The Phoenix Psychiatric Residential Treatment Facility (PRTF) provides intensive residential treatment for children, ages 6–18, whose emotional and behavioral issues prevent them from living safely in the community. The Phoenix PRTF treats a number of different child behavioral health problems, but specializes in treating the effects of complex trauma using Dyadic Developmental Psychotherapy and Practice (DDP).
Children in the Phoenix PRTF Program
Eighty to ninety percent of the youth we see at the KidsTLC PRTF have a history of childhood trauma, abuse or neglect, as well as disrupted attachments. Many are now being raised by foster parents, adoptive parents, or grandparents and other relatives. Most would meet criteria for complex PTSD or developmental trauma disorder, which are research diagnoses and not in the DSM V (see van der Kolk, 2005). These kids usually get diagnosed with a mood disorder such as Mood Disorder NOS or Bipolar Disorder, along with disruptive behavior disorders, such as ADHD and Oppositional Defiant Disorder. Sometimes they have an anxiety disorder like PTSD, Social Anxiety Disorder or Anxiety Disorder NOS. Sometimes they meet criteria for Reactive Attachment Disorder.
Regardless of diagnosis, these youth are admitted to PRTF’s because their emotional instability leads to emotional explosions (or implosions) in which they yell and curse, throw and break things, hit and kick people, and cut and burn themselves. As they reach adolescence these youth become reckless with their lives – driving drunk, having indiscriminate sex, taking drugs. These youth have developed mistrust of adults – i.e. they feel that they can only trust themselves. So they are resistant to and defiant of adults in authority. They cannot accept care and support from adults who have good intentions – parents, foster parents, therapists and case managers. Their dangerous behaviors and resistance to help makes them difficult to treat.
Program Goals and Additional Information
Phoenix PRTF Program Goals
- To reduce destructive behaviors, to redirect the attitudes and feelings, which contribute to these behaviors, to provide a safe environment, and to resolve the emotional effects of abuse/neglect.
- To provide a supportive environment for learning positive ways of interacting with others.
- To provide clients with the freedom to make choices and to accept responsibility for those choices and the ensuing consequences.
- To prepare each client for discharge and re-integration into society.
Program services are offered to each client with an individualized Plan of Care; treatment goals and objectives are developed in response to the client’s needs. Program services provide by a variety of licensed professionals. Treatment modalities assist the client in achieving stabilization and support, and help him or her to return to the community in a short period of time. Preparation for return to community-living usually involves initial resolution of emotional conflicts and the development of new behavioral skills. Program services that are available to clients include:
Psychiatric Evaluations: The psychiatrist and/or psychiatric nurse practitioner will evaluate the client for their needs, which may include medications. Each client is re-examined by the psychiatrist or nurse practitioner prior to Plan of Care reviews to update the diagnosis, medications, and prognosis.
Nursing Services: A nurse is available daily to address any medical issues that may arise, and to provide the client and his/her family with medication education.
Discharge Planning: The treatment team and Case Coordinator provide discharge planning, which begins at the time of admission and is updated until the actual time of discharge. The treatment goals and objectives are integrated into the discharge plan, thereby becoming the criteria, along with the resolution of any family or placement issues, for discharge. Parents and/or custodians are invited to be a part of the discharge planning process. The plan provides the following components: Where and with whom the client will reside after discharge, school placement, follow-up psychiatric treatment, follow-up therapy (individual/family), recreational and/or vocational needs, and other special needs or considerations.
Types of Therapy
Individual Therapy: Individual therapy creates an avenue for confronting secret struggles with honor and self respect, considering and planning new initiatives, and building a partnership based upon support and assistance.
Family Therapy: Family therapy offers an opportunity for re-establishing integrity within the family, demonstrating honor and self respect, planning for safety, beginning relationship repair, earning forgiveness, and for exploring respectful ways of relating.
Group Therapy: Group therapy is a forum for confronting destructive behavior, learning healthy responses to difficult interpersonal situations, and receiving support for successful initiatives. Group services that are provided include:
Art Therapy provides a creative way for the client to explore, understand, and communicate his/her thoughts, feelings, conflicts, and concerns. By participating in art therapy groups, the client will have the chance to learn about, and work, with, basic art supplies and techniques. The art therapist will present activities that will help the client to learn safe and satisfying ways of expressing oneself. One focus of art therapy is to help he client develop his/her own individual style of expression. Whether the client considers him or herself an artist, he/she may enjoy this chance to be creative, while working cooperatively with others in an organized group setting.
Music Therapy may be offered for structured musical activities, such as drum circle and lyric discussion, to increase positive social interaction, trust, self-esteem, communication (verbal/nonverbal), creative expression, and problem-solving skills, as well as a sense of community and support for the client.
Pet Therapy, offered through Mo-Kan Pet Partners, provides healing, security and unconditional love to clients. Pet therapy also assists with goals including improving social skills, building trust and self esteem, as well as serving as a model for healthy relationships.
Recreational Therapy allows the client to participate in structured and unstructured games and activities that can help them relax, have fun, and interact with others in a non-threatening setting. The therapy will challenge the client to target a wide array of issues, including social interactions, anger management, problem solving, and physical coordination. Discussion periods may follow an activity to create opportunities to reflect on the emotions, interactions, responses, and patterns of behaviors visible during the planned recreation groups, and allow the client to develop insight, build character, and increase self-concept.
Equine Assisted Therapy occurs through KidsTLC’s partnership with New Horizon Ranch, Inc. located in Rantoul, KS (approximately 45 minute drive from KidsTLC). Group sessions in New Horizon’s Mending Fences Program are designed to be independent, stand-alone sessions. This allows freedom for variation in group attendance. Sessions are typically scheduled as a series of sessions and the youth must demonstrate a basic level of safety with self/others off campus. Group sessions are typically two hours long. In general group sessions consist of two activities, each one followed by group reflection time with the youth’s treatment team. The activities presented in sessions are designed to address one or more of the following core areas: Trust, Respect, Communication, Leadership, Partnership, and Confidence.
Milieu Therapy: The milieu uses the environment of the unit to help the client increase problem-solving skills and reduce specific behaviors, which make living in a home environment unsafe. Expectations of client behaviors are clearly stated within the program rules, with behavior boundaries and structure defined; every interaction of the client with staff and other clients is an opportunity for therapeutic intervention. Peer group will conducted seven days a week, which will incorporate daily goal reviews and special topics.
When appropriate, the treatment team might refer a client for any of the following services:
Psychological Evaluations: A client might be referred for psychological testing at any time during his/her stay in Phoenix. The psychologist offers a wide range of testing for many needs that include treatment, educational, projective, or diagnostic purposes.
Substance-Abuse Treatment: Group and individual therapy is provided for adolescents who demonstrate impairment in daily living and activities as a result of substance intoxication and/or abuse. Treatment is focused on maintenance of a clean and sober lifestyle, and modification of maladaptive coping skills to prevent future relapse. To assist an adolescent with ownership of his/ her problems, a form of broad-based cognitive and experimental approaches to recovery are utilized, including drug education, which exposes youth to the effects of mood-altering chemicals on the mind and body, as well as the cycles of addiction.
Attachment-Focused Residential Care Treatment Model recognizes that children develop a healthy sense of self, regulated emotions, thoughtful actions and reciprocal relationships when they experience their parents, guardians and other caregivers as a safe haven and secure base from which to explore the world. Many things can disrupt secure-attachment-promoted healthy development. Attachment-focused parenting, therapy and other forms of care teach kids and their caregivers skills to “build the bonds of attachment,” and keep development on track — or get it back on track if it has gone off.
DDP Therapy: KidsTLC has created intensive outpatient and residential programs to help children and their families heal from the effects of trauma.
Our symbol is the Phoenix, a mythical creature who arises from the ashes of its old life with renewed vigor to meet the challenges and possibilities of life’s next chapter. KidsTLC exists because every child deserves an opportunity take flight toward a healthy future and soar.
We create supportive family-focused communities to build resilient relationships, and to transform painful realities into hopeful futures full of courage, warmth, and joy. We help families become trust-builders and skill-builders for their children.
Dyadic Developmental Psychotherapy (DDP) and Practice guides our understanding and treatment of children who have experienced developmental trauma. Dan Hughes and Grey McKellar have trained many of our therapists and staff in DDP principles and approaches as part of our Practicum to become a certified DDP Organization. The Practicum is a sweeping transformative process enhancing our organizational capacity to assure that children feel safe enough to learn to trust again.
Our DDP therapeutic philosophy is guided by George Thompson, MD and Brandon Mock, ATR-BC, LPC, LMFT. You may contact them or our intake director, 913-324-3658, for more information.
PACE is the central therapeutic intention held throughout all interactions in our Attachment-Focused Residential Treatment model. We invite connection and accountability by using the attitude of PACE, which leads to a secure foundation for healthy, safe, and fun relationships. PACE is used to help make children feel a sense of emotional safety so that they can learn to accept care and direction from our staff.
All residential staff are extensively trained to use the attitude of PACE. This “connection before correction” approach is a way to address problems in a way that doesn’t threaten the child. We understand that many of the children in our program will try to “be in charge” of staff emotions and that these children feel a sense of safety from controlling the emotions of others. PACE is a way to protect children and staff from letting strong emotions “hijack” their abilities to make safe decisions. Over time children learn to manage their own feelings and practice “being in charge” of themselves instead of trying to aggressively control others.
“It is the connection between the (staff) and the child that is central to (her success in treatment), not the corrections that are applied. Connection – not correction – is repeatedly able to guide a child in a positive manner without sacrificing her autonomy and individuality.”Adapted from Daniel A. Hughes, Ph.D., Attachment-Focused Parenting, 2009
A Therapeutic “Transitional” Community allows children to practice attachment skills and learn that interpersonal relationships can be satisfying by experiencing meaningful transitional attachments. The community is designed to be a temporary stepping-stone to enable children who struggle with relational safety to learn and practice how to form and maintain healthy attachments. Intense focus on safety and relational reciprocity is emphasized in daily community living. Once a youth is able to practice attachment and interpersonal relationship skills within the therapeutic community the youth returns to new or existing families and their larger community.
A Therapeutic “Transitional” Community is a place where…
- youth learn to accept care and support from others
- youth can learn to notice good intentions
- youth learn to identify, communicate and regulate emotion
- youth begin to understand the consequences of one’s behaviors for others
- youth begin to understand the consequences of others’ behaviors for oneself
Attachment security is based on parental attunement to infant emotional and mental state. Capacity to understand the heart and mind of another (and of oneself) is called mentalizing. Infants/children develop patterns of response to distress based on the security of their attachment to their parents or primary caregivers. Patterns can be secure or insecure. Insecure patterns include anxious/ambivalent which lead to clinging, etc. Dismissive insecure attachment leads to avoidance of connection, avoidance of needing help, etc. Disorganized insecure attachment leads to unpredictable reactions to stress.
- Neglect can lead to dismissive insecure attachment and the infant/ child’s sense that s/he is not important, valued, loved or seen
- Leads to profound sense of shame – Child experiences, “I’m bad, unlovable, and unworthy of having a good family. I am so bad that I deserve to feel unhappy”
- One result of trauma, according to Jon Allen, is the feeling that the victim’s suffering is invisible so he/she can’t get anyone else to help. Therefore the victim is helpless
- Three characteristics include hyperarousal (state of fight/flight/freeze), emotional numbing, and involuntary re-experiencing of the trauma
- KidsTLC trains staff and parents on the short and long term effects of developmental trauma as well as how to effectively manage children’s traumatic re-enactments
- Caring adults need to keep children safe
- The therapeutic residential environment must be a safe and caring community
- Parents & Caregivers work as partners with the residential program
- Parents & Caregivers are vital in guiding treatment
- Parents & staff need to keep children close rather than isolate them
- Parents & staff need preparation to parent and work with children who have developmental trauma and attachment insecurities
- Connect with children before you correct them
- Shame needs to be explored and reduced