De-Implementing a Point and Level System in Youth Residential Care without Increased Safety Risk: A Case Study

Abstract

ABSTRACT Point and level (P&L) systems are commonly used for behavior management and modification in youth residential treatment centers. In 2019, the Association of Children’s Residential Centers (ACRC) released a position paper urging youth residential programs to abolish prescriptive, universally applied point and level systems because they are inconsistent with the principles of trauma-sensitive care and can be counterproductive to treatment. Despite this, few residential agencies have executed this change, possibly due to the complexities of dismantling long-held practices, concerns about youth safety, and lack of knowledge about other trauma-sensitive approaches. In this case study, we describe how one agency de-implemented its universal P&L system across three residential campuses, replacing it with the Neurosequential Model of Therapeutics (NMT) and Collaborative Problem Solving (CPS). An analysis of administrative data before and after the removal of P&L suggests no evidence of increased safety risk for youth or staff. We discuss the agency’s strategies for de-implementation and the determinants that helped and hindered the process and provide recommendations for other residential agencies seeking to make this change.