(Woodbury Reports is printing this as the fourth in a series of articles regarding the evaluation and development of residential schools and programs for children. Each article will address a program component and/or issue that is topical and critical to effective programming.)
Care Plans:
A standard practice with programs that provide help to adolescents and their families is to develop a plan of action that is designed to identify the youth’s needs, strengths, interests and values. Upon identifying this important information, the program staff develops a plan to best address the student in an age-appropriate, comprehensive and holistic manner. These plans are referred to as treatment plans, care plans, and a multitude of other names unique to a particular program. For the purpose of this essay, the term Care Plan will be used.
Purposes of the Care Plan:
Care Plans serve the purpose of aligning the program team. Specifically, the program staff needs to know the goals and objectives of each student and the plans to achieve these goals. To illustrate the importance of alignment, one only has to look at the Laser which amplifies the task at hand. The more coherent and focused the Care Plan is, the more powerful it is. One purpose of the treatment plan is to maximize the gains by taking into account a student’s strengths, weaknesses and needs, and helping him/her to maximize those gains while in the program. The Care Plan can greatly support the staff in nurturing the student’s self confidence. It provides a positive direction by leading the student to the next step necessary to accomplish the goal of successfully returning home. Care Plans also help the students and staff stick to the goals and continually bring everyone back into focus on the desired accomplishments.
A key purpose of the Care Plan is to provide a means to consistently follow up with the progress of the student. Components of the Care Plan will identify areas of concern, long term goals to establish the desired outcome, objectives designed to achieve these goals, and interventions planned to achieve these goals and objectives.
Development of Care Plans:
Information necessary for a comprehensive Care Plan includes the student’s history, educational assessment, psychological and psychiatric evaluations, medical history, parental input, and in-depth student interviews. The Care Plan should be developed and led by the multi-disciplinary team of the program to assure coordination and personal ownership of the plan. The initial goal of the Care Plan is to identify patterns of behavior that brought the student to the program. Questions to be answered are: “What is going on?” “Why is he or she coming to the program?” The focus is to determine what is going on with the student’s life and what needs to be done to improve it. This includes the use of both general and specific program approaches. If a student has identity issues, what in general does the program do to clarify who they are and specifically, what will be done to help the student begin to formulate who they are and what they want in life. What actions need to be taken by the student and staff to help the student gain insight into his/her life and behaviors? Through eliciting facts from the student’s parent’s, and other key people in his/her life, an understanding of what is going on is formulated. Details are obtained and patterns of behaviors are determined. The ultimate formulation of what is going on with the student provides an understanding of what approaches may help resolve problems that the student is dealing with.
General principles of program interventions:
The purpose of a student being in a program is to nurture and support their personal growth. The first fundamental principle is “safety first,” which includes both physical and emotional safety. The environment must be orderly, predictable, and consistent in order to provide optimal security and safety for students and staff. The program is asking the student to be responsible, and it is critical for the staff to have the highest level of integrity and responsibility. This is interpreted as doing work to the best of their ability, focusing on the specific role they have, being willing to clear up misunderstandings, admitting mistakes without excuses and taking on new responsibilities.
The second principle is to develop a trusting relationship between staff and students and between students and students. Repeatedly, experience and research indicates that positive and healthy relationships are a key to real change. In recent years, there have been numerous studies illustrating how quality relationships are critical in helping students. So critical in fact, that a program’s success hinges on this vital principle. In developing a trusting relationship, staff must avoid value judgments and labeling of students.
Nurturing self-confidence in students is the third principle. Nurturing self-esteem includes recognizing both the students' strengths and their progress. It includes an atmosphere of staff sending a clear message that they want to help the students and demonstrate genuineness in this message. Providing a positive direction leads the students to accomplishing goals. Furthermore, the environment must be set up in a manner that models caring and responsible behaviors to enable the student to observe the expected behaviors.
In a positive environment, creativity is also a major aspect of quality and excellence. It not only incorporates doing the best you can in whatever you are doing, it also involves the nurturing and development of a student’s gifts. The challenge of the team is to find the student’s talents and gifts, then nurture them and help the student integrate them into his/her behaviors. Building on individual talents develops confidence in who he/she is and provides glimpses into who he/she can become.
Integration of Care Plan and Program Model:
The Care Plan is carried out within the context of the complete program environment. Previous Woodbury Report’s essays have addressed leadership, philosophy and program model. These define the program’s environment. The program model will direct the majority of interventions a child will experience. For example, the vast majority of programs will have a level or phase system, which monitors the daily behavior of youth. They will often have a set number of individual, group or family therapies. The Care Plans occur within the context of the program philosophy and model. In all models, whether they be emotional growth, residential treatment, eclectic, or experiential in nature, each student should be treated uniquely. The Care Plans direct the unique staff interventions which will assist the student in becoming successful within the model. In an emotional growth curriculum program, while all students participate in a relatively routine manner, the Care Plan provides flexibility to individualize the care of each student. For example, while a student accurately diagnosed as bi-polar can participate in a traditional emotional growth workshop, the nursing and other medical staff must assess the appropriateness of the student’s medication in order for the student to achieve maximum benefit. In a similar fashion, a residential treatment program that primarily describes itself as using traditional psychiatric and psychological approaches, may use an adventure therapy approach to assist a timid and withdrawn student in gaining confidence and leadership skills.
The student’s care and treatment begin with the formulation of his/her situation and individualized care planning, which are uniquely designed for the individual. Regardless of the program model, this multi-disciplinary plan will keep the team and the student on the right path.