The B+ program: a behavior modification program incorporated into a therapeutic milieu for emotionally disturbed children.

Residential treatment programs for emotionally disturbed children vary widely in their treatment approaches. Many utilize behavior modification principles in combination with other treatment approaches. Despite the large number of programs in operation, the behavioral science literature lacks descriptions and evaluations of such programs which target a multitude of behavior occurring throughout the child's day. The purpose of this study was to evaluate whether a combination of behavior modification and therapeutic milieu could be an effective approach to reducing maladaptive behaviors and increasing socially acceptable behaviors of emotionally disturbed children in residential treatment. A therapeutic milieu which incorporated a behavior modification program, the "B+ Program," was chosen for study. This program covered the children's waking hours and targeted behaviors which pervaded most of their interactions with the environment: (1) participation in daily activities, (2) interpersonal relating to others, (3) control of physical behavior, (4) independent functioning, and (5) room care. Change in behavior was evaluated for 20 boys from their first week on the program through week 16. The subjects, ages 7-15, represented a wide rage of emotional disturbances found in children who need residential treatment. The behavior definition, point scale and scoring method designed for the behavior modification component were used as a mechanism to evaluate change in behavior. The scales for all behaviors were directional: an increase in scores was contingent upon a reduction in undesired behaviors and an increase in desired behaviors. Reinforcement was dispensed for acquiring criterion levels of performance, measured by percent of total possible points accrued during one week. Regression coefficients were obtained from weekly percentage scores utilizing a multivariate analysis of covariance. Weekly coefficients were calculated for each child and for the total group, for each behavior category for 16 consecutive weeks. Participation, Behavior, Relating and Independent Functioning scores were analyzed during two interaction periods: mealtime and activity time. Room Care scores were analyzed during tow time periods: morning and evening. Evaluation of change in behavior over time indicated that the combination of behavior modification and therapeutic milieu was significantly effective for the group of emotionally disturbed children (T=0, N=11, p<.01, two-tailed). Although the program was found to be effective overall, not all children improved in all behavior categories. A Wilcoxon Signed-Ranks test for each child indicated a significant increase in scores for 12 children (p=.05, p<.01), a significant decrease for two children (p=.05. p<.01), and no significant difference in scores for six children. Lack of improvement for some children appeared to be due to extraneous variables and lack of reinforcer value to the "unimproved" children. All "unimproved" children did receive reinforcement during the first two weeks, but it did not continue to be reinforcing for these children. Lack of significant differences between the "improved" children and the "unimproved" children measured against the criteria of age, diagnosis, retardation, and prior cottage experience indicated a possibility for generalizing this program to other settings for emotionally disturbed children. Other findings indicated that child care workers were effective in teaching and reinforcing desired behaviors. Mealtime, a potentially stressful event, showed no difference in behavior change compared to activity time, a potentially less stressful event. Children were also performing equally well in Room Care morning and Room Care evening. Change in behavior was significant over 16 weeks for all behavior categories except Room Care. This concrete category was rapidly learned and maintained above criterion level, making a significant improvement unlikely over time. The "B+ Program" appears to be potentially effective means of instituting the therapeutic milieu - behavior modification approach. This program provides a promising approach, to be utilized in a variety of setting by mental health nurses and those who develop, administer and evaluate programs for children.

THE UNIVERSITY OF UTAH GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Barbara Wright Whetstone I have read this thesis and have found it to be of satisfactory quality for a master's d� �ee. } I ,'/{.;,>,,:, Date ,/ ;7? /"? ?�7' // :;'�/' ,'.' ' (....(; �)/ -. ,, ' ." ' _ ./[·[U (/C{.£'A. ?Ii!,tL/! ' ,\ I have read this thesis and have found it to be of satisfactory quality for a master's degree. ., \' Date ..... ,-,1.. C . y Gci le , F. Greger �en Member, Supervisory Committee ) / I have read this thesis and have found it to be of satisfactory quality for a master's degree, Diane M. Hetrick Member, Supervisory Committee THE UNIVERSITY OF UTAH GRADUATE SCHOOL FINAL READING APPROVAL To the Graduate Council o f The Universit y of Utah: Barbara Wright Whetstone I have read the thesis of in its are final form a nd have found that (J) its format. citations, and bibliographic style co n s iste n t and acceptable; (2) its illus(rative materiab i nc lu d ing figures, tables. and charts are in place; and (3) the final manuscript is satisfactory to the Committee and is rcady for submission to the Graduate School. ,,/ ..... .] Beth Vaughan G:01e Member. Supervisory Committee APp roVed for the Major Department / / \. . .: // -zz;M�:.�\� 7 Madeleine Leininge Chairman! Dean Approved for the Graduate Counc:! ��4 v2}f >n� � Ster ng M. McMurrln Dean of The Graduate School Supervisory