are assessed upon
admission, toward the end of each rewaiver period but prior to the next
interagency team meeting and at discharge through the use of CAFAS. The CAFAS
information is documented in the treatment plan as well as the discharge summary.
It uses mutually agreeable and reliable measures of the resident’s choices,
goals, strengths, symptoms, and behavioral patterns.
Administration Schedule: Baseline, 4-months and Discharge
A biopsychosocial assessment is completed on each resident by an interdisciplinary team including admissions, clinical, nursing, recreation, and education staff. This comprehensive diagnostic procedure is intended to examine all significant areas of the resident’s life, including cultural and spiritual, and is used with other assessments for ongoing development of the treatment plan.
Administration Schedule: Baseline
Aftercare Telepsychiatry Services
In the Spring of 2010, The Bradley Center began to provide
Aftercare Telepsychiatry services for a number of youth discharging from our programs. Telepsychiatry aftercare services are
available to youth over age 14 in York and Adams counties. This service will allow our psychiatrists the
opportunity to provide 3 – 6 months of psychiatric aftercare services to
include medication evaluation and psychiatric evaluations and treatment until
the youth’s care can be transferred to a community psychiatrist. Too often, children and youth are returned to
their community after an RTF stay and due to a number of reasons, are not able
to get a psychiatric appointment for some time after discharge. Children that
are sent to Bradley often are referred by a county program that is more than 2
hours away. Although it is ideal to keep
the child in the community, a number of factors prohibit that from
occurring.
The
The
This is an innovative way to use telemedicine to best meet
the needs of youth and their families.
The Blue
Print for Change
“When people are triggered by reminders of past trauma, they become hyper aroused, and only learning gained during past experiences of hyper arousal and danger will be available to them” (Bloom, 1997).
When our residents are fearful, they cannot think clearly,
and revert to their well practiced, though maladaptive responses. The