CYC-Online 78 JULY 2005
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social skills

Integrated therapeutic interactions

Karen A. Blase and Dean L. Fixsen

Children in group care facilities need to develop a broad range of social competencies if they are to achieve greater independence. Therapeutic interactions, developed as an important part of the Teaching-Family Model of treatment have been useful in developing social competencies with a variety of youngsters. This article outlines how to teach, when to teach, and what to teach. Special emphasis is given to teaching in context and taking advantage of opportunities to teach during the course of day-to-day interactions between therapists and children.

Youngsters enter group care facilities by way of the mental health system, the juvenile corrections system, the child welfare system and by means of private placements of children by their parents or relatives. While some children are unique to each system there is considerable overlap among these three systems: a depressed youngster may assault a neighbor, a child who steals things may be abandoned by his family, an abused child may sink into deep depression, and so on. The point is that one cannot assume that one knows very much about a youngster just by knowing which service delivery system he or she is in at the moment.

The common links that bind all these children together are behavioural deficits and excesses that impact many aspects of their lives. Thus it becomes the task of the therapist and of caregivers to teach each youngster how better to deal with parents, teachers, peers, community authorities such as judges and police, employers, etc. From a social competency and therapeutic point of view this means deciding how to teach, when to teach, and what to teach to increase the social competencies of each youth. Essentially, a focus on social competency and teaching requires an integration of therapeutic interactions into the fabric of each child's daily life.

The therapeutic teaching style described in this article is based on the principles of behaviour (learning theory) and has been developed for use in a group home treatment environment. The more general usefulness of these teaching procedures has been demonstrated in parent training, specialized foster care, and public and private school classrooms. However, in each case, the adaptation process has required special attention to assure the usefulness in each new environment and to assure the “fit” of teaching skills into the larger treatment or educational system. Thus, readers of this article should seek training in the teaching skills and carefully plan their uses before attempting to implement the skills with their clients or students.

Teaching Family Model
The integrated therapeutic interactions described in this manuscript have been developed as an important part of the Teaching-Family Model. The Teaching-Family Model for the treatment of troubled youths has been evolving since 1967 (Phillips, Phillips, Fixsen, & Wolf, 1974). Beginning with a series of research studies at “Achievement Place,” a group home for delinquent adolescents in Lawrence, Kansas, the Teaching-Family Model has developed into an integrated service delivery system (Blase, Fixsen & Phillips, 1984). Today, there are over 250 group homes across the United States that have met the requirements to be called Teaching-Family Homes. These homes serve delinquent, pre-delinquent, abused, neglected, emotionally disturbed, autistic and mentally handicapped children and young adults. In addition, the Teaching-Family Model has been adapted for use in parent training, specialized foster care, youth assessment systems, and public and private schools.

After nearly twenty years of research and program development the Teaching-Family Model has evolved a systematic, integrated approach to treatment. Treatment procedures have been discovered through research or borrowed from the literature and the experience of others. These treatment procedures have been integrated into the daily living patterns of staff and youngsters residing in a group home setting. Every interaction becomes a treatment interaction and opportunities for treatment are not restricted to time or place. The treatment procedures and daily-living patterns have been carefully described and analyzed so they can be taught more readily to new staff and so that the processes of treatment can be monitored by all concerned. Administration, treatment supervision, and staff training are integrated to reduce confusion and focus all attention on the treatment goals for those in care.

The general approach centers on providing individualized treatment in a family-style, community-based environment. The treatment program is implemented by the Teaching-Parents, a married couple who live and work with about six youths in the home. The carefully selected and specially trained Teaching-Parents are “teachers” responsible for the social education of the youths. They also are “parents” who look after the whole child in all of his or her environments. The focus is on teaching each youth how to live successfully in a family, attend school, and live productively in a community. This means proactively teaching each youth an individualized curriculum of new skills and social competencies in the family-style environment of the home and working closely with parents, teachers, peers, employers, neighbours, and relatives to help each child internalize the healthier ways of behaving in all aspects of his or her life.

How to Teach
The primary goal of the Teaching-Parents in a Teaching-Family home is to help the youngsters learn new skills and new approaches to solving life's problems. Many of these new skills and approaches will be dictated by the individual child's developmental needs. Others will be based on the specific needs of each youngster to help solve special problems. Just as the treatment plan for each youngster is individualized, so too is the treatment approach for each child. The Teaching-Parents and their treatment supervisor frequently review the developmental needs and treatment goals for each child and develop specific treatment strategies to help the child meet those needs.

Treatment goals, careful observation, and accurate descriptions are important and necessary preparations for treatment. The real treatment occurs when TeachingParents begin teaching. Teaching is the heart of the treatment program for youngsters and is the principal way in which Teaching-Parents help kids learn and improve their chances in life.

Types of Teaching
Over the years, as hundreds of Teaching-Parents have used the Teaching-Family Program to work with thousands of kids, three basic forms of teaching have emerged: Reactive Teaching, Proactive Teaching, and Intensive Teaching.

Reactive Teaching occurs in response to the moment-to-moment behaviour of a child. Social interactions with peers, adults, and authority persons; behaviour related to the Teaching-Family home, natural home, school, and community; and behaviour related to emotions and attitudes are all the proper focus for Reactive Teaching.

Proactive Teaching occurs to help a youngster achieve developmental goals and to remediate deficits. Rather than waiting for a problem to occur, TeachingParents can use Proactive Teaching to work with a youth and teach the youngster a wide variety of social competencies to be utilized in a variety of situations and environments.

Intensive Teaching occurs in order to help a child overcome serious problems that could lead to placement in a more restrictive environment such as a locked facility for severely delinquent or emotionally disturbed youngsters. It is highly concentrated and highly focused teaching to help a youngster who is severely withdrawn, destructive, violent, or otherwise out of control and a danger to himself or herself or others.

Each of these types of teaching are further subdivided into particular teaching procedures, as described below.

Reactive Teaching

Problem-Oriented Teaching: This occurs in response to inappropriate behaviour occurring in the presence of a Teaching-Parent. For example, a Teaching-Parent asks a youth to help another youth with homework. The youth might begin to help out but do so while grumbling and muttering and occasionally complaining about wasting his time. In response, the Teaching-Parent would intervene and teach the youth to help others and follow instructions without complaining. Problem-Oriented Teaching typically is done on an individual basis with a given youngster.

Teaching to On-Going Behaviour: This occurs in response to inappropriate behaviour that happens while a Teaching-Parent is attempting to teach a youngster something. For example, a Teaching-Parent is trying to teach a youth how to respond during a job interview but the youth rolls his/her eyes, complains, and talks about how the Teaching-Parent is wasting time. At this point, the Teaching-Parent stops trying to teach job interview skills and instead initiates teaching on how to follow instructions without complaining or making faces. In essence, it is a teaching interaction within a teaching interaction. It is focussed on those youth behaviours that stand in the way of learning (e.g., pouting, disagreeing, complaining, denying, moving away). It is designed to teach a youth how to be responsive to teaching and to make the teaching interaction a pleasant experience for the youngster and the Teaching-Parent. Teaching to On-Going Behaviour typically is done on an individual basis with a given child.

Effective Praise: This occurs in response to appropriate behaviour that helps the youth achieve his or her developmental goals or that represents appropriate alternatives to problems the youngster has had in the past. For example, a child who has had a lot of difficulty initiating conversations with people has just started a conversation with one of the other kids in the Teaching-Family home. The Teaching-Parent would immediately use Effective Praise to reward the child for using his new skill. Effective praise typically is done on an individual basis with a given youngster.

Proactive Teaching

Planned Teaching: This occurs in response to the needs specified in the treatment plan for a youngster or in response to developmental needs. Planned Teaching occurs at a prearranged time and place that is neutral or positive and does not occur as an immediate response to inappropriate behaviour. For example, at Family Conference the Teaching-Parents might review the components of “constructive criticism” then ask the youths to take turns practicing that skill. Or the Teaching-Parent may sit down with a new youth and teach the youngster the skill of accepting no for an answer, or other basic skills such as instruction following or accepting a point fine. Planned Teaching can be done individually or in a group of two or more youngsters who need to learn the same skill.

Preventive Teaching: This occurs just before a particular event or situation that calls for a specific set of skills. For example, how to behave during a court hearing, how to apologize to a teacher or principal, how to eat in a nice restaurant, and how to calmly and rationally present an issue to parents might be skills that are taught just prior to actually going to court, etc. Or, for a youngster who has difficulty accepting criticism, Preventive Teaching would occur just before some actual criticism was to be given. The youngster mayor may not have had prior difficulties in these areas and mayor may not have practiced the same skills. When the event or situation is important and there is any doubt about the youngster's ability to handle it appropriately, Preventive Teaching is called for. Preventive Teaching can be done individually or in a group of two or more kids who need to learn the same skills.

Preventive Prompting: This occurs under the same conditions and for the same reasons as Preventive Teaching. The difference is that Preventive Prompting is a verbal reminder of the appropriate behaviour that is called for in the upcoming situation as well as the rationales and potential consequences but actual practice of those skills does not occur. Preventive Prompting usually is used with skills that already have been taught and thoroughly practiced. Preventive Prompting can be done individually or in a group.

Intensive Teaching

Preventive (Intensive) Teaching: This is very similar to Preventive Teaching but occurs when the upcoming situation has in the past precipitated serious problems for a youth. For example, the last time a youngster was told, “No, you can't do that,” he blew up, swore, yelled, “It's not fair,” and knocked over a lamp. And now it is time to tell him “no” again. Or, the last time one of the other kids in the home brought up his misbehavior at school he became very angry, screamed denials at the youth expressing the concern, and ran from the room. Now another concern is about to be discussed. Under these circumstances Preventive (Intensive) Teaching is done to let the youngster know what is about to happen, to teach the youngster what skills are called for as well as the appropriate alternatives to each inappropriate behaviour, and to remind the child of the serious nature of such extreme, inappropriate behaviour. Preventive (Intensive) Teaching is done on an individual basis with a particular child.

Crisis Management: This occurs in response to extreme, inappropriate behaviour that is out of control (active or passive). For example, a girl may be yelling, screaming, cursing, pushing things over, and pacing aimlessly in spite of repeated requests to sit down or talk more quietly. Or, a boy may sit down, fold his arms across his chest, and remain immobile and silent in spite of repeated instructions to get up or requests to talk to the Teaching-Parents. Crisis Management is not teaching but is included here because it uses many components of a teaching interaction to help a youth change his or her own behaviour, regain control, and become more responsive. Crisis Management is always done on an individual basis with a given child.

Intensive Teaching: This occurs after a crisis situation has passed (usually immediately after) to bring the crisis to a successful end and to teach the youngster appropriate alternatives to the behaviors that precipitated the crisis. Intensive Teaching is basically the same as Preventive (Intensive) Teaching except that it occurs after the fact and always includes practice on accepting a point fine and following an instruction along with practice on other skills. Intensive Teaching is always done on an individual basis with a given child.

Components of Teaching
There are six components that are used in all teaching interactions and four components that mayor may not be used depending upon the goals of teaching. These six components are: Initial Praise; Description/Demonstration of Appropriate Behaviour; Rationales; Request for Acknowledgement; Other Praise; and Quality Components. While the use of these six components is similar across the different types of teaching, there are variations in how they are used depending upon the goals of teaching. The ten components of a teaching interaction and some of the variations in the use of those components are described below.

Initial Praise: A teaching interaction is initiated by praising a youth for what he or she has just accomplished, by offering empathy for the predicament the youngster is in at the moment, or by expressing affection or positive regard for the youth. This helps to set a positive tone for the entire interaction and makes it less likely that the youngster will be defensive. For example, a Teaching-Parent may say, “Mary, you have done an excellent job on your math homework! You did each multiplication problem correctly and you even finished this whole practice page on four-digit long division! Way to go!” Or empathy may be what is called for if a youth gets upset when he is told “no.” For example, a Teaching-Parent might say, “Jack, I know it's tough when you can't get what you want right away.” Or an expression of affection or positive regard may be called for prior to discussing a serious issue. For example, “Chris, we're really concerned about how you're doing at school. We really care about you and want you to get along well.” Offering praise or empathy or expressing affection helps a youth see that the Teaching-Parent is there to help.

The major variation in the use of initial praise occurs during Crisis Management and Intensive Teaching. These are serious situations that call for a more serious tone. During these situations, there is less use of praise and a greater use of empathy ("I understand that you are upset and angry") and expressions of affection ("I really do care about you,” or “I am very concerned about you") to begin a teaching interaction.

Description/Demonstration of Inappropriate Behaviour: This component is used during Problem-Oriented Teaching, Teaching to On-Going Behaviour, Crisis Management, and Intensive Teaching. Thus this component is always used when teaching occurs in response to a youngster's problems that are occurring now. The Teaching-Parent wants to let the youngster know exactly what inappropriate behaviors he or she just engaged in by specifically describing or demonstrating them and by showing what skill was absent or not appropriately used. These types of teaching need to be done immediately after the youth engaged in the inappropriate behaviour so there is no doubt about what he or she did or said and so the Teaching-Parents' skill label and description or demonstration of the inappropriate behaviour will be accurate and real to the youngster. If objective descriptions or demonstrations of specific behavior are given, it sounds less judgemental and the youth will likely be more receptive to listening and changing his or her behaviour. Verbal descriptions of what the youngster did or said are often sufficient but for those things that are difficult to communicate (e.g., facial expressions, gestures, voice tone, eye movements), demonstrations are very helpful. However the Teaching-Parent needs to be very careful not to mock the youth.

Description/Demonstration of Inappropriate Behaviour also occurs during Preventive Teaching and Preventive (Intensive) Teaching. During these interactions, this component is used to briefly remind the youngster(s) about his or her past problems before the Teaching-Parent goes on to teach the appropriate skill and/or behaviors.

The major variation in the use of Description/Demonstration of Inappropriate Behaviour occurs with its use during Crisis Management. During these times it is used sparingly, usually only to describe occasionally those inappropriate behaviors that must be stopped for the youngster to begin to regain some control and is always followed by a description of the appropriate behaviour ("John, you are still walking back and forth. Would you sit down please?”). However, this is , used only a few times during Crisis Management because the youngster is out of control already and such descriptions (if done very often) may provoke further anger or withdrawal.

Consequences: Consequences are a part of each type of teaching except Preventive Prompting and Crisis Management. This includes giving a youngster positive consequences for appropriate behaviour and negative consequences for inappropriate behaviour. This means giving or taking away points (or other forms of tokens that are linked to privileges in a token economy) based on a youth's behaviour. For example, if a youngster was asked to do something and looked down, mumbled, and sighed he might lose points for not following instructions. Earning and losing points helps to motivate a youngster to change his or her behaviour and the size of the point gains or losses lets the youth know how important the behaviour is. Of course, as the youngster progresses through the various stages of the motivation systems and as he or she experiences more natural reinforcers, the use of artificial consequences is faded out.

For Effective Praise, Planned Teaching, and Preventive Teaching, the consequences are always (and only) positive. The youngster is earning points for learning, practicing or engaging in appropriate behaviour. For Problem-Oriented Teaching, Teaching to On-Going Behaviour, Preventive (Intensive) Teaching, and Intensive Teaching the consequences involve a point loss and are always accompanied by positive correction statements. A youth loses points for the inappropriate behaviour that just occurred but has a chance to earn back up to half of these lost points by practicing the appropriate alternative to the inappropriate behaviour.

The idea behind positive correction is this. The youth just lost points for engaging in inappropriate behaviour. This presents the Teaching-Parent with the opportunity to teach the youth a new or appropriate skill. It presents the youth with the opportunity to earn back up to half the lost points by learning a skill that will help him or her avoid the same problem in the future. In this way, if a youngster responds to a request by looking down, mumbling, and sighing, the Teaching-Parent might say, “Bill, I like the way you promptly began doing your job here. Your cooperation is really appreciated by all of us (Initial Praise). But let's back up a little and talk about how you followed my instruction. When I asked you to do this job you looked down at the floor, you mumbled something under your breath, and you sighed loudly before you said OK (Description of Inappropriate). You need to take out your point card and take off 2,000 points (consequence) for not following instructions (skills label) by looking down, mumbling, and sighing (Description of Inappropriate Behaviour). You can earn back up to half of these points right now by practicing how to follow an instruction, OK?” (Positive Correction Statement). If he lost points for not following instructions, he can earn points by learning how to follow instructions.

Description/Demonstration of Appropriate Behaviour: This component is used to let the youngster know exactly what skills and what appropriate behaviors he or she needs to engage in by specifically labelling the skill and describing or demonstrating the specific behaviors to the youth. The description needs to be specific and objective rather than vague or judgemental. For example, a Teaching-Parent might say, “Bill, whenever anyone asks you to do something, you need to follow instructions (Skill Label) appropriately. This means that you look at the person, acknowledge the request by saying OK or I understand, then go do what you have been asked to do and check back with the person when you are finished (Behavioural Description) OK?” Describing or demonstrating appropriate behaviour is the heart of any teaching interaction and, therefore, the heart of treatment itself. It is the labelling of the skill and the detailed specification of the behaviors that will help the youngster meet his or her goals.

Rationale: A rationale is included in all types of teaching and is a brief, personal, believable statement explaining to a youth the potential natural consequences of his or her behaviour. By pointing out the potential benefits or harms that might befall a youngster, the Teaching-Parents can help the youngsters begin to see themselves as more in control of their own lives. For example, a Teaching-Parent might say, “Bill, you will be asked to follow instructions wherever you go. For example, at your new job at Wendy's you will need to pay close attention to what the manager says and follow her instructions every day if you want to keep your job and get raises. Your ability to follow instructions will help you get along better with your parents and teachers too.” The youngsters can begin to see that what happens to them is determined in large part by their own actions. As the youths come to see the linkages between behaviour and outcomes, rationales become very important to the behaviour change process and help to motivate the youngsters to learn more appropriate behaviour. In essence, rationales give meaning to the teaching process.

Request Acknowledgement: This component is always included and involves checking with a youth to make sure he or she understands what the Teaching-Parent is saying. For example, the Teaching-Parent might say, “How does that sound to you, Bill?” or, “Do you understand?” or, “OK?” or, “That was pretty complex. Would you tell me the four main components of following an instruction?”

Requests for acknowledgement are used throughout a teaching interaction to give the Teaching-Parents feedback on the clarity of their descriptions, rationales, etc., and to get the youngster actively involved in the interaction.

Practice: The practice component occurs during Problem-Oriented Teaching, Teaching to On-Going behaviour, Planned Teaching, Preventive Teaching, Preventive (Intensive) Teaching, and Intensive Teaching. Practice gives a youth the chance to try out a new skill in a non-threatening, supportive situation before having to use that skill in the real setting or provides the youth with the opportunity to use a new skill to recover from a problem. For example, a Teaching-Parent might say, “Now, let's practice instruction following, Sue. Remember, that means to look at the person, acknowledge the instruction by saying OK, go do the job without grumbling or complaining, and check back when you are done. Now, I will ask you to take out the trash so you can practice. Are you ready? OK. Here we go. Sue, would you take out the trash please?” Having a youngster practice helps to guarantee that he or she is able to perform the new skill or remediate the problem. Practicing under conditions that are very close to those the youngster will actually face, having large positive consequences available for the first performances of the new behaviour under “real life” conditions, and continuing to practice over time to increase the youth's comfort level and naturalness all help to encourage the youngster to make continuing use of the skills he or she is learning.

Practice Feedback: This component is always used along with the Practice component. Feedback during practice lets the youngster know his or her strengths and weaknesses during the practice session. The Teaching-Parent gives descriptive praise (i.e., initial praise, description of appropriate behaviour, and rationale) for the youth's strengths and gives corrective feedback (i.e., description of inappropriate behaviour, rationale, and description of appropriate behaviour) on those aspects that did not meet criteria during the practice session. More practice and practice feedback would then occur until the youngster had improved his or her use of a skill or learned all components of the new skill. For example, a Teaching-Parent might say, “Sue, that was great! When I asked you to take out the trash you looked at me, you said, 'I'll be happy to do it,' and you immediately left to go do the job. Following instructions is very important for developing good cooperative relationships with your parents, teachers, and your manager at Wendy's. Now, the only thing that needs a little more work is checking back after the job is done. Did you forget that? That's an important part of instruction following because it lets the person know that you finished the job and you are ready to take on more work. It also gives the person a chance to tell you how well you are doing. That would be neat, don't you think? OK, ready to try it again?”

Other Praise: Throughout every teaching interaction and at the end of the interaction the Teaching-Parent gives the youngster brief descriptive praise for appropriate behaviour such as eye contact, listening well, and following instructions (e.g., “Thanks for listening so carefully,” or, “You're really following instructions well.”). This helps to encourage the youngster to keep trying and helps to maintain a pleasant tone throughout the interaction.

Quality Components: Throughout every teaching interaction the Teaching-Parents need to be very aware of how they are teaching the youth. Their voice tone needs to be enthusiastic and positive when praising and matter-of-fact when offering corrective feedback rather than harsh or accusing. Posture and gestures should be animated and pleasant rather than hands on hips, or arms folded across the chest, or pointing a finger at the youngster. Facial expressions should be neutral or positive rather than frowns, rolling eyes, or hard stares. Verbal statements need to include polite phrases such as please and thank you. Requests should be phrased pleasantly as, “Why don't we try that again?” or, “Would you mind doing – ?” rather than being phrased as demands such as “Get over here” or, “I want you to do this right now” or, “I've had enough of your excuses! Can't you do it right even once?”

The teaching interaction components coupled with a Teaching-Parent who smiles, has good eye contact with the youngster, stands near the youth and occasionally puts an arm around his or her shoulder or touches his or her arm, uses an enthusiastic tone of voice, and uses appropriate humor will help the youth enjoy being taught and will help to establish and develop a good personal relationship with a youngster. Without these quality components a teaching interaction can be punishing and oppressive to the youth and to the Teaching-Parent. With the liberal use of these quality components teaching can be seen as enjoyable and supportive and as an expression of the Teaching-Parents' concern for the youngster.

When to Teach
Teaching goes on continually in a Teaching-Family home. As implied in the descriptions of How To Teach, there is no pre-set time to teach. Instead, on an individual basis, teaching is done in response to a problem that has just occurred, in response to past known problems of a youth, or in response to the developmental needs of a youngster. This requires planning and prompts to help the Teaching-Parents remain aware of the needs of each youth each day and it requires a system to review the progress of each youngster over time so goals can be updated. In effect, teaching is the operationalization of a therapeutic milieu.

At a basic level, social competencies are taught in the Teaching-Family home each day. This allows the kids to learn and practice their new skills in a protective, comfortable, and supportive environment. Like any new skill the social competencies being learned by the kids are a bit stilted and unnatural at first. However, with practice the youngsters become smoother and feel more at ease behaving in new ways with the Teaching-Parents and their peers in the home.

During this time, the Teaching-Parents look for “opportunities to teach.”

They carefully observe each youngster's behaviour to find any occasion to reward progress or teach the next level of a new skill. For example, during dinner preparations two youths may be learning how to read a recipe and prepare a meal. In addition, the Teaching-Parent may be looking for opportunities to use Effective Praise for cooperation and Problem-Oriented Teaching for using fractions with one youth while using Planned Teaching on reading recipes for the other youth. Every interaction is a therapeutic interaction integrated into the routines of daily living.

Improved behaviour in the group home is not the goal. From society's perspective it is a trivial matter. The goal is improved social competencies in relevant community environments with parents, teachers, peers, employers, authorities, etc. Nevertheless, from a therapeutic point of view, we know that the first step is behaviour change in the group home. Once a new social skill is established the task becomes one of generalizing the teaching of that skill to relevant community environments “where it counts.” Thus Teaching-Parents are continually teaching the youths how to respond more appropriately in actual community settings as well as in the home. Again, there are not pre-set “teaching times.” Every interaction in every community setting creates opportunities for teaching. In essence, the treatment milieu is where ever the Teaching-Parents are. The goal is to teach behaviour in the context of real-life situations.

In another sense life is too varied and complex to expect the Teaching-Parents to see and respond to all aspects of each youngster's behaviour. Thus another aspect of creating a therapeutic milieu is developing cooperative relationships with parents, peers, teachers, relatives, social workers, probation officers, police, mental health workers, and others who may interact with a child with some frequency or who may have some authority over the youth's life. It is by means of these cooperative relationships that Teaching-Parents encourage descriptions of what each youth does outside the therapeutic milieu. These descriptions then form the basis for further teaching agendas to encourage each youth to display his or her new social competencies under these more ambiguous circumstances.

What to Teach
Typical Adolescent Development: Underneath it all kids are kids and they have a lot to learn whether they are in a “typical” biological family, in a single-parent family or in a Teaching-Family home. Each one has to learn the concepts and skills necessary to get around in an increasingly complex world. For most children, these developmental tasks are accomplished at home, in the school, and in the community with the help and support of parents, siblings, peers, teachers, neighbours, shopkeepers, ministers, etc. The children in a Teaching-Family home need to accomplish these same developmental tasks in addition to solving their special problems. Growing up is difficult for most adolescents. Growing up in the face of additional problems or deficits requires a lot of help from skilled Teaching-Parents and others.

The job of the Teaching-Parents in a Teaching-Family home is complex enough, but is further complicated by the fact that the Teaching-Parents must exert more than the usual amount of control to help an adolescent at exactly the time when (developmentally) that adolescent must strive for greater independence, self-control, and personal identity. The parent of any teenager has experienced the strained relationships and worries created by a typical, maturing adolescent. When that maturation process must occur under atypical conditions (such as the treatment of a troubled adolescent in a Teaching-Family home) then the process becomes more complicated and more easily denied or subverted by the treatment process itself. As treatment agents, Teaching-Parents and other staff need to be fully aware of these developmental tasks and be very sensitive to the adolescent's need for greater independence even as necessary controls are exerted to assure proper treatment of the youngster's problems. Furthermore, treatment agents should be slow to label some youth behaviours as “problems” when, in fact, they may be only the next steps down the youngster's developmental path.

Treatment Goals: In the past thirty years there have been several massive studies of child and adolescent behaviour to see how you can tell ”good kids" from “bad kids” or to see the linkages between what children do and their eventual outcomes as adults. These studies are very interesting and lead to some general observations about the problem behaviour of children. For example, it seems there are three general categories of problem behaviours: withdrawal, aggression, and immaturity. Withdrawal basically means too little behaviour. Children who are withdrawn grow up to be adults who tend to need more psychiatric services, have many physical complaints, are overly dependent on family, and are unpopular. Aggression usually means too much behaviour. Children who are aggressive grow up to be adults who tend to be unpopular with peers, do poorly academically, become alcoholics, go to jail or prison, and go to psychiatric facilities. Immaturity usually refers to age-inappropriate behaviour. The basic lack of competency in sharing, responding to teasing, responding to failure, dealing with group pressure, goal setting, and concentration among immature children tends to persist into adult years.

Of course, no one child is purely “withdrawn,” “aggressive,” or “immature.”

Over the course of a few months each youngster behaves in ways that fit into each of these categories, although certain kids may have a fairly clear pattern of behaviour that seems to fit one of the characterizations discussed above. For the purposes of understanding the social histories of the kids and for communicating with referral and funding agencies, such characterizations are often helpful. However, for treatment purposes, such “labels” often get in the way of focusing attention on the real problems of a youth. One cannot treat a label. One can only treat real problems.

Thus therapeutic interactions must be directed toward helping a youngster achieve his or her developmental goals and acquire the social competencies necessary to achieve individual treatment goals. It is an ambitious task for children in care. Nevertheless, by integrating teaching into the moment-to-moment interactions between therapists and children it may be possible to help these children overcome their excesses and deficits and lead a more independent and normal life.


Blase, K.A., Fixsen, D.L., & Phillips, E.L. (1984). Residential treatment for troubled children: Developing service delivery systems. In S.C. Paine, G.T. Bellamy & B. Wilcox (Eds.), Human Services that Work: From Innovation to Standard Practice. pp. 149-165. Baltimore, MD: Paul H. Brooks Publishing Company.

Phillips, E.L., Phillips, E.A., Fixsen, D.L., & Wolf, M.M. (1974). The Teaching-Family Handbook. Lawrence, Kansas: University Printing Service.

This feature: Blase, K.A. and Fixsen, D.L. Inegrated therapeutic interventions. Journal of Child Care, 3.1 pp 5972

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