JOURNAL ISSUE 16

2007/2008

 

 

Enriched Environments in Child/Adolescent
Care Setting

Martin J. Masar MSW/LCSW
YouthConnect International, P.O. Box 681
LaJunta, Colorado 81050

There is an increasing amount of literature discussing characteristics of environments that encourage and promote change. These environments can support the acquisition of positive learning, appropriate behavior and healthy emotions. This presentation examines the elements of an enriched environment, as it relates to child and adolescent mental healthcare settings. The more these settings promote the characteristics of an enriched environment, the greater the opportunity for individual growth. Healthy environments stimulate memory and learning that can lead to greater awareness, insight and subsequently more functional and adaptive behavior. An extensive literature review, individual surveys with former adolescents of a mental health care facility, and individual interviews with adults not from care settings were conducted within this study. The individual surveys and interview results supported the concepts that enriched environments build positive neuro networks, thus resulting in healthier development. The more we understand what constitutes an enriched environment within any setting, and certainly mental health care settings, the better we become at influencing healthy change for the children in our care.


“Hello John, it is great to hear from you!” This would not be the first or last call either I or the other facility staff would receive from a former resident of our psychiatric care facility. Early on it occurred to us that we should try and ask several questions of our former adolescent population. We felt these questions would help us do a better job with our current residents by learning from those residents who have already gone through and lived in our residential care system. Who better to learn from than those who have lived in and experienced it in person? As outside observers and supervisors there is a clear and definitive difference between working in an environment and living in an environment 24 hours a day. Within these environments, we know there are both formal and informal decision-making systems, problem-solving systems and a pecking order of influence and power. Independent of the amount of supervision by mental health staff, this undercurrent system exists in every residential care system. No environment is free from the covert power of this undercurrent system which has existed for hundreds of years.


So, what can professionals and care givers in mental health systems do to positively influence the environment of those entrusted to us?


As a mental healthcare facility, we have completed outcome studies for many years. This data dates back to 1987, and involves surveys with over 500 individual youths. Our surveys, then and now, focused on those youth who, successfully or unsuccessfully, had left our system of care. While we also surveyed current residents over the past 20 years, we painstakingly contacted our former youths. Blending the survey results allowed us to evaluate what our current and former customers thought of our services and care. This was not always a pleasant task. At times, it placed before us some very difficult and challenging lessons and decisions. Day to day, we prided ourselves in delivering and insuring quality care in a safe and healthy environment. Yet, we listened to those who live and have lived in that same environment as the evaluators of its effectiveness. Sometimes surprisingly and at other times knowingly, we swallowed our pride to look at ourselves and our system. Thereafter, we implemented changes in response to our most experienced evaluators.


After gathering, analyzing and assessing the data from our outcome studies, we then began an exhaustive literature search of elements and characteristics of healthy or growth producing environments, called “enriched environments” within the neuroscience literature (Diamond & Hopson, 1999). Not unexpectedly, 20 years ago little published information was available regarding enriched environments. However, in the past 3 to 10 years an increasing amount of literature has been published. While the bulk of the literature has evaluated and reviewed environments using laboratory experiments, much can be learned from the literature and outcomes of the scientific studies. I would not suggest that the human lives entrusted to our care should be equated to laboratory experiments; rather, that if similar conditions were present in human care settings, enriched environments, we might be promoting conditions that influence healthy change. Finally, as the youth survey data was analyzed, we separated out those elements that our residents reported were most effective environmentally and combined them with the health and growth characteristics from our literature search.


As a final piece to this study, informal interviews were conducted with older adults not from our care system. In these interviews we sought to determine if there was a relationship or similarity between the results of the youth interviews, the literature review and the adults’ personal experiences of learning environments. The adult survey sample was composed of individuals over the age of 58. There was no scientific determination of the adult age group, rather, and most simply, it was the most readily available adult population willing to be interviewed.


The youth surveys have changed in content over the past 20 years. What we feel is important has changed with time. Our first task was to discern within the data any commonalities and similar concepts in the questions asked. We were also able to rely on the data from the past 10 years where the questions remained relatively similar. The surveys themselves, at least from the past 10 years, were conducted using a neutral assistant. We felt an individual with no experience or emotional connectedness to our system of care would provide for us with the most objective data. In addition, the neutral assistant sought secondary source verification when available. This way we had two sources answering the same questions about the youth. The youth surveys are completed annually, and usually take 6 to 8 weeks to complete. As mentioned earlier, we survey both current residents and past residents. The survey data represented over 500 individual interviews. The average length of stay within our facility was 14.5 months. As a facility that treats youth from across the nation, the youth surveyed represented eight different states and over 70 cities/towns from across the nation. Approximately 35% represented rural areas and the remaining 65% were from communities with populations of 90,000 or more. The average age was 22 years, with the upper end age group at 28 and the lower end group at 12. The average time away from the facility or after being discharged from our care was 34.5 months. Among all the survey questions asked about our service systems, the following were identified for this study:

  • What did you like best about our facility?
  • What did you not like about our facility?
  • What do you think helped you the most? Why?
  • What do you feel helped you in your treatment unit?
  • What was the worst thing(s) about your treatment unit?

We analyzed the survey results for common themes and problems. A summary of the survey results indicated the following:

  • What did you like best about our facility?

Survey results: The answers here varied from individual to individual. Some liked their therapist the best; others liked their teacher or childcare staff. Some talked about a particular class or activity they enjoyed. Despite the individualized answers, we began to see that interactive, relationship-driven activities were meaningful to our youths, and were the most remembered.

  • What did you not like about our facility?

Survey results: The answers here took on a significant similarity. The most disliked aspect of our program was the restrictive techniques we, unfortunately, needed to utilize in the event of a dangerous situation. The youths were clear in their differentiation between appropriate limit setting and the more intensive restrictive techniques. When asked if experiencing the restrictive techniques was helpful later on in their lives, the answer was essentially the same; as one young man put it, “I hated it then and I hate it now.” Other disliked variables included not feeling safe, not feeling cared for, and negative peer influence (usually reported as covert).

  • What do you think helped you the most? Why?

Survey results: Here we were looking for something we were doing that the youth felt positively impacted them. This answer has not changed in 20 years of survey results – relationships. When asked this question during a recent phone interview, one youth answered, “You!” When I asked why he felt our relationships meant so much, he answered, “It was you I carried in my memory all these years, it helped me when I needed it most – you were always there.”


Now within that “You” is much more than just a good friend. It is a complex understanding by trained professionals about the varied and interactive, developmental, emotional, maturation, motivational, cognitive and a host of other mental health variables influencing and affecting the youth.

  • What do you feel helped you in your treatment unit?

Survey results: Here we were looking for environmental aspects reported to promote lasting, healthy and permanent change in the individual. Relationships with the care staff were, of course, mentioned. In addition, survey results also indicated a feeling of being safe, a lot of interaction with the staff, interactive games played with staff, challenges to learn and do better, “generally” good food, rest/sleep, praise and positive feedback, choices and role models.

  • What was the worst thing(s) about your treatment unit?

Survey results: The consensus answers here were not about the physical structure of the living unit, such as the material of the walls, the indoor - outdoor carpet, the amount and number of flowers outside, the color of paint, or even the amount of floor space. The consensus answer reflected times when the youth felt alone, fearful, isolated and uncared for. Times when, despite constant supervision and everything that was fancy, ultramodern and brand-new within the living units, the youth still felt alone.


As the data from youth surveys was being analyzed, we turned our attention to the literature search for enriched environments. A wealth of information has been published which has studied or commented on the characteristics of healthy or growth promoting environments. Marian Diamond and Janet Hopson (1999, 2006 a & b), Marilee Sprenger (1999), Daniel Amen (2006), Louis Cozolino (2002), and Daniel Siegel (1999) are a few authors who have published on healthy or growth-promoting environments, referenced as enriched environments. Louis Cozolino (2002) characterizes an enriched environment as one that promotes “a level of stimulation and complexity that enhances learning and growth”. Marilee Sprenger (1999) draws a number of conclusions about enriched environments. She comments that they include “social interactions, care, challenge and play” (Sprenger, 1999). We know the brain or the way a person thinks changes to reflect the influences of his or her environment. These influences or elements can have a significant positive or negative affect on the individual. I was reminded in a web-based article, by Ashish Ranpura (2006), that while much is known about the influences of an enriched environment “under laboratory conditions”, correlation does not mean causation. Yet, he notes that we know that children who are exposed to enriched environments and varied education early in life develop a great capacity for learning throughout life. Furthermore real learning, not just rote exercise, can have a dramatic influence on the physical structure of the brain (Ranpura, 2006).


The advanced research of Marian Diamond and Janet Hopson (1999) and studies from Josh Trachtenberg, Brain Chen, and Karel Svoboda (2002) have lead to a new awareness of environmental characteristics that promote healthy brain development and growth. The research exposed laboratory animals to different environmental elements. This shifted from the lack of social interaction, lack of care, poor nutrition, no challenge or stimulation and lack of physical exercise to environments with plenty of social interaction, appropriate care/touch, a healthy diet, intellectual challenges and physical exercise. They used a variety of techniques to monitor brain development and growth, including a photon laser scanning microscope. Svoboda (2002) summarized the results of their research on the affects or influences of an enriched environment indicating “a pronounced increase in the rate of birth and death of the synapses… there’s a pronounced rewiring of synaptic circuitry, with the formation of new synapses [within enriched environments]” (Svoboda, 2002, p. 2). These studies confirmed the significant and rapid “neural growth” taking place within enriched environments (Wylie & Simon, 2005). The growth and development of new brain connections, synapses and dendrites, are associated with learning and memory (Cozolino, 2002; Sprenger, 1999; Howard, 2000). Whether a classroom, home, therapist’s office or institution caring for children; the acquisition of new learning and memory are essential to both intellectual growth and behavioral change.


Examining the characteristics of an enriched environment involved comparing the identified similar environmental characteristics from the various studies. These elements or characteristics included challenging educational and experiential opportunities that encouraged the learning of new skills and expanding knowledge. Education, practicing skills and interactive engagement in mental activities also correlate with healthy growth and development (Beaulieu, 2006). Compiling the most common themes from the research-based literature, we developed the following list of elements that appear to influence health and growth in enriched environments:

  • Nutrition = eating well-balanced meals
  • Repetition = reminders and exercises that lead to memory retention
  • Interaction = verbal, social and engaging interactions/conversations with others
  • Challenging = not overly stressful, but stimulating, and limit-setting
  • Care = human touch, emotion
  • Learning = games, dialogue, motivation, and participation.
  • Restful = a good night’s sleep is invaluable to body regeneration.
  • Exercise = physical activity
  • Praise and Positive feedback = this is essential for corrective learning
  • Safety = a sense of feeling safe or the absence of threat to self
  • Choices = opportunities to choose from
  • Role Modeling = demonstration of healthy behaviors and emotions
  • Laughter = though not as clearly defined within the research, laughter promotes powerful interpersonal awareness, a healthy release of body chemicals and engages others in interactive dialogue.

We then turned our attention to literature where the enriched environment characteristics were not present. Obviously, the absence of the enriched environment elements promoted less learning and did at times stop all learning. The literature is fairly well-documented in regards to environments that were unhealthy and not growth-promoting. Imagine poor nutrition, the continued presence of fear, overwhelming daily stress, and limitation to poor interactions with others. We can clearly see why such environments would not be health-promoting. Finally, as our literature search unfolded and volumes of data were analyzed, an interesting phenomenon emerged. Enriched environments should never be assumed to be rich or wealthy environments. Fancy, new age, modern and highly stylized architecture does not promote an enriched environment. None of the elements identified as being part of an enriched environment include modern conveniences or new-age design; rather they include, at the very least, interactive elements that a potential learning environment can assimilate, replicate and demonstrate.


As we began to merge the results of the above two studies, similarities surfaced. We learned from the studies with our youths the characteristics, elements and seemingly most profound memories that the youths identified as being the most influential in their lives’ journeys. We found these elements were similar to the elements identified within the literature.


We learned that an environment can also have a significant deleterious affect on the youth. To conclude that the enriched environment alone is responsible for all change would be erroneous and misleading. For example, in the phone call noted above the young man described his relationship with me as a profound influence in his life. Cozolino (2002) describes it as “empathic attunement”, a “process involved in attachment and bonding” (62). More than just being a good friend or companion, the process of empathic attunement involves the complex understanding of human psychology. In combination with an enriched environment, it is a therapeutic engagement process designed to elicit an emotional response, cognitive awareness, physiological sensation and behavioral correction. Cozolino (2002) also points out that the therapist’s office can become an enriched environment, promoting healthy elements in a therapeutic exchange. Therefore, while an enriched environment becomes a catalyst for growth, the caregiver, therapist, parent, or teacher are the necessary agents of change who assimilate the growth opportunity and potential into cognitive awareness. Learning and memory are the effects of cognitive awareness.


In the final stages of this study, we conducted informal interviews with various adults. We sought to determine from their perspective and lifelong memories which environmental factors they felt influenced their lives in a healthy and productive manner. Not surprisingly, they all referenced an emotional connection – empathic attunement – with a significant other, in a seemingly enriched environment. These persons ranged from parents, grandparents, teachers and therapists to friends. The environments where these individuals reported their most profound learning were most often described as safe, caring, and interactive. One elderly lady explained it best:


Oh that would have been my grandfather’s home. He was such a kind and gentle man. I remember sitting around the kitchen table, in that old house with brightly colored wallpaper and those old linoleum floors – you know, that kind of house where the screened door slammed each time we went out to play. Granddad would sit back and tell us kids all about his life and the things he learned along the way. I think we would sit for the longest time and listen to him. Our imaginations would run wild as he wove stories of learning and life – I remember it still to this day.


She retained the valuable messages her grandparent gave her, within what might characteristically be called an enriched environment.


This study has been in development for several years, and while it is a far cry from pure scientific research and methodology, it nonetheless has given us great insight. Examining 20 years of youth survey data and the literature search results, we have been able to make some definite conclusions. We have thought about a host of other measures we might perform and include in our future data analysis. We might redefine the questions and seek greater specifics. We might identify a control group and perform the same analysis and we might give more attention to the actual physical characteristics of an enriched environment. Yet in the end, the study was extremely helpful. The more we understand what constitutes an enriched environment within any setting, and certainly within mental healthcare settings, the better we become at influencing healthy change for the children in our care. We know today that enriched environments are essential if we are to help children along in their individual life’s journey; and who better to ask about a healthy learning and growth producing environment than the children themselves.


In summary, I have once again identified those enriched environment characteristics that serve a positive function in promoting healthy change. They include:

  • Personal instruction by parents or caregivers
  • Supportive and caring human interaction
  • A personal feeling of safety
  • Love, nurturance and acceptance
  • Not feeling alone - attention
  • Cleanliness or healthfulness
  • Balanced nutrition
  • Exercise
  • Laughter – positive emotion
  • Positive role modeling
  • Educational opportunities
  • Challenges/reasonable obstacles/problem-solving and choice
  • Limits
  • Opportunities in the form of creativity and imagination

An enriched environment cannot be brought – it is created. An enriched environment is often felt – long before it is seen.


References


Amen, D. (2006). Making a good brain great. Arizona conference presentation.


Beaulieu, D. (2006). Impact techniques: Applying our knowledge of human memory systems to psychotherapy. From http://www.americanpsychotherapy.com


Cozolino, L.J. (2002). The neuroscience of psychotherapy. New York: W.W. Norton Company.


Diamond, M.C. (2006a). Response of the brain to enrichment. From http://www.newhorizons.org/neuro/diamond_brain_response.htm


Diamond, M.C. (2006b). What are the determinants of children’s academic successes and difficulties? From http://www.newhorizons.org/neuro/diamond_determinants.htm


Diamond, M.C., & Hopson, J. (2006). Characteristics of an enriched environment. From http://www.newhorizons.org/lifelong/childhood/diamond_characteristics.htm


Diamond, M.., & Hopson, J. (1999). Magic trees of the mind. New York: The Penguin Group.


Howard, P.J. (2000). The owner’s manual for the brain. 2nd ed. Marietta, GA: Bard Press.


Ranpura, A. (2006). Weightlifting for the mind: Enriched environments and cortical plasticity. From http://www.brainconnection.com/topics


Siegel, D.J. (1999). The developing mind. New York: The Guilford Press.


Sprenger, M (1999). Learning and memory: The brain in action. Alexandria, VA: Association for Supervision and Curriculum Development.


Trachtenberg, J., Chen, B., & Svoboda, K. (2002). A new window to view how experiences rewire the brain. From http://www.newhorizons.org/neuro/hhmi.htm


Wylie, M.S., & Simon, R. (2005). How the neuroscience revolution can change your practice. Psychotherapy Networker. From http://www.psychotherapynetworker.org

 

 

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