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Activity programming in the milieu setting: Commonalties in work with children and older adults

Merle Griff

Commonality of functions
Workers in milieu settings, whether these be for children or for elders, experience comparable problems in their daily professional work. It is crucial for staff members in either setting to form trusting relationships with those in their care, to learn how to observe behaviour so that an appropriate management or intervention technique can be used in reacting to behaviour which is often aggressive or withdrawn, to respond in a therapeutic manner to special problems such as runaways, sexual behaviour, and the effects of medication, to interact with families in a non-judgemental, supportive manner even when the worker believes that the family is neglecting their child or parent, and to communicate in ways that the client perceives as being age-appropriate.

Residents in milieu settings, be they children or elders, also endure homologous problems and frustrations. Their admission into a residential "home" is usually not by choice. They experience many losses-disruptions in their daily routines, perceived as the loss of control and independence; the loss, even if temporary, of many of their personal possessions; the inability to have a truly personal and private environment, and separation from friends and family, among others.

Staff members, interacting with either age group, also experience common problems. Although "front-line" workers, whether they be child care workers, nursing assistants, or activity aides, are entrusted with the daily care of often emotionally and physically fragile people, they have historically received minimal training; their observations and suggestions given little attention; and their remuneration for a highly stressful job usually not commensurate.

While most of the formerly custodial institutions have become at least nominally "treatment orientated" through the addition of a few mental health professionals, there has usually been very little change in the procedures that are carried out by "on-line" staff in the living situation. (Carducci, 1962, p. 213)

Although the professional ethos has been slowly changing for child and youth workers, the professional metamorphosis of caretakers of the elderly is unfolding in response to legislative mandates in the guise of recent certification regulations for nursing and activity assistants.

Activity programming
Contributions from the professional knowledge base of child care in developing therapeutic milieus could enhance the effectiveness of geriatric care-providers in offering an environment that would facilitate a better quality of life, regardless of age and/or impairment. For the purposes of this article, activity programming will be the child care skill utilized to exemplify this assertion. In geriatric milieus, activity programs are currently perceived as one of the primary indicators of the quality of care being imparted to residents in geriatric settings.

"Our days with the children can be broken down into two parts: the daily routine and free time" (Pettit, 1976, p. 8). Days with older adults also consist of similar parts: daily routine, meal time, and free time. Activities of various kinds have occupied this free time for both age groups.

Child care workers have recognized for some time that therapeutic activity programming can enhance a child's ability to express his feelings, to promote positive self-esteem, to assist in socialization, and to increase group cohesiveness. Some gerontologists have also noted the value of activities as stated by the milieu staff of the Institute of Gerontology at the University of Michigan: "staff place value on activities which improve the quality of life of residents where appropriate ... Planned activities are centered around a goal and are of adult caliber and are varied and stimulating" (Coons, Metzelaar, Robinson, & Spencer, 1986, p. 176). However, the inclusion of any discussion of the relevancy of therapeutic activity programming to the provision of quality care or its significance in a geriatric resident's treatment plan is sparse and limited.

Carducci, D.J. (1962). A possible solution to the training and orienting of child-care workers. Child Welfare, 41, 212-216.

Coons, D., Metzelaar, L., Robinson, A., & Spencer, B. (1986). A better life: Helping family members, volunteers and staff improve the quality of life of nursing home residents. Columbis, OH: The Source for Nursing Home Literature.

Pettit, R. (1976). Activities: A vital tool. Maryland Association of Child Care Workers Newsletter. Rockville, MD.

Griff, M. (1993) Activity programming in the milieu setting: Commonalties in work with children and older adults. Journal of Child and Youth Care, 8(1) pp.11-18

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