Role of the Environment in Prevention and Remediation

Abstract

The environment, broadly defined, has long concerned clinicians who work with children and families because it impacts prevention and intervention with problems and disor-ders. In this chapter, we specifically define " environment " as the organization of the individual's immediate setting in terms of space, time, materials, activities, and people, variables that have received scant attention in the child clinical literature. Operant behavioral and ecological developmental perspectives are presented to describe the processes by which these variables can affect behavior and development, and their relationship to the more distal surroundings of community and culture. Next, we present illustrative research from behavior modification and related literatures which demonstrates that architectural features, spatial divisions, and fur-nishings; objects, materials, and activities; routines and schedules; and the presence, character-istics, and location of people, affect engagement and modify a wide range of behavior in community settings and homes. Professional psychologists should appreciate the role of the immediate environment in shaping behavior, alone and in conjunction with contingency man-agement and other therapies. They should recognize when a setting must be modified because it is promoting problem behavior or hindering the therapeutic process, and be able to imple-ment changes in the organization of space, time, materials, activities, and people. Changes in the setting may also be effective components of individualized treatment programs, and may be essential for the generalization of treatment effects. Although modifications to the environ-ment cannot usually substitute for contingency management or other therapeutic strategies, they are essential adjuncts and supports to the clinical process, and can contribute to the pre-vention of dysfunctional and problem behavior. 20.1 Overview Behavioral, cognitive-behavioral, operant, and other learning-based therapies are used to address a wide range of childhood problems and disorders including anxiety, depression, con-duct disorder, social skill deficits, school refusal, enuresis, sleep disorders, tics, learning dis-abilities, and developmental disabilities. In most cases, family members are an essential aspect of the treatment program, or the main focus of treatment as in child abuse and neglect. Teachers and staff who interact with the child in community settings may also participate and, in some cases, are the primary means by which treatment is delivered. The therapeutic process typically involves a planned sequence of interactions and a pro-gression of treatment steps directed toward modifying behavior, feelings, and cognitions to ameliorate the presenting problem and to achieve more optimal functioning in everyday life (e.g., Kazdin & Weisz, 2003). Treatment follows the assessment and case conceptualization, and is corrected based on the measurement of progress (e.g., Freeman & Miller, 2002). It can involve didactic instruction, homework, video presentations, and simulations, as well as verbal