Working with programmed activities in a child psychiatric inpatient unit

In the past 18 months we have noticed that the deaf children in our care (n=10)all with psychiatric problems, have an extremely high need for structure, safety and order, enabling them to make sense of the (hearing)world around them.

Experience has shown us that deaf children who have been in our care, mainly function within the first two phases as described by Winnicott in his model : the containment and the structuring phase.

This means that specific demands are required for the content and the organisation of the treament.

The communication competence of these children are in certain areas of a very low level. This has consequencies for their social, emotional and intellectual development in communicating about feeling and emotions.

We have noticed that the children in our care seem to construct the world around them through factual behavioural features. They only seem to pay significance to what they observe in concrete behaviour. More abstract meanings (visually unclear and not directly connected to the presented behaviour)appear to be difficult to relate to for these childen.

Therefore, they often have a different perception of reality. Besides this, partly also due to their psychiatric background, we often encounter a distorted perception of time and space.

Based on the observation as mentioned above we find that these children have a great need to be involved in activities. To be doing something is often easier for them than talking about something. They need to express themselves in concrete activities.

In the process of developing this inpatient unit of Curium, we have come to conclude that for the treatment of this group of severely disturbed children, we need to impose heavy demands on the basic structure of the group climate (containment). Children are encouraged, with a larger or lesser amount of help of groupworkers, to think about feeling, solutions for problems and possible consequences of their behaviour.

We often encounter children with problems in their perception of space. For this reason we have divided the unit in coloured areas. This means that the child knows what he/she can do where in the unit. In the time structuring we place a lot of importance on so-called transitional situations.

As previously mentioned, working with programmed activities in the group is one of the foundations of our methodology. It offers possibilities for position choice (little / a lot of interventions), disentanglement and ordering their emotional lives.