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De-Implementing a Point and Level System in Youth Residential Care without Increased Safety Risk: A Case Study

Samantha J. Stoll, Jerry D. Hartman, David Paxton, Lu Wang, J. Stuart Ablon, Bruce D. Perry & Alisha R. Pollastri

Point-and-Level (P&L) systems are commonly used for behavior management and modification in youth residential treatment centers. In 2019, the Association of Children’s Residential Centers (ACRC) released a position paper urging youth residential programs to abolish prescriptive, universally applied point-and-level systems because they are inconsistent with the principles of trauma-sensitive care and can be counterproductive to treatment. Despite this, few residential agencies have executed this change, possibly due to the complexities of dismantling long-held practices, concerns about youth safety, and lack of knowledge about other trauma-sensitive approaches.

In this case study, we describe how The Village Network de-implemented its universal point-and-level system across three residential campuses, replacing it with the Neurosequential Model of Therapeutics (NMT) and Collaborative Problem Solving® (CPS). An analysis of administrative data before and after removing the point-and-level system suggests no evidence of increased safety risk for youth or staff. We discuss the agency’s strategies for de-implementation and the determinants that helped and hindered the process and provide recommendations for other residential agencies seeking to make this change.

This is the first detailed account of the process that can be used to de-implement a point-and-level system in youth residential treatment, which we hope will inspire others to begin engaging in the process of replacing points-and-levels with more trauma-informed practices to understand and address challenging behaviors in residential care.

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