Our Treatment Approach at Therapeutic Nursery and Preschool
Age-appropriate Activities and Interventions
Milieu Therapy/Therapeutic Classroom
In accordance with the mission of the Matilda Theiss Therapeutic Program to provide therapeutic services within an age-appropriate and natural environment, the primary mode of treatment for all participants is milieu therapy.
The therapeutic milieu is defined as:
“…a clinical setting in which the child’s peer group, facilitated by staff, helps to emphasize the strengths of the individual’s capacity to cope with difficulties. Within such a setting, children are encouraged to examine their behavior, recognize and name distressing feelings, and explore alternative expression of such feelings.”
This child-focused therapeutic intervention is provided within a natural, yet clinical, classroom setting with the child’s peer group.
Group therapeutic activities address:
- Social skills development
- Social problem-solving
- Relaxation training
These are delivered through:
- Organized and free play
- Cooperative games
- Other activities within an early childhood setting
Our belief is that when children play together, the setting becomes structured and the children’s behaviors become governed by the contingencies arranged by the activity; the rules of the activity exhibit control over the children’s behaviors (Bay-Hinitz and Wilson, 2005).
Individualized Behavior Plans
With input from family and teachers, staff psychologist develops and assists classroom teacher-clinicians in implementing behavioral intervention plans designed for the individual needs of the child to include individualized reinforcement programs and crisis management plans, as appropriate.
Individual Play Therapy
If deemed appropriate, nondirective and directive play therapy will be provided by a psychologist or under the supervision of a licensed psychologist.
- Nondirective play therapy: In nondirective or child-centered play therapy, the child leads the play in the session. Within these sessions, the child chooses how to spend his or her time.
The play therapist offers unconditional positive regard, support, and empathy within a safe and consistent relationship with the therapist.
- Directive play therapy: This approach focuses on a particular problem and specific techniques to address the problem.
For example, games and activities that require a child to utilize behavioral restraint may be selected for a child who demonstrates the impulse-control difficulties hallmark of attention deficit hyperactivity disorder.
Parent-child dyadic therapy can be provided for families by a licensed psychologist as part of the child’s treatment program.
This type of therapy works to improve the parent-child relationship by:
- Strengthening communication and attachment
- Increasing parent understanding about child development
- Helping parents to understand their own unresolved issues that interfere with their relationship with their child
Supportive parent counseling
Unfortunately, getting parents to accept their role in their child’s mental health is sometimes difficult. Particularly in early childhood, it is critical that parents be a part of their child’s treatment.
Often parents don’t fully understand their role in treating their child’s behavioral health issues.
When appropriate, a clinician can meet individually with parents to discuss difficulties they are having that interfere with their child’s behavior and development.
Parent education sessions are held on a regular basis and run by the licensed psychologist, program clinicians, or family support specialists.
In addition to providing basic information to families, a variety of approaches are utilized to develop parenting skills. Specific parenting curricula may be adapted for use with families on an individual, rather than a group, basis.
A family support specialist is available to assist families with issues that place additional stress on the family unit.
For example, the family support specialist can assist families in obtaining mental health services for other family members or provide information regarding housing, transportation, and job training.
Child psychiatrists may prescribe and manage medications for those young children requiring this form of treatment.
After a psychiatric evaluation and with input from the treatment team, the psychiatrist will meet with the parent or guardian to determine appropriateness of medication.
On at least a monthly basis, the psychiatrist will review with the parent or guardian the effectiveness of the medication and make adjustments, as necessary.
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Progress on treatment goals will be monitored on a daily, monthly, and biannual basis.
Daily notes are completed by the therapeutic classroom staff to specifically address each child’s progress toward child-oriented treatment goals and interventions implemented in the therapeutic milieu.
In addition to the daily notes completed by therapeutic classroom staff, a progress note will be completed for each time additional services are provided that address child, parent, or parent-child relationship goals.
The treatment team at Matilda Theiss — comprised of a psychiatrist, psychologists, administration, program counselors, and classroom milieu therapists — will convene monthly to review progress towards the goals outlined in the treatment plan.
In accordance with current behavioral health rehabilitation services (BHRS) guidelines, a comprehensive best practice evaluation and interagency service planning team (ISPT) meeting will be held every six months (biannually) to determine the necessity of continued stay.
At these six-month intervals, parents and clinical staff will complete standardized behavioral rating scales in order to objectively monitor the child’s progress. These tools will vary based on the age of the child and nature of his or her diagnosis.
A summary of the issues discussed at the ISPT meeting will be entered into the child's medical record by the psychiatrist, licensed psychologist, or specialty counselor.
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