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By Delmar Devers
Imagine that the year is 1985 and you are a children’s social worker in California. This is the story of one of your youth, John Doe. John is 14 years old and currently lives in a residential group home. He is a smart, and for the majority of the time, a friendly and outgoing child.
However, John has demonstrated aggressive and unsafe behaviors when he becomes upset. He has destroyed property by punching walls, has had temper tantrums, and makes homicidal threats to others in fits of anger.These are the same behaviors that have contributed to his removal of 19 different placements within 6 years.
John witnessed his father’s death at the age of 8 years old. John’s mother was neglectful in her rearing of John, losing custody due to her drug and substance abuse. John has recently started work with a therapist to process these traumatic events.Although he is smart and capable of doing the work, John has difficulty maintaining school placement because of his behavior.
At age 14, John was diagnosed with a behavior disorder called Serious Emotional Disturbance, referred to as SED. You realize that his current placement cannot provide the level of care that is needed to help John. Therefore, you make the decision to remove John from current placement to a higher level of care that will address his mental health needs in a more controlled and secure environment.However, no such place exists in 1985 California.
So, what do you do?
It was not until 1985, that the idea of creating such a placement in California was even entertained. The idea stalled in the California Senate for several years. As late as 1993, a new measure was pushed called Senate Bill 282. It enabled California to establish these kinds of facilities as an alternative to “out of state” placement for SED children. Many of California’s children were sent to Utah, Texas and other facilities that have secured facilities for SED children. These secured, or locked, facilities are called community treatment facilities (CTF).
However, the social problem that my policy attempts to solve, emerged when these seriously emotionally disturbed youth began dying. They died as a result of being incorrectly restrained in CTFs across this country in the 1990’s.
The Hartford Courant conducted a survey of the 50 states of America in 1998, and reported that there were 142 child deaths by restraint within 10 years at CTFs and group homes. Further adding to the fundamental problem of the deaths of disturbed children, was the fact that the staff who were involved in the fatal restraints, were rarely punished. Statistically, this amounts to 14.2 deaths every year. These are deaths that were preventable, and the victims were among the most vulnerable.
Some researchers believe that there were more than 142 deaths, but because there was no regulated way to document them, some deaths and injuries may have gone unreported.
There are theories that attempt to explain the cause of the problem (SED children dying in CTFs). One theory is that governing bodies simply did not care about these forgotten and vulnerable children. The actions of the staff had gone either unnoticed or simply ignored by other co-workers, licensing boards, and/or the legal system.
According to the Hartford Courant study, with nobody tracking, nobody telling, nobody watching, the same deadly errors are allowed to occur again and again. Doing something incorrectly, and without impunity, can definitely lead to more occurrences of the said problem, which makes the case that this is the most important cause of the problem.
The findings of the Hartford Courant survey caught the attention of several United States Senators: Joseph Lieberman, Christopher Dodd, Diana DeGette, Rosa DeLauro, Christopher Shays, and Pete Stark. They introduced the Children’s Health Act of 2000, which was signed into law by President Clinton, in response to the findings.
The Children’s Health Act of 2000 has an overt and stated objective to cover issues regarding the physical and mental health of children. Specifically, section 3208 established a national standard, clearly stating the requirements and conditions under which a physical restraint is warranted:
1) In emergency situations, and child is endangering him/herself and others.
2) Used when the least restrictive interventions are attempted, but ineffective.
3) Used only by those staff members who are trained and certified in restraint techniques, which are recognized and approved by the Department of Mental Health.
These objectives speak to the American value of safety. The goal is to initiate a restraint only when the safety of the child and/or others is threatened.
Next week, we will look at some of the intended and unintended consequences of this law.