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The Efficacy of using “Positive Parenting with a Plan: FAMILY Rules”
In a Crisis Stabilization Unit at a Residential Treatment Facility
Written in 2006 by Denise Greenhalgh, Former Supervisor and Employee
at the Christian Care Communities at Woodlawn in the State of Kentucky

The Research Question: If the “Positive Parenting with a Plan: FAMILY Rules” parenting program works well with families in various home settings across the USA, can it also work in therapeutic treatment settings with improving  the attitudes, behaviors, and compliance of at-risk children? 

Background Information:

The Sanders Crisis Unit accepts children who are in a behavioral, emotional, and/or family crisis.  The “at-risk” child needs an immediate placement and does not meet the criteria for hospitalization.  The Sanders Crisis Unit has seen a significant shift in the severity and diagnoses of the “at-risk” children referred for placement over the past few years, which in turn has created a need to change in the therapeutic milieu. 

The Sanders Crisis Unit program is structured to be a 7–10 day placement for stabilization of the child’s mood and behavior, or longer if treatment or placement goals are not met and further crisis stabilization is needed.  The therapeutic milieu is designed to help the child or adolescent return to the parent or guardian, or to a less restrictive treatment environment.  The behavior modification program used in the milieu is adapted from the “Positive Parenting with a Plan: F.A.M.I.L.Y. Rules” parenting program, authored by Dr. Matthew A. Johnson (2000).  This allows the therapeutic staff to work with the parent and foster parents to implement the original program in the “at-risk” child’s home environment while the child is stabilizing under the same basic behavioral modification program.  Therefore, providing continuity for an “at-risk” child who will eventually return home.

Traditionally, treatment milieus have used incentive systems similar to those in many homes or school based behavioral modification programs.  These incentive systems are usually based on points and levels.  Over my many years of working in residential treatment settings, I’ve found several shortfalls in these programs.  One such flaw in many programs is how to keep “at-risk” children from getting into a “no win” situation for the day once they have had problems.  Let’s just say that a child had a rough night of sleep, woke up in a bad mood, and ended up breaking rules in the morning.   In many incentive or point systems, the child may now have no incentive to work on improving their behavior the rest of the day.  Further, lets say that this “at-risk” child does end up pulling it together some time in the afternoon, but when their points are reviewed for the day, potentially ending up drawing them back into problems once they find out that they didn’t get there points for that day.  The “Positive Parenting with a Plan: F.A.M.I.L.Y Rules” parenting program addresses this by allowing the child to correct their behavior with Good Habit Cards, and then get on with their day.  The Random Acts of Kindness Chips (R.A.K. Chips) further keeps the child from falling into this trap by encouraging them to work above and beyond their Good Habit Cards to make their day successful. 

Other problems occur when residential treatment staff take on the mindset that their job is to “control” or “fix” the behaviors of the “at-risk” children.  This inevitably leads to power struggles and frustrated the residential staff who cannot “make” the children behave.  With the “Positive Parenting with a Plan: FAMILY Rules” parenting program, the residential treatment staff continually put the responsibility back on the children for their behavior.   The staff become more like facilitators rather than enforcers.  Through directing the kids to take responsibility for their behavior, staff see behavior problems as opportunities to work with them – not control them. The focus of redirections become choices of the child and how their choices result in either positive or negative consequences. If the focus is on the child’s choices, there is no power struggle.  Instead of the residential treatment staff coming at problems, attitudes, and behaviors with highly confrontational re-directions, staff can refer back to the rules and the number of Good Habit Cards the child will receive if they break that particular rule.   Since the Good Habit Cards are predetermined and random, there is little room for staff to overreact or become punitive.  In the Sanders Crisis Unit, a list of possible Wild Cards were also developed to further address and alleviate the potential for staff to overreact. 

The Sanders Crisis Unit faces several other challenges for implementing a therapeutic treatment milieu that may not be found in other residential facilities.  One challenge we faced in implementing a behavioral modification system was finding one that would meet the behavioral and developmental needs of the age range of 6 to 18.  Let’s face it; time outs have no behavioral modification benefits for a 16 year old.  Further, most 7 year olds cannot process their behavior in a 3 page written essay.  The “Positive Parenting with a Plan: FAMILY Rules” parenting program addresses this by allowing for multiple sets of Good Habit Cards that focus on the age, therapeutic, and developmental needs of the kids (i.e., It’s a flexible, adaptable, adjustable system that can be tailored to the unique needs of every home environment and/or therapeutic treatment environment).  The set of Good Habit Cards are not necessarily assigned by age groups, but are instead assigned by colors (we used yellow, orange and green 3 x 5 cards) so that the child could be given Good Habit Cards at a lower level of difficulty if they struggle with emotional or cognitive deficits.  The colors do not draw attention to the level of cards that are assigned.  While it is important for the child to correct their behavior, it is also important for them to be able to successfully complete their Good Habit Cards.  Please see Sample Chart below:

Sample Chart of Colored Good Habit Cards used by the Sanders Crisis Unit:

Cards allowed to still receive a Day Bead





Level 1




Level 2




Level 3




Another challenge that the Sanders Crisis Unit faced in implementing the “Positive Parenting with a Plan: FAMILY Rules” parenting program was the nature of the acute crisis that the “at-risk” child and or family was currently involved in.  To expect a child in a crisis to follow every rule from the time of admission would be to potentially set them up for additional failures.  This was addressed by using levels to phase in higher behavioral standards by ability and age, once again basing this on the card color of the child.  The goal is that as the child’s behavior stabilizes, they receive fewer Good Habit Cards. As they progress on the levels, they are experiencing success with the “Positive Parenting with a Plan: FAMILY Rules” parenting program, avoiding feeling the “I can’t do this” mindset from settling in.  They actually learn that they can succeed.

This success was realized by one twelve-year-old foster child with Fetal Alcohol Syndrome (FAS).  The foster parents had tried practically every possible parenting system available in the USA over a 4-year period.  The foster parents and the outpatient therapist could not find a parenting program that would work for their foster child.  Trying to implement the last parenting program resulted in the need to place him in the crisis unit.   At first, he struggled with completing the Good Habit Cards, and continued to engage in tantrums if he received cards for breaking rules.  He continued to struggle with this until the day before his discharge.  The foster parents had tried so many variations of parenting programs that they were uninterested in learning the “Positive Parenting with a Plan: FAMILY Rules” parenting program.  However, about three days after discharge from the Sanders Crisis Unit, the foster parents contacted the unit to ask about this new parenting system.  Apparently this 12 year old foster child told the foster parents that he thought that the Good Habit Cards could help him and that he wanted to try them in his foster home.  Seriously, how many other behavioral modification systems are requested to be put in place by the kids?

A Summary of the One Year Research Study:  

The Sanders Crisis Unit used a pre – and post – test model to assess the degree of change in the symptoms the child is experiencing from intake through discharge.   The Symptom Checklist/Behavior Assessment (ScuBA ) were used in this process to self-report of symptoms.  A self-report behavior assessment was used for the child or adolescent to report their current symptoms.  If a child or adolescent’s discharge plan included placement in another agency program, an interagency referral was completed if the referral source has not already initiated that referral.

“At-risk” children were placed in the Sanders Crisis Unit  for many behavioral and emotional problems.  The diagnosis that these children had were grouped into four categories:

  • Behavioral and Relational Problems (Oppositional-Defiant and Conduct Disorder, ADHD) – 60%

  • Mood Disorders (Depression and Bipolar Disorder) – 14%

  • Anxiety Disorders  and Posttraumatic Stress Disorder – 18%

  • Abuse or Neglect – 1%

  • Other Disorders – 7% 

The statistics continued to show an increase in the number of children reporting at least one form of abuse or neglect.  This percentage increased to 88%, which is well above the percentage for the general population in the USA .  This research study represented 148 of the 168 children who were placed in the Sanders Crisis Unit.  The number of children who reported witnessing or being involved in domestic violence in the past year continued to be at a high rate (41%). The significance of these statistics directed the Sanders Crisis Unit toward the continuing process of adjusting the treatment milieu to meet the changing needs of children in our care. 

The Sanders Center Behavior Assessment (SCuBA) is a symptom checklist given to each “at-risk” child upon their intake session to provide the treatment team with an indicator of the issues that the child may be experiencing.  The symptoms are grouped into 10 categories, which include: Coping Skills, Social Skills, Self-Esteem, Education, Depression, Anxiety, Posttraumatic Stress Disorder, Control of Circumstances, ADHD, and Oppositional – Defiance . 

The SCuBA was also completed at discharge, and the two results were compared to measure the effectiveness of the Sanders Crisis Unit treatment program. If the “at-risk” children’s scores decreased, then child was reporting fewer symptoms, which indicated that they had made improvement during their treatment in the Sanders Crisis Unit.  The overall results of the SCuBA scores demonstrated positive results for children placed in the Sanders Crisis Unit.   

The Outcome Results of the One Year of Research Study:

  • The percentage of “at-risk” children who showed improvement in at least one or more of the SCuBA scales was 97%

  • Although the “Positive Parenting with a Plan: FAMILY Rules” parenting program helped to improve the attitudes, behaviors, and compliance among most of the children in the Sanders Crisis Unit (i.e., 97%), the SCuBA scales which indicated the greatest percentages of improvement include decreased Depression, improved Coping Skills, and improved Self-Esteem.

It appears that the “Positive Parenting with a Plan: FAMILY Rules” parenting program is just as successful in the therapeutic treatment setting at the Sanders Crisis Unit as it is in the various homes across the USA.  The parenting program helped the staff to behave as “facilitators” rather than “enforcers” by redirecting the “at-risk” children to deal with the consequences of their own choices.  The parenting program was easily tailored to the unique needs of the children in the unit.  Acting out children still had an opportunity to pull themselves out of their nose-dive and still end up having a good day.  Finally, although it helps “at-risk” children with all sorts of issues (i.e., 97%), it especially helped children who were struggling with depression, coping skills, and low self-esteem.  It is my hope that other therapeutic treatment facilities will conduct research in the future utilizing the “Positive Parenting with a Plan: FAMILY Rules” parenting program.

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