Relationship – the foundation of residential treatment for kids

By July 15, 2015Blog

After working at Spurwink with youth in residential treatment since 1977, I’ve got some thoughts about what works.  I have known hundreds of kids who have passed through our residential treatment doors.  I can call them kids because they are just that – children.  And since I’m a grandpa now, I can most certainly call them kids.  I’ve watched many of our kids enter our programs feeling hopeless, alone, scared and having experienced many loses and disrupted relationships. It saddens me to think about the lack of understanding many people have regarding the positive impact Residential Treatment has on kids and families. It is not simply a place for kids to live but is an environment full of hope and opportunity for our kids and families — to strengthen their relationships, reflect on their needs, learn how to care for each other, and take courageous risks to grow emotionally, socially, and developmentally.  During the last 38 years numerous clinical treatments have evolved, but regardless of the treatment modality, there are some basic tenants of residential treatment that continue to be fundamental in developing relationships with our kids.  Relationship.  That is the first foundation of providing a therapeutic experience to kids and their families. .

Since my days as a summer camp counselor at Spurwink, I continually hear kids ask in some way “Do you really care about me?”  They are asking about how much we value them, respect them and believe in them. Our kids listen to what we say, what we do and how we care for them in a 24/7 environment that reveals what we really think about them.  In my work, I have realized how meaningful and powerful certain simple, yet powerful, messages of care are.  They are based on first being with and then doing with kids.  And thus I have watched multi-talented Residential Youth and Family Workers, Clinicians and Administers utilize the following 4 Principles of Residential Treatment:

1.  Make the environment personal and meaningful.

It is important to acknowledge when a kid enters a room, saying hello and looking at him or her.  And then just listening to her or him.  Listening for what is important to each youngster and making a mental note of it – though at my age I may have to begin keeping a notebook.  A few weeks ago while I was visiting a residence and a kid in the residence showed staff a book.  The staff person commented that he had never heard of the book or author and asked the kid how he liked it.  He admitted that he hadn’t read it yet.  The staff person told the kid he would like to know if it is a good read because if it is, he’d like to read it.  The staff person explained that he will follow up with him next time he sees him, and ask about the book.  Why? Because the kid will know he had meaning, significance and is cared about.  Relationship.

2.  Respect group and individual boundaries.

During my tenure at Spurwink, I have noticed that the kids appreciate and feel respected by those staff that knock on the front door of residence and wait to be invited into the house, even though the staff may be an administrator, clinician or scheduled to work at the house as fill-in or respite and technically could enter the house.  These staff understand that this is the kid’s home, although temporary, and they are a guest.  These staff also do the same when entering different rooms in the house (study, living room, dining room).  It is about respecting client personal time and space – important for kids with trauma histories.  These staff ask the kid if it is OK to interrupt conversations and if not granted, the staff respect that response.  These staff do not sit at a chair in living areas without asking if the chair is a special chair for a person in the house.  It is important to stand off to the side of the group until invited to join. There is a great deal happening in our houses and we need to respect the work between staff, kids and families, as well as the unspoken needs being met. These staff try to speak to each person for equal amounts of time, noting and respecting if someone is unable to or don’t want to chat.  They ask everyone how they are – staff and kids.  And yes, this takes time but it is quality time.  When these staff leave a residence, they say goodbye to each person, personally if they can.  But if unable to say good bye in person they ask the group to let the kid and family know they said goodbye.  Here we go again – relationship.

3.  Respect human beings. 

How we talk to kids, families and staff, what we believe about our kids, families and staff – this matters.  The best residential environment is one that is respectful of kids, families and staff in gentle, caring voices.  Looking in someone’s eyes acknowledges their importance and presence and lets a person know you care. I am sure someone is now saying there are individuals who do not make direct eye contact for any number of reasons that maybe cultural, developmental or diagnostic. Well, you are correct – so don’t – but make sure you have learned how to acknowledge that person or you may give them the message they are being ignored and insignificant.

4.  Introduce Kids to Activities.

How can a kid be a kid when he or she is not engaged in some sort of activity?  Even when in residential treatment, our kids still need to be kids – play and have fun.  So agencies need a person to the agency’s official or unofficial Residential Activity Master, developing and organizing these opportunities for kids.  These activities bring kids together as a group and help them practice their relationships.

Here are some of the more popular ones we have experienced:

Chili Cook-off.  Each residence makes a pot of chili.  Every person in the house chooses an ingredient to add – the expectation is there is no recipe and everyone accepts each person’s added ingredient (as long as it is a safe ingredient – a rule).  The purpose is to create a meal based on individual contributions, with the group validating each person’s input.  It promotes a whole house experience, communication about what ingredients work well together, and trying new things.  Each house’s chili then participates in a program chili cook-off and the winner represents the house at an agency chili cook off where all ages of kids and all types of emotional, social, behavioral and physical needs/challenges come together and have a community experience.  The winning chili is chosen by 3-5 judges, internal and external to Spurwink.  Past judges have included the agency president, agency administrators/staff, a community member who happened to be in the building, a parent, a policeman, a firefighter, radio announcer, and a TV personality.  A winning chili is announced and bragging rights with a chili bowl is presented to the winning chili team/program. The very best part of the chili cook offs are the smiles of the kids, the relationships the kids develop with staff and new friends, and an opportunity to share positive experiences with their families.

Summer Kickball League.  Each residential program creates a kickball team.  Then each team travels to other program sites to play.  Different ages and skill sets cause either some swapping of team members (promoting cooperation and collaboration), or more often, one team adjusting their ability to match the less skilled team (promoting sensitivity and respect).  Kids with all types of developmental, physical, emotional and intellectual challenges are on the teams, and all are involved.  It is a great experience in acceptance of differences.  This activity offers a sense of community beyond a single residence or program, allowing kids (and staff) to experience Spurwink as a larger entity, to develop new friendships and practice the wonderful new skills our kids are working on in their environments, individual, group and family treatment.

I’ve learned that when we can first show our kids and families respect by genuinely understanding their needs and experiences, accepting them, showing respect, and genuinely appreciating their special gifts, they can feel safe to take courageous risks to grow and try and develop new skills. It is the same for our staff, clinicians and administrators.

I treat the staff who work with these residential kids the same way.  I try to remember which employees have children and any specific events in their lives – marriages, trips, and family occasions.  When I do this, I see that they are more likely to treat the kids in the same way.

I have been blessed in having this opportunity to have worked with so many wonderful kids, family and talented staff during my 38 years in residential treatment at Spurwink.

Dan Hibbs, LCSW | Sr. Program Director

Linda Butler, PH.D., LCSW | Director of Research & Outcomes