Episode 53 reviews the first four tools and techniques that make up the Hierarchy of Interventions (Distraction, Engaging, Verbal Redirection, Labeling) and presents the next two steps in the Hierarchy, Changing the Environment and Limit Setting.  A major emphasis is placed on using these techniques to not only manage behaviors, but also to help clients develop their abilities to self-regulate.

Behavior Management is a necessary component of providing Care to troubled children and youth.  All kids sometimes exhibit behavior problems.  However, kids in residential treatment, perhaps especially because they’re surrounded by other struggling peers, will sometimes use problem-behaviors.  Part of the Care of children is to maintain a safe environment, including efforts to keep kids safe from their own dysregulated behaviors and those of their peers.  But behavior management is not enough.

In addition to providing Care, a residential treatment program must also provide a Treatment experience.  It’s not enough to create an environment in which kids “behave” only to have problem-behaviors reappear after kids leave the program.  For lasting change to occur, kids need to improve their abilities to self-regulate their emotions, thoughts, and behaviors (including internal physiological “behaviors”).  When used skillfully, the techniques that make up the Hierarchy of Intervention can be used in way that not only manages behaviors but also encourages the brain development necessary for improved self-regulation. 

Changing the Environment is a very powerful way to help kids who have become overwhelmed and dysregulated to the point where they can no longer fully process language.  Changing various aspects of a kids surroundings is a generally reliable way to help them to calm down to the point where they become psychologically organized enough to make thoughtful choices.

Limit Setting, when used to clarify behavioral expectations, and especially when used to clarify values, is another way to help kids learn how to better regulate their own thoughts and behaviors.