"Out of control": A youth perspective on secure treatment and physical restraint

Based on a presentation made by Brian Raychaba at the Best of Care Symposium on Residential Care for Children and Youth, Ottawa, May, 1990.

The perspective offered in this paper is based on my own personal experience of having been in care as well as being in consultation with a number of young people involved with the National Youth In Care Network (NYICN)¹, an organization representing youth who are either in or recently out of care. I would like to state clearly at the beginning, however, that I do not pretend to be speaking on behalf of all young people in care in Canada. The most I can hope to do is to offer you a consumer viewpoint on the issue at hand, namely the civil rights (or lack thereof) of children and youth in residential child care in Canada.

Upon meditating on the topic under discussion, one primary issue arose in my own and my informants' minds: the inappropriate use of secure treatment and physical restraint in residential care facilities.

A number of issues and concerns were discussed. The group questioned the therapeutic value of locking up emotionally troubled young people. Comments made by some of the youth I spoke with included the following:

Being locked up made me even angrier!
It didn’t stop me from eventually going back to the streets (as a juvenile prostitute.)
It just houses the problem. I didn’t get any “treatment.”

Speaking from personal experience I can remember being locked up in the adolescent ward of a Toronto hospital because I refused to participate in my “treatment" program by talking with the parent who had placed me there against my will. I found myself stripped of my clothes, threatened with sedation, and branded with an ultraviolet stamp. As my only defense against what I considered an abrogation of my civil rights, I refused to speak for a period spanning roughly two months. I left the staff a little note: “Caged birds don’t sing." In the end, they relented. I was released and placed in foster care. Were the actions of the “professionals" involved in my case therapeutic in any way? Why did I have to almost forget how to speak in order to retain some semblance of control over my life? What had I done to deserve incarceration? I ask what good did this “secure treatment" do me?

Locking up young people in care tells us in effect that it is we who are “bad" and “sick." It once again reinforces our sense that there is something wrong with us and obscures the reality that we are very often responding and adapting to very negative life experiences in a manner which I believe is natural, expected, and, in some respects, healthy. This is not to say that young people ought not to develop a sense of responsibility for their actions; rather, it is to suggest that they should be encouraged to do so with an understanding of how their past experiences may influence the course and direction of their feelings, their sense of self, their behaviour – in short, their lives.

The use of secure treatment, I believe, represents in many instances a short-term crisis response to the disruptive behaviours displayed by young people. The behaviours are often rooted in their violent and turbulent pasts, in deeply imbedded systems issues related to chronic underfunding (Callahan, 1985; Garbarino, 1985; Miller, 1987; Thomlison & Foote, 1987; Lieberman, 1987), and in the misallocation of resources in child welfare services (Krueger, 1983). The reality that youth in residential care are generally coming from turbulent and violent backgrounds is, I hope, an axiom in the training of those working in the field. However, I would argue that the disruptive behaviour of youth also has a structural or “systems" dimension. The absence of an adequate range and variety of residential care facilities and other resources translates into young people living in placements which are often inappropriate and unsuited to their unique needs. This results in a heightened probability of placement breakdown and the consequent need to move the young person into another placement where he or she is now burdened with a host of other attachment, separation, and loss issues and the likelihood of increasingly problematic adjustment or “testing" behaviours.

Another of the system's major structural shortcomings is the lack and even absence of high quality compulsory training programs and agency support for foster parents which results in an inability to adequately understand and deal in a positive and therapeutic manner with the often challenging behaviours of fostered youth (Darnell Consulting Inc., 1988). This has resulted in a dire shortage of foster parents in a number of provinces and the likelihood that a young person in foster care will be moved due to disruptive acting-out behaviour rather than having the issues behind the behaviour addressed positively. Additionally, the high burnout (Lewis, 1980) and turnover rates (Ross, 1983) among Child and Youth Care workers and social workers due to either a lack of professional status and career incentive (Krueger, 1983; Ross, 1983) or unrealistically heavy caseloads (Social Policy and Planning Committee, Newfoundland Association of Social Workers, 1985; Jeffery, 1983) make for a “transiency of relationships," which is yet another factor contributing to disruptive behaviours which service providers often respond to with restraint and secure treatment. These measures, I submit, ultimately represent a “cop out" on the part of Canadian society, in general, and the child welfare system, in particular. It is young people in care who ultimately pay for the flaws and inadequacies of the present state of affairs. Addressing only the immediate symptoms (i.e., acting out behaviour) of an entrenched and deeply rooted systems malaise (i.e., under-resourcing and resource misallocation in child welfare services) serves “the system" more than it does the young people the system is supposed to serve.

This is all well and good in the abstract. But what about the concrete realities of life in care as experienced by young people and front-line service providers at present? Neither I nor any of the young people to whom I have spoken would call for the outright abolition of secure treatment and restraining.

Undeniably, there are times when use of these procedures is both necessary and positive. I refer to times when a young person is truly “out of control" and a danger to either her/ himself (as in suicidal and self-destructive behaviour) or to others (as in overt victimization and battering of other young people). However, I believe that secure treatment and restraining is justifiable only in cases where young people are clearly in immediate danger of harming either themselves or others.

Most caregivers would agree with me on this point. They would refer to the use of secure treatment and physical restraint as a necessary evil to be used only as a last resort (Smith & Barajas, 1988). And yet, in the experience of many young people living in residential care such practices are often used as day-to-day disciplinary measures; for example, as a response to a young person not getting up in the morning, not wanting to go to school, feeling upset or angry, shouting, or telling the staff to “f- off" or “go to hell." This is completely unjustifiable and only serves to reinforce the negative conflict resolution behaviour to which most youth in residential placement have already been exposed in their troubled and often violent natural families, i.e., that aggression, domination, and coercion (what I consider violent behaviours) are proper ways of dealing with disagreements, disputes, and differences of opinion.

The roots of this particular problem lie in vague and unclear guiding statements such as “out of control" and “a danger to him/herself and/or others," phrases which should be descriptive of behaviours requiring secure treatment and restraining. What exactly is “out of control" behaviour? When exactly is a young person “a danger to him/herself and/or others"? Do set definitions and guidelines exist? More importantly, are young people in residential care aware of such definitions so that they will know when they are indeed “in" or “out" of control? I submit that many agencies and authorities offering residential care for young people across this country neither have concrete definitions of what actually constitutes “out of control" and “dangerous" behaviour nor stringent (and implemented) guidelines governing the use of secure treatment and restraining. Yet, staff in residential care facilities are nonetheless given the power to designate certain behaviours of young people as either “in" or “out" of control as they see fit. Once again, I ask, by whose standards are these decisions being made? The arbitrary nature of such decision making gives a great deal of power to residential care staff at the expense of the effectively powerless youth.

Imagine, if you will, that we are having a rather heated discussion which becomes all the more heated as we find ourselves in complete disagreement. As I persist in not seeing things your way, you quite understandably get a little peeved, maybe a bit upset. The tone of your voice becomes harsher; perhaps you begin to shout, clench your fists, stamp your feet, maybe slam a door, and scream to the heavens about how it must be my low brain cell count which is behind my inability to see your point of view. You don’t feel you’re a danger to anyone; you’re just upset and excited (and quite understandably so). In any event, imagine me then saying all of a sudden that you are obviously “out of control" and in need of restraint. This is not fabrication: this happens, not to everyone and not everyday – but it happens. Overworked, undertrained (Gokiert, Ing, & Probert, 1988; Cohen, 1986), underpaid, and stressed (Krueger, 1983; Ross, 1983), front-line residential care staff do sometimes vent their frustrations at the young people very much under their control (Dawson, 1990). A vague and loosely defined concept of “out of control" behaviour only lends itself to this understandable but, in no way, justifiable scenario.

To conclude, let me offer some suggestions to some pressing questions. Should youth in residential care have civil rights? An unresounding “yes" is the only humane reply. To answer “no" is to invite additional victimization of previously abused children and youth. Do civil rights conflict with the Best of Care? Absolutely not. If appropriately implemented and actualized, civil rights can provide a greater sense of safety and personal power for youth in residential care. But what exactly are these rights? Do we have dear and straightforward definitions of those truly “out of control" behaviours to which secure treatment and restraining are a positive response? Are youth living in residential care facilities aware of these definitions? Are young people even involved in the decision-making processes which formulate these definitions? As concerned and committed service providers in the field of residential care, you all have a great deal of soul-searching and hard constructive work ahead of you. Most importantly, you have the formidable task of establishing meaningful dialogue with the young people in your care, dialogue which sees all involved, feeling relatively empowered and in control of their own destinies. This, I know, is an awesome undertaking. But then, doesn’t the Best of Care demand it?

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Notes

1. The National Youth In Care Network (NYICN) is a national association of young people, ages 14 to 24, who either currently are or have been in the care of child welfare authorities in Canada. Directed and staffed by and for young people, our “network" attempts to speak on behalf of the more than 45,000 children and youth in care in Canada as well as those recently out of care. For background information on the NYICN and its activities, see Raychaba, 1990. The NYICN is located at 119 Rue Murray Street, Ottawa, Ontario, Canada, KiN 5M5, (613) 236-9289.

References

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This feature: Raychaba, B. (1992) Commentary: “Out of control": A youth perspective on secure treatment and physical restraint. Journal of Child and Youth Care, Vol.7 No,1, pp.83-87