A Weekend in the life. . .

I will now take you through a normal weekend on our unit. We try to keep it structured, although there is more leisure time. We also like to use a little variety, so this is just a basic template. The weekend is my normal shift, so I can describe it better.

I'll begin with Friday night as there is a difference to the routine from the rest of the week.

On Friday nights, we have a party which the children can earn if they earn at least 80% of their points during group time during the week. Those who do not get to go to the party stay on the unit and have their free time there. Bedtimes are the same on Friday nights as the rest of the week.

Weekend mornings are much the same as weekday mornings. Residents do have an extra hour to sleep, however. They are awakened to do their hygiene one or two at a time. After hygiene, they are expected to get dressed for the day. While they can start on their rooms, they are not required to start straightening their rooms until later.

After all children are done with their hygiene, they eat breakfast together at the tables on the unit. When breakfast is done, children go to their rooms for quiet time and to get two important things done. First, they are expected to straighten their rooms. For those few who keep their rooms neat, this is a quick task and affords them more time for recreation in their rooms--so keeping their rooms clean or messy comes with a natural positive or negative consequence. Second, they are expected to set out two sets of clothing--one to sleep in that night and one for the next day. This helps our shower time go smoother later on. Since many of our children do not have a huge supply of clothing, staff often has to find articles of clothing for them from the clothing closet. I and another staff member have taken that on as our usual responsibility.

After quiet time we generally have a short community group. It is usually around 10:00 by this time. After community group, we usually take the children to the gym until around 11:30 or 11:45. At that time, we return to the unit with the children. The children spend a few minutes in quiet time while we set out their plates for lunch. Occasionally a child will volunteer to help with this. The children then come out for lunch at noon.

Here is where we switch things up a bit. Sometimes after lunch we have journal time (other times after dinner--sometimes both). If we do not do journal, the children serve quiet time again. After quiet time, our usual routine is to either watch a movie or go to the game room. We usually do both, so sometimes we do gameroom before the movie while other times we watch a movie first. Within this time, we break for snack around 2:30 or 3:00.

At around 4:30 or 4:45 (depending on how stimulated the children are) the children return to their rooms for quiet time while we set up dinner. At 5:00, the children eat dinner together at the tables. Again, after dinner we either have quiet time with or without doing a journal. (if a child requests to do a journal they are rarely refused, of course)

After quiet time, we usually give the children some free time before showers. On most weekend nights, movie time starts around 7:00 as it provides a good sit down time to send the children to showers from. After a movie ends, most children will have time left for free time (unless it is an unusually long movie). Bedtimes are the same on the weekend. One difference is that children on level three get 30 minutes in their room before lights out on Friday and Saturday nights.

One neat thing about the weekends is that we sometimes get to take the children on outings. This usually works out well, and the children are generally well-behaved on outings. We make it clear before leaving what behavior is expected. If a child acts out on an outing, they may lose the next outing.

In my next entry I will begin to talk about how each of these routines affects children of different temperaments.

A Day In The Life. . .

So, what's a normal day look like at my facility. There are two templates I'll show you: the weekday and the weekend/holiday routine. I'll describe the unit I work on as I am less familiar with the other unit. It's a bit different.

A weekday starts with the children being awakened one or two at a time to do their daily hygiene. We have a boys' bathroom and a girls' bathroom, so we get a boy and a girl up. After their hygiene, the children are expected to get dressed in their rooms, make their beds, and straighten their rooms.

Breakfast is shared at two tables after all the children are done with their hygiene. Then the children line up and walk downstairs to the classroom. School is from 8:30-2:00. At 2:00, the children line up and we go to the gameroom for some free time and the children's snack. After only 30 minutes of free time, the children transition into the mental health groups portion of the day. From 2:30 until 5:30, the children participate in group therapy together. Some groups are more fun oriented while others are more intensive. From 5:30-6:00 the children eat dinner in the dining room before returning to the unit. On the unit, the children spend 30 minutes of quiet time in their rooms before coming out. Depending on the events of the day, staff may call the children out to have community group--a house meeting of sorts where they discuss their goals and how the day has gone. Showers generally start around 7:00, during which time the children may enjoy free time. Sometimes the children get games out of the game closet or spend their allotted time playing video games. Depending on behavior, staff discretion, and provided staffing is adequate, children on the highest level may be taken downstairs to the gym or gameroom for a while. Bedtimes are scheduled by level. If a child has an early bedtime, they go to bed at 8:00. Children on restriction and level one go to bed at 9:00, children on level two at 9:30, and children on level three at 10:00. Of course, a child may request to go to bed early if he or she wishes. At bedtime, children have fifteen minutes before "lights out" in which to read, play with their toys, or just sit and think.

Introversion vs. Extroversion

Before I begin my analysis of how we can rethink treatment, I believe some background information is in order. I will begin with the definitions of introversion vs. extroversion. Later I will describe how the program I work in is set up as well as how I believe it leaves introverted children behind. There are, of course, aspects which the introverted child can gain more from than the extroverted child, but overall the model is biased toward extroversion.

From http://www.beinganintrovert.com/ By the way, I do recommend reading the author's book, The Introvert Advantage for a more thorough understanding of the topic.

What is Introversion?

Dr. Carl Jung described introversion and extroversion as two in-born ways that people gain and lose personal energy. He understood that introversion and extroversion are on a continuum. At one end are introverts. They feel depleted by too much external stimulation and are energized by internal sources (ideas, impressions, thoughts). Extroverts, at the other end of the continuum, are energized by external sources (activities, socializing, things) and lose energy during down time. Some people use both sides of the continuum almost equally. We all possess both ways of increasing and decreasing energy but most of us inherently require more introverting or extroverting to accumulate our energy resources.

Shyness is often confused with introversion but it is social anxiety and either introverts or extroverts can be shy.

To provide an example, I have two clients who come to mind for each. One is pretty far down on the scale toward introversion. This client would stay in his room for as long as we would let him, reading and listening to music. He interacted fairly well with others, was not shy or passive, and seemed to enjoy the time he spent with others. When he got enough of social interaction, he would retreat to his room for a while.

On the opposite end, another client is always going. He is always in the thick of the action. Quiet time is excruciating for him. After spending too much time alone, he will be cranky and drained. As soon as he is out where the action is, he is cheerful.

In contrast to these, a third client comes to mind. He is, in my estimation, fairly introverted. However, he tries to operate as an extrovert. This leads to more agitation. This client will try to be in the thick of the action, but he visually becomes more agitated as he spends more time in the thick of it. He needs to be encouraged to spend time to himself. The most striking thing is that, magically, after spending some time alone in quiet time or even just taking his shower, he comes back visibly recharged.

I'm more concerned with the third client as the others are comfortable with and functioning well within their dominant temperament.

Next I will give you a picture of the program and how it affects the different temperaments.

Time to Rethink This

I have been thinking about this for a while. I've come to the conclusion that it is time to totally rethink the way we do residential treatment--or all treatment for that matter.

We tend to have a one size fits all approach, which caters to the majority of clients but poorly serves clients in the minority.

I'm talking specifically about tailoring treatment to the client's temperament. I have studied temperament for the past several years since I took the Myers-Briggs in a college course. Being a very rare temperament--INFP--I have always felt like a fish out of water. Only about 1% of people share this combination of tendencies. There are many variations even within these classifications.

However, to start with, I would like to begin with the difference between introverted and extroverted clients. Since 75% of the population are dominantly extroverted, treatment seems to be taylored to them. This is a poor fit for introverted clients. I will explain further when I actually begin posting sections.

I am no expert on the subject of temperament, but I WILL be. Through my research and through coming up with my ideas, I will develop the knowledge to position myself as an expert on the subject.

This project is not even in its infancy yet. Let's just say it's at the 9th month of pregnancy. The ideas are swirling around in this genius head of mine. Once I start writing, my ideas always seem to gel almost effortlessly (a typical introvert trait I might add). So keep checking back here as I add to and develop this idea.