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Taking personal items away from clients

2016

Hello everybody,

I am currently doing my second year of practicum from the child and youth care counsellor program at Mount Royal University. I am currently working in a residential treatment centre with youth ranging in age from 8 to 12 years old.

Of our three clients, our oldest is the only one without any type of cognitive delay. She is a very smart girl and uses this to her advantage. Often during her escalations, she is fully aware of what she is doing, and will plan her actions very intentionally, whereas our other clients don't think so much as react and act.

The only technique we have found to be at all effective in calming her escalations (which often result in property damage or violence towards others) is taking items out of her room until she is calm again. This was also only discovered when a night staff working alone was out of any ideas to de-escalate the client. Removing items from clients’ rooms (when it is their own property) is against agency policy. I was around once more during one of her escalations where the removal of her property (temporarily) was threatened, she immediately stopped destroying the program home.

My question to you all is: do you as professionals see any aspect to the situation that validates us workers to remove personal property (even if it was not against our policy)? For many of these kids, their own items are all they have right now, or have ever had that is there and that is safe for them, so I think that we should not threaten this again and will unfortunately just have to "sit through" her escalations until we find a better method to help calm her down.

Thank you for any input you may have!

Melissa
...


Melissa,

It is great to see that the child has enough attachment to items for her respond positively to their threatened removal. That suggests that (as you say), she is in control of her behavior and is not operating from a psychotic place. I can see the temptation for a staff member to use the child's attachment to those items in order manipulate her behavior. After all, that is the principle of behaviorism.

Carl Rogers once said that if the only tool you have is a hammer, then you will treat everything as if it were a nail. I think you have given us a good example of that, so thank you for reminding me.

I cannot over emphasize how wrong I think it is to remove the child's personal possessions in order to control her challenging behaviors. All the staff are doing is compensating for their own lack of knowledge, and in doing so they are teaching the child not to have an attachment to anything, because if you do, someone will eventually take it away from you. That message is the exact opposite to what we are trying to do, which is to build on the attachment to transitional objects so that the child can eventually form attached relationships to people.

Your colleagues would be better off trying to establish a therapeutic alliance (form a working relationship) with the child than engaging in ongoing power struggles that are usually more to do with staff egos than young people's behaviour. They should also try harder to be proactive in de-escalating the child's behaviour before it gets to the stage of rooms being trashed. Having said that, there can be therapeutic value in trashing a room provided it is part of a CAREFULLY managed process, but that is a whole other discussion.

I would be interested to hear Adrian Ward's input on this.

John Byrne


Good treatment is the same everywhere! I’m with you John.

Lorraine Fox
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Hi Melissa,
 
I too work in residential treatment however with older youth diagnosed with various mental health diagnoses.  I can understand the worker's desire to find a strategy to help manage this client's aggressive behaviour however I don't believe all her items need to be removed (or threatened to be removed).  I would only remove personal items when there is an immediate risk of harm to the client or others (i.e. significant self-harm, use as weapons etc.) and even then would not take everything.
 
I am interested in what the outcomes of her escalations are?  All behaviour serves some sort of purpose and part of developing a therapeutic relationship with the youth we care for is learning what their needs are in the moment and helping them meet them.  It's easy to get caught in a power struggle instead of stepping back and trying to understand what our clients are telling us (in the many ways they often do!).  I also believe that part of our role is to "sit through" escalations – these behaviours have worked for our clients for some time.  Regardless of the intentionality we perceive, that does not mean there are not very real emotions and feelings being experienced.  Sometimes our clients need to know that there are supportive people that will be with them through a crisis, that our care is not conditional on how they act.
 
Jennifer Morrow
...

I am wondering what others think about…providing items, resources, services etc. to attach to as an incentive for behavior change rather than removing? 

Just pondering.

Lorna McPherson

Hi Melissa,

How very sad that we should give in to the (possibly vengeful) desire to further deprive these children, who have probably already lost just about everything – and everyone – that really matters to them. The more I've thought about this over these last few days, the more I've had that feeling of the heart sinking.

And yet I do also find it understandable: sometimes children's behaviour is impossible, just maddening – and yes, dangerous. We do have to find a response and to try everything we can to keep them safe, and eventually to help them start to feel better and more in control of their lives and situations. When things start to get out of hand we'll try all sorts of things, and will be tempted to do anything that seems to work, even if it's against agency policy and against our own better judgement. But we've got to resist the temptation to hit back (if only metaphorically): it might appear to 'work' in the short term, but ultimately it's adding to the problem rather than solving it.

This situation that you have described cries out for better support and training for staff so that they would feel more centred in themselves and better able to respond from a position of positive and patient concern rather than desperation.

I am also interested in your repeated use of the terms 'escalation' and 'de-escalation'. These words perhaps tell us something about the speed at which these situations deteriorate, but they sound like jargon to me – as if they are in that category of words which we apply to others (in this case to the 'clients') rather than to ourselves. So I would encourage some reflection on these words: perhaps 'escalation' refers to the child's (and/or adult's) feeling that things are getting out of hand, and perhaps to a panicky feeling inside, which is what really needs to be understood and responded to?

I would have liked to know more about what you imagine this girl is feeling in these moments – what (or who) tends to upset her and why, and what then happens to make everyone feel so panicky?

And finally, you are careful to say that the girl 'will plan her actions very intentionally': but what lies behind her apparent intentions? What do you think she is really wishing for, and how would she really like to feel? Her actions and reactions may appear deliberate but in fact they're not so smart, since they seem to be repeatedly getting her into the same old trouble, with the outcome usually being that she probably feels worse rather than better – even though there might be some temporary relief for her when she 'blows her top'. As with any other person in difficulties, the more you can put yourself in her shoes, the better you will be able to help her.

Wishing you well, and hoping that you and your colleagues can find some solutions, especially as we head into the holiday period.

Adrian Ward
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