ABSTRACT
Creating a milieu treatment adapted to the often extreme and varied needs of children within residential psychiatric care is an exciting and major challenge. Any unit's response to this challenge will be influenced by a philosophy of treatment and prevailing social and economic conditions, but it should now also be a matter of empirical testing rather than ideology as to what forms of milieu provide the best and most economical treatment for different kinds of problems. This chapter reviews a variety of solutions to the task of milieu care and important themes that have emerged in practice. It treats the in-patient environment as a treatment modality in its own right; looking at the elements that make up the treatment and the mode through which they may act. Other chapters address the efficacy of this treatment (chapter 27) and its potential unwanted effects (chapter 18). As a treatment modality it has been subjected to little empirical research (see chapter 27): milieu programmes in the future will need to address these empirical issues explicitly and research is greatly needed into the dimensions of care best suited for different disorders.
