The state of Michigan is aiming to ban the use of restraints and seclusion in its juvenile justice system and at other institutions that care for children unless a situation is life-threatening.
This action comes in response to the death of 16-year-old Cornelius Frederick after being restrained by staff at Lakeside Academy in Kalamazoo on April 29th of last year.
He died two days later.
"Cornelius was a good kid," said Meghan Folkerson, who was director of case management at Lakeside, which closed last summer. "He definitely went through trauma and things that no one could even fathom.”
He was goofy and loved music, chess, and technology and was smart in ways that schools might not always label smart, she said.
“He was tough. He definitely had moments that he would push your buttons," she said. "He would push my buttons. He would push other students' buttons, but that was really just his defense considering everything he had to go through and being part of this system you kind of have to put up some of those fronts."
His death made the state take a closer look at its policies when it comes to child care and residential services and implement changes.
“It became clear to us that we needed to limit the use of restraints. Restraints are extremely unsafe," said Stacie Bladen, interim executive director for the Children's Services Agency at the Michigan Department of Health and Human Services
She says the licensing rules that govern institutions that provide residential services for children allow for the use of restraints and have not put a lot of parameters around the use of restraints.
"After Cornelius's death, we issued emergency rules, which limited the use of restraints on a temporary basis," Bladen said.
Restraint use still occurs, Bladen said, but its been limited.
"We were running, I want to say roughly 600 restraints per month before Cornelius died...Now we're down to 272, roughly and we're sticking right around there a month," she said. "So restraints are still being used. We're trying to limit restraints. The time of restraints, has to be serious, that the child is at imminent risk serious of serious injury to himself or herself or someone else. So we've put limits on the use of restraints and we can see them going down."
But Bladen says they knew that they needed to create permanent rules that embodied much of what was in the emergency rules and even take it a step further to limit the use of restraints and eventually completely eliminate the use of restraints and seclusion in institutions that care for children.
The revised rules would prohibit chemical restraints, pressure point control and pain adherence techniques, the use of straight jackets, hogtying, and restraint chairs. It will also prohibit restraining children to objects like beds or walls, using restraints for punishment or discipline, and also peer-on-peer discipline.
“Restraints are difficult," Folkerson said. "I can recall times where to keep staff and students safe that kind of had to be done. But I also believe that there is a line. I don’t feel like taking a student to the ground and using the restraints that were used that day are ever appropriate.”
Debbie Plotnick is the Vice President for state and federal advocacy at Mental Health America. A non-profit that advocates for people with mental illness. The non-profit strongly supports getting rid of the use of restraints and seclusion.
"Seclusion and restraint really are akin to torture. There's no nice way to say it, holding someone down, tying them up, putting them in what it, what amounts to solitary confinement is torture. It is akin to torture, and it is traumatizing," Plotnick said.
"Restraints, in particular, can happen in a lot of different ways you know we think about tying people down we think about handcuffs, but it also can be chemical restraint, it can be overuse of medication or improper use of medication to subdue individuals because of how their behavior is perceived, but all of those things are dehumanizing and traumatizing."
But if they get rid of restraints what would be implemented instead?
"Kids do have violent outbursts and they're not able to regulate and control their behavior all the time so what do we do. So, there is what we call Six Core Strategies," Bladen said.
"It includes things like workforce development training, coaching, mentoring, staff on prevention and intervention skills to avoid power struggles and de-escalating youth," she said. "This is not about watching a youth about to lash out and get violent, and then start to de-escalating, you know de-escalating them by talking to them. This is backing up much much earlier," she said.
Like having a conversation with a child and their family right when they're admitted about what triggers them and what calms them down.
"What are the things that we can do and what things should we be looking for doing to include in your treatment plan, or to include in your environment that will help you," Bladen said, "and those seem like very simple things but they're very effective."
These aren't changes that institutions will be able to make overnight, she said. It takes time.
"After you've eliminated restraints, it is not as easy as a light switch going on and off, it is significant organizational change. And so, we know from talking to partners across the nation that this could take two, three years to fully implement successfully and sustain the six core strategies,"
Plotnick says one state that has had success doing this is Pennsylvania.
From 2001 to 2010, patient-to-patient and patient-to-staff assaults have gone down in Pennsylvania, according to Mental Health America. They also said the use of containment procedures has gone down.
"New York has really recognized how damaging putting people into an environment where they are secluded. In fact, they have just passed a law for their jails and prisons that no one will be held in solitary confinement longer than 15 days. And that's an important first step, because in all situations when people are only in a room by themselves with nothing else with no human contact. That will cause severe mental health issues, even more, if none had existed before," Plotnick said.
Michigan leaders hope to have the rules changed by May 2022.
Folkerson said it's something Cornelius would want.
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“We lost a kid to something senseless," she said. "But really, in all, what Cornelius would want is to make sure no one else has to go through this. He would want his name to make change.”
The public hearings for the revised Child Care Institution licensing rules are scheduled for June 3rd and June 10th on Zoom. Public comment will be allowed and parties that are interested may provide testimony to support the rules or voice concerns.
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