A Schema Therapy Based Milieu in Secure Residential Youth Care: Effects on Aggression, Group Climate, Repressive Staff Interventions, and Team Functioning

Marjolein Francisca Van Wijk-Herbrink*, Arnoud Arntz, Nick J. Broers, Jeffrey Roelofs, David P. Bernstein

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Group care workers of residential youth care settings face the challenge of creating a warm and involved treatment climate against the demands and restrictions of the treatment setting. We tested the effects of SafePath, a milieu-based intervention based on Schema Therapy principles, during the first year of implementation on two secure residential treatment units compared to two control units. Staff's daily reports on 139 individual patients were coded on use of schema mode language (implementation check), occurrences of aggression (primary outcome) and repressive staff interventions. In addition, repeated questionnaires were filled out by patients (n = 87) on group climate and by staff (n = 50) on team functioning. Compared to the control units, SafePath units showed higher improvements in group climate and repressive interventions. Both SafePath and control units showed decreased aggression over time. Team functioning was consistently better in the SafePath units compared to the care-as-usual units from baseline through 12 months. In conclusion, a Schema Therapy based milieu as implemented with SafePath may contribute to a warm and supportive group climate with less repressive interventions in secure residential youth care.

Original languageEnglish
Pages (from-to)289-306
Number of pages18
JournalResidential Treatment for Children and Youth
Issue number3
Early online date25 Nov 2019
Publication statusPublished - 2021


  • Schema therapy
  • SafePath
  • secure residential youth care
  • repressive interventions
  • group climate

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