In a variety of treatment settings, a therapeutic milieu provides intensive psychotherapeutic and psychoeducational experiences for disturbed children and young adolescents. It is generally agreed that effective psychosocial treatment requires a developmentally based treatment approach, collaborative parental involvement, and provision for ongoing staff support and training. In such settings, the treatment plan for each child reflects developmental, psychosocial, biological, cognitive, and neurointegrative aspects of the child's problems and identifies specific roles for psychotherapists, caseworkers, educators, occupational and recreational therapists, and parents (Alt, 1961; Pfeffer, 1979; Redl, 1959; Trieschman, 1969).

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ABSTRACT." The use of a developmental framework enabled milieu staff and psychotherapists to view the child from a multiaxial developmental framework and so gear each aspect of the therapeutic work in the milieu, individual therapy, and work with parents to each child and family's unique needs. A high level of parent participation in the milieu led to earlier identification of parental resistances and parent-staff conflicts. Such rapid problem indentification and confrontation leads to earlier effective parent-staff collaboration and a more rapid involvement of parents in the treatment process. Milieu day treatment can provide high quality intensive treatment of psychotic children and their families at much less cost than residential or inpatient treatment.The Children's Day Treatment Program (CDTP) is an intensive psychotherapeutic and psychoeducational milieu program for young preschool and school-aged psychotic children. The program opened in the Fall of 1977 despite several problems with staffing, physical quarters, and financing. This paper will discuss several of the problems and attempts at resolution, involved in creating a high quality, intensive treatment program in a community mental health center-related setting within very difficult constraints.From the very beginning, the staff most involved in the planning and implementing of the CDTP determined that the establishment and maintenance of the highest quality of treatment and education possible for the program was the overriding priority. It was this determination that maintained the high morale of the front line treatment staff while simultaneosly contributing to the difficulty of decision making. Efforts to provide maximal therapeutic contacts with children and parents also needed to consider the burdens upon staff.

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