Listen to thisIf residential staff are asked about their most difficult problems the most likely response would be “aggressive or acting out behaviour”. In Locking Up Children (S. Millham et al., 1978.) S. Millham and colleagues showed clearly that many children in secure homes were no more behaviourally disruptive than older young people in group homes, open community home units or community hostels. Contact with residential staff in a variety of homes reinforces the impression that difficult behaviour is likely to occur in most homes to some degree and that all residential establishments for young people can expect to be faced with difficult behaviour as a normal rather than exceptional part of their work. Little evidence is available about the range of disruptive behaviour and responses to it, attention being focused mainly on absconding and physical violence to staff or older children.
This gap is now partly filled by a valuable study published by the Child Welfare League of America’s research centre in 1980. Coping with Disruptive Behaviour in Group Care (E. Russ & A. Shyne, 1980.) is the most comprehensive survey yet of the kinds of disruptive behaviour experienced in residential homes and the methods used to cope with it. A lengthy questionnaire was completed in 1978 by 144 residential facilities, including a mixture of small group homes, institutions and treatment centres, all members of the Child Welfare League of America. The impetus had come from the feeling that gradually more difficult children were being found in residential care, partly arising from the growing number of status offenders, i.e. children whose behaviour (truancy, promiscuity, alcoholic drinking, unruliness) would not be illegal if they were adults. Young people with lesser degrees of difficulty also had a greater access to a variety of non-residential interventions.
Although the majority of establishments included in the survey were run by voluntary organisations, the majority of children were sponsored by public child welfare agencies and were similar to those in Britain in that most were from families in or on the margins of poverty. A high proportion of the children were adolescent in the 12-15 year age group. On an emotional/behavioural classification 17 per cent were deemed dependent/neglected; 32 per cent mentally disturbed; 29 per cent were severely disturbed and 20 per cent were delinquents. Between 1973/77 there had been an increase in the proportions of severely disturbed arid delinquent children.
Sixteen types of disruptive behaviour were investigated, varying from verbal and physical abuse, self abuse and destruction of property, drug taking, setting on fire and hyperactivity. More than 75 per cent of facilities listed all but fire setting and drugs as affecting at least some of their residents; verbal abuse, absence without leave, loss of impulse control and stealing occurred in 97 to 99 per cent of facilities. However, although they occurred from time to time, most of the disruptive behaviours “were not pervasive amongst the residents". Only verbal abuse was reported for most residents by more than half the facilities, in 57 per cent of the cases. Loss of impulse control was reported as prevalent in 22 per cent of the facilities and the use of marijuana in 16 per cent. None of the other behaviours involved most residents in more than one facility in 10.
How did staff cope with disruptive behaviour? The study distinguished between the “usual methods” and the methods used to deal with “acute situations”. Usually talking to a resident, withholding privileges or addition of chores or tasks, separation, reparation for damages were likely to be employed. Physical restraint, medication, calling police, discharge, secure confinement, staffing and behavioural modification were used relatively infrequently. Yet in acute or crisis situation the order changes. Discharge was the most frequent response, followed by withholding privileges or giving extra chores, separation, calling the police, talking, physical restraint, secure confinement and medication. Staffing, reparation, and behaviour modification were used very little.
In discussing their findings the authors took their stand on the child care principle that correction, particularly exemplified in the use of medication and secure confinement, should be restricted as far as possible and, where used, should be strictly controlled and monitored. Where possible, alternative methods should be developed. On “isolation” it was recommended that “it should be handled as isolation from a situation. It is essential for the child to have an adult nearby and in contact with bin”. They concluded that the “great variety of methods employed produced no uniform set of recommended solutions to the dilemma of providing constraint without risking harm".
This may appear a negative conclusion but such an impression would be misleading. Our British experience with secure units confirm that it is a fallacy to assume that any method is going to provide the answer to dealing with disruptive behaviour. The researchers lay much emphasis on enhancing the skills of the staff through in-service training and supportive and accessible supervision and consultation. Similarly many of the respondents to the survey stressed the need for a carefully thought through regime and programme, coupled with individual planning for each child.
One treatment centre went so far as to state “that “acting out” on the part of residents is largely the result of deficits in the programme". The fact that most of the respondents to the survey seemed reasonably satisfied with the methods used to cope with difficult behaviour, however, gives no ground for complacency. Escalations of mild disruption to acute situations and subsequent discharge as a response is a frequent enough occurrence to demonstrate the failures of staff in individual homes and the negative feature of the child care system.
What this admirable survey shows is that there is no panacea, but that the slower and more painstaking alternative of improving the quality of care and treatment through investment in staff skills is our best hope for the future.
References
Millham, S., Bullock, R., Hosie, K., Locking up children. Farnborough; Saxon House 1978.
Russo. F. M., and Shyne, A. W.. Coping with disruptive behaviour in group care. New York; Child Welfare League of America 1980.
This feature: Walton, R. (1981) How can staff cope with disruptive children. In Payne, C. & White, K. The Best of In Residence. Vol.2 London: Social Work Today. pp. 122-123
