Stop-Gap

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

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

Target Population: Children and/or adolescents with disruptive behavior disorders (Conduct disorder [CD], Oppositional Defiant Disorder [ODD], attention-deficit hyperactivity disorder [ADHD]) living in residential treatment centers

For children/adolescents ages: 6 – 17

For parents/caregivers of children ages: 6 – 17

Brief Description

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.

Program Goals:

The primary goals for the Stop-Gap model are:

  • Reduce length of stay in residential treatment
  • Reduce disruptive and aggressive behaviors
  • Improve outcomes in post-discharge environment

Essential Components

The essential components of Stop Gap include:

  • 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 and (b) the Anger Coping Program.
    • 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
  • 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.

Child/Adolescent Services

Stop-Gap directly provides services to children/adolescents and addresses the following:

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

Parent/Caregiver Services

Stop-Gap directly provides services to parents/caregivers and addresses the following:

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

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Residential Care Facility

Homework

This program does not include a homework component.

Languages

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

Resources Needed to Run Program

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

Minimum Provider Qualifications

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

Education and Training Resources

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

Training Contact:
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

Implementation Information

Since Stop-Gap is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Stop-Gap as listed below:

A readiness checklist is used to determine if teams have the resources and commitment to adopt a new model.

Formal Support for Implementation

There is formal support available for implementation of Stop-Gap as listed below:

Both didactic training and coaching is provided to programs looking to adopt. Interested parties should contact Barry L. McCurdy, Ph.D., BCBA-D at the Devereux Center for Effective Schools by email (bmccurdy@devereux.org ) or phone (610-542-3123).

Fidelity Measures

There are no fidelity measures for Stop-Gap.

Implementation Guides or Manuals

There are no implementation guides or manuals for Stop-Gap.

Research on How to Implement the Program

Research has not been conducted on how to implement Stop-Gap.

Relevant Published, Peer-Reviewed Research

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

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.

Type of Study: Non-randomized comparison group
Number of Participants: Approximately 25 per group

Population:

  • Age — 13-18 years
  • Race/Ethnicity — Not specified
  • Gender — 100% Female
  • Status — Participants were in a residential treatment program.

Location/Institution: Western U.S.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The article summarizes the elements of the Stop-Gap environment-based intervention. The authors then present a plan for evaluation of the model using comparison to residential treatment centers offering standard services. Data is presented on the comparative rates of therapeutic holds (a method in which one or more adults physically hold children in order to contain unsafe behaviors) in two units of a residential treatment center, one of which introduced the environment-based intervention after seven months. At twelve months, the intervention residence showed a decline in therapeutic holds, while the comparison group showed an increase over the same period. Groups were matched on population number, gender, and disability. The authors suggest that this approach should be broadened to include matching on further critical variables and measures that include post-discharge outcomes. Limitations include small sample size, lack of long-term follow-up and lack of statistical analyses to determine the significance of between group differences at baseline and outcome measurement.

Length of postintervention follow-up: None.

References

Barth, R. P. (2005). Residential care: From here to eternity. International Journal of Social Welfare, 14, 158-162.

James, S., Leslie, L. K., Hurlburt, M. S., Slymen, D. J., Landsverk, J., Davis, I., Mathiesen, S. G., & Zhang, J. (2006). Children in out-of-home care: Entry into intensive or restrictive mental health and residential care placements. Journal of Emotional and Behavioral Disorders, 14, 196-208.

Zakriski, A. L., Wright, J. C., & Parad, H. W. (2006). Intensive short-term residential treatment: A contextual evaluation of the "stop-gap" model. The Brown University Child and Adolescent Behavior Letter, 22(6), 1-6.

Contact Information

Name: Barry McCurdy, PhD, BCBA
Agency/Affiliation: Devereux Center for Effective Schools
Website: www.devereux.org/site/PageServer?pagename=ces_services2
Email:
Phone: (610) 542-3123
Fax: (610) 542-3087

Date Research Evidence Last Reviewed by CEBC: June 2017

Date Program Content Last Reviewed by Program Staff: November 2016

Date Program Originally Loaded onto CEBC: June 2008