Providing evidence-based trauma-informed care for boys

The Devereux Massachusetts Boys’ Program serves males ages 9 to 21 years old across a continuum of settings that includes three campus units and two community-based residences. The focus of the campus units is stabilization and to assist the clients in developing effective, safe coping strategies, increasing prosocial skills, and improving their ability to attend to daily living skills. Clients who are successful on the campus setting can progress to one of our community-based residences located in Rutland. The programming on these two units emphasizes independent living skills and participation in the community.
Utilizing a trauma framework that understands symptoms as adaptations, the therapeutic milieu of the Boys’ Program uses relational strategies and positive behavior support to decrease safety-interfering behaviors and to foster the development of effective communication and coping strategies. The Therapeutic Behavior Change System (Step System) reinforces these concepts through its focus on validation, in-vivo coaching of skills, use of restorative tasks (i.e., repairs), and use of logical/natural consequences to address socially unacceptable behaviors. Throughout the continuum of care, clients are exposed to numerous milieu-based groups including, but not limited to, milieu skills group (merging Dialectical Behavior Therapy and Aggression Replacement Training), Adventure-Based Counseling, PAYA (Preparing Adolescents for Young Adulthood), fitness, therapeutic recreation groups, sex education and substance-abuse education.

Admission Criteria

The Boys’ Program serves child and adolescent males who present with a variety of social, emotional, and behavioral issues including: disruptive behaviors, mood/anxiety disorders, complex trauma, psychotic symptoms, high functioning pervasive developmental disorders, and abuse-reactive behaviors.

Eligible children/adolescents are/have:

• Age 9-21 years
• Intellectual functioning ranging from Mild Intellectually Disabled to Average
• A diagnosable mental disorder of sufficient duration to meet criteria specified in DSM-IV
• Functional impairment that substantially interferes with or limits the child’s functioning in family, school, and community activities
• Less restrictive forms of treatment have been attempted and have not been effective

Admissions Procedure

Contact the Admissions Department by phone at 508-886-4746 or by e-mail at MA_Admissions@devereux.org.

Mission Statement

The mission of the Devereux Massachusetts Boys’ Residential Treatment Program is to teach clients the skills they need to function as independently as possible in the most normalized, family-like setting appropriate to their developmental level and cognitive, emotional, and social abilities. In order to accomplish this mission, we offer a safe, warm, predictable, empathic environment that enables clients to stabilize their behavior and learn the specific skills they need. We provide a continuum of treatment settings that encourages progressively greater levels of self-management. We reach out to families, involve them in their child’s treatment, and support them in caring for their child.

Program Objectives

• Decrease unsafe, challenging behaviors (i.e., self-injury, aggression, running).
• Increase use of prosocial, coping strategies.
• Learn how to self manage psychiatric symptoms.
• Develop age-appropriate functional living skills.
• Improve academic achievement and plan the next academic and/or vocational step.
• Improve family relationships and increase behavioral stability in home environment (if applicable)
• Reintegrate into a community setting with the skills necessary to maintain an adequate level of functioning.

Treatment Components

Our program is based on three assumptions about the development of problem behavior in our clients. (1) Problem behavior is the result of clients trying to meet their needs without having the skills to do so appropriately. They attempt to get what they need in socially inappropriate, self-defeating ways. (2) Problem behavior occurs when the demands placed on a client cause him to become emotionally over-aroused. Our clients can easily become emotionally and behaviorally dysregulated by the demands of the environment. (3) All behavior, including problem behavior, is caused by interactions between people. It is never caused by just one person. The way we relate to a client or respond to his behavior is important in determining how he acts.
These assumptions suggest that we should focus our efforts at helping clients in the following areas: (1) Teaching Skills - If we want to make lasting changes in clients’ behavior, we have to teach them skills that will enable them to meet their needs in more appropriate ways. These are called replacement skills because they replace problem behaviors. Clients often misbehave in order to connect with others. Lacking the skills to relate appropriately, they resort to unpleasant, ineffective behavior to engage adults. One important way to change problem behavior is to teach clients replacement skills, especially positive ways to connect with others. (2) Changing the Environment - No client can learn new skills if he/she feels overwhelmed or unsafe. In such an environment, clients become disorganized and out-of-control. This is especially true of clients with a history of trauma who are easily overwhelmed by unstructured or highly stimulating environments. One important way to change problem behavior is to change the environment to help clients control their behavior and emotions. Program services include:

• Residential milieu utilizing a Relational Approach & Positive Behavioral Support
• Individual, group, and family therapy
• Parent involvement
• Medication management
• Therapeutic recreation
• Special needs therapeutic school

To help the clients in our care address their mental health issues, we employ the following approaches:

• Trauma-Informed Care. Many of our clients have a history of abuse and/or neglect. We have learned that trauma affects the functioning of the brain. Long-term effects of trauma include difficulty controlling emotions, poor impulse control, and distrust of others. Children who have a history of trauma have learned to distrust adults and to expect disappointment, rejection, and abuse in their relationships. In addition, traumatized children have often failed to learn basic skills of how to form relationships. These skills include the ability to talk about their own feelings, tuning in to others’ feelings, the ability to see things from others’ point of view, and the ability to follow social rules.


• Relational Approach. Positive relationships between clients and staff are the most important factor in creating a treatment environment that is safe, warm, predictable, empathic and makes clients feel competent & successful. All learning occurs in the context of relationships and behavior change techniques are most effective when they are employed in the context of a positive relationship. We have adopted a training curriculum to help staff learn how to form positive relationships with children affected by trauma. The Risking Connection curriculum is centered in the belief that a collaborative healing relationship is one marked by Respect, Information, Connection, and Hope (abbreviated: RICH).


• Positive Behavioral Support. Positive behavioral support emphasizes assessment prior to intervention, manipulation of antecedent conditions to reduce or prevent the likelihood that a problem behavior will occur, development of new social and communication skills that make problem behaviors irrelevant, and careful redesign of consequences to eliminate factors that maintain problem behaviors and to encourage more acceptable replacement social skills and behaviors.


• Dialectical Behavior Therapy (DBT). DBT assumes that (1) clients are doing the best they can, (2) clients want to improve, (3) genuine compassion is essential to meaningful change, and (4) behavioral principles of learning apply to both clients and staff. DBT stresses the coaching of skills in the client’s natural environment. Assisting clients to utilize the skills they learn in psychotherapeutic groups during real life situations is critical for client progress. DBT skills are an important component of the residential milieu skills groups.


• Aggression Replacement Training (ART). ART is a treatment program based on the assumption that aggression is a learned behavior. More specifically, social learning experiences of aggressive youth have not taught them the requisite interpersonal and cognitive skills that constitute effective prosocial behavior. Another assumption of ART is that certain youth exhibit an over-reliance upon aggressive means to meet their daily needs and longer-term goals reflecting a deficiency in anger control. ART skills are an important component of the residential milieu skills groups.


• Family Involvement. Family plays a central role in the life of the adolescent, whether or not the discharge goal is family reunification. Children will almost always have a life-long relationship with their family, even if they never again live with them. Therefore, we strive to involve families as partners in the assessment and treatment of their children.