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Institutionalised

Perhaps someone can help us with this question? What do you do with a youth that "gets off" on intensive residential treatment? This person has been in residential intensive treatment for over four years during that time he has made very little progress other than to learn how to play the system. In the beginning this client was manageable however the longer his placement the worse he got. He learned how to manipulate child advocates, therapists and the court system to his advantage. Any house he was placed in was immediately thrown into chaos as the other clients were afraid of him. In each placement he was moved to he managed to set back the other clients treatment as all staff attention was directed towards him. Finally this young man threatened to injure a staff and followed through enough to get charges against him and was moved into the juvenile prison system. Just when staff had moved on and treatment of other clients was going great this young man was admitted back into treatment. Now twice as big and mean he has started running his old routine again. The client claims to want to go to jail yet he won't awol and he deliberately waits till staff place hands on him to cause his damage during a restraint because he knows he can't be charged when he does things this way.

Does anyone have some suggestions of have dealt with similar clients? Please share your wisdom as I would not like to have to wait until he has to hurt staff or clients to meet his needs.
 
From: Rainbow Wilderness Adventures
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Hi,
This young man appears to have taken a lot of power in his life. He is a major force to be reckoned with and needs all the attention and space for himself. It must take a lot of energy to do all of this. As to "getting off" on residential treatment, he seems to be having his needs met. Certainly it isn't functional, but maybe helping him figure out what it is he gets from the environment, from the people, from the situations and getting him to channel this in more positive ways. He also sounds like a born leader. What I always come back to is the need for him to be in relationship with good people, enduring, solid, and consistent. He sounds like a very damaged boy.
 
I can't help but think of some of the boys I have worked with, but one in particular. He was 17 when I last worked with him. He was in a house and program just for himself. Several workers per day. He and I just hit it off. We connected, we found things that we had in common, we did what he wanted to do and it gave us the opportunity to talk about some things in his life. I accepted him and treated him with humour and respect and talked to him about possibilities. His scary persona never came out to me, although it certainly came out to others. He's one of those kids that I wish I still knew. I've heard he was in jail recently too. But I know that we both enjoyed the time we spent together and that counts for something. I would hope that there is also some connection with family for him and that all efforts have been made for all parties to have some good intensive therapy.

Good luck,
*Tracey*
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I am sure that you will receive many different views concerning what to do, how to react, and suggestions for new interventions. One perception that I have in these situations of people/youth learning to play the system is, that they have developed coping skills. This is not necessarily a negative attribute. There will be some clients who believe they require this intensive management around them in order to cope and function. Reaction to others' attitudes, fear and likely history would be contributing factors. 4 years is long time to be in limbo. If they have learned how to, as you suggested, "play the system" then they have progressed. Possibly not in the way that you had hoped for. We manipulate every day. Why is this such a horrible skill for children or youth to learn? Is it only a skill when it suits us? We manipulate to get our needs met on a daily basis. Some of us are better and more subtle at it than those less skilled. I would look at helping to figure out what this young person would hope to control in their life.
 
When we talk about intensive residential treatment, consider how intrusive this would be, and work from this perception of the client.
 
Ron
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The first red flag that went off in my head was regarding his many placements. I feel that he's learned that no one will keep him, he can't trust anyone, and he can manipulate anyone. Keep him in one placement, and do treatment. He should not be able to manipulate workers that way, workers need to be one step ahead of him at all times especially if his 'routine' is already common knowledge. Remember that he is still a person and he has needs just like anyone else. It does not matter what he has done wrong.
 
From: Charlene Mauger
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Have you tried bringing a Custodial Individual program to them? Put them on an identical Level system to the ones in Custody and that way they are aware of all expectations etc. Most of these "Highly institutionalized Clients" you are speaking about act macho and say that they would rather be in custody because they do want to go back. They feel safe there, all expectations are written in stone, nothing is negotiable and everything is black and white. So bring a level/point system to them in an individual treatment program and as they excel in their program gently remove their levels until at the end of their program they only work off of one. These children that you are speaking about also begin to do these behaviors once they have established a relationship with someone and these behaviors are a way of breaking down a relationship so they don't have to feel. With these kids I always tell them no matter what they do I still like them. We have many of these children at my one facility and I know we have had some success stories but then others are so lost in the system they will turn 18 and then become an adult offender. Basically this boy you are speaking about is a child who has been abandoned many times in his life and before you and your facility abandon him he will ruin the relations with you guys before that happens. The whole 'I dumped you first' thing. Anyway I hope this helps.
 
Deanna
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Hi, my name is Chris and I know the kind of client you're talking about. I've been in the field for about 10 years now and have seen a few like the one above. My first question is how old is this client? Is there a social worker involved or a case manager? If there is they need to get involved in the treatment planning of this client. It is very clear to me that this child is not placed in the right placement. I would go as far as suggesting an individual program set out just for him. Clearly, group care is not the right placement. The case manager needs to get clear about what the long term plan is for him. You are not doing treatment, so therefore he shouldn't be in a treatment facility. However, if your placement is the only way then you need to be very creative. First, I would get him and the case manager to sign a contract clearly stating the treatment plan and have him involved in planning. This may give him some of the power he is lacking. As part of this you may want to take a solution-focus treatment approach (Michael Durrant is a great reference). This approach will work on anyone if your team is all willing to follow it. It will help the team also get out of the negative and into a positive frame of mind. Anyway, I don't know if this will be helpful but it's just my thinking on the subject.

Let me know how it goes!
Chris
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Hello,
Just a comment about the young man who has been bounced from institution to institution. His thoughts might be, "Does anyone care enough to stick with me or to keep me?" I'm not suggesting his behaviour be excused or ignored or that I have any answers; however, something in the system has to change so that this young man gets his needs met. He is asking for help through his behaviour and unfortunately he is developing a pattern with the help of the system that will be hard to break the longer it goes on.
 
Glenys
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