Current concepts in milieu treatment of seriously disturbed children and adolescents.

Abstract

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).

Nurse‐Parent Relationship Building in Child Psychiatric Units

“…Goren (1979) seconded this idea, believing nurses should treat parents as having done the best they could. A few more articles appeared in the 1980s (Berlin, Critchley, & Rossman, 1984;Critchley, 1982;Critchley & Berh, 1981) that provided some direction for nurses working with parents in the milieu.…”

The physical restraint of children: Is it therapeutic?

“…The most basic function of physical restraint is administrative, in that it stops or prevents dangerous behavior when other approaches have proved ineffective. The aggressive child and others in the vicinity can be protected, and "group contagion" can sometimes be prevented (Berlin et al, 1984;Drisko, 1976;Redl & Wineman, 1952). However, with behaviorally disturbed children it could be argued that the function is also therapeutic.…”

“…These concerns are legitimate and should be addressed by practitioners, but effective responses are needed to control the dangerous aggression that occurs in many substitute care settings. Moreover, the overwhelming majority of writers in the psychiatric and child care literature accepts that physical interventions may be necessary to protect an aggressive child and others from harm (Berlin, Critchley, & Rossman, 1984; Drisko, 1976, 1981; Garrison, 1984b; Murray & Sefchik, 1992; Schloss & Smith, 1987; Trieschman, 1969). Indeed, Drisko (1981) has suggested that the failure to intervene to protect a child could itself be construed as a form of abuse.…”

“…Former child care workers have pointed out that emotional issues surrounding the management of aggression cause the greatest stress among child and youth care workers and no doubt contribute to the high burnout rates in the field (Birnbach, 1973; Helmer, 1978). A recent survey of child and youth care workers (Hunter, 1989) found that the management of aggressive clients, particularly the personal issues aroused during highly charged encounters, raised “many troublesome feelings.” These writers and others (Berlin et al, 1984; Bowie, 1989; Vander Ven, 1988) stressed the importance of timely and supportive supervision of staff involved in the management of aggression to, among other things, assist care workers in understanding their emotions in the course of these episodes and their aftermaths. The need for specific training in crisis management that includes safe restraint techniques, as well as the provision of adequate organizational support, is also stressed.…”

Nursing Diagnosis vs Goal‐oriented Treatment Planning in Inpatient Child Psychiatry

“…As aresult of these economic forces there is tremendous pressure on child psychiatric inpatient teams to evaluate, stabilize and discharge children from the hospital to lesser levels of care as quicklyas possible Uemerin & Phillips, 1988). To accomplish these tasks it appears that a high degree of cooperation among clinicians is required (Berlin, Critchley, & Rossman, 1984;Doherty, Manderson, & Carter-Ake, 1987).…”