“You Leave in a Body Bag or You Leave on the Points System”: Participant Perceptions of a Points and Levels System of Behavior Management

Residential Care and Cure: Achieving Enduring Behavior Change with Youth by Using a Self-determination, Common Factors and Motivational Interviewing Approach

“…Second, research suggests that some residential care workers use a treatment approach that is aimed at achieving behavior change of the young people with regard to daily routines in the residential care setting instead of behaviors that were the reason for their residential care placement (cf. Drumm et al, 2013;Henriksen et al, 2008). Residential care workers also intuitively apply a controlling approach in handling externalizing behavior problems (Anglin, 2002;Bastiaanssen et al, 2012;Kromhout, 2002;Van Dam et al, 2011;Wigboldus, 2002), which are prominently present with adolescents in residential treatment (Harder, 2011).…”

“…Residential workers and treatment programs also regularly use external rewards (e.g. earning tokens that can be exchanged for privileges or goods), persuasions and confrontations as instruments to achieve behavior change with adolescents (Andreassen, 2015;Bartels, 2001;Drumm et al, 2013;Durrant, 1993;Eenshuistra, Harder, Van Zonneveld, & Knorth, 2016;McCurdy & McIntyre, 2004). However, the use of external regulations, such as confronting, persuading or deterrence by care professionals seems to be ineffective in achieving the desired behavior changes with clients, because external regulation approaches are associated with poor care outcomes (Apodaca & Longabaugh, 2009;Lipsey, 2009;Petrosino, Turpin-Petrosino, & Buehler, 2003).…”

“…However, the use of external regulations, such as confronting, persuading or deterrence by care professionals seems to be ineffective in achieving the desired behavior changes with clients, because external regulation approaches are associated with poor care outcomes (Apodaca & Longabaugh, 2009;Lipsey, 2009;Petrosino, Turpin-Petrosino, & Buehler, 2003). Moreover, this token economy approach is criticized in different studies as being antithetical to individualized, culturally and developmentally appropriate treatment (Drumm et al, 2013;Mohr, Martin, Olson, Pumariega, & Branca, 2009;Mohr & Pumariega, 2004;VanderVen, 1995).…”

“…A risk of applying an external regulatory approach by residential care workers (Gilman & Anderman, 2006;Ryan & Deci, 2000b) is that youth will show social desirable behaviors during care to satisfy external demand (cf. Abrams, 2006;Drumm et al, 2013;Eenshuistra et al, 2016;Ryan & Deci, 2000b), since they know what is expected of them and how they should behave (cf. Abrams, 2006).…”

“…In other words, youth show behaviors during care that can be seen as indications of improvement, but that are in fact behavioral adaptations of young people to the residential care environment (cf. Abrams, 2006;Drumm et al, 2013;Eenshuistra et al, 2016;Ryan & Deci, 2000b). Although these adaptive behaviors of youth can be very functional during care, for example in terms of improving safety or diminishing the amount of conflicts with care workers, this behavior is mainly performed on the basis of extrinsic motivation.…”