REFLECTION COTTAGES

Intensive Therapeutic Reflection Centers/Donegan Hall

 Purpose

The purpose of the Intensive Therapeutic Reflection Centers is to provide a structured, supportive environment for residents who need crisis stabilization. The Reflection Centers provide a higher level of supervision and therapy along with a greater staff ratio of 1 to 4. The therapeutic focus of this crisis intervention is for the residents to reflect upon their core issues that drive unsafe behavior. This period of reflection is intended for the resident to come to a greater understanding of their underlying beliefs and to then develop new skills /tools for effective coping and constructive behaviors.  All El Pueblo policies and procedures are applicable to this dimension of the El Pueblo Performance Program for Youth©.

Population Served

The Intensive Therapeutic Reflection Centers/Donegan Hall serve the boys’ CHANGE Program in Cottage 4, the girls’ SPIRIT Program in Cottage 30, and the boys’ OSTAY Program in Donegan Hall.

Admission Criteria

Residents are admitted to the Reflection Centers/Donegan Hall based upon clinical need.   When a resident displays a repeated pattern of unsafe behaviors or is experiencing a crisis, the treatment team will meet to review the resident’s need for crisis stabilization.

Persons involved in the review must include the primary therapist and the reflection center therapist.  If a resident is determined to need the level of care provided in the Reflection Center, the treatment team will develop a short-term treatment plan geared to meet the resident’s current needs and help the resident out of crisis.  This plan is communicated to DSS, DYC, Probation and parents, and is documented on the pre-critical review.

Specific Admission Criteria

1.      Continued behaviors that pose a danger to self or others such as:

·        Suicidal behaviors

·        Self-mutilation

·        Physical aggression

·        Abuse of prescribed medication

·       Behaviors do not meet criteria for hospitalization

2.      High risk to run due to:

·        A pattern of multiple past runs

·        Multiple run attempts;

 3.      Psychiatric impairments such as:

·       An increase in symptoms preventing normal functioning in the cottage

·        Refusal of life-sustaining medications

Treatment Reviews

Treatment progress is reviewed on a daily basis via the grade card and meetings with treatment staff. Continued placement in the Reflection Centers/Donegan Hall is reviewed every 24 hours and Rehabilitative Services Meetings are held twice a week.  Residents may be returned to their home cottage at any time that it is determined to be clinically appropriate.  Should a resident continue to exhibit dangerous behavior necessitating further intensive treatment beyond 7 days, reviews may take place less frequently. Referral sources and families will be involved in the decision to keep the resident at this level of care on a longer term basis.

Discharge Criteria from the Intensive Reflection Centers/Donegan Hall

A transfer staffing will be held to facilitate the resident’s return to his/her assigned cottage.

Discharge Criteria

1.     Resident has not exhibited dangerous behavior noted by a lack of level C offenses.

2.     Resident demonstrates understanding of appropriate coping skills and has used therapy sessions to address their crisis behavior as noted by completing their treatment goals for the Reflection Center Program.

3.     Resident has demonstrated appropriate behaviors which show that they are out of crisis and able to control their own behavior.  This is noted by earning A level on the behavior card for approximately 3 consecutive days.

 Provisions of Care

 Clinical Services

Individual Therapy

Therapy will focus on the immediate crisis driven behaviors to reach some resolution and to develop improved behavioral functioning.  Residents will receive daily therapy sessions with BA/BS/BSW counselors under the direction and clinical supervision of the Reflection Center Therapist.  These therapy sessions are Solution-Focused and Strength based.

The resident’s primary therapist will develop the crisis intervention plan with the resident and will communicate and review it with the Reflection Center Team.  These treatment goals will guide the individual and group sessions in the Reflection Center Program.  The primary therapist will also participate in the supervision of the team by attending the Reflection Center Rehabilitation Meetings.

The Reflection Center therapist will meet with the resident for one to two sessions each week in addition to the daily therapy sessions provided by bachelor’s level direct therapy staff.  The Reflection Center Therapist will provide group therapy twice a week in each Reflection Center Cottage.  The Reflection Center Therapist will guide on-going interventions with the Reflection Center Team through both training and supervision.

Family Therapy

Family Therapy is provided by the primary therapist according to the Resident’s Treatment Plan.

Group Therapy

Residents will have group therapy sessions every day that will be psycho-educational in nature.  The focus will be identifying core beliefs and defense mechanisms, and then developing effective self-management skills based upon increased understanding of self.

Psychiatric Services

Psychiatrist will be notified of a resident’s move to a Reflection Centers/Donegan Hall. Psychiatrist will see the resident for medication management as needed, no less than one time a month if the resident is on medication, and no less than one time every three months if the resident is not on medications.

 Medical Services

El Pueblo’s nurse will conduct sick call upon request at the Reflection Centers/Donegan Hall and will perform brief assessments to determine need for any further medical services.

Milieu Services

The Reflection Centers/Donegan Hall are intended to be self-contained. Meals are brought in from the facility kitchen. All services take place in the living area or fenced yard for recreation. The daily schedule is highly structured with an emphasis on therapy.  The schedule shifts from structured group activities to individual time focused on learning skills and self-reflection.  An emphasis is placed on building healthy relationships with staff and focusing on their own ability to manage their behaviors and symptoms. 

Residents receive a copy of rules and expectations when placed in the Reflection Centers/Donegan Hall. A copy may be provided to referral sources and family. Phone calls and mail continue on a regularly scheduled basis.  Visits are at the discretion of the treatment team.

Recreation and Leisure Therapy Services

Residents will have organized staff directed and supervised recreation activities for at least one hour a day. Part of the recreation schedule will include three hours per week of instruction from a recreation specialist who are under supervision of a Certified Therapeutic Recreation Specialist. Recreation specialists conduct group activities that are therapeutically designed to address team work and trust. At the end of each activity, the specialists process with the residents to assist them in gaining understanding of their interactions with others.   In addition, residents will have one hour a day of physical fitness exercises with large muscle activity.

Education Services

While residents are assigned to the Reflection Centers/Donegan Hall they will continue to receive educational services consistent with the El Pueblo education curriculum.   An assessment will be conducted to determine whether a child may attend school in the general education setting to ensure that the child receives his/her education in the least restrictive environment. 

All academic assignments that are conducted in the school setting shall be sent to each resident in the Reflection Centers/Donegan Hall through a coordinating licensed teacher. The Reflection Center teacher will coordinate the teaching with the paraprofessionals in the Reflection Center.  If a student has an IEP, there will be a planning staffing to ensure that services are continued and any changes are noted.  The teacher will spend half the day in each Reflection Center Cottage giving instruction and the paraprofessionals will help using a tutoring model in the Reflection Center.  All school assignments will be graded and counted towards each resident’s academic grade point average and earned school credit.

Residents who are assigned to the Reflection Centers/Donegan Hall are primarily assigned to the Reflection Centers/Donegan Hall due to exhibiting an increased need for a higher level of care, structure, and therapy. As such, a component of the education piece will be helping the residents “learn to learn”. This will occur by the residents conducting and completing assignments that will improve their performance and success rate in a school setting. The “learn to learn” curriculum will focus on, but is not limited to: organizational skills, test-taking strategies, time management and study skills.

Alternative Programming

Residents are usually able to return to their assigned living unit without further problems.  However, some residents are only able to remain out of crisis if they have the option of returning to a more therapeutically intense environment for short periods.  For such residents, the primary therapist will create an Individual Crisis Management Plan (ICMP), which will give instructions to staff that may include allowing the resident to return to the Reflection Center Program for brief periods to give themselves time to regroup and focus on their skills.