Monday, January 18, 2010

A Warning Sign

"It’s the tasks" your program manager says to you. "We just cannot seem to think of enough tasks to assign to the kids in my unit. And those we can think of they don’t take seriously, they are done quickly, and I just don’t think they are significant enough to deter the behavior."

What would be your response to this plea? Would you start researching tasks that the unit could use?

I think this is a sign that more training is needed. In my experience, this focus shows that staff are still considering the tasks as punishments, and thinking that their power for change is found in their deterrent function. That is, the kids won’t want to do the tasks so they will avoid that behavior. If you are thinking that way, you start to wonder if the tasks are hard enough, significant enough for the bad behaviors. You become concerned if the kids seem to enjoy the tasks. You hear statements like "they did ... and THAT is all they have to do?"

Let’s step back a few steps. Our basic premise is that symptoms are adaptations- that the kids are doing the best they can, and they are doing these behaviors because they do not know any other way to handle their intolerable feelings. Therefore, in the Restorative Approach we respond to behavioral problems with tasks that are designed to help the child learn new skills and to repair damaged relationships.

So- Kayla has a difficult call with her mother. (A small (or large) set back happens in the present.) Kayla does not trust relationships and cannot ask for help. She is already over activated and is now completely lost in her stress response. She has no sense that there is any one who loves her and will care how this turns out. She feels pretty worthless anyway, and knows that this latest event is just one more sign of what a lousy person she is and how her mother gave her up because she is such an awful girl. And she does not know how to notice, identify or sooth her feelings. So, Kayla is plunged into the depths of fear and hopelessness. Who wants to feel that way? So she does something, anything, to escape these feelings. She cuts herself. She throws a chair. She runs away. She hits a staff.

So what Kayla needs to be able to handle a setback in a better way is:

Relationships she can trust
A calmer body
A sense that people care about her, and the ability to remember them when they are not present
The knowledge that she is worth the air she breathes
Skills to identify and soothe her feelings

And hopefully we know Kayla. We know the neglect, sexual abuse, and multiple placements she has experienced. We know her strengths in drama and her ability to teach younger children, and we know how mornings are hardest for her. And we have a formulation, a theory about what is going on with her and that our primary theme in working with her is learning to trust others and ask for help.

So this is where the tasks come in. The tasks are a chance to practice some part of what she needs. To put one building block in her wall of creating a competent self.

Kayla will act better when she feels better. After her blow up she is feeling worse, more shame, more self hatred. And that can send her into another acting out episode.

So- the tasks.
Making amends helps strengthen relationships and teaches how to fix problems in relationships.
Doing a task with a staff member is practicing trust and accepting help.
It is also practicing effective action- when something goes wrong, Kayla can do something about it. She does not have to freeze.
Practicing what to do when upset (a feelings chart, a poster to illustrate what Kayla was feeling or six steps I can take when she is angry, interviewing others, making a plan for her next contact with her mother, etc) help to develop feeling skills, and include methods to create a calmer body.
Doing something to make things better (chores, create a bulletin board, make brownies, helping a younger child with her homework) increase self worth.

The idea is to use the opportunity that an episode provides to help give Kayla what she needs to handle life better.

Kayla doesn’t have to hate the tasks. She has to take them seriously and do them well. Then its over, and we go on, hopefully just that little bit closer to what she needs.

This is where I would focus with the unit that needs more tasks.

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