OACYC - History of Child and Youth Care in Ontario
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THE MILIEU THERAPY NOTES

By the end of the first two years, Lawson was able to put together the 'Training notes on milieu therapy and child care work'. These were prepared on the basis of the course discussions with the child care workers and the psychiatric staff at Thistletown Hospital.

They serve now as important first statements about the beginnings of the discipline of child care work in Ontario.

In them, Lawson explained that Milieu Therapy in simple language, means that everything that happens to the child from the moment he makes his first contact with the institution until his discharge should be therapeutic. Every contact the child has with an adult or with other children, all his daily routines and activities and the living space in which these are carried on down to the smallest details of the use of space, types of furniture and equipment, food and methods of its preparation and serving — all of these should be planned and coordinated from the point of view of a definite philosophy of treatment.

For Lawson, the creation of the therapeutic milieu was the job of the child care worker. Lawson summarized the role of the child care worker by stating the functions of the child care worker in the treatment centre are to accept the child and give him love, to meet his dependency needs, to give him active support around the crises of his day, to play and have fun with him, to assist him where progress is possible, and to restrain him when this becomes necessary.

Lawson went on to explain how the child care worker carries out these tasks through the use of relationships, play, group activities, rules and routines, rewards and consequences (not punishments), limits and controls and techniques for controlling behavior.

Lawson posited that behavior, rather than words, is a typical vehicle for expression of feelings for a child. Just as children often express themselves in play, so do they express themselves in the normal behavioral outlets during the day. Therefore, this behavior is not to be so limited that it never exists, rather it is to be used as the material to be worked with in a therapeutic manner by the child care workers.

Thus, in the first two years at Thistletown Hospital, Lon Lawson and John Rich laid the groundwork for the discipline of child care work. The child care worker would be the person who would have a close intimate relationship with the child based on a real respect for the child as a person; he would be familiar with and able to implement techniques for controlling behavior. These would be indirect; in the environment, through the use of rules and routines, and, direct; in the use of himself in handling certain behavior and limiting children. The child care worker would be able to physically care for a child, have a good understanding of the meaning and necessity of play for the child and be able to further the child's self discovery through play and through group interaction. The child care worker would be able to help the child realize his potential through activities and social relationships.