Behavioral Management and Children in Residential Care
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An October 1998 Hartford Courant investigative series and a recently released report by the General Accounting Office (http://www.gao.gov), Mental Health: Improper Restraint or Seclusion Use Places People at Risk (GAO/HEHS-99-176), have increased public interest in and prompted congressional concern about the use of restraints and seclusion in residential facilities.
- The national trend away from large institutions has resulted in approximately 10,000 smaller, community-based facilities that provide residential and group care programs.
- These facilities serve child welfare, juvenile justice, mental health, and developmentally disabled populations.
- 500,000 children in the U.S. are in state custody, more than 200,000 of those children are placed in group care settings.
- Children in residential care today have complex problems. They often show violent behaviors, multiple diagnoses, severe learning disorders, and an increased frequency of alcohol and drug addiction. Typically, children and youth in these facilities have histories characterized by instability, abuse, neglect, and rejection.
- Typically, children in residential care are angry, they are depressed, and they act out. For many youths, their placement into residential facilities very often is their last chance at social services before a move into the juvenile justice system. For younger children, their successful placement in residential and group settings prevents them from being hospitalized in more institutional settings.
- The goal of treatment programs is to assist children and youth experiencing mental health and behavioral difficulties to handle stress and develop self-control.
- It is possible to minimize the need for and use of physical interventions through social skills education, anger management, psychotherapy, behavioral systems, cognitive approaches, positive relationships, confinement in a crisis unit, police involvement, and medication.
- CWLA is establishing guidelines for best practice behavioral management policies and procedures addressing de-escalation techniques and physical, mechanical, and chemical interventions.
Need For Change
- There is no reliable national data and very little state data on how many child deaths and injuries involve behavior management restraints.
- It is estimated that 8 to10 child deaths in the U.S. each year involve behavior management restraints and countless injuries that include bites, damaged joints, broken bones and friction burns
- As part of a recent series, the Hartford Courant reports that there are between 50 - 150 deaths of all age groups each year as the result of restraints
- There is no data on the number of injuries to staff members occurring during behavior management interventions.
- There are no national standards or guidelines for behavior management in residential care facilities.
- Most states have some regulations that address behavior management, but there is no uniformity between states, or even internally within the different jurisdictions of a state.
- Even within states, each of the many different public systems that deal with children and young people, such as schools, child welfare, mental health and juvenile justice addresses these issues-or fails to address them-in its own way.
- There are many crisis intervention training models currently in use, including SOLVE, CPI, TCI and PART.
- Recommendations for physical restraint techniques, including positions, holds and the number of staff members involved, vary widely as do the points of view on the safety of particular strategies.
Agencies and staff need guidance for dealing with challenging behaviors in a way that protects the child's safety, respects the child's dignity, and minimizes the risk to both children and staff. This requires ongoing and regularly updated training on behavior management techniques, and especially de-escalation. A principle guideline must be that best practice is least restrictive.
Residential facilities are too often understaffed and struggle with high staff turnover. These are issues which must be addressed through better pay and appropriate training and supports.
Public and private facilities must report all injuries and fatalities to a central data bank and a comprehensive monitoring program.
Need for a better understanding of what crisis intervention models work in what situations.
Commitment of Funds
Need for funds necessary to address issues of training, staff professionalization, data collection and research.
The need for minimum national standards for residential facilities to care safely and appropriately for children and young people.
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