Comprehensive Program Plan

Copper Hills Youth Center (CHYC)

General: Copper Hills Youth Center is a residential treatment center for adolescents 12
to 17 years of age. They treat boys and girls who have emotional, behavioral and
psychiatric disorders. They also specialize in caring for people who have Aspergers
syndrome. They have an on-site, accredited, private high school to allow students to
continue their education while receiving treatment. CHYC is accredited by the Joint
Commission, Northwest Accreditation Commission and is licensed by the Utah
Department of Human Services.

Programs: CHYC offers 6 programs (in no specific order):
1. Boys Residential Treatment Program- 24-hour supervision for boys 12 to 17 years
old, this program is for boys with psychiatric disorder such as anxiety problems,
bipolar disorder, obsessive-compulsive disorder or depression. The boys in this
program have usually failed in an outpatient therapy program or other attempts at
recovery.
2. Girls Residential Treatment Program- 24-hour supervision for girls ages 12 to 17,
this program is for girls with a psychiatric disorder such as anxiety problems,
bipolar disorder, obsessive-compulsive disorder, or depression and have usually
failed in outpatient therapy or other attempts of recovery.
3. Boys Sexual Misconduct Treatment- based on a supportive peer system and
provides rewards for good behavior. During treatment residents use specially
designed workbooks to help them learn and create changes to inappropriate
behaviors.
4. Aspergers- Autism Spectrum Disorder Program- offers a highly-structured
environment that creates teaching and learning opportunities. The goal is to
prepare the child to return home and use the skills learned in everyday life.
5. Recreational Therapy- gives students a chance to work through their issues both
mentally and physically. Taking a student into a new environment make him use
himself and the support of peers to complete a task. Some activities include:
rafting, hiking, skiing, climbing and camping.
6. Substance Abuse Treatment- is different for each patient and qualified therapists
work with each patient to create a treatment plan that is right for them. The goal is
to heal the person as a whole rather than just their substance abuse problem and
provide each resident the tools needed to stay clean and healthy.

Mission, Vision, and Values:
Mission Statement
o Throughout teamwork, integrity, accountability, communication and
respect, Copper Hills Youth Center strives to make changes for the
greater good and provide extraordinary service to the youth we serve,
their families, our employees, and our community.
Vision
o Copper Hills Youth Center will invest its time and resources in the
youth and the families we serve and support positive change. This will
be accomplished through quality programming, collecting and
analyzing data and exhausting every ethical means necessary to
produce the wanted change.
Values:
o Respect: We believe that each individual is unique, capable of change
and deserving of our respect.
o Integrity: We believe in doing the right thing and doing it well,
regardless of the consequences.
o Teamwork: We believe in working as a team through open and
continuous communication. We respect every persons voice and
actively work for the greater good.
o Communication: We believe the through active listening, compassion,
understanding, honesty and cooperation, we will communicate the
needs of those we serve and respect.
o Accountability: We believe in being responsible for the outcome of
our words and actions.



























Diagnostic Protocol: Autism Spectrum Disorders

Diagnostic Grouping-
Neurodevelopmental Disorders are, a grouping of conditions with onset in the
developmental period (DSM-5, 31). Disorders in this category are labeled by
deficiencies in social, personal, academic, or occupational functioning. Many of
the neurodevelopmental disorders can occur simultaneously in one person.

Specific Diagnosis- Autism Spectrum disorders (ASD) are defined in the Diagnostic and
Statistical Manual of Mental Disorders 5 by five criteria:
1. Persistent deficits in social communication and social interaction
across multiple contexts
2. Restricted, repetitive patters of behavior, interests, or activities
3. Symptoms must be present in the early developmental period
(but may not become fully manifested until social demands exceed
limited capacities, or may be masked by learned strategies in later
life)
4. Symptoms cause clinically significant impairment in social,
occupational, or other important areas of current functioning.
5. These disturbances are not better explained by intellectual
disability or global development delay.
In general terms, ASD is a complexity of brain development disorders. These
different disorders are categorized in various severity levels from high
functioning to low functioning. These levels are determined by each persons
social interactions, verbal and nonverbal communications, and repetitive
behaviors (Autism Speaks).
As stated in the DSM-5, Diagnoses are most valid and reliable when based on
multiple sources of information, including clinicians observations, caregiver
history, and, when possible, self-report (DSM-5, 53). There is no medical test to
determine an ASD, however there are medical test that can rule out similar
disorders (Autism Society).

Defining Characteristics & Identified Problems-
Autism is usually diagnosed in the first five years of life but it can be diagnosed at
any age. The key diagnostic features for autism in children are verbal and
nonverbal communications, social-emotional reciprocity and restricted, repetitive
behaviors.
Verbal and nonverbal communications are used in social situations. Verbal
communication is using words and speech and nonverbal communication is
pointing and body language. In normal child development, nonverbal
communication is established before verbal. Once verbal communication is
established, they are both used together to create sufficient communication. In
children with autism, they will show, absent, reduced, or atypical use of eye
contact, gestures, facial expressions, body orientation, or speech intonation
(DSM-5, 54) as signifiers.
o Some functional gestures can be learned, but children with autism will
have much less than a normal child. Social-emotional reciprocity are,
the ability to engage with others and share thoughts and feeling
(DSM-5, 53).
o Children with autism may not show interest in other children or even
adults.
o They wont show the normal stages of play that a child with normal
development would.
Repetitive behaviors are described in the DSM-5 as, repetitive motor
stereotypes (e.g., hand flapping, finger flicking), repetitive use of objects (e.g.,
spinning coins, lining up toys), and repetitive speech (DSM-5, 54). Among
repetitive behaviors, children with autism can show extreme adherence to
schedule and agitation when a routine is changed.
Identifiable problems of ASD that are treatable by a Recreational Therapist may
include:
o Social-emotional reciprocity-
A TR professional can treat social-emotional reciprocity by
creating programs to build social and personal relationships.
In these programs, the person should be taught how to interact
socially with another person, how to verbalize wants and needs,
and also be taught social manners that are considered to be normal
(e.g., eye contact, body language).
o For repetitive behaviors, a TR professional could create physical programs
to help the person learn to channel their energy in the form of ticks or
other repetitive movements into other activities.
o Also, programs to teach a person with ASD to cope with changes in
schedule or routine could be a possible job for a TR professional.

Related Factors or Etiologies- Autism spectrum disorder is often associated with
intellectual impairment [Intellectual Development Disorder] an structural language
disorder (DSM-5, 58). Intellectual developmental disorder is diagnosed by three
criterion; first, is a lack of the ability to reason, problem solve, plan, think abstractly,
make judgments, learn in an academic setting, and learn from experiences (DSM-5, 33).
The second criterion is deficits in adaptive functioning that result in failure to meet
development and sociocultural standards for personal independence and social
responsibility (DSM-5, 33). And the third criterion is the deficits occur during
developmental stages (DSM-5, 33). Intellectual Developmental Disorder is related to
ASD because the symptoms overlap and occur in both disorders. Structural language
disorder is diagnosed with four main criteria. The first is a lack of use of language in
different modalities (e.g., verbal, written), which are usually a result of a lack of
understanding of language. The second is that the language development is quantifiably
lower when compared to children of normal development in the same age group. The
next criterion is that the symptoms are shown in the developmental stage of life. And the
final criterion is that the above symptoms are not due to a hearing impairment or any
other sensory impairment. (DSM-5, 42).

Process Criteria-
Stress Management- can be used as a program to help cope with repetitive
behaviors.
Social Groups- can be used to learn social manners and relationships.
Challenge Groups- can be used to reduce
Relaxation/ Stress Management- can be used to help reduce repetitive behaviors
in the form of ticks.


Outcome Criteria-
After completing stress management courses;
o Clients will have reduced repetitive behaviors.
o Clients will learn how to calm their body and mind and eliminate ticks
After social groups:
o With a group member of their choice, client will form a friendship with
another person
o Client will be able to verbally and physically greet their friend (e.g., say,
Hello, how are you? and shake hands).
o Client will verbally express wants and needs to friend
After Challenge Groups:
o Clients will learn to control their physical repetitions through playing
games and using energy in a different way.
o Clients will learn individualized ways in which to relax
After Stress Management:
o Client will have learned resources for dealing with over-load of input or
emotion.


T. Swartz TRS, CTRS





Resources

American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.

"Autism Society - Homepage." Autism Society - Homepage. N.p., n.d. Web. 23 Oct.
2013.

"Home | Autism Speaks." Autism Speaks. N.p., n.d. Web. 23 Oct. 2013.


Intervention Protocol:
Social Development Group for Children with Autism Spectrum Disorder

General Statement of Purpose: The purpose of social development group for children
with autism spectrum disorder is to teach clients general social manners (e.g., eye
contact, body language), how to communicate general wants and needs, and how to build
social and personal relationships.

Description/ General Goals-
The social development group will meet once a week. Each week there will be a different
activity to work on a different goal. Some activities will be test activities. These test
activities will be repeated once every month to evaluate progress on the focus goal.
1. With their group friend they choose:
a. Demonstrate their idea of how a friend verbally greats another friend (in a
positive manner)
b. Demonstrate their understanding of how a friend would physically great
another friend (e.g., handshake, hug)
2. Be able to have a minimum of 10-minute conversation with another group
member.
3. In a controlled sample situation, be able to successfully communicate 3 wants
and/or needs to another person.
4. In a conversation, demonstrate ability to use normal social manners for minimum
of 3 minutes (e.g., eye contact, body language).

Problems or Deficits to Address-
Social-Emotional Reciprocity
Repetitive Behaviors

Client Referral Criteria-
Clients will be placed into program based off minimum of three sources (e.g.,
doctors referral, parent observations)
Criteria for program-
o mild to severe autism
o deficits in social skills
o lack of understanding of social norms





Contraindicated Criteria- what would prevent them from doing program
physical aggression towards others
o need to first participate stress management program
nonverbal
o need to be able to communicate with group and/ or instructor

Intervention of Facilitation Techniques-

Staff Program Responsibilities-
Staff to client ratio- 1 staff: 4 clients
Set up prior to group
o Gather supplies
o Set furniture structure
o Count any sharps that may be used
Facilitation during group
o Explain directions carefully and in depth
o Observe and document observations
o Once activity is complete, lead discussion of activity
Clean up after group
o Recount all sharps or potential hazardous supplies
o Return furniture to original settings

Training Requirements for Staff-
CTRS
TRS
Minimum 2 years experience with children with Autism

Risk Management Considerations-
Activities with sharps
Activities in an outdoor setting, clients that are flight risks
Clients with tendencies to become physical with other clients

Expected Program Outcomes-
After social groups:
o With a group member of their choice, client will form a friendship with
another person
o Client will be able to verbally and physically greet their friend (e.g., say,
Hello, how are you? and shake hands).
o Client will verbally express wants and needs to friend







Program Evaluation Methods-
Test Activities will evaluate progress on a certain goal based on
documentation of prior test activities
Parental Feedback- once a client has left the facility, the parents will fill out a
survey about their childs social interactions. The survey will include questions
pertaining to each goal.
If applicable, clients will fill out their own survey about how they feel their social
abilities are after the program.

T Swartz TRS, CTRS










































Written Plan of Operations:
Copper Hills Youth Center
Recreational Therapy Services
November 2013
Purpose: At Copper Hills Youth Center, recreational therapy services are an important
part of making a difference in every childs life. Recreational therapy provides
interventions in five realms; social, cognitive, behavioral, emotional, and cultural. Each
client is assigned an individualized treatment plan upon arrival and also gives goals and
objectives to meet throughout their stay at Copper Hills Youth Center.
Philosophy: Through our values; teamwork, integrity, accountability, communication
and respect, the recreational therapists at Copper Hills Youth Center provide our clients
with the engaging, fun, and memorable experiences to help them overcome any issue. An
array of interventions is used to as tool, and some of these interventions include:
individualized treatment plans, family therapy, recreational therapy, assistive technology,
and dietary services.
Team Mission: Through teamwork, integrity, accountability, communication and
respect, Copper Hills Youth Center strives to make changes for the greater good and
provide extraordinary services to the youth we serve, their families, our employees and
our community.
Department Administration: The RT department is managed by a Master Therapeutic
Recreation Specialist (MTRS) and Certified Therapeutic Recreation Specialist (CTRS).
The Manager of RT is responsible for maintaining staff competencies according to the
ATRA standards of practice, and NCTRC Job Analysis, managing the departments
resources including establishing and monitoring the annual budget, maintaining
continuous improvement planning, providing/coordinating the clinical supervision, and
providing opportunities for professional development. The Manager of RT is actively
involved in annual evaluations of all full-time staff and is responsible for the evaluations
of all PRN employees.
The R.T. manager conducts bimonthly staff meetings to discuss program development,
quality improvement, departmental goals, staff development, and enhance interpersonal
working relationships. Continuous staff development opportunities are provided through
the department, by other disciplines within the hospital, or through opportunities by the
larger medical center.
The RT department is committed to the training of recreational therapy students. The
Coordinator of Internships facilitates the application process and identifies supervisors
for those students excepted for a practicum.
Formal individual or group clinical supervision is provided when requested or
recommended by; a service director, department manager, or when an employee requests
personal clinical supervision. Informal clinical supervision may be provided in the RT
departmental meetings or on an individual basis. When there is no specific or adequate
modality of supervision available at CHYC, professionals outside CHYCs system will
be consulted.
Membership in professional organizations is highly encouraged. State licenses, national
certifications and registrations are required as designated on job description. Copies of all
credentials are maintained with the Human Services Department and also with the
Manager of Recreational Therapy. License and certifications are posted at each
therapists desk.
Each recreational therapist will hold a current Utah State license as a Therapeutic
Recreation Specialist (TRS) or a Master Therapeutic Recreation Specialist, (MTRS) and
will be certified by the National Council for Therapeutic Recreation Certification
(NCTRC) as a Certified Therapeutic Recreation Specialist, (CTRS).
All Recreational Therapists adhere to the ATRA Code of Ethics which is maintained in
the department handbook.
Scope of Care:
Patients with emotional, behavioral, psychiatric disorders, and Aspergers
syndrome as outlines under CHYCs admission criteria
Serve patients between the ages of 12 and 17
Programs receiving service:
o Boys residential treatment program
o Girls residential treatment program
o Boys sexual misconduct treatment
o Aspergers- Autism Spectrum Disorder Program
o Recreational Therapy
o Substance Abuse Program
Recreation Therapy Treatment Modality:
Therapeutic Recreation is the provision of Treatment Services and the provision of
Recreation Services to persons with illness or disabling conditions. The primary purpose
of Treatment Services, often referred to as Recreation Therapy, are to restore, remediate
or rehabilitate in order to improve functioning and independence as well as reduce or
eliminate the effects of illness or disability. The primary purpose of Recreation Services
are to provide recreation resources and opportunities in order to improve health and well-
being. Therapeutic Recreation is provided by professionals who are trained and certified,
registered, and/ or licensed to provide Therapeutic Recreation (ATRA Standards of
Practice).


Program Description/ General Goals:
The social development group will meet once a week. Each week there will be a different
activity based intervention to work on a different social development goal. Some
interventions will be test activities. These test activities will be repeated once every
month to evaluate progress on the focus goal.
5. With their group friend they choose:
a. Demonstrate their idea of how a friend verbally greats another friend (in a
positive manner)
b. Demonstrate their understanding of how a friend would physically great
another friend (e.g., handshake, hug)
6. Be able to have a minimum of 10-minute conversation with another group
member.
7. In a controlled sample situation, be able to successfully communicate wants
and/or needs to another person.
8. In a conversation, demonstrate ability to use normal social manners (e.g., eye
contact, body language).

Delivery of Service:
Assessment Process:
o Based on minimum of three sources (doctor referral, guardian observation
etc.) each client will be place into the program
o Upon arrival, clients will be assessed based on Copper Hills Youth
Centers admission criteria
o Based on criteria met, client will be placed in the appropriate program (see
scope of care)
Documentation:
o During each program, CTRS is required to make notes (mental or written)
of each clients behavior and/or actions during social skills groups
o All notes are compiled in clients file and can be referred to and changed
as necessary
Implementation:
o Social skills groups will be held once a week
o During each group, the interventions will differ
All groups will provide each client with necessary skills to achieve
all goals from each clients individualized treatment plan
Evaluation:
o Once the CTRS has documented that all goals from ITP have been met,
the client will be evaluated by the Director of Recreation Therapy for the
center.
Discharge:
o After evaluation, the CTRS and MTRS together will decide on discharge
or referral to another facility to further clients progress

Program Evaluation and Research:
The R.T. Services are interwoven into all treatment and community services provided by
CHYC. Due to this structure the evaluative responsibilities of the service are included in
program services. Patient satisfaction results are reported to the Manager of RT and
quality improvement indicators are developed when appropriate.
The R.T. Service maintains a quality improvement plan that is integrated into the total
hospital Quality Improvement Program. The RT Department also adheres to the
Infection Control and Risk Management plans of CHYC and ensures the department
contributes their specific concerns to those plans.
Advancement of the recreational therapy profession is a clear objective of the RT
Department. Ongoing research of the institutes evidence based practice is critical and an
active research agenda is established with the Copper Hills Youth Center Recreational
Therapy Program.