Beyond Point and Level Systems

Wanda K. Mohr, PhD, APRN, FAAN, University of Medicine and Dentistry, New Jersey; Andres Martin, MD, Yale University; James N. Olson, PhD. University of Texas–Permian Basin; Andres J. Pumariega, MD, Temple University, Nicole Branca, MSN, APRN; University of Medicine and Dentistry, New Jersey

Many residential treatment facilities and child inpatient units in the United States have been structured by way of motivational programming such as the point and/or level systems. On the surface, they appear to be a straightforward contingency management tool that is based on social learning theory and operant principles. In this article, the authors argue that the assumptions upon which point and level systems are based do not hold up to close empirical scrutiny or theoretical validity, and that point and level system programming is actually counterproductive with some children, and at times can precipitate dangerous clinical situations, such as seclusion and restraint. In this article, the authors critique point and level system programming and assert that continuing such programming is antithetical to individualized, culturally, and developmentally appropriate treatment, and the authors explore the resistance and barriers to changing traditional ways of “doing things.” Finally, the authors describe a different approach to providing treatment that is based on a collaborative problem-solving approach and upon which other successful models of treatment have been based.

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