Positive Psychology: Bringing Attention to Child and Adolescent’s Wellbeing in an RTF Setting

Key Topics: Positive Psychology, Wellness, Welfare & Wellness, Residential Treatment Facilities

Various psychological practitioners and mental health organizations aim to promote the concepts of wellness to adults, children, and communities. Recently, the field of positive psychology has become more widely accepted, and the principle of wellness has been brought to the forefront of mental health. So much that, a numerous amount of community programs emphasizes rehabilitating families and educating them on the importance of a positive quality of life.

However, there is a disconnect when community programs or mental health organizations attempt to include wellness in a child’s treatment. The field of psychology has offered multiple domains of making this integration happen.

By including community psychology, positive psychology and child-centered psychology in a child mental health treatment, there is a higher opportunity for the child to flourish and thrive while in and out of treatment.

Positive Psychology

The field of positive psychology has opened the door for people to learn how to live a more fulfilled life and sustain positive welfare. To attest to this point, founder, Martin Seligman stated that positive psychology and wellbeing go hand in hand; wellness is a principle of positive psychology and has been suggested to provide a framework to increase health, life satisfaction, increased and promotion of creativity, and ultimately moral development (Seligman, 2011).

Defining the idea of wellness has been left to the subjectivity of a person’s experiences and their circumstances. There has been a substantial amount of historical research from pioneers like Maslow (1962) and Rogers (1961) that aim to promote the idea of people reaching their full potential and how psychology can aid in that process of self-discovery. Similar, John Dewey (1900), and Maria Jahoda (1958) also added a community component to psychology. Dewey expressed that in order to bring value to human life there should be a focus on promoting wellness in community settings. Jahoda criticized psychologist for focusing only on the mental health of a person and instead on their overall wellbeing. She explained that “the absence of mental illness is not a sufficient indicator of mental health” (1958, p.15). However, there is minimal evidence that targets the need for institutionalized wellbeing. 

Clinical psychologist, Stephen Schueller is agreeable to this distinction as he explains this in his research, “positive psychology has focused almost exclusively on the individual and ignored groups and communities. Community-based psychology offers theoretical foundations around educating and promoting adaptive functioning (Schueller, 2009).

While individualized positive psychology delves into the interpersonal relationship with a client and a therapist while building a strength-based approach to building personal happiness. Community psychologists, on the other hand, know much more about working with groups and communities to improve the quality of life (Schueller, 2009; Kelly, 1971). Both domains have done a substantial amount of positive work. Despite their similarities and differences, there have been minimal attempts to combine the two. This amalgamation could create a new basis of care for children in the mental health system. 

With little to no research surrounding institutionalized wellbeing for children, the goal of this current research is to integrate the two domains (community/ positive psychology) and construct a possible solution of how to integrate all three areas of community, positive psychology, and institutionalization of wellness in a Residential Treatment Facility (RTF) for children and youth. This research will also define what wellness is and its essential components, while offering a first-hand implementation of wellness in an RTF from the researcher. 

What is Wellness?

Wellness can be defined as a “broad state of health, including physical, mental, and social well-being and not merely the absence of disease or infirmity” (Peterson ,2006, pg. 247).

Wellness is not the absence of illness or distress but instead wellness highlights the positive characteristics and positive encounters in one’s life (strengths) (Sen, 2005; WHO, 2004). Put simply, wellness includes both livings well and doing well. Furthermore, the National Wellness Institute (NWI) incorporated a similar definition of wellness to their organization. They explained that wellness is a conscious, self-directed and evolving process of achieving full potential. It is multidimensional and holistic, encompasses mental and spiritual well-being, along with environmental well-being. Lastly, it is positive and empowers (Hettler, 2018). The NWI also created the Six-Dimensional Model of Wellness, which includes the six dimensions of wellness that can help build a holistic sense of wellness and fulfillment. Several key areas build an individual’s unique wellness profile.

  • Occupational (Financial):recognizes personal satisfaction and enrichment in one’s life through work. The premise is about one’s attitude about their work (Hettler, 2018).
  • Physical:recognizes the need for regular physical activity. People are encouraged to understand their diet, nutrition, and drug intake (Hettler, 2018).
  • Social (Environment):encourages people to contribute to their environment and community. Emphasizes interdependence between others and nature (Hettler, 2018).
  • Emotional:recognizes awareness and acceptance of one’s feelings. Focusing on the degree to which one feels positive and enthusiastic about one’s self and life (Hettler, 2018).
  • Spiritual:recognizes the search and meaning of purpose in human existence. Offering the development of a deep appreciation for depth and expanse of life and natural forces that exist (Hettler, 2018).
  • Intellectual:recognizes ones creative, stimulating mental activities (Hettler, 2018).

By applying the model as a framework for children to follow they can become more aware of the interconnectedness of each dimension. As they begin to build wellness in one area, they can notice that other areas of their lives begin to increase in positivity and can also find pleasure in what they do to better themselves.

Other Contributing Factors of Wellness

There are also factors that go into wellness that highlight different experiences while practicing wellness. For example, Peterson explained that pleasure can also be a form of wellness and combines both hedonic and eudaimonic conceptualization of well-being. Schueller agreed to this point and shared that, an individual is well when he or she experiences frequent positive emotions, evaluates his or her life as satisfying, and demonstrates an ability to function and adapt to the environment (2009). Ben-Arieh (2010) agreed to this point when he stated that children have agency in shaping their well-being, focusing on a child’s daily life and personal stories constitute an important dimension of the well-being approach, through his research on welfare and wellness. Subjective wellbeing allows for the child to be an active participant in their wellness growth.  Subjective well-being includes all areas of the six dimensions, while also including how the child interprets and evaluates their conditions around their happiness and deprivation (Ben-Arieh, 2010; Diener, 1984; Diener, Sandvik & Pavot 1991).

In conjunction with pleasure and wellbeing is the concept of flourishing. The state of flourishing, defined by Keyes (2007) is based on three indicators of a life well lived, (1) having positive emotions, (2) positive psychological health, and (3) positive social functioning. Understanding the components that make up wellness aids in understanding how wellness works individually or within a community. Irrespective of an individual’s age, size, shape, economic status, religion, and other demographic indicators, it can be understood that wellness is the cornerstone of quality of life.

A person’s view of their wellness determines how well they thrive in life.

There is a need to bring wellness to the adolescences level. Incorporating wellness at a younger age establishes a baseline of wellness for young adults to carry into adulthood.

Welfare and Wellness

As of recently, there has been more focus on a child’s wellbeing and the social indicators that promote holistic and person-centered approaches to a child’s wellbeing (Ben-Arieh et al., 2001). Prior, to this new-found wave of child development, there was a focus on a child’s welfare instead of well-being. There must be a differentiation between a child’s welfare and child’s wellbeing.

Licensed social worker Michael Adamowicz (2015) explained that welfare is a group of services designed to promote the well-being of children by ensuring safety, achieving permanency, and strengthening families to care for their children properly. Most families first become involved with the child welfare system due to a report of child maltreatment. Whereas wellbeing is, understanding and addressing child, youth, and caregiver functioning in physical, behavioral, social, emotional, and cognitive areas. Well-being should be a focus in all aspects of child welfare services reported on the Child Welfare Information Gateway site. 

The United Nations policy maker Ben-Arieh (2009) focused on the transition from welfare to wellbeing. There was preparation done to ensure that a child’s continuation of life would function well, along with educational sessions to guide families to understand and practice the importance of wellness. Ben-Arieh explained that, this process, which can be called the movement of child indicators aided in bringing wellness to the forefront of governmental support in wellness for children (2009).

The goal of child wellness has not only been catered to supporting all children but to also place the child’s future and their current state at the forefront of care. Welfare solely focuses on children who are neglected or in need of assistance, and once they have been cared for or supported, the services end. 

Implementing Wellness in an RTF Program

Children are referred to a Residential Treatment Facility (RTF) based on their intensive needs. RTF programs accept children based on how severe their behaviors are and if all other care options have been exhausted. RTF’s tend to be the last option for these children. An RTF focuses their long-term treatment on the child’s rehabilitation back into society. An RTF is another form of community psychology as it capitalizes on several critical areas of a child’s life: academic performance, prevention of mental disorder, mental health, positive behaviors, community capacity for change, empowerment, sense of community, and community involvement (Walters, 2011; Kelly 1971).

RTF’s provide a continuity of care and attempt to integrate the families in the process. However, there are concerns that RTF programs do not emphasize the child’s overall wellness. Too often, the program focuses solely on the presenting issues of why the child has been admitted into the program and fail to incorporate a whole person perspective to the child care (Thompson, Kilbane & Sanderson 2008).

To facilitate change and growth in the child, there must be a need to work with all domains of the child’s life. Including a wellness component to RTFs will allow programs and children to adopt an attitude of wellness, which will then leave the child with the belief that being well is a natural and healthy component of growing and thriving. 

RTF Program Wellness Implementation Example

A great way to introduce a whole person and wellness intervention is to incorporate positive psychology in the mission and value of companies and communities that house and treat children.

Peterson mentions that positive psychology is the scientific study of what makes life most worth living (Peterson, Park & Sweeney, 2008).

Peterson also includes that positive psychology is an approach that focuses on interventions and techniques on human thoughts, feelings, and behaviors (Seligman, M.E.P., Csikszentmihalyi, 2000). Positive psychology also focuses on the strengths of a person instead of the weaknesses. Communities and companies that do not function under a premise such as this face the consequence of lacking the accountability and structure it takes to build a culture of wellness.

All children are born into groups and communities, and without a strong foundation, they are more susceptible to negative influences. Children are vulnerable in that they are continually learning and growing within themselves. The wellness approach gives them the footing to make these decisions on their own and build their lifestyles around positive well-being. A community can help provide and instill necessities to aid this perspective. Combining RTF communities and positive psychology in order to build an institution of wellness is a difficult task initially. Nonetheless, having the right framework and plan to instill wellness can help programs get on the right track. Below, I have included an example of a wellness initiative being implemented at an RTF. Identifying information has been removed in order to keep the confidentiality of the program and participants. 

RTF programs across Pennsylvania have partnered with Community Care Behavioral Health Organization (CCBHO) to bring wellness to the forefront of residential treatment. The youth and young adult Behavioral Health Home Plus Model (BHHP) offered by CCBHO focuses not only on individual physical health but also on population wellness and mental health. 

The goal is to create a wellness culture which promotes good health and positive lifestyles by bringing together aspects of prevention, education, community, and health promotion. It also strengthens the RTFs ability to have a stronger awareness of the youth and their family’s specific health needs. It recognizes the locus of control for a healthy lifestyle within the youth and makes the RTF better equipped to assist each holistically (Wasilchak, Carney, & Schake, 2018)  

Wellness refers to the overall wellbeing of a person. It incorporates the mental, emotional, physical, occupational, and intellectual aspects of a person’s life. The BHHP model promotes health, wellness, resiliency, and coordinated care across delivery systems. The objective of the initiative is to increase the overall wellness of the residents and place emphasis on the whole person. While enhancing the community’s framework and program description. The program implements foundations to build a culture wellness in the RTF setting and train case managers, and peer specialist in wellness, so the residents can have a mentor throughout the initiative. 

Each resident is assigned a wellness coach. Each coach must be trained in wellness and have at least 16 hours of wellness training. To begin, the wellness coach and the residents will complete an initial evaluation- here coaches will gather data and learn more about the resident dimensions of wellness (social, financial, emotional, environmental, intellectual, occupational, physical, social and spiritual). After the initial session, the residents will choose an area that they deem insufficient to their lives and will create a goal to improve the area.

For 12 months the wellness coach will meet with their residents and implement techniques and interventions to work on the goal and complete a weekly progress note. Over time, goals will be achieved, and new goals will be constructed. Family engagement is a valuable asset to these residents and coaches are encouraged to include families in treatment (Wasilchak, Carney, & Schake, 2018). 

After 12 months of implementation, programs should notice that residents are more likely to ask questions about their goals, other areas of their lives and ask mentors and peers about personal wellness achievements. During home passes and family engagements, wellness along with other aspects of the treatment will be highlighted. Based on the emersion of these wellness interventions and community’s investment in wellness the children can certainly feel more in control of the different areas in their life. If the RTF values the idea of culture their residents are more likely to utilize the tools once they have discharged from the program. If the program fails to pursue the expectations, then their residents are more likely to overlook wellness once they discharge. 

Conclusion

The mental health community is a significant component for child rehabilitation. May it be rehabilitation into society or in the home it is relied on heavily. Families, communities, and programs can all utilize a wellness approach to the care of these children. Each group has a role in how to facilitate change in these children and must be open to shifting their perspectives. The approach offers a holistic framework in which the child can demonstrate an understanding of wellness and how it can enhance their quality of life while offering a framework that can be utilized by communities, and families to start implementing in their programs or daily lives.

For future research, building a program analysis on how each member in the community can function as a domain for the child can help programs feel more prepared to implement wellness. Being a wellness role model allows children to see a first-hand glance on ways to capitalize on one’s strengths and abilities that lead to more fulfilled and hopefully more meaningful life.

With Intention, Sarafina

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