Care, treatment and planned environments
esidence in community homes means that the basic provision of physical needs for the whole twenty-four hour period of the day must be met. The Project report has rightly paid a great deal of attention to the designing and setting up of living accommodation and stresses the importance of each child having his own personal space for being alone when he wishes. Around the basic physical needs has to be built the social and caring needs appropriate to the child's stage of development. Beedell uses the word 'parenting' to cover this provision and says that 'the essential character of residential work for children is that it takes over a more or less substantial part of the responsibility for parenting' .(C. Beedell, 1970) He distinguishes three aspects of parenting: holding, the provision of experiences of care, comfort and control; nurturing, encouraging development of skills; development and maintenance of personal integrity, growing up and becoming a whole person. These aspects describe the function of parenting a child in a substitute living base. Whatever the reason for committal to care, every child needs parenting in this way, so that for the residential staff this will be a primary task. Parenting takes place within the residential community in the midst of the whole complex network of relationships which the staff influence. C. Winicott, describing the influence, states 'the essential skill of the residential worker is to achieve a way of living for a group of individuals'. (C. Winicott), This recognises that while the worker must have the individual relationships implicit in the parenting function, these relationships take place largely in the group living situation, and therefore the worker must be able to create, balance and control the way of living for the children in his or her care.
The Project report describes the planned environment as providing not only a supportive framework for a variety of treatments, but also an environment which is in itself therapeutic...
All aspects of a child's day are used therapeutically, that is in such a way as to heal the effects of past damage and to promote emotional and social growth; the ordinary group living arrangements in the home contribute a major part of the treatment methods.
Despite the number of pioneer and experimental schools, there is a real lack in our knowledge of precisely how to organise such a planned environment. There is, however, no doubt as to the prime importance of the unconditional love and acceptance of each child as he is. It is this which gives the warm and accepting environment necessary for care and treatment. Most of the writing on residential work in this country centres on this aspect of the environment and on understanding the emotional disturbance of the child. Much that is helpful and that forms a body of knowledge for residential care and treatment has been recorded and is incorporated in the Project report. The gap in the knowledge of organising and planning the environment remains unfilled. The title of the Project report indicates that the members of the Project were conscious of this and they have attempted to rectify the situation by planning out the environment in many ways. There is consideration given to the ways in which group living can be used therapeutically and at the same time a concern for individualised treatment. I want to suggest that in the swing from using the overall effect of the regime to individualised treatment the report centres on individualised treatment. This is not to say that there is no concept of the overall influence of the environment but that it is not used to the best possible advantage for treatment.
Most of the work on residential care has been done by those in the psychodynamic tradition of psychological interpretation and their work naturally reflects this. Within this tradition the thinking of the Project report parallels that of 'planned environmental therapy'. This therapy is the most generally acknowledged theoretical base for work done with maladjusted children in this country. Within a theoretical framework which comprises a mixture of social psychology and post-Freudian psychoanalysis, it attempts to conceptualise the practice of such pioneers as Lane, Lyward and Wills. The chief exponent is Dr. Marjorie Franklin, who describes the approach as having become a serious branch of psychotherapy some time ago. The Planned Environmental Therapy Trust was formed after some years of experiment (at Arlesford Place) and discussion to promote 'the serious clinical study of the use of the environment as a means of correcting social and other related character deficiencies'. (M. Franklin)
Environmental therapists have a concept of maladjustment which emphasises the environmental causes of the disturbance. The environment can be interpreted to include the whole life experience, but experience within the family is particularly important. The maladjustment is seen either as emotional disturbance related to the quality of love received or as the result of social factors, and so treatment in the planned therapeutic environment must give a new social life with opportunities for love to be experienced.
As May says this is the heart of the treatment model, because treatment systems are largely concerned with the identification and treatment of pathological behaviour. Delinquent behaviour is not seen as a real problem as it is merely a presenting symptom. (D. May, 1971). This unfortunate neglect of behaviour in the treatment goals seems to be partly related to the swing from the overall effect of the regime training type of treatment to individualised treatment. However, the concern for the individual in the treatment situation is much to be desired, and it is the individual's need which should be used to evaluate the efficacy of treatment. Planned environmental therapy would appear to be concerned with the overall effects of the environment but the brief survey above shows that it is in fact specifically related to therapeutic treatment of emotional needs. The Project report does, as already quoted, mention the necessity of behaviour receiving attention in the treatment situation, but appears to view this as being provided for in the general therapeutic environment. The psychological orientation also focuses attention on the individual and the planned environmentalists can be seen as trying to apply general psychodynamic principles to the environment instead of merely to each child separately. In doing this they are also bringing together the strands of experience gained from the various pioneers. This is difficult to do because 'such pioneers have inspired disciples rather than formulated theories'. (R. Tod, 1968)
Residential workers have always been well aware of the effect of the institution and its environment on the behaviour of those residing in it. What has been lacking is a scientific planning of the total environment both for therapeutic purposes and for the shaping of behaviour. Ryall summarises his research conclusions as being that delinquent behaviour is a self-reinforcing habit which is central to the self image of the delinquent, and which is buttressed by a self consistent set of attitudes (such as hostility to conventional social values and authority figures) towards the social environment. He sees the mechanism by which these attitudes are developed as central to the treatment of the delinquent and says that for the treatment programme the ideal theoretical model would be to place the delinquent in a peer group whose membership he values highly, where he can find success in areas which are esteemed by the group, and in which the commission of offences incurs active disapproval and explicit low status.
Bridgeland notes in the conclusion of his large work surveying the history of pioneer residential work that there has been a complete neglect and resistance to attempting to use behavioural principles. This has resulted in a lack of development of alternative methods in this country and the only studies of the application of learning theory to residential environments are American ones. (M. Monkman, 1972) These studies show that carefully structured relearning experiences can be provided by using behaviour modification principles. In treating delinquency as a learned condition this approach is particularly appropriate. There are many possible applications of modification techniques not only to be 'built into' the total environment, but also for treating individuals within this environment. Examples of such individual treatment include modelling appropriate behaviour and teaching social skills by imitation, reward and punishment programmes, and specialised techniques for influencing the behaviour of an individual within a group. The effect on behaviour of both the regime- and individual-centred treatment environments can be equally unfortunate. A child may receive indiscriminate punishment in the first and indiscriminate reinforcement of love and acceptance in the second. Neither of these extremes is likely to teach socially acceptable behaviour. It is these effects on behaviour which need to be realised in planning for community homes.
It is not easy to set up a planned environment which takes account of all the principles discussed in this chapter. Every aspect of residential life has to be carefully thought out and related to the treatment goals. The general working principle of the American studies referred to earlier was that the therapeutic process could be most usefully and heuristically conceptualised within a scientific framework. In the scheme described by Monkman the theory was translated into practice by reducing the different parts of the living situation into smaller and smaller entities and then setting them up in relation to each other. These entities were physical and social variables and they were arranged to be moving and changing over a period of time such that they increased the probability of specified human actions occurring. This produced a progressive movement system from admission to discharge, daily routines, and a pattern of expected social functioning with a reinforcement and punishment system. The behaviour causing the child's admission was discussed openly with him but was not a focal point in the treatment programme in the way that prosocial behaviour was. The child was taught to deal with frustration and anger as it occurred in a given situation in a way that was socially acceptable instead of acting out his pent-up feelings in any way he chose. It was more important, and rewarding to the child, that time was spent doing appropriate things than that time was spent being punished for inappropriate behaviour.
Cohen and Filipczak applied a positive reinforcement approach which' did not force children to do anything, They operated a free enterprise democracy where points were earned for work achieved. These points were later converted into money and each child could buy himself the things he wanted within the school. The emphasis in this experiment was on increasing academic skills and returning to normal schools. Again the focal point was rewarding the child for appropriate behaviour. The principles of programmed environments and token economies need to be applied to the specialist community homes. The challenge is to combine a therapeutic environment which, while accepting the child no matter what he does, encourages and promotes appropriate behaviour.
Franklin, M. Quoted in Pioneers, p. 266
May, D. Delenquency control and the treatment model: some implications of recent legislation. British Journal of Criminology, xi, 4 October 1971, pp. 359-370
Monkman, M. (1972). A Milieu Therapy Programme for Behavourally Disturbed Children. San Francisco: Josey-Bass
Tod, R. (1968). Disturbed Children. Vol. 2. London: Longman. P. xi
Winicott, Claire. Quoted in Beedell,
op. cit. p84