Who Are These Kids?

If I walked up to the first child care worker I saw at your place and asked, "Who are the kids who come here? What are they like?" what response do you think I would receive? Would the person say: "They are kids who have experienced severe difficulties in their lives, who are hurt, who haven’t developed the skills they need to have lives worth living. But they are really great kids"? Or would the response be more like: "they are very difficult, aggressive kids. They have committed crimes or done other bad things. They are wild and out of control. They can’t be trusted, they will hurt you, you need to watch them, you can’t let them get away with a thing"?

Of course the response would vary with the day, with the minute. It might be different from program to program. And most likely the response would contain parts from both responses above.

But who we think the kids really are determines what we think they need. In the first scenario (again, keeping in mind that these are extremes on a continuum) those kids need to heal, to learn to manage their pain and emotions, and they need skills. In the second scenario, those kids need control, punishment, vigilance, to be watched, a tough staff who holds them accountable and doesn’t let them get away with a thing.

And that leads us to who we have to be. Who we think the kids are leads us to our ideal for child care staff. What is the actual ideal that is operating in your culture? Are new child care staff socialized by experienced workers that they should be kind, calm, soothing, and should gently teach the kids new skills? Are they taught and shown that liking, enjoying and appreciating the kids is essential to what we do here? Or are they scared by violent war stories, shamed for being innocent and trusting, or weak, and taught you have to be tough and firm and not let the kids get away with anything? Do staff brag about their moments of connection? Or are they proud of the battles they have endured, the injuries they have received without flinching or showing any response? Is the staff ideal closer to a person or to a rock?

Again, the reality is undoubtedly somewhere in the middle. But let’s have these discussions out loud. Ask staff what they learned from experienced staff when they first came to work here. Talk about what we want the ideal to be and how we can put that into practice. Remember, how we see the kids is undoubtedly how they will act.

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Manipulation Part Three- Us

I may seem to be obsessed with the concept of manipulation, as this is my third blog post about it. This concept, for me, represents how hard it is to create an entire world-view change in the treaters who work with our damaged kids. So often we teach the section in Risking Connection on manipulation, only to hear as I did the very next day a child care worked in the training say with indignation something like: "and I couldn’t believe that child was trying to manipulate me to get what he wanted, what did he think I was, an idiot? And by going to that other staff he did get exactly what he wanted!"

First of all, it actually isn’t a crime for a child to get what he wants. And if we would like to encourage direct communication of needs, we have to be prepared to say yes when ever possible.

Secondly, the question of what may have prevented this boy from asking directly for what he wanted was missing. And more and more I become aware that our systems prevent a child from asking directly- for more phone time, for an extra snack, for a later bed- because we are so wedded to our structure that we automatically say no. "He knows the rules. Who does he think he is?"

Yet we ourselves often ask for and get extra, against the rules- an extra cookie from the cafeteria staff, the ability to leave early just because we are tired from our supervisor, some extra telephone time (when we are being paid to be working) because our child is sick.

I have begun wondering why we get so angry about this. We feel angrier than we do for more severe behaviors, such as aggression, at times. One aspect, I think, is that manipulative behavior appears deliberate and calculating, within the child’s control, as opposed to an angry out burst which is clearly emotionally based. We lose sight of the factors beneath the child’s inability to meet his or her needs directly.

What do we feel when we have been tricked or manipulated? When we are vigilant to spot and stop all manipulation what are we guarding so heavily against?Staff comments give us clues: Does he think I am stupid? I felt like a fool. The rest of the staff will not respect me. He thinks he can get over on me. I looked bad in front of every one. I felt like an idiot because I believed him.

So, being tricked makes us feel foolish and stupid. It taps into our fears that we may be incompetent. We feel unsafe, exposed, laughed at. We imagine we look bad in the eyes of our peers and they are judging us as naïve, gullible. In short, we feel a type of shame. We strengthen our resolve never to feel this way again, and become more guarded and distrustful with the kids. We determine to be trickier than they are.

Can we use this experience to develop a new depth of empathy for our kids? After all, they feel this way most of the time. They have been tricked, used, and made to feel foolish. They have trusted and then discovered lies. They have been counting on someone and been left. They, too, have felt unsafe, exposed, judged, laughed at. And just as we do, they develop the protection of being hardened, guarded and distrustful- and indirect.

Humans, adults and kids, are vulnerable. We don’t like to be exposed. We don’t like to be rejected. We don’t like to be taken advantage of, tricked or lied to. If this happens a lot, we close down, form a protective barrier, hide our true hearts, and interact defensively. We try to get what we can through indirect, covert ways. When we feel safe and trusting, we are most likely to ask directly for what we need and want.

When we hear ourselves use the word manipulation, and we feel that familiar indignation, let’s look deeper into our selves. Let’s use what we feel to help us understand in a new way what our kids feel. Let’s use this understanding as a platform to create meaningful, caring discussion about the possibility and benefits of honesty between people.

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Dr. Ross Greene

I did attend a training by Ross Greene (http://www.ccps.info/) at the Brattleboro Retreat (http://www.retreathealthcare.org/) Ross Greene does not speak much about trauma. However his approach that children do well if they can, and that defiance and other problems are caused by learning disabilities, are very compatible with our work. He states that rewards and punishments teach that external bad effects rapidly follow bad behavior, when you are caught. This is not always true in the world, and leads mainly to an emphasis on not being caught- a radar detector approach to speeding. Learning how your behavior affects others is a much more powerful force for change.

As I have often stated, it all goes back to your formulation of what you think is going on when that kid is acting up. Why do you think he is not doing well? If you believe it is because he doesn’t want to, then an approach of increasing motivation (rewards and punishments) is appropriate. But if you believe he doesn’t know how, then a skill teaching method is called for.

Ross Greene had some thoughts to add to our investigation of manipulation. He stated as others have that our kids are bad manipulators- their manipulation is too obvious and makes other people feel bad. Good manipulation is more subtle, makes the other person feel they are doing just what they want to do. It involves planning and organization and the other person does not know they are being manipulated, or does not resent it. So- can we start working "being a good manipulator" into our skills classes?

I liked the phrase Dr. Greene used: "decisive not punitive". When we first teach staff about the Restorative Approach some feel that it means that they should ignore kid’ harmful behaviors, not step up to what they are doing that is hurting others. The best Restorative Work requires very active involvement with the kid and lots of feed back on how what they are doing affects others. Decisive but not punitive!

Dr. Greene describes our role as being a "surrogate frontal lobe" for the kids while helping them grow one of their own.

Dr. Greene’s method of collaborative problem solving is certainly an excellent idea. One thing I like was the suggestion to teach kids a few key phrases they can use when they are starting to feel upset. As we know, our kids don’t know what to do when they become over whelmed, don’t know how to ask for help, and resort to old solutions such as throwing chairs. Learning some phrases like: "Gimme a minute"; "I need a break"; "Something is the matter"; "I can’t talk about that now"; and "I don’t know what to do" could be a great help.

Dr. Greene suggested there are really only three basic ways to solve a problem between two people: ask for help, give a little, or do it a different way.

I enjoy the convergence of these various methodologies.

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Taking Responsibility Part Two

In treatment programs we talk a lot about kids taking responsibility for their behavior. It seems to be very important to us that the kids acknowledge when they have done something wrong. It is, of course, important to identify when one has done something wrong- how can you fix it if you don’t acknowledge that it ever happened? I have previously written (June 15, 2006) about how shame paralyzes our kids in this area: doing something wrong to them feels like all is lost, all my worst fears about myself are confirmed, no one loves me, everything that has happened is my fault. If admitting you have done something wrong plunges you into total hopelessness, and you have no feelings managements skills, and you have no skills for repairing relationships, your only defense is a complete refusal to own the behavior.

Recently I have been thinking that our indignation that kids "won’t even take responsibility for their own behavior!" might be tempered if we look at ways we find it difficult to take responsibility for our own behavior.

I attend Weight Watchers and that is a wonderful place to learn about adults (including myself) who are trying to make difficult changes- like our kids are. These adults (including myself) by in large have many more assets than our kids do- supporting networks, developed feelings management skills, intellectual abilities. Yet what do we see? People having difficulty taking responsibility for their behavior.

If a person has not been following the eating plan their first impulse is to skip the meeting all together, and to think of a good reason they cannot attend. If they go to the meeting they may want to skip the weigh-in. If they have gained they have many reasons and many extenuating circumstances (in the kids we would call this making excuses, although just as with the kids many of these reasons are completely legitimate). If any one has a bad day of over eating, we often feel that all is lost, that we will never lose weight, and then we keep on over eating more and more. Much in the same way the kids are plunged into hopelessness and despair, these high functioning adults are similarly affected.

We can think of other situations in which we hide our failings, conceal our mistakes, find reasons to excuse our less desirable actions.

I guess it just isn’t that easy for the human being to take responsibility for his or her behavior.

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When Programs Have Problems…

Recently we noticed that one of our units, the Acute Unit, was experiencing an increase in the number of restraints and seclusions. This unit provides excellent treatment for extremely damaged children ages five through twelve. The unit has fourteen kids at a time and is co-ed. This was our first unit to transition to the Restorative Approach. The program has a high reputation for attachment focused treatment.

The first step in responding to a problem is to notice it and pay attention. It took us longer than it should have to take the increase in restraints seriously, analyze the data and begin discussions with the staff and with the kids about what was going on. When a program is in crisis mode people’s time is eaten up responding to the demands of the moment. This stepping back and thinking is especially hard. But it is also especially necessary. The staff of the unit described a feeling of relief when the restraint numbers were reported to them- so that is why I am feeling so tired and drained! Finally someone is paying attention!

We analyzed the reports as to time of day, staff involved, reason restraints started, which kids were involved, etc. and then scheduled a meeting with the entire team and administration to discuss the problem. The meeting tone was not "what’s going wrong down here?" but instead "what help do you need?" However, by the time we had the meeting the team had already reduced the restraints and seclusions and changed the unit situation. So, instead we discussed how they did it. These discussions are as important as problem solving. They serve to underline and re-enforce the changes made, give employees recognition, and further unite the team.

So how did they change the unit atmosphere and reduce restraints and seclusions?A therapist from the team led training on "The Attitude" from Daniel Hughes (playful, accepting, curious and empathetic) and everyone committed to using this through out the day.

The difficulties had partly been caused by staff turnover- several people had left at once and the unit had been operating with open positions. So now that the positions were full, they had activities to create the new team, get to know each other, and discover each other’s strengths and interests. That way each staff could lead from their strengths. An example given was staff starting activity groups based on what they liked to do. As one child care worker said: "don’t have the crafty people leading the sports". The retreats and trainings focused on self awareness, understanding one’s emotional responses to the kids, and asking for and receiving help. They spoke proudly of their ability to be honest with each other and share their feelings, let each other know when they are burnt out or depleted.

Analysis of the data revealed some times when restraints were highest, notably after dinner. So the team changed the structure of that time period. They divided the kids into two groups for dinner (instead of all eating together), eliminated "siesta time" when they were supposed to be in their rooms but didn’t want to be, instituted calming and relaxation groups, and decided their would be no gym or active games after 7:00. They also added more structure and planned activities on the weekends, deciding in advance how to split the kids up to break up difficult combinations.

A large turnover in kids had also contributed to the restraints and seclusions. The data showed that only 4 of the 14 kids contributed most of the incidents, and that both the frequency and duration of restraints decreased over time for each of them. So the unit decided to adapt ways of getting to know new kids sooner and better, such as by assigning individual staff to spend time alone with each child. They reported that when they concentrated on this they more quickly learned how to help the child avoid escalation. One example was a kid who could accept a tight hug and avert a restraint.

We also discussed: what are other indicators of how unit life is going, in addition to restraints and seclusions? People identified- there is more laughter. We see the positives in the kids and in each other more clearly. We say more complimentary things to each other. We feel closer to each other. We have more fun with the kids.

The unit management now plans to watch all these indicators, including restraint and seclusion numbers, more closely and report them in staff meetings weekly. There is a tendency that when things get better we drop the practices that made them better, such as carefully planning the activities of each shift. The weekly discussion will guard against this. Also, key times such as a grouping of discharges and new admissions, or several very young kids coming at once, have been identified. When such a time approaches, staff will implement special active plans.

It was so moving to see a team of people realize a problem, take it on, and change it, through using the fundamental building blocks of this approach: relationships, the Attitude, planning, and thoughtful understanding of our traumatized kids.

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I Don’t Do Vulnerable

More and more I see a lot of our kids’ behaviors as desperate attempts to avoid being vulnerable.

Priscilla tells me she does not care about her foster parents. Why do I keep asking how she feels about their divorce? Nothing that happens with them affects her, why would I imagine it would? They are just people she happens to live with.

Joey, a boy who is small for his age, enters the unit insulting everyone, making death threats, talking about his gang affiliations and the weapons he claims to have hidden in his room.

Aaron is scheduled for discharge. He becomes aggressive and angrily attacks his favorite child care staff.

Katie is desperately hurting herself, refusing all offers of help, screaming that she needs to go to the hospital shortly after moving to a new group home. She finally says how unsafe she feels the place to be, the locks do not seem secure, it is in the middle of no where, who knows what the neighbors are like, and she’s not all that sure about the staff.

I think we can go far by looking at every episode of aggression we see and think: fear. When we observe unexplained anger, look for anxiety.

The video "Multiple Transitions: A Young Child's Point of View on Foster Care and Adoption" available from The Infant-Parent Institute is a profound and moving story of the child welfare system from the child’s point of view. One part that has always stayed with me is:
"Did I mention how much I am growing to hate smallness, and weakness and defenselessness? It's getting so the only thing I know how to do is to just be as tough as I can, and to try to rub out smallness and weakness wherever I see them:
In the kittens that get hung by the clothesline in the backyard and squished with a tennis racquet.In the babies in my recent foster homes who turned up scratched. In my own Self, which I attack, particularly when I am feeling small or scared, and I need to beat myself into more toughness."

Our kids have seen weakness and where it leads. They have been vulnerable. They have seen their mothers beaten and bleeding. They have been too small to stop the hitting. They have been molested and been unable to protest. They have had it with being too small, too weak, too powerless, too vulnerable. Now they are going for power and protection, whatever the cost.

So what does this mean for us? Try to keep the vision of the hurt little child in your mind’s eye when you relate to the raging teen-ager. Validate the anger and (when you can) identify the fear underneath, and validate that. Understand that the child has real and necessary reasons to hate the softer feelings. Mostly create a caring and respectful environment in which the child can relax and feel safe enough to dare to share how scared she is.

And this will be the priceless gift that you can give these kids.

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One of Those Scary Nights

I was expecting eighteen people from the Department of Children and Families Juvenile Justice Division for a presentation on the Restorative ApproachSM. As I was arranging the room, checking on the food and preparing the brochures I began learning about the previous nights’ problems.

It all started with boyfriend issues, and then rapidly escalated from there. One girl pulled the fire alarm, one ended up in the emergency room. The Program Director had to come in to help the girls calm down.

I started to wonder- am I a fraud here? I am teaching all these people about this new approach, and yet we experience a night like this. We have just been enjoying a period of relative peace and calm with the girls- why did this happen? When I do training I teach that staff should not judge their work by whether the kids act up. Judge the night instead by how they, the staff, act, and whether they use the Attitude (courtesy of Daniel Hughes)- playful, accepting, curious and empathetic. Do I actually believe this?

As often happens, I learned from our child care staff. During the presentation the Girls’ Unit Supervisor Karen Pac began to talk about the differences she experiences during a crisis since we began the Restorative Approach. Staff are warmer and more compassionate with the girls. The emphasis is not on the rules, but on helping the girls calm down. If Katie wants to take a shower, although it is not 'shower time'- let her, that is an excellent de-escalation technique. The team of therapists and staff works closely and calmly together. The team concentrates on reaching out to the girls- what is the matter? That approach allows Robin to switch away from anger at her boyfriend and Nicole who has talked to him and the staff that won’t let her beat both of them up. She begins talking about her father, who said he was going to become re-involved in her life and has disappeared. Now she is crying instead of yelling and threatening. Staff are next to her sharing and validating her sadness. The next morning, the conversation centers on what is happening in the girls lives and better ways to help them. Education staff comes to the unit to meet with the girls and gauge their mood, to make plans with them for entering school (where of course the boys are) and becoming students. The girls are calm and able to attend school. Life goes on.

Our Boys Unit presented a skit for our visitors in which they act out 'before' and 'after' we switched to the Restorative Approach. The situation they chose this time was Steve who had not done his homework and was supposed to be in his room completing it. Instead he was sitting in the lounge refusing to move. In the 'before' scenario, staff concentrated on the fact that there was a rule and Steve was not following it. We must be consistent. We must focus on compliance. The therapist stood near by, but she was not relevant when the goal was to get Steve to do as he had been told. This situation rapidly escalated into a restraint. In the 'after' scenario staff asked Steve what was wrong. They noticed that he had been acting differently all afternoon, had been withdrawn and sad. They called in his therapist. They ignored the fact that he was still in the lounge. Soon Steve began talking about what was troubling him, went for a walk with his therapist, and then easily finished his homework.

These kids come to us severely damaged. They have no ability to manage emotions, and every small setback escalates into despair and panic. A problem with a boyfriend evokes all of their many devastating losses. We cannot expect that we will have no crisis’s, no emotionally over-wrought nights. Instead, we can change how we act in those times. We can stay emotionally regulated ourselves so the children have a chance of regaining emotional regulation. We do this by having a plan and through strong teams. We can shift our focus from rules to compassion. We can concentrate on helping kids calm down. And then we will experience crisis that are shorter, less destructive, less frequent, and that provide opportunities for growth for our children.

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