A trauma-informed level system is a controversial subject with behavioral health organizations (particularly residential facilities). Traditionally, on one end of the pendulum organizations used a level system to incentivize youths to improve their behaviors. Youths would start at the lowest level when they arrived in care, then work their way up to higher levels as their behavior improves. However, research and other findings proposed that these methods were not trauma-informed. The studies found youths lost privileges or were dropped a level due to behaviors created by trauma triggers. Therefore, the level system was proclaimed to be harmful to youths in foster care and recommended to be disbanded.
Then organizations moved to the other end of the pendulum. At the request of governmental child welfare agencies, they eliminated the level system. Subsequently, youths felt unmotivated to stop risky behaviors. Smoking, drug use, assaults, and other behaviors increased on residential campuses as well as in foster homes. And caregivers had no means to modify a youth’s behavior. Rather than be focused on their personal motivation for improved behavior, youths would be more influenced by the behaviors of peers. According to research, youths associating with peers who have the same behavioral difficulties can mirror those behaviors and increase, rather than decrease their pathology.
Neither approach seems to work because they do not address the adolescent’s need to address the risk vs. benefit of their actions. Because using a trauma-informed level system requires an understanding of how adolescents function. In Dr. Frances Jensen’s book, The Teenage Brain, she discusses how adolescents define their actions by how the risk of the event compares with the benefit. As long as the risk is worth it, they will engage in the action. This plays into the need for a motivating factor to help youths improve their functioning. They won’t do it on their own, but if the rewards of a better level in their home improve their life, then they will adapt their behaviors. Besides, if the level system works in the real world, why can’t it work in residential facilities? Employees start at an orientation phase and then have opportunities to receive higher levels of reward (benefits, salary increases, promotions, perks).
Creating a trauma-informed level system means using the principles of trauma-informed care and incorporating them into the platform. This means using the following:
1. Using reinforcements and consequences. When youths with trauma receive a positive interaction following their behavior, it leads to an increased repetition of that behavior. The same holds for consequences; it is based on their behaviors and is non-punitive. Even offering praise for youth returning after an AWOL for coming back lets them know they are valued and missed.
2. Get the youths’ buy-in and feedback about the plan. To make the level system work, hold monthly meetings about the incentives and reinforcements. When youths incorporate what they want, then they participate in collaborative decision-making. Teenage girls may like spa treatments like manicures and pedicures, makeup, and other hygiene incentives. Teenage boys may like access to video games, courses on how to get along with girls, and better clothing.
3. Establish levels based on achievable goals and prohibit youths from going down levels. The first level focuses on intensive services to help stabilize the youth. Then each level afterward is based on achieving goals or behaviors, along with additional rewards (allowance, curfew, use of electronic equipment, and passes). But the youths never go down a level; they only stay at a level if their behavior doesn’t improve. This approach lets the youth know they can only go up the levels, not down.
Praxes offers training on establishing trauma-informed level systems and consulting. For more information, please contact us.
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PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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