An Interview

My friend Ann currently works in a rehabilitation center that uses behavior modification to help teens that are out of control and unable to function in their communities safely.  She readily agreed to the interview to give an example of how a treatment facility works that respects the rights of teens.




Did you have to go through a background check before working at your facility?

Yes of course.  We all do.  Every new hire does.  We are fingerprinted, background checked, bonded.  The whole deal.



What are the criterion for a teen to get into the center where you work?

In order to get into our facility, a teen has to have a history of violence or are out of control mentally and in need of anti-psychotic medication.

When a teen comes in off of their medication, how is that?

A kid off their meds-- when they come in they are high off of street drugs, dirty, inappropriate attire-- they dress like hookers-- with various untreated S.T.D.s, head lice, scabies, pregnant, malnourished.



As part of your current job duties, do you have to restrain teens?

Yes.

How does that go?  What is the process?

When a teen is for instance attempting to choke a staff member.  The kids being restrained are violent, out of control, a danger to themselves and others.  These teens have severely hurt staff people:  blindness, broken bones, compound fractures, stab wounds, murder, bleach thrown on staff, attempts to set staff on fire, held hostage, had family members go after staff family members.  It is really important that the restraint be carried out successfully.

 Those things have happened to staff members.  So take downs and restraints are something that has to be done for the safety of the out of control teen, their peers, and the staff members.

Once the teen shows signs of de-escalating, then we are able to help them by talking them down and then gradually let them up.

Restraints are not done to punish the kids.  They are done to take control of the kids so that they don't harm themselves or others.  Our kids are capable of hurting themselves and others.  They have done so.  A restraint hopefully prevents injuries to the teens and to the staff.

You've said that there is a de-escalation process?

You can feel in the kid's body that they are not fighting you-- they've stopped fighting you-- and their levels go down.  Once they've started relaxing into the restraint, you give them simple directions.  Like, "I'm going to release you.  You are going to sit up.  I'm going to help you sit up.  You will keep your hands on your knees.  If you don't keep your hands on your knees, you will go back down on the floor."  

I may give them written assignments to do afterwards.  They are put on a program separate from the other teens.  They are given packets to do that addresses their issue.  They are made aware of their other choices through problem solving with the staff that they had the issue with as long as both parties are willing.

If a teen cooperates, does the packets, is willing to talk through their behavior the process will take maybe a couple of hours.  If they are not cooperative, the process can take days--

More than a week?

Yes, more than a week--

More than a month?

Sometimes more than a week but not a month.  They are motivated to cooperate because they want to be back with their peers, doing the regular schedule.

Are they put in a room by themselves during that time?  In isolation?

No.  They are kept in an area with the other kids but they are on their own program.  They  are not allowed to talk with the other kids during day program time.  We want their attention to be on their behavior and what they could have done different.  This is not done to punish them.  It is done to further their rehabilitation.

During this time, are they allowed to receive mail?  Visits?

If they have assaulted someone and get arrested, then it is out of our hands and they go to the county lock-up and have to answer in court.  If they are in the treatment center with us-- not arrested-- they are allowed to receive and send mail.  A worker is present during a supervised visit to discuss what happened.  The teen, their family, and a worker discuss together what happened during the incident leading up to the restraint.

Anything else?

A teen may lose some privileges-- an hour of their television time, no playing cards with the other teens for a set amount of time, no off campus trips until the teen can show us that they are keeping their behavior under better control.  Keeping a teen back from trips is not really a punishment.  It is a safety and security issue.  If your child was out of control, would you take them to the grocery store?  If a kid attacks you with a pencil, would you allow them to have another pencil because they are calm for the moment?



So what is the regular program like?

Education.  The kids have teachers and classrooms.  They can study for G.E.D.s or go to college on-line or in the community.

The classroom teachers are required to be licensed and they are trained by necessity to do restraints.  The teachers instruct the teens in small groups of ten kids.  There are computer classes to learn how to use one, vocational classes, and self-contained classes for the kids with special needs.

Besides education, there are arts and crafts, drugs and alcohol, behavioral groups, life skills group, and individual counseling with a Master's level therapist.  The kids are expected to do chores routinely as a way to learn responsibility and team work.  They can get a paid assistant or kitchen job for exemplary behavior-- and those jobs pay minimum wage.



What is the food like?

The food is quite good.  The kids meet once a month.  They can make complaints or tell what food they've liked.  We had an upgrade in food about five years ago as a result of the meetings with the kids.  The kids have snacks too.

Are they ever forced to eat?

No.  That is not allowed.



What happens when a kid gets sick or says they are sick?

All staff are trained in First Aid.  Choking.  Blood contact.  There are nurses and a physician assistant or a nurse practitioner  present on campus twenty-four hours.  Kids are evaluated by the medical staff and are taken to the emergency room via ambulance if the medical staff say so.  The med staff have to err on the side of caution.  

Some kids do fake sickness and injuries.  But they are sent to e.r. on the basis of observable symptoms and on the symptoms they report, even if they are suspected of faking.  

Kids ever fake or show symptoms of asthma attacks?

Medical staff are called immediately if a kid has an asthma attack.  Medical staff are called immediately even when we know that a kid is faking.  Because the sickness or injury that we ignore can very well turn out to be the real deal.  We have to assume that the injury or illness is real every time.



Is a teen allowed to use the phone if they want to report being mistreated?

Kids are given access to a phone and privacy to call an ombudsman who looks out for their rights.  Anytime they ask for the phone to do that, they are immediately given access to one.

We are required to do that.  Some kids play on that, they make false reports.  But others have turned in reports of staff having sex with the kids or bringing in alcohol for the kids that are accurate.


Every report is looked at as being founded until proven otherwise.  The accused staff gets moved around, away from the kids until the complaint is unsubstantiated.  Staff have complained about this as being unfair, because it is our lives being disrupted by a false report.  Staff are moved into jobs away from the kids during the investigation.

The reports that are substantiated-- staff have been fired, arrested, dealt with in criminal court.



Anything else you want to add?

 Locked facilities like ours are necessary.  By the time a teen gets to us, there are no other options left except for the prison system. They cannot live safely with their families in their communities.  The teens that I work with are not kids who experiment with pot or cut school or talk back to a parent once in awhile.  The teens at our facility are dangerous.  We are not allowed to humiliate or verbally or physically abuse the teens in our care in any way.  Some teens do go on to commit violent crimes after release and go through the adult prison system.  I have seen some teens having success after release.  

Like the girl we ran into last summer at her job.  I remember how happy you both were to see each other.


Yes, you would not have recognized her when she first came in.  That makes my job worth it.