All students at Little Keswick School are supported in their efforts by an experienced and well-qualified clinical team.  The Director of Psychological Services, who provides administrative coordination for clinical services and staff training, is joined by the Consulting Child Psychiatrist and Clinical Psychologist in providing consultation to academic and residential staff, as well as individual, group, and family psychotherapies.  Upon enrollment, Child Psychiatric treatment is assumed by the Consulting Child Psychiatrist.  These services are coordinated with related services (Speech/Communication Skills, Occupational Therapy, and Art Therapy) as indicated by the student’s individualized education/service plan.  Together these components inform and support the relationship-based behavior management program, the core element of social, emotional, and behavioral change in the Little Keswick School program.

Relationship-Based Behavior Management Program

We have found that the only real antidote for a history of struggles and failures is the experience of sustained success.  At Little Keswick, careful selection of appropriate challenges and the development of effective strategies provide constant opportunities for new successes.  The behavior management system sustains student awareness of specific goals, organizes goal-directed behavior, and illuminates clear pathways to success.   Developmentally-graded level criteria create a template for more generalized gains.  Choice theory, integrated throughout the program, teaches students to generate acceptable alternative behaviors, as opposed to developing compliance without self-management and personal responsibility.  Formalized and consistent practice of dignity and respect encourages the development of a strong sense of personal influence and self-esteem.

The major elements of the Relationship-Based Behavior Management Program are the point sheet, the level system, and most importantly, the therapeutic environment.  The therapeutic environment is engineered to provide a continuous stream of support and guidance, and constant opportunities for positive practice.  This allows boys who do not typically respond to contingency-based programs (pure behavioral approaches) to practice until success becomes a habit.  Natural drives for competency and acknowledgment support strong motivation if tasks are selected appropriately.  While incentives and contingencies are employed, shaping of behaviors, thoughts, and emotions through relationships is our primary tool to support growth. 

The point sheet is an instrument that facilitates communication of feedback and helps sustain a student’s focus on his goals.  Every forty-five minutes, the student is asked to consider his performance and make necessary adjustments or prepare for success in the coming activities.  Point sheet goals are identified collaboratively by the student and his Advisory Team.  Success then can be measured by attainable goals, which supports a strong self-concept. 

Our level system defines success at points corresponding to progressive developmental plateaus of social and behavioral functioning.  Privileges and responsibilities both increase as each student establishes greater stability, organization, and specific skills.  Students experience success as “level one,” “level two,” and so forth, without an all-or-none definition of either success or failure. 

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Individual Therapy

All students who attend Little Keswick School are seeking support in various areas of social, emotional, behavioral, or cognitive functioning, and require individual psychotherapy on a weekly basis.  At times, clinical need dictates more than one session per week for specific students.  The role of individual therapy is to develop a strong working relationship with the student, identify potentially effective interventions, and develop an understanding of the student with which to guide interventions throughout the program.  Individual therapy is provided by the Director of Psychological Services, the Clinical Psychologist, and the Consulting Child Psychiatrist.  

The assigned therapist, parents, and student all collaborate to identify appropriate initial and ongoing goals.  These goals are incorporated into the student’s IEP/ISP and become the template for our therapeutic contract.  Often during the course of treatment, students’ diagnoses, goals, and foci change.  To maintain coordinated efforts, the student and his family as well as the psychotherapist must communicate effectively and be open to evolving pictures of the student.

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Group Therapy

Group therapy is a primary avenue for work on important social and relationship goals.  The Director of Psychological Services and the Clinical Psychologist capitalize on the benefits of providing social interventions in context by leading weekly group sessions during dorm meeting time.  Themes addressed in these meetings are then repeated throughout the week, with dorm staff facilitating sessions.  Joining and belonging, community support, social relating, and social responsibility are major areas addressed.  Typical group curriculum consists of a balance of didactic and experiential agendas.  Often experiential activities drive a point home more effectively for our young men than spending the entire time sitting and talking.  However, specific rituals of social interaction, such as giving and receiving honest feedback, provide a reference point for the development of positive relationships.   Many of our students also benefit from direct instruction and positive practice on social skills that require accurate perception, reciprocity, and social initiative. 

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Family Therapy

Family therapy at Little Keswick School is both intensive and comprehensive.  Since our inception, we have not only welcomed involvement of parents, we have required it.    Without the full support of his family, and the knowledge that he continues to be an important part of that family, the student cannot grow and shape the person he needs to become.  Even if significant gains could be realized without also preparing a strong holding environment at home, progress would not be maintained at home and in his community after a student transitions out of Little Keswick School.  We also believe that people become who they are within the context of their families, making it important to support all aspects of the family relationship.  Parents of Little Keswick School students courageously look at themselves, their relationship, and old patterns of interacting, as well as re-examine their approach to parenting, in the effort to exploit all avenues of support for their son. 

Family therapy usually involves three types of interactions.  The first is support for the student within the program.  When parents know what is involved with a petition for the next level, or what the requirements are to earn the “Respect Award,” they can truly appreciate and support their son’s work.  With their son in the 24-hour care of professionals, parents are afforded the luxury to shift into a less confrontational role and become consultants and advisors.  The second area of family work involves improving the dynamics at home that currently may not result in optimal interactions between members.  Finally, through scheduled family sessions and structured breaks, skills learned at Little Keswick School are practiced in the home environment so that gains can be realized and sustained there as well.  

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Medication Management

The School’s Consulting Child Psychiatrist participates as a team member, along with the parent(s),
the child, and the school staff to support the student’s efforts when positive change cannot be effected through the behavioral program alone. Living in a residential environment allows a comprehensive perspective to be established with regard to the benefit of medication. Data is obtained from the school staff, the child, and the parent(s) detailing both short and long-term
effects of medication on behavior, mood, attention, sleep, and eating habits. Effects are evaluated continuously, and all team members are kept informed of medication and treatment plan changes.

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Related Services

• COMMUNICATION SKILLS / SPEECH THERAPY
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• OCCUPATIONAL THERAPY
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• ART THERAPY

Communication Skills/Speech Therapy

The Communication Skills/Speech Therapy Program at Little Keswick School teaches students how to be effective and appropriate communicators.  Through direct instruction, role-playing, observation, and discussion, students learn how and why specific social language guidelines can improve interpersonal relationships in all aspects of life.  Competent social language skills are as important as reading skills for success in today’s world.  Most students develop adequate social language skills as part of natural maturation through imitation, trial and error, and general recognition of what makes the world work well for them, yet some students need direct instruction and supportive training to acquire effective social language skills. 

The Communication Skills Curriculum teaches students to:

• Use appropriate nonverbal body language during conversations with peers and adults
• Use appropriate verbal styles during conversations with peers and adults
• Use appropriate turn-taking skills during conversations with peers and adults
• Interpret nonverbal signals of the listener
• Get attention appropriately
• Adjust communication style to the listener and the situation
• Give and receive compliments
• Use appropriate communication for expressing disagreement
• Use appropriate jokes, sarcasm, and humor
• Use politeness markers such as “please” and “thank you.”

At Little Keswick we offer two service delivery models to meet the needs of our students:

Individual / Integrated - This model combines one individual session per week and one small group session within the academic classroom setting. Communication goals addressed in the individual sessions are incorporated into the integrated classroom sessions.

Communication Skills Group / Integrated - Students meet for a weekly communications skills group during lunch or breakfast. Goals are also addressed through a weekly small group integrated into the academic classroom setting.

The communication skills program is a core component of treatment at Little Keswick School. Because the social and neurological processes involved in successful communication are central to the academic, relational, and individual well-being of all of our students, these services are integrated throughout the program and they are specified on each student's IEP/ISP. Initial screening determines whether the student receives intensive one-to-one work, or is assigned only to group interventions.

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Occupational Therapy

Occupational Therapy at Little Keswick School is individualized therapy that promotes “skills for the job of living.”  As students, the boys need:

• To regulate their attention and emotions
• Trunk stability to sit and learn
• Fine motor skills and perceptual skills to write, type, and do projects with their hands
• Gross motor skills to run, jump, throw, kick
• Motor planning ability to automatically know how hard to press when writing, to have the timing to run to a soccer ball and kick it, to move food around in their mouth to chew adequately and eat neatly
• The ability to cross their midline with their eyes, arms, and legs in order to read, write, and do sports
• The ability to accurately process sensory information and screen out unnecessary information (sensory defensiveness)
• To know how to manage their stress and modulate their anxiety with relaxation techniques
• Age-appropriate social skills.

Sensory integration and a variety of O.T. techniques are used to promote an adequate neurological foundation for the development of these skills.  Stress Management/Relaxation group sessions are offered, which include techniques and practice to be aware of one’s level of attention, emotion, and stress, and ways to manage them in everyday life.  Occupational Therapy is intertwined in the program at LKS.

Occupational Therapy at LKS provides evaluation, individual treatment, small group treatment, observation in the classroom and other activities, consultation with other staff, and staff education.  Identified students have individual programs that usually include two 45-minute individual sessions per week, and one group Stress Management/Relaxation class per week.  Students that benefit from O.T. are those with developmental disabilities, learning disabilities, ADHD, sensory processing disorders, dysgraphia, sensory defensiveness, Tourettes Syndrome, affective disorders, OCD, and others.

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Art Therapy

Art Therapy provides a means by which students may explore feelings, increase awareness of self and others, enhance cognitive abilities, and enjoy the pleasure of making art in non-verbal and socially acceptable forms.  Images become a metaphor for the individual’s understanding of his situation or reality, allowing for discharge of feelings, conflicts, fears, and concerns, and allowing for dialogue at a symbolic level.  Art becomes an extension of the child, which can be used to support, to value, to empower, and to give the child a voice.  The process of the session may be structured or open-ended, depending on the interest or goal of the child.  Some choose to engage in long-term projects, whereas others create a product in one session.  The student may verbally discuss his artwork or he may work quietly.  Referral for Art Therapy may include an interest in art, an interview, and/or a screening process.  Students do not have to be artistically inclined, but may have an interest in expressing themselves creatively, which is helpful for students who have difficulty with verbal expression.  Art Therapy usually meets one time a week for a 45-minute session, although it can be more frequent. With the student's permission, the art process and artwork is often shared with the treatment team.

A variety of materials are presented to the student, such as pencil, colored pencils, oil and chalk pastels, markers, watercolor and acrylic paints, and three-dimensional materials such as clay, plaster, sculpey, and craft items.  Another avenue for self expression includes the sandtray, which uses miniature figures for the student to make a picture in the sand and then to tell a story.  This allows him to set up a world to explore the inner conflict, fears, strength, and emotions in a symbolic form, in a safe, protected, accepting environment. 

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