As part of growing work we are doing with law enforcement and correctional systems across North America, we are thrilled to have launched collaboration with the Oregon Youth Authority. This collaboration is led by their Director of Treatment Services, Dr. Whitney Vail, who is one of our Certified Trainers. She recently delivered the following testimony to the Ways and Means Subcommittee in Oregon:
I am a licensed Psychologist and have been working in institutional settings with youth for 15 years.
I sit before you today as the Treatment Director for OYA for one primary reason: a youth whom I will refer to as Sam.
I first met Sam in the spring of 2010, when I was working for OYA as a Contract Psychologist. Sam was 17 at the time, and had been in OYA close custody, on charges of Criminal Mischief 1, for 4 months. Sam was referred to me for a comprehensive psychological evaluation due to concerns from his treating psychiatrist about possible psychosis. Prior to his commitment, Sam had received outpatient mental health services, was placed in day treatment and at least 3 residential treatment programs, as well as detention 10 times.
Sam was raised by his grandmother most of his life. His mother reportedly had a substance abuse history, and he didn’t even know who his father was. Though Sam would never speak negatively of his grandmother, they did not appear to be close and the relationship did not appear to be one of nurturance, though I’m sure his grandmother did the best she could with the skills and the resources she had. By the 7th grade, Sam had essentially dropped out of school. He became engaged with the legal system at age 14, when he first ran away.
I remember how oddly Sam presented in the first few testing sessions, appearing unkempt, presenting as paranoid, and laughing inappropriately. After multiple sessions and attempts at building rapport and helping Sam understand the importance of the evaluation process, Sam’s psychological testing results were deemed invalid due to him responding dishonestly, randomly, and at times intentionally trying to present as less capable than he was. I recall being frustrated with how useless the results were.
After analyzing the test results, I decided to pay a visit to Sam, who was in isolation after having assaulted a peer and then smearing feces all over the walls of his isolation room. I distinctly remember standing in the isolation room with Sam, careful not to lean against the feces covered walls. We discussed motivation in general, as well as Sam’s personal motivation. Sam was able to identify tasks that he was motivated to work at. However, he did not find the behavior management unit that he was placed on to be helpful in any way, and therefore he was not motivated to return to the unit from isolation, nor to move on from the unit to one with more privileges.
After completing my report, I met with Sam to discuss the general results and recommendations of his evaluation. Though I had used information from both the assessments and my interactions with him, I distinctly remember Sam saying, “You got all of that from our talk!” Though I found myself defensive at first, I quickly realized that he was right… I had learned a lot about Sam that day I stood with him in his isolation cell, and it was only with that information that the rest of the testing information made sense. All my years of education and complicated psychological tests could not compare to the power of a face-to-face honest conversation.
About 7 months later, I met with Sam to assess him for suicide risk. During this meeting, he asked me about the diagnosis I had assigned to him after the psychological evaluation. His diagnosis was one that is uncommon and marked by social disinterest and bizarre thinking and behavior, often somewhat paranoid in nature. I was concerned about how he was going to react to my response. To my great surprise, the resulting conversation was one of great depth and insight. Sam was saddened by his diagnosis and the thought of being that way for the rest of his life. This provided a great opportunity for us to discuss what this meant in real life: how others perceived him, how he perceived others, his interests and goals in life, etc.
Shortly thereafter, Sam requested to read his full psychological evaluation report. I was quite concerned about how someone with such a paranoid outlook would respond to the negative information in the report. It was difficult for him, but it was also a critical point in Sam’s development. Up until that point, he had relied on adaptive skills of avoidance, running away, bizarre, aggressive, and self-harm behavior to deal with distress. Sadly, he also believed that he could get financial benefits if he acted “crazy.” I will never forget the look on his face when he realized the true impact of his functioning on his future. Sam was a kid who not only lacked pro-social skills but who was truly lost in any social interaction. His best skills for managing his negative emotions were to partake in suicidal behavior, laugh inappropriately, or take his feelings out on others physically. He assumed the worst in others and had difficulty looking past the immediate. He was doing the best he could with what he had, which wasn’t much. He had many lagging skills, no consistent supports, and traditional behavioral interventions only lead to him further implementing his adaptive skills, which made things worse.
But now, Sam had enough insight to understand that if he continued on the path he was on, things would, at a minimum stay the same, and likely get worse. Sam was not happy with the path that he was on, but he didn’t know how to find a different path. Attempts from others to show him “the right path” only made him retreat more. Sam had not only repeatedly failed to learn from his consequences, his undesirable behaviors were actually further reinforced by the consequences. When you don’t know what else to do, or have the ability to do it, you do what you know.
Sam is a prime example of a youth caught spiraling in the traditional correctional system. Each negative behavior is met with a negative consequence. But, a lack of skill prevents the youth from replacing the negative behavior with a positive one, and feelings of shame are processed as trauma, resulting in the brain retreating to basic survival. In a traditional correctional system, we assume that behavioral interventions will teach these youth to decrease their negative behaviors and increase their positive behaviors. However, these interventions are highly limited to teaching basic lessons and extrinsic motivation. For our youth to be successful long-term and independently, they need to develop skills and intrinsic motivation.
Sam had just developed intrinsic motivation. And, it wasn’t by me dangling a carrot on a stick for him, or by threatening further consequences if he didn’t change his behavior. All of those things had been tried and failed miserably. Rather, Sam’s motivation was to feel like a happier, healthier, person. And, he came to this motivation, not by my stunning psychological testing results, but by my honesty… My willingness to stand in a room covered with feces and have a conversation with him like a normal human being… My willingness to admit when he was right and I was wrong… In Sam’s words, I treated him “like an equal,” like “a normal person.” And, he was right… When I worked with Sam, he was an equal. He was the expert on himself, not me. He knew best how he felt, what he thought, how he perceived the world. I was merely a partner in helping him find a new path. And, despite his oddities, Sam was a normal person. He had faults and skill deficits like the rest of us. He also had strengths. And, he had adaptive skills that may not have been ideal, but which served a purpose in him getting through life.
Sam and I proceeded to meet weekly for about 6 months to help him develop skills that would ultimately decrease his diagnostic symptomology, while improving his overall functioning. In the time that Sam and I worked together, his hygiene improved from keeping his facility-issued clothing dirty and stained, to wearing his own clothing with pride, which he kept clean and tidy; as well as keeping his hair cut, clean, and his face shaven. He moved off the behavior management unit onto a mainstream unit, where he was mentored by a cousin he admired. For the first time in years, he not only attended school regularly, but he completed his GED. And, Sam was taking interest in self-improvement activities such as ToastMasters and obtaining a job on campus. He smiled and laughed appropriately, accepted compliments, and communicated his thoughts and needs in words.
And, to give you some numbers, comparing the six months prior to Sam and I working together to the six months while we were working together, Sam’s number of documented incidents of Major Group Disturbances decreased from 4 to 2; Contraband from 6 to 1; Youth Misconduct from 73 to 17; Suicidal Behavior from 9 to 1; and Assaults from 21 to 4.
After 19 months in close custody, Sam was demonstrating readiness to parole. He was truly turning his life around. And, it wasn’t because of external consequences or rewards, it was because he had built positive relationships and developed skills. It was a team effort, with Sam learning to trust through our relationship, and work with us to build skills, one of which was to learn to better read others, and through that Sam was able to build trust in other professionals that he worked with on a daily basis… He was better able to ignore peer negativity and understand that those were not the people to trust. He gained greater insight into his own strengths and capabilities, and he developed pride in his accomplishments, which motivated him further. Sam was eager to leave close custody, and yet he was realistically anxious about his ability to function in the community. Institutionalization had set him back in his adolescent development, and he knew he had to keep working on his skills if he was going to remain in the community successfully.
In all these ways, Sam’s story appears to be one of success. But, in the end, we failed. We were too late. While we were still responding to Sam with traditional correctional methods: punishing him for his negative behaviors and trying to motivate him with carrot-and-stick incentive programs to comply, Sam still failed to have the skills to meet our expectations, and we failed to respond to him in a trauma-informed way, inadvertently increasing the negative behaviors and further impeding the necessary skill development. During this time, as Sam instantly became an adult on his 18th birthday, with a brain that still had approximately 7 years of development ahead, Sam received adult charges for behaviors in our facility. By the time of his conviction, Sam was ready to parole from OYA with referrals to community providers. Instead, he was sentenced to DOC to serve (I believe) 6 more years… These valuable and vulnerable years of prefrontal cortex development will occur behind bars, with limited opportunities for positive social skill, emotional regulation, and other critical problem-solving skills. The likelihood of pruning will be greater than the likelihood of growth, Sam’s trauma responses will be more ingrained, and Sam will most likely be less prepared and capable of functioning as a crime-free, productive citizen in the community.
We failed with Sam, and yet, what I learned from working with him is invaluable… He put everything I learned in school into perspective, and taught me things that could only be learned in real-life… Sam is a prime example of the youth we serve at OYA. He entered our system with a myriad of struggles and barriers. Our intentions and attempts were good, but misled by an outdated approach. We now know better… We have the research to help us understand why Sam’s brain worked in a way that he not only didn’t meet our basic expectations, but didn’t respond to our traditional interventions. We have the research to verify that the number one factor of change in people is the helping relationship. We have the research to help us understand how our attempts to set clear boundaries only traumatized and retraumatized him, and actually resulted in him responding with dangerous behaviors towards himself and others. We have the research to know that there is a better way. One that helps get our expectations met, while building skills, positive relationships, and preventing further trauma.
Through the Youth Reformation System, OYA is forging ahead full-force with this better way. Through Trauma-Informed Care, Positive Youth Development, and Collaborative Problem Solving, all of our youth, including those as complicated as Sam, will have a greater chance of developing pro-social and appropriate problem-solving skills, as well as personal mastery, … promoting brain development and increasing the likelihood that they will become crime-free, productive, healthy citizens.