Stop-Gap
About This Program
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
Program Overview
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
Logic Model
The program representative did not provide information about a Logic Model for Stop-Gap.
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.
Program Delivery
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.
Recommended Intensity:
The intervention is a model of treatment intended to produce short lengths of stay in a residential treatment environment. Three levels of intensity are described: (a) environment-based intervention is for all residents of the treatment program and is available to all upon entry; (b) discharge-related intervention occurs simultaneously with environment-based intervention and is intended to connect the child, or resident, with critical community supports; and (c) intensive intervention, including function-based assessment and support, is for those individuals requiring a greater intensity of intervention.
Recommended Duration:
Depending on the needs of the individual child, it is anticipated that the duration of service may range from 90 days to one year.
Delivery Settings
This program is typically conducted in a(n):
- Hospital
- Group or Residential Care
Homework
This program does not include a homework component.
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
Manuals and Training
Prerequisite/Minimum Provider Qualifications
- Direct care professionals should have a Bachelor's degree
- Clinical consultant should have a Master's degree (minimally)
Manual Information
There is not a manual that describes how to deliver this program.
Training Information
There is training available for this program.
Training Contact:
- Barry McCurdy, PhD, BCBA
barrymc@pcom.edu
phone: (215) 871-7128
Training Type/Location:
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
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
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(3), 137–158. https://doi.org/10.1002/bin.151
Type of Study:
Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
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 basic study design, measures, results, and notable limitations)
The purpose of the study was to describe a model of residential treatment (Stop-Gap) that is designed to serve as a ‘stop-gap’ for children and youth caught in a downward spiral of increasingly disruptive and antisocial behavior. Participants were either Stop-Gap participants or matched control groups. Measures utilized include comparative rates of therapeutic holds (a method in which one or more adults physically hold children in order to contain unsafe behaviors). Results indicate that at twelve months, the intervention residence showed a decline in therapeutic holds, while the comparison group showed an increase over the same period. 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 controlled postintervention follow-up: None.
Additional 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
- Barry McCurdy, PhD, BCBA
- Title: Clinical Professor
- Agency/Affiliation: Philadelphia College of Osteopathic Medicine
- Department: School of Professional & Applied Psychology
- Email: barrymc@pcom.edu
- Phone: (215) 871-7128
Date Research Evidence Last Reviewed by CEBC: June 2024
Date Program Content Last Reviewed by Program Staff: July 2023
Date Program Originally Loaded onto CEBC: June 2008
