Prosthetic environments for high-risk adolescents: Toward a multi-dimensional model.

Abstract

The concept of prosthetic environments is proposed as a unifying concept for the design and implementation of adolescent mental health services. Sufficiently molar in clinical reach to guide program design and sufficiently molecular to stimulate effective treatment planning for individual patients, the notion of prosthesis is inclusive enough to simultaneously address the multidimensionality and dynamism of adolescent developmental needs while encompassing the systemic complexities of family, school, and community. An examination of residential, educational, and socialization services illustrates the utility of the concept in bridging gaps between mental health and educational sectors as well as between psychodynamic and behavioral approaches.

In defense of "restrictiveness": A critical concept in consumer-oriented treatment planning.

“…For example, proponents of the concept of prosthetic environment, neutrally defined as a milieu designed to compensate for individual biopsychosocial deficits, implicitly urge the application of the principle of least restrictiveness to select from among those potentially therapeutic environments the program setting that presents the highest level of normal life demands with which the patient can cope without endangering him- or herself or others (Byalin & Lieberman, 1989; Lieberman et al, 1985). Whether or not one adopts this terminology, it is clear that the needs of some patients cannot be met except in non-natural settings.…”