Stop-Gap - Detailed Report

The model proposes three levels of intervention:

Environment-Based (E-B) Intervention.
All youths entering a residential treatment center (RTC) are exposed to E-B intervention which includes:

• Token economy: Focus is on the reinforcement of positive, pro-social behaviors (e.g., volunteers to help, follows directions, completes chores) which could serve as the youth's initial treatment goals. Additionally, it is advised to include a response cost component.
• Academic intervention: Children and youth with severe behavior disorders have the highest academic failure rate of all students with disabilities. The use of direct instruction curricula for reading and math incorporates many of the teaching techniques necessary for success with this population of students.
• Social skills training: A comprehensive intake assessment should include a measure of social skills. Specific skills should be targeted as individual treatment goals and directly instructed to promote acquisition. Performance monitoring, via daily checklists or goal ratings, should accompany instruction with specific reinforcement strategies designed to increase or improve performance. Finally, to promote generalized responding, it is recommended that all staff in the residential environment employ incidental teaching tactics.
• Problem-solving and anger management skills training: Research with aggressive children and adolescents has demonstrated positive effects for two skill -raining programs, both of which could be easily immersed within a residential treatment setting. They include: (a) problem-solving skills training (Kazdin, Siegel, & Bass, 1992) and (b) the Anger Coping Program (Lochman, Burch, Curry, & Lampron, 1984).

Discharge-Related (D-R) Intervention.
This level of intervention begins simultaneously with "environment-based" intervention and is intended to connect the youth to critical community supports.  D-R intervention components include:

• Intensive case management: The RTC may serve, in some capacity, as the provider of intensive case management services for the duration of RTC placement and even after the youth's discharge.
• Behavioral parent training: Parent Management Training (PMT) is a model of parent training consistently associated with positive outcomes for children with disruptive behavior disorders. PMT consists of a standard set of procedures taught to parents for the purpose of altering the child's behavior in the home. The central focus of PMT is to alleviate the coercive interchange between parent and child or adolescent by teaching parents and other caregivers a specific set of skills to address child noncompliance, one of the core ingredients of antisocial behavior.
• Community integration: Given that the RTC is a contrived environment, youths should be able to access the community for many of their needed services including enrollment in a local public school, part-time employment, and community-based recreational activities to name a few.

Intensive Intervention.
This level of intervention is reserved only for youths requiring more support to adequately address their behavioral needs. The purpose of intensive intervention is to return the youth to the E-B level of intervention as quickly as possible. Intensive intervention components include:

• Function-based assessment (FBA and functional analysis)
• Function-based behavior support planning.

McCurdy, B.L., & McIntyre, E.K. (2004). "And what about residential...?" Re-conceptualizing residential treatment as a stop-gap service for youth with emotional and behavioral disorders.  Behavioral Interventions, 19, 137-158.

Type of Study: Non-randomized comparison group
Number of participants: Approximately 25 per group
Population:

Age Range: 13 to 18 female residents
Race/Ethnicity: Not given
Status (e.g., foster care, CW): Residential Treatment Program

Location/Institution: Western U.S.
Summary: (To include comparison groups, outcomes, measures, notable limitations) The article summarizes the elements of the Stop-Gap environment-based intervention. The authors then present a plan for evaluation of the model using comparison to residential treatment centers offering standard services. Data is presented on the comparative rates of therapeutic holds (a method in which one or more adults physically hold children in order to contain unsafe behaviors) in two units of a residential treatment center, one of which introduced the environment-based intervention after seven months. At twelve months, the intervention residence showed a decline in therapeutic holds, while the comparison group showed an increase over the same period. Groups were matched on population number, gender, and disability. The authors suggest that this approach should be broadened to include matching on further critical variables and measures that include post-discharge outcomes. Limitations include small sample size, lack of long-term follow-up and lack of statistical analyses to determine the significance of between group differences at baseline and outcome measurement.
Length of post-intervention follow-up: None

Barth, R.P. (2005). Residential care: From here to eternity. International Journal of Social Welfare, 14, 158-162.

James, S., Leslie, L.K., Hurlburt, M.S., Slymen, D.J., Landsverk, J., Davis, I., Mathiesen, S.G., & Zhang, J. (2006). Children in out-of-home care: Entry into intensive or restrictive mental health and residential care placements. Journal of Emotional and Behavioral Disorders, 14, 196-208.

Zakriski, A.L., Wright, J.C., & Parad, H.W. (2006). Intensive short-term residential treatment: A contextual evaluation of the "stop-gap" model. The Brown University Child and Adolescent Behavior Letter, 22(6), 1-6.