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Zachary Road Intensive Residential Treatment Facility

Neurobehavioral Residential/Educational Treatment Program
200 Zachary Road
Manchester, NH

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Easter Seals has developed a Neurobehavioral Residential/Educational Treatment Program at the Zachary Road facility designed for males and females from ages eight to 21 with pervasive developmental disorders, nonverbal learning disabilities, traumatic brain injuries, and other neurological disorders. The goal of this program is to provide a structured and therapeutic environment that is tailored to each individual’s needs. Options for 24-hour care and day treatment are both available.

Specialized educational and treatment plans are developed to meet the unique needs and goals of each child and account for transition planning focused on movement to the least restrictive environment. These plans target functional domains and include medical/psychiatric care, communication, activities of daily living, recreation, social skills, vocational training and community integration. Treatment modalities consist of individual therapy, group therapy, and family therapy as well as speech and language supports, nutritional intervention, occupational therapy including a well-equipped sensory integration room, and recreational therapy and activities. Supplemental approaches emphasize the interrelationship between mind and body and offer additional resources to a child based on his/her needs and/or interests; these consist of animal assisted therapy, dietary interventions, expressive therapies such as art, dance, and music, and stress reduction techniques such as massage therapy. 

Residential and classroom environments, daily schedules, and goals of treatment are individually adapted to recognize and meet children “where they are” while challenging them to reach their full potential. Programming across the residential and educational settings is consistently structured to reflect the needs and interests of each child while also considering individual and family goals for their future. Team meetings are convened regularly to monitor each child’s progress, to problem solve when necessary, and to amend individual programs when indicated.  Families are integral to the treatment process and provide important opportunities for children to practice and master newly learned skills and work on treatment goals in different relationship and environmental contexts.

The expertise provided by a multidisciplinary approach is critical to the comprehensive assessment and treatment planning process. The program provides on-site psychiatry, nursing, psychology, education, nutrition, recreation therapy, teaching of independent living skills, vocational training, clinical social work, speech and language and occupational and physical therapy evaluation and services. 

Effective Programming for Children with Autism Spectrum Disorders

The essential characteristics of our Neurobehavioral Program include the capacity for meaningful assessment, the development of relevant and measurable goals and objectives, and the provision of curriculum content in support of those learning objectives. Primary treatment goals, as well as therapeutic objectives and specific lesson plans, are based on careful data collection and include planned maintenance and generalization strategies. Learning occurs in the context of highly supportive residential and educational environments with organized and predictable routines.  A functional approach to problem behavior is implemented, allowing for effective intervention and support for each child.

Assessment
Based on the principles of Applied Behavioral Analysis (ABA), the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) instrument is used to evaluate each child’s abilities in 25 functional domains including learning readiness, academic skills, and life skills and provides the foundation for the development of child-specific learning/treatment goals and objectives. Specifically, the ABLLS-R translates the principles of ABA into measurable objectives and shapes the academic, life skills and behavioral interventions within the classroom and residence.  Further assessment of specific repertoire areas by multidisciplinary team members may include speech and language ability, occupational therapy needs, independent living skills, and sensory profiles.  More traditional psychological testing including assessment of cognitive, academic, and adaptive behavior is also available on an as needed basis.

Curriculum Content
The Neurobehavioral Program is designed to address the core challenges and characteristics of Autism Spectrum Disorders: impairment in social interaction, deficits in both verbal and nonverbal communication, repetitive or stereotypic behaviors and restricted areas of interest. Within the context of these underlying problem areas, educational goals and objectives are highly individualized for each child’s developmental level, targeting challenges for instruction and building on strengths. The development of learning readiness skills (such as the ability to attend to a task, to imitate requested behavior, and to begin to respond to structure and sequential activities) sets the stage for the acquisition of functional skills.

Highly Supportive Teaching and Therapeutic Environments
It is essential that the learning environment is designed to accommodate and be sensitive to the core challenges and characteristics of children with Autism Spectrum Disorders. Targeted skills and treatment objectives, identified as described above, are taught in highly supportive and structured environments and are systematically generalized to more functional, natural environments. The learning environments are carefully planned to consider the following:

Adaptations for children who have difficulty processing and modulating in-coming sensory stimulation. The physical environment provides environmental organization for the children (clear physical/visual boundaries via furniture arrangement, reduction of visual stimulation, etc).

Visual support and other strategies to allow children to understand expectations and to assist them in responding and behaving accordingly.  These strategies are designed to emphasize children’s cognitive and processing strengths to minimize stress and anxiety and to promote optimal independent functioning.

Specialized Staffing
Well-trained staff members who understand the unique needs of children with Autism Spectrum Disorders are an essential feature of the program offered at Easter Seals and imperative in providing an appropriate teaching, learning, and residential environment that is supportive as well as effective. Staff members, working in collaborative teams, are involved in:

The Zachary Road DBT Program has been developed in response to an increasing need to effectively treat young women with extreme emotional dysregulation and self-harming or life threatening behaviors. Many of these young women have had multiple psychiatric hospitalizations and have experienced treatment failure in other settings. DBT, an approach which combines cognitive behavioral strategies with elements of eastern spiritual practice has been developed by Marsha Linehan to treat individuals with Borderline Personality Disorder. DBT has been demonstrated effective in reducing Para suicidal behavior and increasing patient skills to cope with overwhelming emotional response to circumstances in their lives. DBT has been adapted for the treatment of adolescents.

The Program incorporates the essential DBT components of individual therapy, group skills training, telephone coaching with the individual therapist, and weekly consultation for the therapists and staff. All staff working within the program is trained in DBT and participate in the weekly consultation group.

Program participants apply for acceptance to the program to enhance commitment and engagement. They reside together on a separate unit with capacity for seven young women. The milieu is structured to reinforce skills development and to support the goals of treatment.

Within DBT, the focus is on current problem behavior and factors controlling that behavior. Primary methods of individual treatment include validation of the participant’s feelings and responses and problem solving to manage these feelings and circumstances more effectively. Weekly skills group teaches five skills modules: core mindfulness skills, interpersonal effectiveness, emotion modulation, and distress tolerance, and walking the middle path. Parents or support persons are recommended to attend the group with each young woman. While residents of the program learn skills to increase effective functioning, parents and support persons learn the same strategies and are better able to support their children. All program participants have access to phone contact with their individual therapist for coaching and support. Weekly consultation groups provide support to staff and clinicians to adhere to DBT principles.

Importantly, DBT provides structure and support—and optimism--to effectively treat individuals who have traditionally challenged clinicians and suffered poor outcomes in treatment. Residents completing the program and transitioning to the community will have access to skilled DBT clinicians in many of NH’s community mental health centers.

For more information about the Zachary Road Intensive Residential Treatment Facility, contact:

John Soucy
Vice-President
603-206-6675
jsoucy@eastersealsnh.org

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