ABSTRACT

Group care workers of residential youth care settings face the challenge of creating a warm and involved treatment climate against the demands and restrictions of the treatment setting. We tested the effects of SafePath, a milieu-based intervention based on Schema Therapy principles, during the first year of implementation on two secure residential treatment units compared to two control units. Staff’s daily reports on 139 individual patients were coded on use of schema mode language (implementation check), occurrences of aggression (primary outcome) and repressive staff interventions. In addition, repeated questionnaires were filled out by patients (n = 87) on group climate and by staff (n = 50) on team functioning. Compared to the control units, SafePath units showed higher improvements in group climate and repressive interventions. Both SafePath and control units showed decreased aggression over time. Team functioning was consistently better in the SafePath units compared to the care-as-usual units from baseline through 12 months. In conclusion, a Schema Therapy based milieu as implemented with SafePath may contribute to a warm and supportive group climate with less repressive interventions in secure residential youth care.

摘要

青年寄宿家庭护理机构的团体护理人员面临着创造温暖和参与治疗环境的挑战，以应对治疗环境的要求和限制。与两个控制单元相比，我们在两个安全住宅治疗单元实施的第一年测试了 SafePath，这是一种基于图式治疗原则的基于环境的干预措施。工作人员关于 139 名个体患者的每日报告被编码为使用模式模式语言（实施检查）、攻击的发生（主要结果）和压制性工作人员干预。此外，患者（n = 87）和工作人员（n= 50）关于团队运作。与控制单元相比，SafePath 单元在群体氛围和压制性干预方面表现出更高的改善。随着时间的推移，SafePath 和控制单元都表现出攻击性降低。从基线到 12 个月，与照常护理单元相比，SafePath 单元的团队运作始终更好。总之，使用 SafePath 实施的基于图式疗法的环境可能有助于营造温暖和支持性的团体氛围，并在安全的青年寄宿家庭护理中减少压制性干预。