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Abstract
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A variety of techniques for preventing youths from being physically assaulttve are introduced. Techniques are presented in three categories: (a) those that may be applied to an individual prior to, or immediateIy after, assaultive episodes, (b) those that promote prosocial behavior as applied on an individual basis, and (c) those that are utilized on a group basis with assaultive behavior diminishing as prosocia1 behaviors are promoted. Also introduced are ways to approach psychotic youths so that violent outbursts are eschewed. Treatment modifications are presented which may be helpful to children or adolescents as they progress to less restrictive settings. VioLit summary:
OBJECTIVE:
The aim of this article by Kupfersmid et al. was to introduce programming strategies for preventing, reducing, and managing physical violence in youths. These strategies were intended for application in both residential and hospital settings.
METHODOLOGY:
The authors employed a non-experimental design in which treatment strategies for violent youth were presented. The discussion was based more on a review of relevant literature than on an empirical study. The strategies presented were expected to adhere to the following criteria: 1) the results of the behavior change should assist the youth in improving important aspects of daily living; 2) the procedure should produce rapid results; 3) the behavior change should be long lasting and have an effect on other situations; 4) the changed behavior should not negatively influence established desirable behavior; and 5) the techniques should be efficient with time and money, easy to implement, require little specialized training, and not be objectionable to those implementing it.
FINDINGS/DISCUSSION:
The authors focused on those aspects of a youth's treatment program which relate to institutional rules and procedures as well as behavioral strategies which can be employed by staff members. Their discussion was organized into different sections related to the type of treatment strategy being employed. The first section dealt with techniques applicable to youth prior to and just after an assaultive episode. Based on the assumption that assaultive behavior is learned, the authors suggested that treatment must occur for the entire day and in every location of a facility. The goal of this technique is to reduce the need for violence as a means of gaining a desired outcome. The technique is more effective when a team approach is followed. Every member of the team should have the opportunity for input and everyone must abide by the team's decisions. Most treatment programs utilize an "Individual Treatment Plan" (ITP) which guides the direction of a resident's treatment. ITPs normally contain three parts. The first deals with the major problem behind the resident's hospitalization and/or institutionalization. The second part addresses the goals of treatment for each problem. The third part consists of related issues requiring attention but are not a focus of treatment. The authors suggested that ITPs should be updated every 30 days by comparing perceived progress with the ITP's initial behavioral objectives. The authors also presented individual techniques for reducing physical assault. The primary goal of these techniques is to encourage the development of an internal control mechanism which inhibits violent outbursts while encouraging prosocial action in an individual. "Differential Reinforcement of Other behaviors" (DRO) is a technique which involves rewarding desired behavior while discouraging undesired behavior. For DRO to be effective, all adult participants must agree beforehand on what will constitute desired and undesired behavior, what rewards will be, and a reinforcement schedule. "Extinction" is a strategy whereby an individual's undesired behavior is not rewarded by another and is usually ignored. This strategy is most successful when the undesired behavior is minor and unlikely to affect others such as minor self-injury. A third strategy, "natural consequence", consists of allowing an undesired behavior to proceed such that the individual experiences the consequence of his/her behavior. A fourth strategy, "logical consequences", involves contingencies placed upon the youth for undesired behavior. "Response cost" is a logical consequence in which the youth is assessed a penalty for displaying undesired behavior. "Overcorrection", an additional logical consequence, involves two processes: "restitution" and "positive practice". Restitution consists of the youth either repairing damaged goods or environment better than prior to the destructive act or paying for their replacement. Positive practice involves the youth engaging in repeated demonstrations of desired behavior. Timeout is a final logical consequence in which the youth is removed from the environment which appears to be encouraging the undesired behavior. A number of preventive interventions that can be applied on an individual basis to encourage prosocial behavior is the theme of the next article section. One technique, "self-monitoring" (SM), consists of the youth recording the rate of a specific behavior over a predetermined amount of time causing the youth to anticipate recording negative behavior prior to enacting it. This was considered to be effective insofar as the youth is forced to think about an act before committing it. "Task assignments" involve the youth engaging in specific behaviors for a designated period of time in order to encourage positive behavior at which the youth normally believes he/she will fail. A "contingency contract" is a written agreement between staff and youth which states what will be the rewards and consequences for designated target behavior for a certain length of time. Finally, "Social Skills Training" (SST) is an approach which refers to the teaching of behaviors which improve a youth's functioning with others in situations where inappropriate behaviors have occurred. In the third section the authors presented prevention intervention techniques designed to be applied to groups. Four approaches were discussed: "modeling", "checklists", "token economies", and "level systems". These approaches are intended to provide social-emotional growth, improve coping skills, and encourage appropriate behavior. Modeling involves the individual imitating the actions of an appropriate role model figure. A youth whose behavior has improved relative to his/her peers can be utilized as a "slide model" to others. A "checklist" offers a simple structural approach to behavior programming; behavioral expectations are prepared in which acceptable and unacceptable behaviors are listed and youths earn checks for engaging in appropriate behavior. "Token economies" or "token systems" are secondary reinforcers of positive behavior based on concrete rewards (e.g., points, tokens, poker chips). Often implemented alongside a checklist and/or token economy, a "level system" is a programmatic structure in which individuals move from one level to the next while receiving rewards for positive behavior and penalties for negative actions. The fourth section of the paper offered suggestions for the construction of a treatment program for youth who are too emotionally disturbed to profit from the previously described strategies. The author described the common symptoms of these out-of-contact youth; "delusions", "loosening of associations", "hallucinations", and "affective incongruence". The primary goal when dealing with youths displaying the above symptoms is to help them return to a more "normal" state. The authors therefore suggested four strategies for recreating this more "normal" state: "consistency", "structure", "population dynamics", and "establishment of interpersonal relationships". A consistent program is often reassuring to psychotic youths because they know what to expect. Similar to implementing a consistent program for youth, the authors found that the structure of a psychotic youth's living arrangements should be calm and without a great deal of activity. The authors also found that placing a psychotic youth in an environment with nonpsychotics can be beneficial. The population dynamics of this arrangement are such that nonpsychotics tend to appreciate the situation of the psychotic and want to help with the severe conduct disordered individual. A final strategy is the establishment of interpersonal relationships as a means to bring psychotic youth out of their own "inner realities". Adults are encouraged to be overly supportive and empathic with these youths and staff should talk to psychotic youths regularly throughout the day. In the final section, the authors offered strategies for handling improved behavior. They pointed out that one of the greatest problems when dealing with individuals who have successfully completed therapy is the assumption that they will respond the same when they move into more "natural" environments. Hence the major goal of moving someone from a structured program to a less structured environment is to help them prepare for the inconsistent application of rewards and penalties outside the treatment facility. The authors advised that it is a good idea to slowly phase these youths into the environment in which they will eventually reside. They should also be encouraged to occasionally return to their "old" programs for stability during their readjustment period. The authors concluded that prevention and management strategies could best be implemented in the form of an integrated system of institutionalized procedures and behavioral rules. AUTHORS' RECOMMENDATIONS:
The authors suggested that treatment programs will vary according to unique features of different facilities. Since empirical evidence of the effectiveness of the different strategies wasn't provided, the authors recommended such an evaluation for future research. EVALUATION:
The authors present a thorough overview of different types of treatment strategies for managing physical violence in youth. However, a section on implications for policy would have been helpful. Nonetheless, the discussion is clearly presented and broad based such that it provides a valuable survey of contemporary treatment strategies for violent youth. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
KW - Residential Treatment
KW - Mental Health Treatment
KW - Mental Health Institution
KW - Prevention Recommendations
KW - Intervention Recommendations
KW - Treatment Recommendations
KW - Juvenile Violence
KW - Juvenile Offender
KW - Juvenile Treatment
KW - Juvenile Patient
KW - Patient Treatment
KW - Offender Treatment
KW - Violence Intervention
KW - Violence Prevention
KW - Violence Treatment
KW - Treatment Program
KW - Program Recommendations |