The information in this program outline is provided by the program representative and edited by the CEBC staff. The Stop-Gap program has been rated by the CEBC in the area of: Higher Level of Placement.

• Types of Maltreatment: Does not target any specific kind of maltreatment
• Target Population: Children and/or adolescents with disruptive behavior disorders (CD, ODD, ADHD) living in residential treatment centers.

The Stop-Gap model uses a multi-component approach (i.e., environment-based, intensive, and discharge-related) to service delivery for residential treatment settings. The two-fold goal of the Stop-Gap model is to interrupt the youth's downward spiral imposed by increasingly disruptive behavior and prepare the post-discharge environment for the youth's timely re-integration. Youths enter the model at Tier I, where they receive environment-based and discharge-related services. The focus at tier I is on the immediate reduction of "barrier" behaviors (i.e., problem behaviors that prevent re-integration) through intensive ecological and skill teaching interventions (e.g., token economy, social and academic skill teaching). Simultaneously, discharge-related interventions commence. To the extent that problem behaviors are not reduced at Tier I, intensive Tier II interventions that include function-based behavior support planning are implemented. The Stop-Gap model recognizes the importance of community-based service delivery while providing intensive and short-term support for youths with the most challenging behaviors.

The model proposes three levels of intervention:

Environment-Based (E-B) Intervention
All youths entering a residential treatment center (RTC) are exposed to E-B intervention which includes:

• Token economy: Focus is on the reinforcement of positive, pro-social behaviors (e.g., volunteers to help, follows directions, completes chores) which could serve as the youth's initial treatment goals. Additionally, it is advised to include a response cost component.
• Academic intervention: Children and youth with severe behavior disorders have the highest academic failure rate of all students with disabilities. The use of direct instruction curricula for reading and math incorporates many of the teaching techniques necessary for success with this population of students.
• Social skills training: A comprehensive intake assessment should include a measure of social skills. Specific skills should be targeted as individual treatment goals and directly instructed to promote acquisition. Performance monitoring, via daily checklists or goal ratings, should accompany instruction with specific reinforcement strategies designed to increase or improve performance. Finally, to promote generalized responding, it is recommended that all staff in the residential environment employ incidental teaching tactics.
• Problem-solving and anger management skills training: Research with aggressive children and adolescents has demonstrated positive effects for two skill training programs, both of which could be easily immersed within a residential treatment setting. They include: (a) problem-solving skills training (Kazdin, Siegel, & Bass, 1992) and (b) the Anger Coping Program (Lochman, Burch, Curry, & Lampron, 1984).

Discharge-Related (D-R) Intervention
This level of intervention begins simultaneously with "environment-based" intervention and is intended to connect the youth to critical community supports. D-R intervention components include:

• Intensive case management: The RTC may serve, in some capacity, as the provider of intensive case management services for the duration of RTC placement and even after the youth's discharge.
• Behavioral parent training: Parent Management Training (PMT) is a model of parent training consistently associated with positive outcomes for children with disruptive behavior disorders. PMT consists of a standard set of procedures taught to parents for the purpose of altering the child's behavior in the home. The central focus of PMT is to alleviate the coercive interchange between parent and child or adolescent by teaching parents and other caregivers a specific set of skills to address child noncompliance, one of the core ingredients of antisocial behavior.
• Community integration: Given that the RTC is a contrived environment, youths should be able to access the community for many of their needed services including enrollment in a local public school, part-time employment, and community-based recreational activities to name a few.

Intensive Intervention
This level of intervention is reserved only for youths requiring more support to adequately address their behavioral needs. The purpose of intensive intervention is to return the youth to the E-B level of intervention as quickly as possible. Intensive intervention components include:

• Function-based assessment (FBA and functional analysis)
• Function-based behavior support planning.

Stop-Gap was designed with a child component that addresses the following presenting problems and symptoms:

• Disruptive behavior disorders including non-compliance, conduct problems, and aggression.

Age range: 6 – 17

Developmental Delays:

This program was not developed for children with developmental delays, and has not been tested for children with developmental delays.

Stop-Gap was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

• Lack of effective parenting practices such as limiting setting, communication, reinforcement procedures, tracking and monitoring behavior, etc.

Stop-Gap was designed to be conducted in a group setting, and has been tested for use in a group setting.

Recommended group size:

There is no set number of individuals. The program is designed as a model for a residential treatment center. Within each center, there may be a number of residences that may include up to 25-35 residents.

Testing References:

McCurdy, B. L., & McIntyre, E. K. (2004). "And what about residential...?" Re-conceptualizing residential treatment as a stop-gap service for youth with emotional and behavioral disorders. Behavioral Interventions, 19, 137-158.

Recommended Intensity:

The intervention is a model of treatment intended to produce short lengths of stay in a residential treatment environment. Three levels of intensity are described: (a) environment-based intervention is for all residents of the treatment program and is available to all upon entry; (b) discharge-related intervention occurs simultaneously with environment-based intervention and is intended to connect the child, or resident, with critical community supports; and (c) intensive intervention, including function-based assessment and support, is for those individuals requiring a greater intensity of intervention.

Recommended Duration:

Depending on the needs of the individual child, it is anticipated that the duration of service may range from 90 days to one year.

This program is typically conducted in a(n):

• Hospital
• Residential Care Facility

This program does not include a homework component.

Stop-Gap does not have materials available in a language other than English.

The typical resources for implementing the program are:

• Program is provided in a residential treatment center with direct care staff (ratio: 1 staff/8 youths)
• Direct care supervisor
• Clinical consultant with training in principles of applied behavior analysis

• Direct care professionals should have a Bachelor's degree
• Clinical consultant should have a Master's degree (minimally)

There is not a manual that describes how to implement this program; but there is training available for this program.

Training Contact:

• Barry McCurdy, PhD, BCBA
  Devereux Center for Effective Schools
  bmccurdy@devereux.org
  phone: (610) 542-3123

Training is obtained:

On-site.

Number of days/hours:

2 days.

Additional Resources:

There currently are additional qualified resources for training:

• E. Kent McIntyre, PsyD
  Kids First Foundation
  (760) 789-7060 x102
  Kent.mcintyre@uhsinc.com

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Safety