The Implementation of Milieu Therapy Training to Reduce the Frequency of Restraints in Residential Treatment Centers

The therapeutic milieu plays a critical role in the management of patient behavior and delivery of therapeutic content. Formal training in the techniques of milieu therapy and collaborative problem-solving (CPS) provides mental health employees with a unique set of practical strategies that enhance pro-social behavior of children and adolescents. The empowering techniques of milieu therapy and CPS include skills to establish and maintain a healing milieu, address targeted behaviors, de-escalate potentially dangerous situations, and prevent individual or unit crises. We hypothesized that formalized training in and implementation of milieu therapy and collaborative problem-solving would allow for proper management of aggressive behavior, thus reducing or eliminating the need for restraints in a residential treatment program. We sought to determine whether formalized, Web-based milieu therapy training for adult mental health staff would be a successful intervention to manage and prevent disruptive behaviors in children. We implemented our program at Maple Shade Youth and Family Services, Inc., located in Mardela Springs, Maryland. All levels of staff participated in a training program for the prevention and management of disruptive behaviors in children and adolescents. Pre-initiative and post-initiative totals were compared as an indicator for successful implementation of milieu therapy techniques. There was a substantial reduction in the post-initiative number of restraints required as a result of these trainings. There were 205 restraints required in 2006, which was the year immediately following the beginning of the implementation of the program. The number of required restraints decreased in 2007, when only 97 incidents occurred. The full program was implemented in 2008, and there were only four instances requiring restraints that year and the year after.