The Importance Of Physically Organized And Therapeutically Structured Environments

James R. Harris, Jr., Ph.D.

The social worker did not know what to do. The house was definitely filthy and John and Jeremy were stuck living there. The walls were covered with dirt and handprints, the floor looked like it hadn’t been vacuumed in months. The kitchen floor was just as dirty and the social worker thought to herself, “I wouldn’t eat off those counters myself.” She walked in the bathroom and out just as quickly. The bedrooms were messy and a stench permeated the entire house.

The outside was no better. The grass was growing high, paint was peeling off the house, and debris cluttered the driveway. The social worker had told them to remove the clutter and clean the house during her last visit, and she had given them plenty of time to complete the tasks. She thought to herself, “Some people just don’t listen.” Well, there was nothing she could do now. It was appalling to her that kids had to live like this.

The problem the social worker faced was monumental. She knew that she couldn’t pull the children from the home and move them into residential placement. They were already living in a residential placement! And, to think that her hands were tied because this was supposedly one of the best placements in the state… She wondered what the majority of taxpayers would think if they saw how their hard-earned money was being spent – on messy facilities, and staff that tolerated such a practice. In fact, the social worker was certain that children had been pulled from (permanent) homes that were not nearly as messy as this facility.

Should children in residential placement have to live like this? Definitely not!

There is no doubt that many children who enter residential placement come from disheveled, unstable homes. Our jobs are to provide these youth with quality care so that they deal with the issues of their past. The facility should be warm and inviting, showing the child they are in a good place. When staff members do not care enough to keep the residential site clean it sends just the opposite message. (The same is true of foster homes. In fact, many portions of this article apply to both residential treatment facilities and foster homes.)

The other important component that goes hand in hand with the physical appearance of the milieu environment is the structure employed within the residence. Especially in our work with abused children, structure often is an important (though much complained about) aspect in residential programming. That is why this article will also review the role that a structured routine plays in the treatment of a child in care. It is not an issue we can discard or take for granted.

This article will review the following issues:

• The impact of a clean or messy environment on a child’s treatment;
• Ensure a tidy and organized milieu;
• Structure and Routine.

The Impact of the Physical Environment

As stated by Charlie Appelstein (1998):

“A disorganized, messy setting intimates, Things are out of place here. Life is unpredictable. We don’t take pride in our possessions, or even, We don’t care about you. For troubled children, who require a high degree of structure, predictability and safety, such chaos is a behavioral hazard (pg 68).

Working with troubled children (who have underdeveloped internal structures) need intensive external structures to experience a sense of order, organization and safety (Appelstein, 1998). These youth need to live in an orderly home environment. If they came from chaotic, out –of control homes, why would programs (who are being paid to treat these children) replicate such an environment? Nicely painted homes, exterior and interior, furniture that is in good condition, and carpeting that is still padded and comfortable, all tell the children that we care about them.

Even the small details count. When my wife and I worked in a group home we even made sure that all the dining room chairs matched. This is important. We want to make the environment as warm and as inviting as possible. This sentiment is expresses in the words of John Seita (an individual who grew up in the child welfare system) in his book, In Whose Best Interest? One Child’s Odyssey, A Nation’s Responsibility (1996). In describing one of his placements, Seita attests

“The home wasn’t unfit for human habitation, but it certainly lacked any pretence of providing for privacy or respect for dignity. The dusty and worn-looking brick exterior of the building was crumbling. Large rectangular windows, six feet high and about three and a half feet wide, provided our vision to the outside world. The interior lacked any feeling of home or happiness. It was large and the floors were covered with yellowing linoleum and area rugs. It wasn’t a home….it was food and shelter (pg. 14).

The physical appearance of the milieu is very important. We don’t ever want the children to feel that the home they are living in is just “shelter” and nothing else. Many of them were removed from places that provided them “shelter”. These children need to believe that they are worthy. In this sense a clean, tidy and organized milieu, helps them feel good about themselves and adds to their potential to feel safe. A dirty, cluttered, unorganized environment, as stated in the aforementioned quote, can only show that the children are not valued and unimportant. If residential programs operate to help children, why would we want them to feel so de-valued?

Every residential environment has the potential for deliberate destructive. After all, we work with troubled children. Holes in walls and doors should be expected. However, staff members must fight the temptation to let the destructive child live amidst the devastation they have created. He and she will once again feel like the messy kid living a messy life (Appelstein, 1998). While it is not unrealistic to have the child help repair the damage that they have caused, staff may have to restore the environment themselves. In this scenario, find another way to hold the child responsible for their actions (Appelstein, 1998). It should not be acceptable to allow damaged walls and doors to go un-repaired.

There are many ways that we can keep the environment looking orderly. In addition to maintenance and daily cleaning, there are things we can do to create an aesthetically pleasing home. Some ideas include:

• A coat of fresh paint on the interior walls every few years.
• Artwork on the wall that is reflective of culture.
• Cheerful curtains and window treatments.
• A plant or two.
• Modern bedrooms (including room themes: wall colors/bedding/posters reflective of a child’s favorite movie. This is especially true with younger children in care.)

A spruced up environment sends a message of safety and caring (Appelstein, 1998). In regards to bedrooms I truly believe that the decorum is very important. Reflecting on my experiences when I worked in a residential setting, we allowed the kids to dictate the appearance of their rooms. At one point in time we had bedrooms that incorporated an Aladdin theme, a Power Rangers theme, and, for an older child, a sports theme. The rooms were newly painted with bedding and posters that reflected the room’s theme. In fact, I brought the children with me to the hardware store to help me pick out the paint and other supplies. And, when the bedrooms were completely decorated, the children loved their rooms. They felt comfortable and safe in them, and it eliminated some of the common bedtime issues. More importantly, it was a space they could call their own.

Maria Montessori, who founded schools that encouraged children to work independently, placed a premium on the learning environment. Montessori, who was nominated for the Nobel Peace Prize three times, believed that children learn significant life skills, without conscious effort, from the environment in which they spend their time (Garhart Mooney, 2000). She believed that the way a setting was arranged, organized, and maintained, played an optimal role on the child’s ability to learn. Based on the wide-spread success of Montessori Schools in this country and abroad, her theories are of sound importance.

My wife was a stickler on the group home we worked in being clean and orderly. Her belief was that if the house looked organized and neat, the children would feel much better about themselves, even safer. She was right! For, while the children initially complained about our daily routines of sweeping floors, vacuuming carpets, cleaning counters, fixing slip covers on the couch and chairs, etc., they actually developed an after-dinner routine. They liked living in a clean house. And, twice a year, they would actually help us wash the woodwork, molding, walls and helped shampoo the carpets. I used the phrase “our daily routine” because we did not believe that the children, alone, should be responsible for maintaining a clean house. We helped create the mess, too. Besides, children are not placed in treatment to be ordered about, and to maintain the housework. They are here to work on some really intense issues. While they can help keep the residential environment in order, staff members must also do their share. This also helps establish unity, not only within the physical sense, but, also, helps to show that staff members connect with the youth.

Ensuring a Tidy Milieu

A few messy programs can definitely impact our entire field. This type of thing will be discussed in other chapters but it will be stated here: we cannot allow a few placements (no matter how hard they are trying) to dictate the fate of an entire field. There are too many exemplary programs that can be negatively impacted by newspaper stories of how children in state care are living in messy environments. This section will explore:

• Programmatic systems that reflect accountability;
• The state/county department’s role in ensuring acceptable milieu environments.

Program Systems to Ensure Cleanliness

Perhaps the best way to ensure that an agency’s residential site(s) are maintained is to develop a system of accountability. Residential staff members must be the first line of accountability. It is the direct care staff’s responsibility to make sure that the milieu environment is clean. It is not the children’s sole responsibility. While residents may be expected to participate in age-appropriate chores, they are not maids. Even when a child completes their chores, staff members can assist if the youngster has missed something.

The next person to be accountable for the cleanliness of the milieu environment should be the residential coordinator or supervisor. If this person lets the program remain messy they should be fully accountable. It is up to this individual to make sure that staff members maintain an environment that is respectful of the children. If the need arises, the supervisor can make a list of all the items that are involved in the agency’s definition of a clean milieu. Some of these would include:

• Vacuuming the carpets at least twice per week.
• Washing floors at least once a week, and sweeping when needed.
• Cleaning bathroom toilets, sinks, bathtub/shower stalls once per week.
• Cleaning counters and tables after each meal is prepared/served.
• Washing windows as needed, and at least once every couple of months.
• Dusting/polishing furniture at least once per week.
• Minimal tnclutter – especially near fire exits.

These are just some suggestions and they are all basic. Some might argue that they are common sense. This is good. It means that all programs maintain these standards.

When I was a supervisor I used to make announced and surprise visits to the residential sites. I also would work shifts at the facilities. I was fully invested in the program and expected that all residential staff members cared enough to take care of the house. In fact, I went out of my way to make sure that staff knew my position. I drafted a policy that stated: The homes are to be neat and clean at all times. House inspections and/or site visits may occur without notice. While a crisis may interrupt the household, thereby making it impossible to keep tidy, no staff member is to leave their shift with the house being cluttered and messy. Staff members are expected to maintain appropriate decorum throughout the residence, including the child’s room.

Not only was this policy to be abided by all staff, it was followed. I actually would go out and conduct official inspections on a quarterly basis. I had a format that I followed and a check-list of things that I expected to see, and not see, in the residences. I would then review these written reports with the staff members from each of the sites. Direct care staff members are responsible for providing structure and safety in a child’s life. I took that to mean an orderly residence. Fortunately, through proper training, the staff at our agency saw the importance to maintaining a tidy environment.

Now, the issue of training staff to learn how to keep a tidy home may seem silly. It is not really all that amusing. Some folks are just not all that interested in being tidy. Their culture may have allowed for things to be unorganized. They may have come from homes that were cluttered or rarely clean. While programs cannot condemn a person’s culture, they can place the expectation that while they are working at this agency all staff members will be expected to abide by rules x, y and z. We all have our notions as to what “tidy” means. The agency needs to spell their definition out (through training).

In addition to the supervisor, the agency’s hierarchy should make period stops to the visit the residence. If they see a messy environment the supervisor should be held accountable. They should make sure this individual knows that the agency does not appreciate, nor desire, a messy home. The supervisor should be encouraged to then develop policies and protocols that will remedy the situation. This can include instituting unannounced visits, scheduled (formal) house inspections, and training for staff. There is just no excuse for an agency to not know the general condition of their program(s).

State or County Departments Ensuring Orderly Residential Placements

Most states, or at least counties, have a Department (of Children, Youth and Families, or Social Services, etc.) that contracts/licenses programs to take care of children. These agencies have the ultimate responsibility to make sure that programs are orderly and clean. Therefore, it is up to these state agencies to make sure that programs that they pay to take care of s communities most vulnerable children are actually doing what they are supposed to do.

The majority of agencies actually do provide warm and nurturing environments that are clean and respectful of the children residing there. I have had the chance to visit many programs in Rhode Island and am very impressed with what I see. I have even been to some of our state’s shelter program and can attest as to how great they look. The majority of sites do not subscribe to a “minimum level” of cleanliness, structure, etc.

This article was deliberately started with a vignette (a collection of stories I have heard/read about over the years) that demonstrates the dilemma that many state social workers face. They often carry big caseloads and find it difficult to make it out to the sites where their “children” are placed. This is not a justifiable excuse for a state not being aware of a potentially deplorable living environment in a licensed program. But, it is a sad reality that social workers are often bombarded with huge caseloads allowing some things to “fall through the cracks.”

It is not necessarily the social workers job to make sure that agencies (and foster homes) are complying with minimal standards in their residential programs. Instead, this should be done by a Department’s Licensing Division. These folks should make announced, and unannounced, site visits. And, when a state is fortunate to have a Child Advocate’s Office, they, too, should be making announced, and unannounced, visits to the milieu. Whenever a state is paying an agency to provide care to children in their custody they have every right, and responsibility, to make sure the children are being properly cared for.

Accreditation is another safeguard, becoming more prominent as state and county department encourage facilities to become accredited. When an agency is accredited it allows the state or county department to access additional funds for psychiatric services provided to children and youth. However, accreditation bodies will mandate that an agency’s facilities are clean and orderly. If it is not, the agency could lose its accreditation or be sited.

In spite of oversights a program should be proud of its facilities. (Again, this applies to foster homes.) Our programs should want folks to come in and see the wonderful environment they have established. Doors should always be open to agency and state personnel – no advanced needed. And, whenever there is an inspection by conducted by the state or county, the children should want to show these folks their bedrooms and give them a tour of the house. The children and youth residing there should be proud of their home.

Structure and Routine

The last section of this article is by no means the least important. Therapeutic structure is just as important as the physical structure. As was mentioned earlier, the two go hand in hand. Just as the setting must look neat, the daily routine must be predictable. This is important to youth who came from unstructured settings were anything went. In this sense, structure is equal to stability. The following are commonly accepted practices within the milieu:

• Orderly Transitions: This is true when the children wake up, head off to school, return from school and prepare to go, or return from, an off-site activity or outing. In The Gus Chronicles II Charles Appelstein (2002) states that children cannot say hello without first saying good-bye. This is especially helpful to note when it comes to transitions. As a worker I used to like to have the children take some time in the morning (before school) reading or doing another quiet activity. The same was true when they came home from school – regardless of how well or poorly they did in school. This transition time 10-15 minutes reading or listening to music on their headphones helped them make the transition. My wife and I would have them do the same before an activity (amusement park, movie). During the transport in the van we would turn the stereo on low (the tape player was used so we could select appropriate music). Upon arrival at the destination, before we all left the van, we would calmly (not in a punitive or threatening manner) go over the rules (stay together, no roughhousing, etc.)
• Meals, Bedtime and Other Activities Occur at the Same Time Each Day: Children in placement can often feel powerless and out of control (due to rules, staff directions, programmatic design). By keeping meals, bedtime and other activities at the same time each day it gives the children back some semblance of control in their lives (Appelstein, 2002). While bedtimes can be extended or going out to dinner/ordering a pizza is a good wee-end treat, during the week it is good to keep a solid routine in place.

Rules and Routine: Finding the Right Balance

It is very easy for direct care workers, especially those new to the field, to struggle when it comes time to find a balance adhering to rules and maintaining structure. While rules must be maintained, there is no reason for a program to have an endless array of rules and regulations that they expect the children to abide by. I once attended a seminar whereby the presenter cited that there are some residential programs out there with as many as 73 rules for the children to follow. How can the children (or even the staff members) even be expected to remember this many rules?

While agencies must develop training programs for their staff regarding structure and rules, they must also be sure that staff members know the rules that are paramount to the program. A good rule of thumb is to keep rules simple and remember that an endless list of rules will be nearly impossible to enforce and could lead to chaos within the residence. Rules should provide basic structure and keep all the residents safe. Children in care are not robots who can simply be commanded at will to “do that”, “don’t do this”, “pick up that”, “don’t walk that way”, “don’t do that.” Programs that develop an abundance of rules that are punitive, without ever giving the children the autonomy to try something, are doing a disservice to the youth in their care. And, remember, just as we teach the children, please and thank you should be expressed when adults are talking to children.

The other issue regarding rules is that they must be followed fairly – and apply to all the residents. If a staff member wants to create dissention in the house try letting one child get away with a particular rule, and then try to enforce that same rule with the other residents. Staff members who connect with a youngster to the point where that child is shown outward favoritism are doing a disservice to the children. These folks risk damaging the other residents’ self-esteem, trust of adults, and serve to create a chasm between the favored resident and his or her peers. Not only do children need the respect of adults, but they also value this attribute from their peers. While it may be impossible for us (at times) to not have a favorite kid we work with, we must strive to treat all of them equally.

Summing It All Up

There is no doubt that we have challenging jobs. Residential workers (and foster parents) are faced with many tasks. However, no tasks are more important than establishing physically organized and therapeutically structured milieus. Youth in care spend the majority of their time in these environments. It is important for us to makes sure the milieu looks orderly and that structure is evident. Without these two tasks in place how can we hope to do good work with the children in our charge.

Make the environment count!

Download a printer friendly [pdf] version of this article.

Portions of this article are from Respecting Residential Work with Children (2003) by James R. Harris, Jr.

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