Our unit builds on the foundations and philosophies of neuroscience, child development and trauma, and incorporates such evidence-based approaches and techniques as:
- Collaborative and Proactive Solutions (CPS)
- Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavior Therapy (DBT)
- Eye-Movement Desensitization Reprocessing (EMDR)
- Positive Reinforcement Behavioral Therapy
Central to the program is understanding the extent of neurological and cognitive impairments, deficits and delays, the situational expectations and demands of living that magnify and exacerbate such impairments, and the supports and interventions needed to compensate for, improve or resolve the impairments.
Our model is grounded on the pillars of ecological, relational and reinforcing principles. It prioritizes supportive interventions to build skills and functioning over behavioral consequences.
The program is designed to provide a predictable, consistent environment with basic expectations around safe behavior while gradually building lagging skills. The level of behavioral expectations, supervision and support is based on the individual’s needs and abilities. This therapeutic model recognizes that the children served do not function emotionally, cognitively or behaviorally in “neurotypical” ways.
For these children, the environment can be overwhelming in the sense of space, sensory stimuli, associations and safety. Our neurobehavioral environment is carefully designed to comfort, contain and support the children in our care.
Our primary goal is to cultivate a sense of safety, consideration, responsibility, positivity and respect within each individual. To help ensure a fluid transition between units and through the admissions process, we have established a clear phase breakdown. This comprehensive approach enables us to provide consistent care and support to our patients at every stage of their journey and outlines the shift protocols and responsibilities of our staff.
Relational Methods of Skill Teaching
To further develop higher-order cognitive functions, staff and therapists must continuously engage the child in frequent problem solving, education and skill building. These interventions are provided on a group and individual level and include redirection, prompting, modeling, mentoring, direct teaching, completing re-dos, restorative repairs, collaborative problem solving, role playing, activity by activity and refocus programs.
Consequences and Behavioral Contingencies
Positive consequences including verbal praise and increased privileges, rewards and social status are major components of our treatment program. As youth demonstrate new or emerging skills, staff should provide verbal acknowledgment and reinforcement to help the child increase self-awareness, build a sense of competency and increase motivation to engage in treatment. The program uses an “80/20 rule” with the expectation that staff provide positive reinforcement and praise for demonstrating prosocial behaviors or emerging skills a minimum of 80% of the time.
Staff are observing for positive behaviors and compliance with unit expectations. For each expectation met and skill displayed, the student receives points. Students accumulate points that they can turn in to the point store for small tangible items and weekly points that they can use for special privileges and rewards.
Key parameters of the point system include the following considerations:
- Patients focus on earning points based on developing essential life skills.
- Patients develop connections and improve relationships with staff and peers to participate in off-unit activities.
- Patients earn points for meeting well-defined treatment goals and unit exit expectations, along with additional positive reinforcements/privileges.
Group and Individual Therapy
Patients receive one individual therapy session and one family therapy session each week. In addition, they receive three to four psychotherapy groups per week and two to three recreational therapy groups per week. Core mental health staff provide two daily groups consisting of a goals group in the morning and reflection group in the evening. Individual therapy includes experiential modalities such as play therapy, expressive therapy, adventure therapy, psychodrama and adventure therapy, which are developmentally appropriate, clinically indicated and engaging.
Given the significant diversity in diagnostic categories as well as the developmental, intellectual, social, emotional and physical continuum of the children on the neurobehavioral units, programming has been structured to better accommodate these disparities.
Structure and Schedules
Unstructured and unpredictable activities create a great deal of anxiety for most children with neurobehavioral issues. For this reason, each daily activity is planned and communicated with careful attention and purpose. Each activity is selected to promote needed skill building and incorporates expectations and tasks that are commensurate with the level of functioning and abilities of most children in the group.
Interpretation of Problem Behaviors
Caregivers and professionals understand that the children and adolescents with neurobehavioral issues are developmentally, cognitively, emotionally and socially delayed and impaired. Challenging behaviors are likely to emerge when societal expectations require them to behave or perform using skills that they lack.
Basic Program Structure
Children will progress through treatment as they gain and demonstrate increased skills. They will not be dropped or demoted to previous levels if they fail to demonstrate those skills at a later time. Instead, this will signal that there is some factor that is causing them new difficulty in their path and that they need support to get back on track.
Progression through Phases
The neurobehavioral unit is made up of a heterogeneous group of youth with varying behavioral deficits, histories and capacities. As a result, youth are expected to progress through treatment at individual rates and idiosyncratic pathways. The pathway to progress is also non-linear and may resemble the “one step forward, two steps back” trajectory. Behavioral expectations and goals will be individualized for youth to match their specific competencies and deficits.