“Recovery: a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential.”
– The Substance Abuse and Mental Health Services Administration (SAMHSA), 2012
We know that building a living wellness and overcoming our barriers (occasionally with a self-administered butt kick) is a passion that constant readers share here. Those constant readers are often survivors, helpers, parents or others who value a life of recovery. But how is that life built and sustained?
Way back in 2011, in an article called I Hate Cookies, we looked at how anyone raising kids, be they parent, group home, orphanage, hospital, school or summer camp could help them become conscientious, adaptive, healthy adults “from the inside out” rather than from the “outside in” with rewards alone. We discussed blending Dr. Bernard Weiner’s “Attributional Theory of Achievement Motivation and Emotion” (1985) with Dr. Scott Turansky (2006)’s conscience building techniques to create a system of rules that re-enforced self-governance based in self-motivation and rooted in positive emotional responses. Acting to preserve and increase that positive feeling within, we agreed, was a much more humane and healthy lifestyle than constant cookie-seeking.
Though that focus is excellent, as an exercise, let’s blow the doors wide open. Let’s crumble all the cookies. In fact, let’s see what life would be like without the cookie jar itself, the outside-imposed system. In most organizations, that takes the form of a level system. At home that could look like a mix of a sticker chart and an “In the Dog House” board. In most organizations that system has tiers to which residents ascend as they accrue points for daily living.
Level systems are based in decades of science and most organizations across the world use them successfully. However, a growing belief is that level systems, by design, must focus on the negative and become unintentionally punitive. Also, when working with diverse age, development or upbringings, level systems can punish “symptoms or normal human expressions” that don’t fit within level behavior. Those seeking a better method say that a level system doesn’t prepare kids for a real life in which we don’t earn points. This, they say, leads to a difficult return to “real life” and “if behavior is changed…it tends to be temporary” (Mohr, et al, p. 11-12).
Some organizations, like a facility in Texas, are finding a new way to raise kids—they’re baking a brand new cake, without cookies or levels at all. “Eliminating the levels made [kids] feel more normal, more motivated and less pressured. Residents said there was less judgment and overall ‘we felt more like a teenager at home,’” (Schenck, 2013).
What Kind of Cake?
“A compromise is the art of dividing a cake in such a way that everyone believes he has the biggest piece.”
– Ludwig Erhard, German Politician
Like any cake, the flavor is crucial. During the 2006 SAMHSA National Summit on Mental Health Recovery experts “articulated 10 fundamental components…expected to infuse services and systems that are recovery oriented…” as part of their Recovery Oriented System of Care (ROSC) “approach for transforming behavioral health service systems” with care that values “Person-centered partnership, growth, choice, strengths perspective, wellness and health.” (SAMHSA. 2012, p.8) That’s a lot of flavor to blend. In the end, a move in a non-level direction would be just like adding that pinch of salt to the sweet in the batter; a balance between two opposites—Developmental Individuality and Structural Integrity.
An awesome article in the American Journal of Orthopsychiatry (Mohr, et al., 2009) titled “Beyond Point and Level Systems” struck the fine balance between the crucial role of any parent or program system to set the atmosphere and standards of the environment, help praise achievement and redirect problems, while allowing for individual development and flexibility.
If “the expectations…exceed the emotional or cognitive capacity of the child” they will feel stuck or punished, but kids will thrive if those strategies can be built in a neutral tone focused more on the “teaching component” with activities that “provide contexts for learning and testing more adaptive ways of functioning…practice skills and receive feedback from staff…geared toward helping children develop self-responsibility and healthy interdependence” (p. 12).
The Perfect Recipe
“The fear that there will be no structure is not true and there is still quite a bit of structure and far more room for learning…staff also realize that sometimes natural consequences are the best ones.”
– Kim Schenck, Program Director Texas Network of Youth Services
There is no perfect recipe, just like there is no perfect kid (or grown up!). That is what makes successful parenting and programming so awesome. Every time it works, every time a kid is raised healthy, is a profound wonder. I’ve been asked before “How can you work with kids who are so hurt? How can you work in that kind of hospital? I’d be so sad!” Every time I hear that I smile and tell the truth; I’m so glad I do what I do where I do it. I thank God that there are behavioral health hospitals, group homes and orphanages. The world is a hard, dangerous place—I think parents and kids “in the real world” have it much harder!
There are some ingredients that would help bring out the flavor that SAMHSA and Dr. Mohr seek though. First, let’s step beyond the diagnosis that we have. Let’s just look at raising a kid that simply wants to live, feel and do well. Isn’t that what we all want? The Indivisible Self Model is a strength-based, person-centered, holistic approach that helps people overcome a lack of “physiological and psychosocial wellness” (Myers & Sweeney, 2005, p.69). It has been found effective among thousands of teens to reduce rates of depression, anxiety, risk taking, violence, aggression and general health.
To that “sweet” note, let’s add the salty structure. The Collaborative and Proactive Solutions Model (Greene, 2013) has been around for many years under the name “Collaborative Problem Solving” and has helped “countless families, schools, inpatient psychiatry units, therapeutic group homes, and residential and juvenile detention facilities,” address challenging behavior in kids through relationships.
According to Dr. Greene (2003), author of the foundational best seller The Explosive Child, “challenging behavior in kids is best understood as the result of lagging cognitive skills…” because challenging behavior happens when demands exceed the kid’s skills or ability to respond successfully. The best way to reduce challenging episodes is “…by collaborating…rather than imposing adult will and intensive use of reward and punishment…because doing well is always preferable to not doing well…supported by research in the neurosciences for past 30-40 years.”
He advises using adult-kid interaction to increase flexibility/adaptation, frustration tolerance and problem solving skills using teaching and an in-the-moment 3 step intervention plan. Best of all, in 2013 Dr. Greene started www.Livesinthebalance.org, a non-profit resource site for CPS, and much of the start-up worksheets are part of the free on online resource for parents and programs.
Two components that SAMHSA prioritized in their list resonate deeply. That those raising challenging kids, in any environment, must instill a feeling of responsibility and hope. That is our challenge as helping adults. Can the mom who is called to the school for the 50th time this year still hope for her son? If she can’t, how can she teach him to hope for himself? Can the group home that had to restrict a number of allowances because of some dangerous behavior now justify returning some responsibility to the kids? If not, how do they learn it?
There is not a single answer and it is an ever evolving question. Most importantly it is not a question that only requires the helping adults to respond. We must share the answer and share the power. “Sharing the power with kids is actually extremely empowering,” Schenck (2013) said. But that sharing of power shares ownership of the problem “…and improves roles and decreases opposition considerably.”
In raising children who are motivated internally to live rightly, not only must we move beyond rewarding cookies in simple jars, but we must all be part of baking the cake.
Green, R. (2013) Collaborative and Proactive Solutions: A more compassionate, productive, effective approach to understanding and helping behaviorally challenging kids. Livesinthebalance.org.
Mohr, W., Martin, A., Olson, J., Pumariega, A. (2009) Beyond Point and Level Systems: Moving toward child-centered programming. American Journal of Orthopsychiatry. 79,1.
Schenck, K. (2013) Eliminating Level Systems in Residential Treatment Centers. Texas Network of Youth Services
Substance Abuse and Mental Health Services Administration (2012) Operationalizing Recovery-Oriented Systems. Rockville, MD: Author