De-Implementing a Point and Level System in Youth Residential Care without Increased Safety Risk: A Case Study

ABSTRACT

Point and level (P&L) systems are commonly used for behavior management and modification in youth residential treatment centers. In 2019, the Association of Children’s Residential Centers (ACRC) released a position paper urging youth residential programs to abolish prescriptive, universally applied point and level systems because they are inconsistent with the principles of trauma-sensitive care and can be counterproductive to treatment. Despite this, few residential agencies have executed this change, possibly due to the complexities of dismantling long-held practices, concerns about youth safety, and lack of knowledge about other trauma-sensitive approaches. In this case study, we describe how one agency de-implemented its universal P&L system across three residential campuses, replacing it with the Neurosequential Model of Therapeutics (NMT) and Collaborative Problem Solving (CPS). An analysis of administrative data before and after the removal of P&L suggests no evidence of increased safety risk for youth or staff. We discuss the agency’s strategies for de-implementation and the determinants that helped and hindered the process and provide recommendations for other residential agencies seeking to make this change.

KEYWORDS:

• Point
• level
• CPS
• NMT
• residential

Acknowledgments

The authors are grateful to the Ariel Foundation in Mount Vernon, Ohio, for supporting The Village Network’s training in the CPS and NMT approaches.

Disclosure statement

At the time of publication, JSA and ARP were employed by Think:Kids at Massachusetts General Hospital, which received fees in exchange for providing CPS training at The Village Network. BDP is the developer of the NMT and the Principal of the Neurosequential Network, which received fees in exchange for providing NMT training at The Village Network.