Program Highlight: Treatment Models

Posted January 30, 2018

Program Highlight: Treatment Models

In the fall, we had the Child Protective Services (CPS) caseworker for a young girl living in our Residential Treatment Center (RTC) request to move the child to another facility because she believed she was not making progress at The Settlement Home. This scenario happens from time to time when a caseworker does not understand trauma and the healing process. Behaviors are a symptom of trauma, and during deep treatment work, behaviors often become more severe before they improve. At The Settlement Home, we do not view a child by her behavior. Instead, we view her by her story and her strengths.

When a child enters treatment, there is an expectation to see results. Many times this means that people want to see kids being compliant, and they want to see the intense behaviors subside. Of course, this is the end goal for any child that has experienced trauma, but if quiet compliance is all we see from a resident while she is in treatment, we miss out on learning about her pain and what is really going on with her. From there, we can help her learn the coping skills she needs to recover from her trauma. Behavior is a form of communication that gives the treatment team valuable insight into the child’s experience of the world.
One tried and true method of creating compliance in children is through behavior modification programs. Rewarding positive behavior and disciplining negative behavior typically results in obedience. However, research tells us that behavior modification does not create lasting results with children who have traumatic backgrounds. Instead, it causes them to become dependent on the behavior reinforcement, and they are unable to internalize the stability that it provides them. Once they leave the behavior modification environment, they revert to former maladaptive behaviors. This is what we know, and why we have a different approach at The Settlement Home.

We train all of our program staff and foster/adopt families on a trauma informed caregiver model called Trust Based Relational Intervention® (TBRI®), which is an evidence based training curriculum that addresses trauma, attachment and the brain. This model was developed at Texas Christian University by the late Dr. Karyn Purvis and her team with TCU’s Institute of Child Development. Many of you have heard of this model and know that The Settlement Home adopted the use of it a few years ago. Those of you who have not heard of TBRI® and are interested in knowing more can do so by visiting:
In addition to the implementation of TBRI®, The Settlement Home has three unique characteristics that we believe are the keys to success in seeing tremendous healing occur. These three components are our houseparent model, our therapist model and our continuum of care. Since we know that consistency and predictability are two vital factors in working with youth who have experienced trauma, we designed our treatment model to ensure this.

Our campus has three cottages within the Residential Treatment Center and three group homes. Each cottage and group home has two houseparents assigned to it with separate living quarters for the houseparent. One houseparent works from Wednesday morning until Saturday afternoon, and then she trades out with the other houseparent who works from Saturday afternoon until midday Wednesday. There is intentional overlap in the shifts on Wednesday and Saturday to allow for communication between the two houseparents so that consistency is upheld. Each houseparent has a partner that we call a Youth Care Counselor (YCC) that works alongside her throughout the waking hours.
This model provides consistency, promotes connection with a healthy adult and enhances the ability for a child to trust her caregiver. For many of the kids we serve, this is the first time they have experienced a relationship with a safe caregiver. Healing takes place when trust and connection are established.
Our houseparent model is the perfect way for a child to connect to a safe adult because the same person that wakes her up in the morning tucks her in at night. In other facilities, staff members rotate on shifts. Therefore, relationships and trust take longer to develop.

The Settlement Home’s therapist model is unique because each RTC cottage and group home is overseen and guided by a licensed therapist. This therapist does not just meet one hour per week for therapy with a resident as they do in other residential programs. The model allows the therapist to provide individual, group and family therapy (when it is appropriate). The therapist also supervises the houseparents and YCCs that work at that cottage.
Additionally, having the therapist constantly in the cottage or group home provides opportunities for clinical observation, assessment and intervention. Imagine a teenager sitting with a therapist for 50 minutes a week in an office setting versus the daily interaction that occurs with the therapist in the child’s home environment. The therapist has so much more information to work with in understanding the child, developing trust and providing consistent intervention and treatment planning.

Houseparents and YCCs learn from the therapist about the clinical assessments and interventions, which is one of the many reasons we call ourselves a teaching facility. On the job learning is one of the most powerful ways to learn.

At The Settlement Home, we provide a continuum of care, which means that as residents complete their goals for treatment, they have the opportunity to move to one of the other programs within our community. For example, a child admitted to the Residential Treatment Center has a tangible next step of working to move to the lesser restrictive setting of our Group Home Program. The youth we work with often do not have a reliable discharge plan in place, which means that after they leave us, they have no idea where they will go. This concrete next step motivates residents to complete their treatment goals. Our continuum of care allows them to move in either direction in the continuum based on their needs and creates stability so that residents do not have to move to another facility if their treatment goals change. When a resident moves throughout our continuum, she does so without having to change schools, doctors or location. The child knows us, knows our model and receives the predictability and consistency she needs to feel safe and connected.

These three unique characteristics set The Settlement Home apart from other programs. It is important to consider that healing takes time, and results do not happen overnight. If kids are rushed through treatment, they can hold their emotions and behaviors together for the short-term, but they will likely see failure when they move to the next place. We want to be the last stop on a child’s journey to finding safety, stability and healing, and we know through experience and many stories of success, that this takes time.