Our Residential Treatment Group Homes use an evidence-based treatment model
Our Residential Treatment Group Homes house males ages 8-17
Our program provides 24 hour nurturing; structured and supervised care in a residential home setting
Our Residential Treatment Group Homes are located in the counties of Los Angeles, San Bernardino, Riverside and Orange
Our Residential Treatment Group Homes are located in the cities of:
Azusa, Baldwin Park, Bloomington, Fontana (2), North Hollywood, Redlands, Santa Ana, and San Jacinto
Our Residential Treatment Group Homes homes are fully licensed by the State of California Community Care Licensing (CCL) and equipped to care for six to twelve boys, ages 8 to 17
Our program is delivered by a team of highly trained professionals with extensive experience in such fields as child development, behavioral science, social work and residential care. Staff members, as well as residents, actively support their communities, often volunteering their time to help local organizations and causes
Youngsters are able to heal in a safe, stable, compassionate environment, as they have access to a broad range of therapeutic and other support services including individual and group counseling, social skills development, academic and vocational assistance, psychiatric assessment, psychological evaluation, independent living skills, and recreational programs
Each Ettie Lee residential home shares the common goal of helping those in their care become whole – to develop a positive self-image, along with the skills needed to become productive members of society
Ettie Lee offers a complete range of mental health services to the children within our care. Services include: Dialectical Behavior Therapy (DBT), Therapeutic Behavioral Services (TBS), Violence in Prevention (VIP) and Drug/Alcohol services specifically designed for adolescents with both mental health and substance use disorders
Dialectical Behavior Therapy (DBT) is an evidence-based and trauma-informed treatment that increases client motivation; safety, skills and positive outcomes for adolescents. DBT is proving to be highly effective across the country in treating multi-problem adults and adolescents in reducing emotionally driven at-risk behaviors such as aggression and violence, substance abuse, eating disorders, self harm and suicidal behavior.
Our success with DBT specifically shows:
92% Increase in probation youth family reunifications
93% client attendance at Drug/Alcohol treatment groups
20% reduction in youth to youth violence
51% reduction in youth conflict with staff
27% reduction in AWOL
40% reduction in police involvement
45% reduction in property destruction
DBT was originally developed by Marsha Linehan, PhD at the University of Washington to treat severe, suicidal borderline personality disordered clients. It is now demonstrating success with other difficult to treat populations including adolescents and substance abusers. The model is especially effective for those who have highly reactive emotions that lead to impulsive, destructive behaviors and chaotic relationships.
Dr. Linehan recognized that clients who are vulnerable to criticism and have behaviors that are primarily driven by emotion have had some difficulty in effectively utilizing standard Cognitive Behavior Therapy (CBT). DBT adds the components of Acceptance and Validation to the excellent Change strategies found in behavior therapy. These clients often hold tight to learned problem behaviors. The addition of acceptance and validation strategies provides clients with the tools to accept themselves and change their behaviors.
The basic dialectic in DBT is Acceptance & Change – this continuum reminds both staff and residents to accept that a youth has very good reasons for choosing the behaviors that he has chosen in the past and that those behaviors need to change in order for him to be effective in meeting his goals to leave placement and function successfully at home, in school and in the community. Acceptance strategies are used to help residents tolerate things that they can not change, like being in a group home, following rules they are not used to and loss of significant others in their lives. Change strategies are used to teach new problem solving skills and ways to regulate their emotions without getting into further trouble or making their situation worse.
While there is no guarantee that every adolescent entering our program will be successful, our outcomes to date provide positive evidence of the exceptional benefits of this model. This model is increasingstability and safety in placement while providing the youth with skills to take back out into the community.
DBT is skills based and teaches the clients how to make more effective behavioral choices by identifying and addressing the triggers that have in the past lead to impulsive or aggressive behaviors. The group homes provide structured daily practice of these new skills and ready the residents for return to the community.
The five (5) functions of the Dialectical Behavior Treatment Model are to:
Motivate and Engage Youth and Families
Increase Skills
Structure their Environment
Generalization the Skills to everyday life
Motivate and Engage Staff to continue working with difficult clients
Children are assigned to attend DBT skills and acquisition and practice groups as well as other groups indicated through assessment and evaluation of specific needs. One of the essential underpinnings of the model of treatment is that learning new skills requires extensive practice in a variety of settings and that the skills need to be generalized into the clients “real life arenas”.
Engagement - Development of a working partnership between the therapist and the client and joining with him to meet his personal goals for treatment
Teaching the client about the treatment approach
Establish agreements for working together
Obtaining a commitment from the client to “do what it takes” to work with the therapist toward his long-term goals, as well as, the therapist providing a commitment to the client that they will also “do what it takes” to assist the client to achieve the identified goals
Stage 1 Treatment Targets
Decreasing Life Threatening and Other Threatening Behaviors
For our population this includes, but is not limited to the following:
Suicide;
Para-suicide (Self injury/mutilation);
AWOL;
Repeated Hospitalizations;
Debilitating depression;
Violence, Fighting, Intimidation of others;
Sexual acting out;
Dangerous gang related behaviors;
Drug/Alcohol usage that places the child at risk;
Threats to harm self or others;
Other behaviors that put self or others at risk.
Decreasing Therapy Interfering Behaviors - both those of the client and of the therapist or other mental health provider. This is one of the unique and most powerful facets of this model. Once life threatening behaviors have been significantly reduced or eliminated, the focus moves to what would traditionally be identified as “treatment failure, resistance, lack of motivation, etc.”. The treatment targets the very behaviors that prevent treatment from taking place or behaviors by both the client and the treatment providers that interfere with the client’s benefiting from the treatment that is offered.
Examples of Therapy Interfering behaviors seen in our population include, but are not limited to:
AWOL
Refusing to see the therapist;
Walking out of groups;
Vocal disrespect toward the therapist or to the treatment provider;
Crossing over personal limits and boundaries;
Refusal to participate; non-attention; sleeping during sessions;
Disrupting groups or rehabilitation activities;
Crossing over staff boundaries;
Threatening staff;
Non-collaborative behaviors “Yea But” syndrome;
Refusal to do treatment assignments;
Behaviors that interfere with other clients;
Behaviors that burn out staff.
Therapy interfering behaviors from the treatment providers side are also addressed both as part of the treatment with the client and in the treatment team consultation. For our treatment staff working with this difficult population, examples may include, but are not limited to,
burning out on the client;
not respecting the client;
avoiding sessions with a client because he is difficult;
starting groups late;
canceling appointments;
acting upon feelings of intimidation by the client, etc.;
avoiding clients who are unpleasant or insulting to staff.
Decreasing Behaviors that Interfere with Quality of Life
Examples related to the children we serve include: criminal behaviors; repeated incarcerations or placement changes; school related dysfunctional behaviors that functionally impair a child from being successful in school, getting a job and/or emancipating; unhealthy relationship patterns; high-risk or unprotected sexual behaviors; use of drugs/alcohol as a coping strategy, etc.
Stage 2 Treatment Targets include, but are not limited to:
Focus on addressing underlying dynamics related to behavioral disorders, such as, post-traumatic stress, mood disorders, cognitive restructuring of beliefs, inhibited grief, etc.
Prior to focusing on the underlying issues, this model seeks to provide some of the necessary skills, capabilities and supports, both in therapy and in the milieu environment needed to sustain the discomfort of resolving trauma, abandonment, grief or other underlying issues successfully. Satisfactory progress through the Stage 1 treatment targets readies the client for work on the underlying issues related to trauma or circumstances that created the client’s specific cluster of behaviors that interfere with his functioning. The skills learned are then used as strengths and resources when dealing difficult issues without reactivating the negative behaviors.
This approach has also been successfully used when working with addictions. The focus in Stage 1 of treatment is to eliminate the use of substances and THEN to address the underlying issues related to the substance usage in Stage 2. The skills learned in eliminating substance use then become a resource to the client while dealing with the difficult and painful issues of secondary recovery (underlying issues and trauma).
Treatment strategies during Stage 2 include the use a variety of proven therapeutic methods to reduce the trauma, abandonment, related cues, etc. Techniques are drawn from family systems. cognitive-behavior, interpersonal, narrative, and other therapies to address underlying issues related to the behaviors and symptoms targeted in Stage 1.
Stage 3 works on daily living problems as the child learns to function successfully in the community in a non-restricted family environment. This stage is often continued in out-patient therapy following discharge from residential care.
Children are enrolled in the most appropriate educational setting for their educational needs. School settings include: Regular School, Non-public Schools, Special Day programs and Opportunities for Learning Charter School. Children who attend the Day Treatment Program who qualify are able to be enrolled in the Opportunities for Learning Charter School for at risk youth and displaced youth. Ettie Lee has partnered with Opportunities for Learning Charter School to provide an excellent individualized educational experience for our children while in placement. The school is chartered to work with children who are in and out of regular educational settings due to changes in out-of-home care placements, juvenile halls, homelessness, etc. The school, like Ettie Lee’s program is outcome based. Ettie Lee residents are being more successful in this environment than they have been in the past. Boys are catching up on credits and able to graduate from school. Children attend the Charter School as part of their Day Treatment week as well as participate in other treatment services throughout the week.
Therapeutic Behavioral Services (TBS) are available for eligible children who need short-term behavioral support in addition to any other mental health services they are receiving. TBS's goal is to help children avoid being placed in a higher level of care such as a psychiatric hospital or juvenile detention or to help children make a successful move to a lower level of care such as returning home or to a foster home following discharge from group care residential treatment.
TBS is a short-term program that focuses on changing a child's behavior, while emphasizing the child's strengths. TBS works in collaboration with the child, the child's caregivers and the primary mental health provider to address 1 to 3 behaviors at a time that jeopardize the child's ability to remain in his or her current home.
TBS services are provided in the child's home, school or community and other environments when and where the child's problematic behaviors occur. Services are approved for 30-60 days at a time and are expected to produce the desired changes within a few months.
The TBS program works in conjunction with the primary therapist and existing treatment team and or parent to develop and implement plans to reduce symptoms/behaviors that jeopardize the child’s placement or prevent a child from moving to a lower level of care. [TBS can not be used as a crisis service, it is a planned service] TBS unfolds in three phases:
TBS staff begins by working with the child, parent, primary therapist and treatment team to gain an understanding of the child's behavior. TBS then develops replacement behaviors for the child to use as alternatives to the undesirable behaviors. Strategies include the development of a behavioral plan, such as a step-by-step process in which TBS coaches follow a guideline to manage specific behaviors as they occur, and an incentive plan to reward the child is rewarded for choosing productive replacement behaviors.
Next, TBS staff works directly with the child and those who care for the child. During this time, TBS staff, the child and the child's caregivers are learning together and taking responsibility for their parts of the child's behavior plan. Interventions and strategies focus on improved self-management, self-awareness, and communication skills as well as positive reinforcement of desirable behaviors. Dialectical Behavior Therapy skills and strategies are integrated into the treatment to enhance overall treatment impact.
During the final phase, TBS staff oversees a transition plan to ensure that the positive behavioral changes will continue. A child graduates from TBS once the frequency, duration, and intensity of the 1 to 3 targeted behaviors have been reduced and interventions and strategies have been transitioned to support persons.
The Violence and Intervention Prevention (VIP) Program is a multi-dimensional program designed to address gang and violence issues as they arise and teach anti-violence skills and pro-social skills. Children identified with gang violence historiesare provided individual and group rehabilitation servicesto address the social and emotional issues related to the anti-social, violent and criminal facets of gang involvement.
This program, working with children who want out of gangs or to decrease involvement in the unhealthy aspects of gang involvement, is provided in the group homes and to the communities and school surrounding the group homes. Activities and services provided include, but are not limited to, individual counseling to children, educational groups, crisis intervention in gang conflicts in the group homes and the community, facilitation of tattoo removal, tagging and graffiti identification and analysis, participation in community graffiti removal and identification of gang related contraband, and training to parents, staff and the community.
DBT is integrated with Violence Intervention & Prevention (VIP) to address violence associated with gang affiliation, domestic violence and pro-social values development,and Independent Living Skills for children who need combined services.One of the essential underpinnings of the model of treatment is that learning new skills requires extensive practice in a variety of settings and that the skills need to be generalized into the clients “real life arenas.”
Drug & Alcohol Treatment Program is for adolescents diagnosed with substance use disorders. Many of the children who suffer from mental health disorders also have a diagnosed substance related disorder or a significant level of substance use that negatively impacts their mental health disorders. Our history has demonstrated that approximately 85% of the children referred to us meet the criteria for a chemical abuse or dependence diagnosis.
The curriculum integrates the DBT skills into the treatment.One of the essential underpinnings of the model of treatment is that learning new skills requires extensive practice in a variety of settings and that the skills need to be generalized into the clients “real life arenas.”
Treatment also includes, but is not limited to:
The short and long term emotional and physical effects of drug and alcohol (including tobacco) use;
Addiction cycle
Urge surfing
Relapse prevention and planning;
Alternative coping strategies and lifestyles;
The power of belief;
Interaction between mental health symptoms and use of substances;
Abuses and dangers of over-the-counter and prescription medications;
HIV, TB, Hepatitis education and resources assessment and treatment;
The intergenerational impact of substance use on the family (past, present and future);
Relationship between the gang and drug culture;
The long and short dangers of substance use or abuse during pregnancy and impact on the fetus;
Developing effective stress management and coping strategies to prevent substance abuse; and
Self-help resources available in the community to address substance abuse and dependency issues, e.g. 12-step programs for both, alcohol, drugs and co-occurring disorders, etc.
The enriched treatment program consists of five major components:
Assessment and treatment planning
Individual and family therapy
DBTSkills training groups
Coaching in the group home milieu and community
Consultation tot the treatment providers
Each client is assigned to attend individual therapy at a minimum of one hour per week and, if family is available and willing the child may receive as much as four hours or more per month of family therapy. Family involvement is solicited and supported.
Children are assigned to attend DBT skills and acquisition and practice groups as well as other groups indicated through assessment and evaluation of specific needs. One of the essential underpinnings of the model of treatment is that learning new skills requires extensive practice in a variety of settings and that the skills need to be generalized into the clients “real life arenas.”
Ettie Lee Youth & Family Services has a long established successful independent living program to assist young men emancipate into the community, including one group home dedicated to meet the needs of emancipation track children ages 16-17. Pre-emancipation readiness and independent living skills are taught to all children ages 14 and older. Children receive life skills and independent living skills training through a variety of modalities. They include:
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