please help, need advice, I work in a Residential Treatment Center (RTC).....

[raybaro]

Hello everybody,

I am new to the forum. I really enjoy the site, there is a lot, of, great info here. I have been working in an Residential Treatment Center (RTC) for around a year. I was recently moved to an all girls unit (I'm a male). I have been having a very hard time. I cannot go into detail due to legal issues but I am dealing with odd, Reactive Attachment Disorder (RAD), and ptsd.

at this point I don't know what to do. it is total chaos. we have to apply holds (cpi) o a daily, basis. they don't listen and want to do whatever they want. the ages range from 8 to12.

I hope someone can help, I've been having a very rough time having to put everything in order.

Thanks

 

[busywend]

Raybaro - didn't the facility train you?

 

[timer lady]

I'm assuming that you've gotten training for your position in the girls unit. Especially on PTSD & Reactive Attachment Disorder (RAD). These 2 particular diagnosis's fairly often present themselves as ODD. in my humble opinion, ODD is just a symptom of so much more going on.

Saying the above, as a male, I would not on any level ever do a restraint of a female resident with-o another female staff person in the room. Attachment disordered & PTSD children have the tendency to report false allegations of abuse on every level. Additionally, many of these children have no concept of what is abuse & what isn't ~ therefore the false allegations.

I'm going to assume there is a treatment plan in place along with other staff members on board.
What are the steps before a physical restraint is used?
Is there an area where the resident is given time to cool off by herself?
Is the resident being taught self calming?
Are residents being given therapy? What about medications & PRNs?

Knowing that the young women there have PTSD & Reactive Attachment Disorder (RAD) you should be aware that any touch, any restraint of this nature can bring on flight or fight responses. Flashbacks of abuse or worse.

Restraint should be the very last option ~ period.

What you should do is get the treatment teams together & come up with a better plan. For your safety as well as the safety of your residents.

 

[slsh]

Hi Raybaro - the key thing I noted in the 2 excellent RTCs my son was in was the rigid scheduling and control of the environment. Not to say it didn't occasionally get chaotic, but... that's the nature of where you're working, you know? Consistency and detachment are also key. Good staffing is also important. In my son's first Residential Treatment Center (RTC), from age 9-12, he was in a unit of 10 kids and there were always 4 staff members on the unit during waking hours. The Residential Treatment Center (RTC) also had roaming staff available for crises.

It's really hard to address restraints broadly. The underlying reason for restraints is going to vary by kid. Obviously (hopefully), you are only restraining kids who are engaging in dangerous behavior, you receive frequent training in CPI, and the treatment team for each kid is aware of the frequency of restraints and is addressing this in the treatment plan.

For my son, he thrived on restraints, actually sought them out. It gave him control of the situation (in his distorted thinking) and he got the undivided attention of several staff members. Knowing this didn't really help the treatment team come up with- new solutions for deescalating him because he would simply up the ante until a restraint was the only choice left. I'm not sure what finally broke the cycle at age 15 - at that point he was in a facility that used chemical restraints (last resort, not something I was real happy about, but he was 6', 200 pounds, and was getting physically restrained multiple times a day, at risk not only to himself but also to staff). I don't know if he finally matured and "got it" or if it was his loss of control of the situation when they chemically restrained him - I suspect a combination of both.

The keys to a good Residential Treatment Center (RTC) in my book are structure, structure, structure, well-trained staff with- good supports from admin and ancillary staff, and more structure. If you're walking onto a unit that has not been run well, you're going to have to expect out of control behaviors from the kids that will probably get worse before it gets better as you implement structure and routine.

You also need to remember who your clients are. They are not there because they can comply with rules, control their behaviors, and follow instructions. Your job is to help them learn self-control while addressing the underlying issues and at the same time keep them safe from themselves and their peers, while also keeping yourself safe. Unit staff are in the trenches - you're dealing with behaviors that we could not manage at home. It's an incredibly difficult job.

 

[susiestar]

Welcome! If the facility hasn't trained you then you need to go to HR and ask for more training (after you speak with your boss first and take notes of the discussion). In this case (no or not enough training), document each discussion in a letter, memo or email sent to "make sure I understand our earlier discussion" or to "confirm what we discussed this afternoon", etc... Keep track of these and make sure they are dated. If you get replies to them, keep those also. You mentioned legal issues and this can help you a LOT in a legal situation. I would include a line that asks the other person to reply if soemthing was misunderstood or mis-stated in the letter. Then if you get no reply you can assume you got it right. If they reply verbally make another email about that.

Timerlady is an excellent resource on RTCs and kids with Reactive Attachment Disorder (RAD), etc... She has great ideas and really knows her stuff. We have others who have had a lot of familiarity with RTCs and they will come along soon.

Thanks so much for caring enough to work in an Residential Treatment Center (RTC) and enough to seek us out and ask questions. The kids need more people like this in their worlds!

 

[raybaro]

Thank you everybody for the warm welcome. I should have given you guys some of my background information. I'm in my 20's and have a degree in Psy with a minor in Soc. I was recently moved to this unit to try to fix what was going on. This Residential Treatment Center (RTC) has no structure and sincerely it's a nightmare.

There's 3 different shifts; (morning, swing, and graveyard).
Group A (includes HM) works Mon-Fri from 7-3.
Group B works Sunday 8-8 and Mon-Wed from 1-10.
Group C (my shift) works Sat. 8-8 and Wed-Thur. from 1-10.

Most of us work on Weds (the most chaotic day). Each group has 2 staff members, except on Weds (4).

The biggest issue like I stated is structure. I tend to try and run things strictly but their is a lot of defiance. Kids will start provoking staff and state the other group would let them do stuff, therefore they will refuse to listen at all causes.

 

[raybaro]

I'm assuming that you've gotten training for your position in the girls unit. Especially on PTSD & Reactive Attachment Disorder (RAD). These 2 particular diagnosis's fairly often present themselves as ODD. in my humble opinion, ODD is just a symptom of so much more going on.

Saying the above, as a male, I would not on any level ever do a restraint of a female resident with-o another female staff person in the room. Attachment disordered & PTSD children have the tendency to report false allegations of abuse on every level. Additionally, many of these children have no concept of what is abuse & what isn't ~ therefore the false allegations.

Yes, I try to avoid any form of restrains. I use it as a very last resource. I also always have my other staff member (female) with me at all times when conducting a hold.

I'm going to assume there is a treatment plan in place along with other staff members on board.

They all have goals and have to work their program.

What are the steps before a physical restraint is used?

I try to talk to them, ask them to take seats, etc. Restrains are only used as a last resource. I only use them when Ct is a danger to him/her self or others.

Is there an area where the resident is given time to cool off by herself?

Usually it's called a seat. They sit down when a major re-diagnosis is given.

Is the resident being taught self calming?

I believe so but not always the case.

Are residents being given therapy? What about medications & PRNs?

Yes, they have group therapy and school. All of our girls are on medications.

[/QUOTE]Knowing that the young women there have PTSD & Reactive Attachment Disorder (RAD) you should be aware that any touch, any restraint of this nature can bring on flight or fight responses. Flashbacks of abuse or worse. [/QUOTE]

I agree, I have been trying to avoid any sort of restraint or touch.
Restraint should be the very last option ~ period.

[/QUOTE]What you should do is get the treatment teams together & come up with a better plan. For your safety as well as the safety of your residents.[/QUOTE]

Sorry for the "dumb" question but is there any advice you can give in regards to this?
[/QUOTE]


Thank you,
R

 

[raybaro]

Hi Raybaro - the key thing I noted in the 2 excellent RTCs my son was in was the rigid scheduling and control of the environment. Not to say it didn't occasionally get chaotic, but... that's the nature of where you're working, you know? Consistency and detachment are also key. Good staffing is also important. In my son's first Residential Treatment Center (RTC), from age 9-12, he was in a unit of 10 kids and there were always 4 staff members on the unit during waking hours. The Residential Treatment Center (RTC) also had roaming staff available for crises.

It's really hard to address restraints broadly. The underlying reason for restraints is going to vary by kid. Obviously (hopefully), you are only restraining kids who are engaging in dangerous behavior, you receive frequent training in CPI, and the treatment team for each kid is aware of the frequency of restraints and is addressing this in the treatment plan.

For my son, he thrived on restraints, actually sought them out. It gave him control of the situation (in his distorted thinking) and he got the undivided attention of several staff members. Knowing this didn't really help the treatment team come up with- new solutions for deescalating him because he would simply up the ante until a restraint was the only choice left. I'm not sure what finally broke the cycle at age 15 - at that point he was in a facility that used chemical restraints (last resort, not something I was real happy about, but he was 6', 200 pounds, and was getting physically restrained multiple times a day, at risk not only to himself but also to staff). I don't know if he finally matured and "got it" or if it was his loss of control of the situation when they chemically restrained him - I suspect a combination of both.

This is the case with most of the ct's.

The keys to a good Residential Treatment Center (RTC) in my book are structure, structure, structure, well-trained staff with- good supports from admin and ancillary staff, and more structure. If you're walking onto a unit that has not been run well, you're going to have to expect out of control behaviors from the kids that will probably get worse before it gets better as you implement structure and routine.

This seems to be the biggest issue. It is just becoming very hard to deal with. I feel like I have something going on Thursday to Sat and when we come back on Wed, things just get worse. I want to integrate good structure but I don't know what to do.

You also need to remember who your clients are. They are not there because they can comply with rules, control their behaviors, and follow instructions. Your job is to help them learn self-control while addressing the underlying issues and at the same time keep them safe from themselves and their peers, while also keeping yourself safe. Unit staff are in the trenches - you're dealing with behaviors that we could not manage at home. It's an incredibly difficult job.

I agree, it's been very difficult. Developing self control is very hard for some of them.

 

[raybaro]

Welcome! If the facility hasn't trained you then you need to go to HR and ask for more training (after you speak with your boss first and take notes of the discussion). In this case (no or not enough training), document each discussion in a letter, memo or email sent to "make sure I understand our earlier discussion" or to "confirm what we discussed this afternoon", etc... Keep track of these and make sure they are dated. If you get replies to them, keep those also. You mentioned legal issues and this can help you a LOT in a legal situation. I would include a line that asks the other person to reply if soemthing was misunderstood or mis-stated in the letter. Then if you get no reply you can assume you got it right. If they reply verbally make another email about that.

Timerlady is an excellent resource on RTCs and kids with Reactive Attachment Disorder (RAD), etc... She has great ideas and really knows her stuff. We have others who have had a lot of familiarity with RTCs and they will come along soon.

I am always open to ideas and suggestions. I have learned from mistakes in the past and I am always trying to improve.

Thanks so much for caring enough to work in an Residential Treatment Center (RTC) and enough to seek us out and ask questions. The kids need more people like this in their worlds!

Thank you very much, I appreciate it. I love my job but lately it has taken it's toll on me. I was very successful in the other two units and I want to be able and help these girls out. I am willing to try what it ever it takes.

 

[BusynMember]

If they just threw you in there with no training, they did a terrible job both for you and the girls. You have to understand...you got these children because they are out of control, often due to serious disorders such as childhood bipolar, reactive attachment disorder, post traumatic stress syndrome, conduct disorder...they are not necessarily going to respond to discipline of any kind. Some of the kids are there because their families feel they are unsafe at home. I'm going to guess that some or many kids have accused you of abuse. Many of the kids have been sexually abused and they do tend to make false accusations, but CPS has to investigate each one. I'm not a big fan of CPS and would not choose a field where I had much to do with them.
Good luck!

 

[Lucedaleblessed]

The Residential Treatment Center (RTC) which was just down the street here in Lucedale and in operation for more than 20 years did not train their staff either.

My neighbor worked there for some months but he did quit because the place was run by some Christian people who believed that if you locked the kids up and kept the bible in front of them combined with exercise they would surrender to God so they could return to their facilities as good kids. The state shut them down a couple of times. Then a firm from Utah moved in. It was not that much better but they hired outside security so there were less than 10 runaway episodes. I guess that every Residential Treatment Center (RTC) is different.

What is important that the staff is trained to focus on the mixture of kids located there. No Residential Treatment Center (RTC) in the world can fix every illness at the same time. I guess that training would be too hard to get as the times are tough. Try to stick at your job while you apply for another in secrecy.

 

[slsh]

Kids will start provoking staff and state the other group would let them do stuff, therefore they will refuse to listen at all causes.

Sounds like the unit needs to go back to really basic basics. It's essential that staff all be on the same page so that there is none of this triangulation. Again, expect the kids to rebel as you guys tighten things up, but once they realize everyone is consistent, it should start to get more manageable at least.

Schedule - should be written in stone and posted about the unit so clients (and staff) have that visual cue.
Rules - again, should be written in stone and posted about the unit. You need to make sure staff have got rules down cold, and are on board with them.
Rewards - first Residential Treatment Center (RTC) used video games/extra TV time/outings as rewards. Again, visual cues on the unit to remind the kids what they're working toward. Probably *NOT* a tally by client on the general unit, but perhaps in their room (if they're in private rooms) or in other relatively private area so kids and staff can keep track. My son's Residential Treatment Center (RTC) had a separate room on the unit where video games were set up, to minimize distraction/acting out by clients who didn't make goals. I'd start first with- really small increments, i.e. girls who can do breakfast without a meltdown gets X number of minutes of video games (or whatever), then girls who can get thru morning hygiene (always a major trigger on my son's unit) get X minutes (or whatever the reward is), etc.

The only consequence my son's unit had was an LSI. He would have to stay in his room (except for school and meals) until he completed it. Now, my son was the poster child for oppositional/defiant - he would end up with- literally stacks of LSIs. I asked him today about them and he said that most of the time he waited staff out. According to him, they could only have him on room restriction for 30 days (?? I'm not too sure about the length of time, think he's mis-remembering, it was probably a week), but occasionally there'd be something good going on and he would get them done. Then he would have to sit down with- staff to review LSI, and then he would be off restriction (until the next time).

He said the one thing that really bothered him, though, was when staff would be nice to him during/after one of his meltdowns. At a bare minimum, it's absolutely essential that staff *not* react emotionally to the kids' provocations. No anger, no impatience - those are like throwing gasoline on a fire. It takes an iron will, but even here at home I saw for myself that when I stopped reacting and just remained neutral, he did not get the same payoff. Ticked off mommy? Huge payoff for him. Works the same way with- staff.

It's all about control and manipulation and divide-and-conquer for these kids. Chaos is their friend.

 

[raybaro]

Sounds like the unit needs to go back to really basic basics. It's essential that staff all be on the same page so that there is none of this triangulation. Again, expect the kids to rebel as you guys tighten things up, but once they realize everyone is consistent, it should start to get more manageable at least.

Schedule - should be written in stone and posted about the unit so clients (and staff) have that visual cue.
Rules - again, should be written in stone and posted about the unit. You need to make sure staff have got rules down cold, and are on board with them.
Rewards - first Residential Treatment Center (RTC) used video games/extra TV time/outings as rewards. Again, visual cues on the unit to remind the kids what they're working toward. Probably *NOT* a tally by client on the general unit, but perhaps in their room (if they're in private rooms) or in other relatively private area so kids and staff can keep track. My son's Residential Treatment Center (RTC) had a separate room on the unit where video games were set up, to minimize distraction/acting out by clients who didn't make goals. I'd start first with- really small increments, i.e. girls who can do breakfast without a meltdown gets X number of minutes of video games (or whatever), then girls who can get thru morning hygiene (always a major trigger on my son's unit) get X minutes (or whatever the reward is), etc.

The only consequence my son's unit had was an LSI. He would have to stay in his room (except for school and meals) until he completed it. Now, my son was the poster child for oppositional/defiant - he would end up with- literally stacks of LSIs. I asked him today about them and he said that most of the time he waited staff out. According to him, they could only have him on room restriction for 30 days (?? I'm not too sure about the length of time, think he's mis-remembering, it was probably a week), but occasionally there'd be something good going on and he would get them done. Then he would have to sit down with- staff to review LSI, and then he would be off restriction (until the next time).

He said the one thing that really bothered him, though, was when staff would be nice to him during/after one of his meltdowns. At a bare minimum, it's absolutely essential that staff *not* react emotionally to the kids' provocations. No anger, no impatience - those are like throwing gasoline on a fire. It takes an iron will, but even here at home I saw for myself that when I stopped reacting and just remained neutral, he did not get the same payoff. Ticked off mommy? Huge payoff for him. Works the same way with- staff.

It's all about control and manipulation and divide-and-conquer for these kids. Chaos is their friend.

Thanks for sharing this, I appreciate it. would you be able to share what kin of schedule they have. everything seems improvised over here and I want to be able to set a schedule.

 

[raybaro]

update

The house has recently been put on shut down. this means they have lost clothes, personals, toys etc. they can only read or do hw. two of them seem to be the ones acting up the most.

One of them told me they have something planned for staff. ct enjoys getting staff upset and will imitate peers negative bx so that she doesn't feel left out.

She also mentioned that she is acting up due to hearing why peer got discharged (insurance, money). she truly believes she will go home because of this.

Theit plan seems to consist of making child abuse allegations.

 

[HaoZi]

Did they just toss you in there and expect you to run everything? *picks self off floor*
I can't say how glad I am you are out here looking for help from parents who have been there done that and have a good idea of what works and more importantly, what doesn't work. Personally when creating a schedule, especially for kids, I'd start with establishing meal and snack times at reasonable intervals, because if they're hungry or having blood sugar spikes/dips, they'll be more challenging.