State Must End Use Of Restraints On Juveniles
By ANDREA WEISMAN | OP-ED
Many states are moving away from the use of restraints in juvenile facilities because evidence shows that restraints re-traumatize already traumatized youths, do not improve behavior and lead to more acts of aggression. Unfortunately, Connecticut is inappropriately using restraints as a behavior management tool in the Pueblo Unit, a locked treatment unit that's effectively a prison for girls in Middletown, and at the nearby Connecticut Juvenile Training School, the state's juvenile prison for boys.
In a review of incident reports and video in September, the state's Office of the Child Advocate found:
Staff at Pueblo used prone restraints on multiple girls — one whose asthma led to a medical alert specifically prohibiting the use of prone restraints. There is a vast literature on the potential for positional asphyxia during prone restraint. In addition, staff used physical restraint to get girls to comply with directions when there was no safety concern. They used handcuffs on girls in violation of the facility's own policies. Four incidents at the Pueblo Unit were reported by the advocate's office as suspected child abuse.
There have been calls for an independent review of the facility and for an ombudsman to safeguard the rights of girls at Pueblo and boys at the Connecticut Juvenile Training School. Both these measures cannot possibly happen too soon.
Psychiatric hospitals around the country have virtually eliminated the use of restraints. So too, have juvenile justice facilities. For example, Ohio has systematically reduced and has vowed to eliminate the use of restraints — again, with the understanding that restraining youths does not bring about desired outcomes but instead leads to more aggression, putting both youths and staff at greater risk of injury.
"Restraint and seclusion have no therapeutic value," the National Alliance on Mental Illness has stated. "They should never be used to 'educate patients about socially acceptable behavior;' for purposes of punishment, discipline, retaliation, coercion and convenience; or to prevent the disruption of the therapeutic milieu."
There are better strategies for working with youths with challenging behavior. Well articulated behavior management plans are critical in this effort. Successful plans identify one or two target behaviors that are seen as interfering with a youth's progress. Most typically they are noxious behaviors. These plans articulate what the child will do instead of the target behavior. That is, it's all about skill acquisition. Each time a youth displays the new skill, she should be rewarded quickly with incentives that are meaningful to her. Consequences for not engaging in the new behavior should be also be immediate and brief in duration.
We know that the juvenile justice population is overwhelmingly dealing with issues of complex trauma. Confrontation and restraint simply do not work with this population.
In addition, new research coming out of Britain demonstrates that as many as 60 percent of the juvenile justice population has suffered one or more traumatic brain injuries, known as TBI, leading to greater impulsivity and acting out. These youths are frequently misdiagnosed with various mental health disorders and treated with psychotropic medications, which does not address the underlying problem.
In recognition of this, the Juvenile Detention Alternatives Initiative Standards now require all juvenile detention facilities to screen for TBI. In the event the screening is positive, detention centers have a responsibility to arrange for treatment of the youth either while in detention, a commitment facility or the community. Treatment is neuro-feedback with a trained neuropsychologist. In the District of Columbia, one youth was so aggressive he was unable to live or attend school with other youths. Twelve neuro-feedback sessions later, he was able to return to a living unit and attend school.
Most fundamental of all is a well trained and informed clinical and direct care staff that understands the trauma-informed needs of the population it serves. It is indefensible to maintain that some youths are so aggressive and challenging that nothing can be done with them. Innovators have proven otherwise. But these young people's success depends upon adults turning away from interventions that do not work — interventions such as restraint — and embracing new practices that do.
Andrea Weisman is a juvenile and correctional mental health consultant based in Washington.
Copyright © 2014, Hartford Courant