Residential and day treatment programs should focus on growth and development in the child’s total life sphere rather than on the remediation of psychiatrically defined syndromes or the extinction of certain problematical behaviors.
The basic purpose of all child helping should be the teaching of skills for living. Our goal should be the development of a model of child rearing which emphasizes the competence and mastery that all children need to develop in basic life skills and then demonstrates how these skills may be taught to children with special needs. The illness model of residential treatment that pervades our case records has not served us well; in fact, a majority of the children we serve do not suffer from underlying disease processes, psychoneuroses, or character disorders. We should therefore make use of assessment procedures that are behaviorally specific and contextually grounded; that is, directly applicable to the real-life environments the children encounter in their home communities. We should also proceed on the assumption that no single format for teaching skills is sufficient; neither psychotherapy nor behavior modification of itself provides education for living. We need instead to think about a variety of teaching formats, including group intervention, behavioral modification, games and activities, special education, and family work. Such an orientation to total child growth and development requires us to take three additional steps:
1. Demystification of the helping process. Parents and child care workers are most often the best experts on the children in their care. Both should be involved as central actors in the helping process; specifically, they should have access to all information possessed by the clinicians. Too often parents and parenting persons are kept in the dark regarding clinical assessments, which themselves are often couched in jargon that confuses more than clarifies. Assessment should include a look at the child’s total range of functioning and begin not with clinical presuppositions but with those areas that are causing parents and child the most pain and strain. Finally, taking the mystery out of child treatment means saying honestly, "I don’t know," when the situation warrants.
2. Relabeling of program elements. Hobbs (1975a, 1975b) and his associates have written of the dangers of labeling individual children. Similarly, program labels help the child define himself. The basic elements of the child treatment program require a relabeling to reflect a living/learning rather than an illness/treatment orientation. For example:
“Campus” not “Grounds”
“Student” not “Patient”
“Dormitory” not “Cottage”
“Graduation” not “Discharge”
“Residential” not “Treatment”
“School” not “Center”
The reason for this semantic change (for which I am indebted to my colleague Albert E. Trieschman, whose own program – the Walker School – uses this terminology) is partly political – “education” is more positively valenced in the society than “treatment.” In addition, however, the new terms provide a much better set of descriptors for what the program is all about: teaching the child something about the reasonable limits of his own behavior and, at the same time, providing him with the opportunity to acquire competence in a whole range of life skills. The illness/treatment terminology suggests the presence of some identifiable psychic disease processes in children – a view that is not supported by the available evidence.
3. Designing learning experiences with an eye toward maximum “portability.” Adjustment within the program should be seen as the means and not the end of the helping process. Developing “marketable peer skills” should mean just that: how to make a friend, join a game, or negotiate with someone who is bigger and tougher than oneself. The ultimate proving ground should be the child’s own home, school, and community. As we know from clinical experience and from the available research, adjustment within the program is not necessarily a good predictor of how the child will fare on his return to the community.
Whittaker, J. K. (1960). The Changing Character of Residential Child Care. Caring for Troubled Children. San Francisco: Jossey-Bass. pp 8-10
Hobbs, N. (1975a). The Futures of Children: Categories, Labels, and Their Consequences. (2 vols.) San Francisco: Jossey-Bass.
Hobbs, N. (1975b). (Ed.) The Futures of Children: Categories, Labels, and Their Consequences. (2 vols.) San Francisco: Jossey-Bass.