| Importance of Measuring Progress
Progress in treatment is perhaps the most asked question to staff at Provo Canyon School, and for good reason. Parents and family members invest money, time, and emotional concern in placing a child in treatment. They understandably want assurance that their child is gaining insights and making behavioral changes that will allow them to return home and to a normal environment. The adolescent enrolled in Provo Canyon School also has a great need to feel that they are making progress so that they can see a light at the end of the tunnel, so to speak. Progress inspires hope and continued effort in a teen. Insurance companies, school districts, and other third-party payers want to know that the funds paid to Provo Canyon School are paying off and not being wasted, and that only those funds necessary are expended in behalf of the child's care. The direct care givers at Provo Canyon School also need to know what constitutes true progress in the program so that they can appropriately treat the patient and make preparations for discharge and aftercare services.
In order to assist all stakeholders at Provo Canyon School in making important decisions about continuing treatment, standards of measurement are established to identify where the adolescent is in treatment and if further treatment is justified. These standards of measurement vary depending upon the stakeholder. Ideally, all standards of measurement for care at Provo Canyon School should be set up to benefit the youth in treatment, but stakeholders do not always see eye-to-eye about what is essential and what is not. This disagreement can cause conflict and aggravation, but the varying points of view can also act as an important check and balance. For instance, it is important that those providing the care be monitored by those outside the direct care system so that the period of care is only for the essential time period and accomplishes only desired goals. Agreement among stakeholders of Provo Canyon School on standards of measurement of progress is necessary if conflict is to be averted during treatment.
Treatment Needs and Objectives
Treatment begins with a clear definition of and agreement upon the needs of the child that can and should be addressed at Provo Canyon School and others in aftercare. An agreement upon the treatment needs and goals of the program can serve to establish cohesiveness between stakeholders and avoid disagreements in the future that can be detrimental to the youth's progress.
The treatment team at Provo Canyon School is the body tasked with defining, measuring, and reporting on a client's needs while in treatment. With the assistance of other stakeholders, the treatment team defines the treatment needs that are specific to residential care, and also identifies treatment goals and standards of measurement.
The needs of the adolescent at Provo Canyon School are defined as problems in the treatment plan. Each diagnosis or specific area of concern is defined as a separate problem. A goal is defined in a way that explains in understandable language the problems caused by the problem in the quality of life for the patient. When possible, the problem is defined in terms of problem management skill. For example, a youth manifesting defiance to authority might have a problem defined as: patient lacks care and concern for self and others, and lacks the skills to accept authority, rules, and structure.
Goals and objectives are defined out of the needs as target outcomes that each youth at Provo Canyon School should achieve from the treatment given. These objectives are described in terms of actual attitudes and behaviors that are observable, measurable, and sustainable in nature. It is important that these objectives be reasonable and achievable for each youth to whom they are ascribed. Using the example in the paragraph above, the client's treatment objective would be to demonstrate proper ability to live within rules and show care and concern for self and others, especially authority figures.
Standards of Measurement
Progress is a relative thing, and it is important that stakeholders do not confuse actual internal growth or change with simple achievement of status in an artificial treatment environment. Frequently, patients, parents, and referring professionals only mark progress by a client's achievement of program status. Provo Canyon School has several statuses within its program that have associated privileges and responsibilities with each, and it is true that a client's general progress up the ladder of statuses is marked by their obedience to program procedures. While these statuses are designed to give the client motivational targets and a sense of accomplishment, they do not by themselves necessarily identify true, inner change, nor do they always predict sustainability of behavior in aftercare. They more likely measure behavior modification or compliancy.
Provo Canyon School is committed to achieving sustainable growth in its clients, not just behavior modification based upon a temporary treatment setting. Sustainable change requires a deeper change than mere behavior that must strike at the roots of behavior: beliefs, attitudes, and convictions. Thus, the School's standards of measurement must measure these less observable but crucial elements of change along with status advancement.
Standards of measurement are ascribed that provide actual yard markers for progress made by students at Provo Canyon School toward their goals and objectives. Without some meaningful standard of measurement, progress would become a very subjective process without much tangible credibility. Parents and outside professionals play a very useful role in helping to define needs and problems to be addressed in a residential setting, and even the aftercare process. But the actual treatment objectives and standards of measurement are the forte of the treatment team because they have the day-to-day perspective of the patient's progress at Provo Canyon School, and they know their treatment program.
Standards of progress measurement become critical guides to a client's preparedness to reenter the aftercare world. It is important that all stakeholders of Provo Canyon School understand and generally agree to these standards of measurement. Progress for clients at Provo Canyon School is measured in three distinct areas:
Achievement of Therapeutic and Psychiatric Goals : A client is expected to demonstrate appropriate progress in important goal areas before being recommended for discharge. A client requiring medication for a psychiatric or organic disability should show sustainable cooperation, understanding for the need of medication, and a clear benefit by marked improvement in the condition for which the medication is prescribed. Goals established by the therapist related to problem areas should also show improvement.
Achievement and Demonstration of Problem Management Skills :
A client must demonstrate over a sustained period of time an ability to identify, take responsibility for, and manage individually identified problem areas through self-regulation and positive prompts as reported by members of treatment team. These are directly related to the problems/needs they have and are among the most accurate truth tellers to sustainable change that there are. The client must show an ability to manage their problem areas in two ways:
• Respond to positive prompts from staff at Provo Canyon School and peers on their team.
• Self-manage problem areas by controlling impulses and self-defeating behaviors, and living by team core values.
Program Status Advancement : A client's ability to follow program structure and make statuses is an important indicator of true inner change when combined with the other indicators. Each client has the opportunity to advance through statuses that provide specific privileges and motivation to succeed.
REPORTING PROGRESS
Progress for each client is reported through daily observations by coaches, therapists, teachers, and medical personnel. Formal reports are given at least monthly by the treatment team at their weekly meeting. Progress is reported by therapists in weekly family therapy phone calls and also during visits and parent support group meetings. Official reports are also given by telephone to referring professionals and third-party payers if authorized access to information.
When all stakeholders are in agreement with the needs, the objectives of treatment, and the indicators for measuring progress, harmony in reporting is achieved and the patient has a much better chance of receiving the care that will yield sustainable improvement.
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