Eliminating Level Systems in Residential Treatment Centers

As RTCs are moving towards eliminating level and point systems in their programs, we thought it would be interesting to hear what residents had to say about their experience. We negotiated with a local RTC to interview youth who had recently eliminated the level system on their cottage. We met with a group of five residents and asked them about the impact of eliminating the level system; how it was better, what was different, and what they would want other programs who were considering doing this to know.

Here is what they said: Eliminating the levels made them feel more normal, more motivated, less pressured. Residents said there was less judgment, and overall “we feel more like a teenager at home.” Residents shared with us that we “care about each other more too.” Previously a 4-level color system dictated what privileges they got on a daily basis. Youth said it was just “too easy to mess up.” The color level system distracted them from their treatment goals. They would get preoccupied with what color they were on as well as what color everyone else was on. Youth stated that once they messed up (dropped a level) there was no point in doing better. “Why try?” one said.  Another said,  “If we don’t have levels we can focus on our treatment.”  There was also less envy among peers. “I was just too focused on colors not treatment.” Another youth mentioned, “Now it is just more relaxed and your body is not tense”.

Having no level system in place now requires residents to “talk it out” with staff. Youth decide what their consequence should be for “causing a safety”(cultural language for residents being unsafe). Weekly goals are individualized and discussed with staff on an ongoing basis. Residents said “this is more like it is at home and less like a placement.”

The most impressive outcome was a sign on the staff office window “29 days” restraint free. A celebration was being planned and the youth were very proud and eager to share this with us. Many of the residents are also involved in the Leadership Council where youth get to voice their opinions about the program and recommend changes that should be made.

Reset Rooms – or sensory rooms, help residents “reset” and practice new skills. They can take a break, think about their weekly goals and ponder if anything needs to be changed.

The overall atmosphere on the cottage was very positive, staff were relaxed and residents very proud of what they had accomplished. It was evident that creating a home like environment was a priority for this group and eliminating the level system definitely moved them that direction. Towards the end of our visit one resident summed it up, “A level system is just not normal.”

Since our visit to this RTC we have learned that they are now 49 days restraint free.

Eliminating Level Systems – Staff reflections

Here is what the staff on this cottage had to say about their experience.

• Staff like that the consequences are more immediate and directly linked to the youths actual behavior.They are more appropriate than arbitrary consequences and levels. Staff are able to connect more action and consequences when talking with the kids and can do more teaching around this. Staff can also involve the kids more in setting their own consequences and feeling empowered in their treatment.
• Staff like that the kids don’t get set up to fail with this system like they did with a level system. They would get hopeless and figure “Well, I’m already on X so why try…”
• Staff say that this seems much more normalizing than the level system.
• Staff also like that they are able to engage more clinically with the residents and set limits that feel right in the moment as well as walking away and not needing to know what the consequence is immediately.
• Each resident initially created a list of positive and negative consequences that they feel would be good for them to earn and staff started from that point instead of a blueprint of consequences.
• Staff say it has opened up a whole new level of team collaboration and that has been really cool for them as a team.

What to let other programs should know:

• It is not as scary as it seems.
• The team must have a strong working relationship and be able to honestly and positively communicate with each other to make this work.
• That the fear that there will be no structure is not true and there is still quite a bit of structure and far more room for natural consequences and learning.
• That sharing power with the kids is actually extremely empowering for staff and improves our roles with the kids. It also decreases textbook opposition considerably.
• That setting a limit is not the same thing as a power struggle.
• That it can be hard to make sure that things don’t slip through the cracks and stay in the moment but also staff realize that sometimes natural consequences are the best ones and we don’t need to add any.
• That it is really hard to feel like you are giving up “control” and allow yourself to not know what the consequence should be. However, it is completely worth it because that is when we don’t feel the need to have a consequencein the moment then the youth frequently become the most motivated.
• That it is important to not get stuck in the same consequences and get in a rut but to be creative and individualize the consequences for the particular kid and the particular situation.
• That it can be really rough to not give too many consequences in response to one behavior, even if that behavior is extreme. It is still hugely important to just walk away and/or limit the consequences to one.

Written by former TNOYS Program Director Kim Schenck and one of Youth Development Specialists,  Carina Moreno.