Insights

For decades, point and level (P&L) systems have been a mainstay of youth residential treatment programs. These systems promise structure and accountability—but at what cost? As our understanding of trauma deepens, so does our responsibility to reexamine practices that may unintentionally harm the very youth they are designed to help.

Recent research and real-world experience suggest that it's not only possible to move away from traditional P&L systems—it may actually be essential.

Why the Point and Level System Falls Short

Point and level systems rely on behaviorist principles of reward and punishment. Youth earn points for compliance and lose them for noncompliance. These points translate into “levels” that determine access to privileges like social time, outings, or family visits. In theory, the model promotes accountability and motivates behavior change.

But according to the Association of Children’s Residential Centers (ACRC), universally applied P&L systems are inconsistent with trauma-informed care and can exacerbate dysregulation, fuel power struggles, and leave youth unprepared to navigate life outside the rigid structure of a facility. In 2019, the ACRC urged programs to eliminate universal P&L systems altogether.

A Case Study in Change: The Village Network

The Village Network, a behavioral health organization in Ohio, took that call seriously. In a multi-year process detailed in a 2023 case study published in Residential Treatment for Children & Youth, the organization successfully de-implemented its P&L system across three residential campuses. In its place, they implemented the Neurosequential Model of Therapeutics (NMT) and Collaborative Problem Solving^® (CPS)—two approaches that prioritize understanding, relationship-building, and skill development over control and compliance. With ongoing support from Think:Kids to implement CPS, The Village Network was able to shift the mindsets and practices of their direct care staff in a sustainable way.

“We feel more like helping professionals and less like jailers,” shared one staff member, reflecting on the transformation that occurred when youth were no longer managed through point deductions and loss of privileges.

What Changed? Everything.

Through staff training, leadership engagement, and a gradual transition, The Village Network shifted from a system that punished skill deficits to one that addressed them. Instead of saying “Daren refused to make his bed,” shift reports began to say, “Daren didn’t make his bed. He struggled to manage anxiety about his home visit.”

Staff began using CPS “Plan B” conversations to collaboratively solve problems with youth—fostering connection, autonomy, and emotional growth. Importantly, this shift didn’t compromise safety. On the contrary, data from The Village Network showed significant reductions in both physical restraints and critical incidents after the point system was removed.

From Compliance to Collaboration

In interviews, leadership at The Village Network emphasized that moving away from a P&L system wasn’t about reducing structure or expectations—it was about how those expectations were pursued. CPS helped staff maintain accountability in a way that respected youth voice, fostered empathy, and built lasting skills.

“We used to ask, ‘What do we do to this kid to make him behave?’ Now we ask, ‘Why is this kid struggling to meet expectations, and how can we help?’”
—Jerry Hartman, Director of Program Development & Fidelity for Residential Services, The Village Network

“The youth … see the staff as a source of support and problem-solving, rather than rule enforcers … there’s just a deeper level of engagement.”
—David Paxton, LISW-S, Chief Clinical Officer, The Village Network

Together, these quotes reflect a culture shift—from controlling behavior to understanding it, and from enforcing rules to building relationships. It’s a change that doesn’t just reduce incidents—it changes lives.

Why This Matters Now

The takeaway is clear: you don’t have to choose between safety and trauma-informed care. In fact, you might not get one without the other. Systems that rely on rewards and punishments often miss the deeper, developmental needs of youth who have experienced chronic stress and adversity.

“These kids don’t lack the will to behave well. They struggle with the skills necessary to manage their behavior. Relying on systems of power and control to try to change behavior not only doesn’t build these skills, it can actually cause developmental damage by adding stress and interfering with skill development.”
—Dr. Stuart Ablon, Director, Think:Kids, Massachusetts General Hospital

Trauma-informed, neurodevelopmentally sensitive approaches like CPS and NMT offer a viable—and research-backed—alternative to P&L systems that don’t rely on power and control and instead leverage the power of therapeutic relationships.

Ready to Make the Shift?

If your organization is considering moving away from a point and level system—or you’re simply looking to implement more effective, compassionate, and sustainable behavior support practices—we’d love to talk.

At Think:Kids, we specialize in helping organizations implement Collaborative Problem Solving in a way that sticks. It’s not always easy to change long-held systems, but with the right support, it is possible—and worth it.

Contact us to explore how Collaborative Problem Solving can work for your program.