It makes sense, given the range in popular opinion about children and media (music, video games, social media, television and movies), that there would be differences of opinion about these in the psychiatric residential treatment (PRT) setting. Grafton’s PRT in Berryville tends to take a fairly restrictive approach that is directed by therapeutic professionals. For example, clients are not allowed to access social media, have limited use of sports-centered and nonviolent video games, and watch minimal television and movies that are monitored for sexual, profane and violent content. But do these restrictions make sense given the clients will return to a community and environment where these medium will be widely accessible?
The vast majority of children entering psychiatric residential treatment have experienced trauma including complex trauma that has the potential to significantly delay development. As well noted by the Sanctuary Model,to address the emotional injuries, rather than “controlled chaos” the planned environment is a central part of the treatment and involves emotional education through social learning concepts, group dynamics, and nonviolence.
It would not make sense for the electronic input to directly contradict the emotional education, even through storylines (narratives) that may be similar to those in their personal trauma experiences. For this reason, the treatment team provides input on the types of media that may be especially harmful the child. The “re-sensitization” to violence or sexual content, and labeling of emotions related to the past experiences, is a central part of trauma-informed care. By restricting the media input, we are best able to accomplish this goal.
Risk vs. benefit
Given the trauma framework, it is important for television, movies, video games and social media to not be just “not harmful” but beneficial. Best practice recommendations include assessing the nature of past media exposure including musical preferences, the nature of toys, violence in video games, movies and TV shows (Pennsylvania Mental Health Treatment Guidelines). The American Academy of Pediatrics recommends the “mindful use of media” and emphasizes conversations about online citizenship and safety and balance with active time. As long as the media are thoughtfully selected and unexpected trauma responses addressed, television and movies, and even some video games, can be a positive part of residential treatment.
What about social media?
Adolescents are more than ever focused on social media to engage with their peers, with a variety of negative effects noted in early research. These may include problematic social comparisons, exposure to bullying, and skewed impressions of “normality”, as well as difficulty engaging face-to-face and an increased sense of loneliness. It is important to openly discuss these risks with caregivers. There are those that feel that the use of monitored social media during home visits is acceptable. It is vitally important that social media usage be not only monitored but limited and processed with children and adolescents. This is clearly an issue and area that warrants further and ongoing discussion.
Engagement of the family
The American Academy of Pediatrics identifies clear recommendations for media use among school-aged children and adolescents. These emphasize the use of a Family Media Use Plan that the family owns and incorporates the patterns and identifies potential areas for change www.healthychildren.org/MediaUsePlan. Family engagement during family therapy can address media use patterns identified through assessment and education on the impact of media and ways to monitor and increase discussion around media. As previously noted, families often enter residential treatment overwhelmed and maintaining physical safety becomes the primary focus, meaning often deferring conversations about media due to the potential for escalation. Residential treatment provides the opportunity for the family to “reset” limits and expectations in general, as well as regarding media.