A couple of years ago on my personal blog, I wrote a scathing (even for me) piece against news editors who ignored the story of a seven-year-old girl who died a day after being physically restrained by employees at a Rice Lake, Wisconsin counseling center. News editors like me; I had ignored the story, too.
In late May 2006, Angellika Arndt was placed in a "control hold" after several infractions, such as gargling her milk, an initial state investigation showed. She died the next day at Children's Hospital in Minneapolis and, for the most part, her case was -- and continues to be -- ignored.
Last week, the Wisconsin Protection & Advocacy Agency (Disability Rights Wisconsin), an independent agency, released its investigation and I won't make the same mistake twice.
In its 75-page report to the state, called "A Tragic Result of a Failure to Act," investigators chronicled the very definition of tragedy in such a short life. Angellika was only three when she was taken from her biological parents for physical and sexual abuse. She roamed the foster care system and by age five, she'd been diagnosed with a host of psychological problems. But she'd made progress with a new foster family and was sent to the Rice Lake facility to "help prepare her for first grade."
Subsequent investigations showed the girl was placed in restraints for hitting her chin with her hand and in some cases -- said to be routine -- staff members held her face-down on the floor for an hour and a half. This was how children looking for help transitioning to first grade were treated in 2006. They still may be.
Here is the account of her final hours:
Angie arrived at RLDTC around lunch time, and a short time later found herself in a "cool down" precipitated by staff's determination that she had not followed directions for talking and was gurgling her milk with her straw. When Angie couldn't sit still in the chair for her time out, staff took her to the special cool down room. This was the special seclusion room that had no window or furniture besides the single "cool down" chair. The hard floor was covered with a thin carpet glued down to the concrete below. Staff reminded Angie that her cool down time didn't begin until she sat still and in the proper position. Instead of obeying, Angie curled up in the chair, began to cry and soon appeared to fall asleep.
After about five minutes Angie awoke and began to swing her legs back and forth in the chair. Staff warned her that if she didn't stop, they would have to place her in a control hold for safety. Undeterred, Angie continued to swing her legs and cry. Eventually, staff reported that Angie made an aggressive move as she sat in the cool down chair, so they took her down with a prone restraint. More staff were called to assist with the restraint.
One staff person placed his body across Angie's small back and held her head face down on the floor. Three others held her arms and legs immobile. Angie was restrained in this position for over an hour until they felt she was calming down. In the RLDTC report written after her death, staff reported that Angie stayed on the floor making cooing noises after they freed her. Staff left her there for about five minutes, thinking she had fallen asleep. Only then, when Angie failed to respond to questions, did staff roll her over and discover that her lips were turning blue.
One staff member was sent to jail for 60 days. The facility was closed and just when you think this tragedy couldn't be any more senseless comes the revelation that nowhere near enough has been done as a result of Angie's death to prevent it from being repeated with another child.
The Wisconsin Department of Health Services formed a committee to create a plan for training and technical assistance. It still hasn't finished its work. A memo on prohibited restraint practices has never been issued. And worst of all, "nothing has been done to review or revise the children's day treatment regulations," the report said.
After Angie's death DHFS did cite the facility for numerous violations, leading to the facility's closure. However, the Department has been slow to take action to decrease the use of seclusion and restraints in children's programs and goals dealing with care planning, training, quality assurance, and monitoring have not been met. In November 2007 a number of mental health advocacy groups wrote the DHFS Secretary requesting an official DHFS memo to providers that would identify prohibited practices in the use of restraint with children, so that additional deaths such as Angie's would not occur. That memo has not been issued.
Well more than a year later, nobody has provided a fit answer for why children are treated as Angie Arndt was.
Here's a full copy of the report.
This is still happening and has been for centuries. And nothing ever gets done about it. Nobody wants to be held accountable for their actions.
"A Tragic Result of a Failure to Act"...
This is tragic on so many levels. So many disservices and wrongs over such a short life. Perhaps the greatest tragedy is, like you say, that it seems so little will be done to prevent this from happening again.
Stories like this are 'missed' because the news does not have a grieving family that can be shown. If this was a child that was part of a upper/mid income family and they could show crying brothers/sisters and parents it would be all over the news. News stories are frequently overlooked because they don't 'connect' with the audience. This is not right! I would much rather hear about items like this that require action than the 'soft news' stories that are constantly published.
Having young children, the part that trouble me the most is she had a tough life and likely died feeling very alone and unloved.
Really. People need a grieving relative to be able to come to the conclusion that 7 year olds sent to day treatment to prepare for first grade shouldn't be killed?
That's a whole 'nother level of sad.
I think what upsets me about this article, and about the wave of child treatment practices in general, is that she was punished for "gurgling her milk". While this may be annoying, and while she was probably more accurately disciplined for not following directions, I don't know any situation where this would necessitate laying her on the floor for an HOUR AND A HALF! She wasn't hurting anyone. She was only being a kid. I think today too much typical play behavior is diagnosed as ADHD or behavioral disorders and blamed on the kids, when it is really the adults who have lost their patience and don't want to figure out why the child is doing what it is doing. I do believe that such disorders exist and can be serious, especially if the child is hurting themselves or others, but for gurgling milk? I'm 28 and I still do that sometimes. Admittedly, I wasn't there. Admittedly, I don't have a degree in psychology or behavior or whatever the latest child care degree is, but does this make sense to others? This situation is so sad, because if someone had just taken the time to talk to her about what she was doing instead of enforcing strict, almost military, response to direction, it might have been solved without harm to the little girl.
In the year before her death, Angie came to live with loving and attentive foster care parents, Donna and Dan Pavlik, who - along with their extended family - continue to grieve the loss of a sweet and loving little girl. As pointed out in the report, Angie's foster mother felt that she had been misled as to the nature and frequency of the seclusion and restraint that Angie was subjected to during her brief time at the day treatment center.
Tonya gets at the heart of the story and that is that in areas of emotional issues in children, many "professionals" don't know what they're doing. Keep in mind just a few years ago, it was assumed, for example, that children couldn't suffer from depression. And in many cases, professionals view childhood issues as behavioral issues, not necessarily neurological ones.
There is widespread disagreement (as our series at MPR on the state of mental health care in Minnesota pointed out) as to the proper treatment for various situations. Perhaps this also explains why the committee in Wisconsin has yet to complete its work.
That her foster mother felt misled is also -- tragically -- not surprising. Again, in many cases, the parents -- foster or otherwise -- are not deemed participants in the emotional health care of the children, but as another obstacle to be ignored. By the way, one fascinating element of the report was the note that even though Angie had been at the Rice Lake facility since April 2006, her "team" had not yet met to discuss her treatment at the time of her death, and were not scheduled to until June.
It is, of course, a sad and tragic case of a 7 year old. It is also a symptom of an even more tragic systemic failure.
As a parent (of a soon-to-be 2 year old), I expect I'd be eligible for charges of child abuse if I addressed a child's tantrum by laying on him or her for 60 to 90 minutes to 'calm them down'. Unbelievable.
jesus, mary & joseph - obscenities fail me.
My 4 1/2 year old still gurgles his milk at the table. He sits in his time-out chair and occasionally screams or kicks the wall while there. He acts out when he's angry (as do adults). He's only 4. It annoys me, but he's still only 4. In ten years, he'll still only be 14.
As bsimon mentioned - god help me, if I was caught doing what happened to this little girl, even if she didn't die. I would assuredly have been front-page news, with a media circus for a trial, and definitely more than 60 days in jail. 60 days for murder?
Sometimes I get so close to losing my temper with my kids. It can be extremely difficult to be calm and rational after a very long day at work to come home to two screaming wild boys who are either trying to push my buttons, or who just don't understand the consequences of their actions on others.
Children are not little adults. Even a kid who is trying to push your buttons (and, god, some of them are good at it, and yes, do it intentionally)- do it to get a rise out of you, or your attention. They don't understand the wider ramifications of their behavior.
Somehow, I find this even more shockingly incomprehensible than the terrorists in Mumbai. That's illogical, yes, and certainly not morally different. It just seems that "I hate all of you people because of some perceived injustice" is more understandable than "I specifically hate that 7 year old child who makes me mad". Because both of these actions cannot possibly have been fueled by anything other than a complete and total apathy to another person, a good definition of hate.
Angelika's story is the worst of example of how seclusion and restraint can go wrong. Children w/ disabilities are restrained or secluded regularly in public schools as well as other treatment programs. What law is there against it? What are you going to do about that? When children act up the police may be called. I've never thought it a good idea to put a 7 year old in handcuffs but I know for a fact it has happened. I know that mace has been used by police called to a school by staff. The fact that the person with a disability had autism with sensory issues made no difference. Had the school staff been following the student's treatment plan they would have moved away and given him space as the plan stated. Instead they tried restraint which was the cause of the students complete loss of control. How long do you think it will be before a student is tazered by police? Google seclusion and restraint in Wisconsin and find out what's really going on. I would bet that prisons and jails have more rules about seclusion and restraint than public schools or treatment programs. That's a darned rotten bet to take with children who have disabilities.
Isn't it obvious to everyone that children with trauma histories need to be treated with compassion, not with bullying? bsimon is dead on in saying that regular people would be in deep trouble for treating a child this way, and the people who killed this little girl should be in much deeper trouble than they are. If I ever hoped for one big-a** karmic boomerang, it was after reading this story. Since when is blowing some bubbles such a big fat hairy deal?
well done! I think angel' is smiling!
This is an important story, Bob.
As a mental health professional, I can say that not all "therapists" ascribe to the whole restraint rationale. Granted, there ARE times when kids in treatment programs need to be physically restrained-- because of the therapists' obligations to ensure the safety of other kids. But obviously gargling milk isn't a safety concern.
A major systemic problem here (in MN) is that, in the mental health world, daytreatment jobs are largely for the newest therapists. The people doing the holds usually have the least experience and psychological training. Unfortunately in these programs, the most seasoned and educated therapists (psychologists, clinical social workers, etc) mostly serve a supervisory function and have only limited contact with the kids-- not really by choice. Largely because of the reimbursement system's purely capitalist intentions, the only finanically feasible model of daytreatment demands a high number of under-trained workers. Why is that?
The definition of mental health "professional" here can be debated. There is a great degree of variance in the level of training in therapists. Some come from shoddy pay-for-degree programs and have minimal training in how to cope with their own emotional reactions to clients (anger). Others are perfectly professional and wouldn't have had this outcome. Newbie therapists working with the most difficult cases without adequate supervision is not the answer. Not all therapists allow for this type of accident.
Tragically, having worked in these programs before, I can say that her daytreatment center was probably the center of Angelika's life. Most of these kids leave school to live in complete hell.
But the public will watch their Dancing with the Stars and return to Biggest Loser. I mean-- that was THAT kid over THERE. Isn't it a shame that happened in HER world?
The real tragedy here is that people don't see that Angelika dies in OUR community. Her death affects us all-- whether we pay attention or not.
Another important point here is that "therapist" [unfortunately] can mean many things: bachelor's in psych (or history for that matter), master's degree and no license, MD psychiatrist, Psychologist, etc. The term "therapist" isn't regulated by the state, and an electrician could advertise themselves as a therapist if they wanted to.
Terms like Psychologist, Family Therapist, Clinical Social Worker are all regulated by the state, and it's illegal to call one's self that unless they're licensed, etc-- these are considered "Mental Health Professionals" in the law. Terms like "mental health practitioner" or "mental health worker" can mean almost anything, though.
Typically in these programs, the licensed professionals do the supervision and some therapy, but the unlicensed workers are more responsible for the minute-to-minute contact with the kid-- again, moslty because of the financial constraints insurance companies dictate-- not by choice. What insurance company is going to pay a Psychologist with ten years of training to watch a kid gargle milk during lunch? Some state programs/grants allow for more flexibility, but those are disappearing too.
And not every daytreatment center is bad either. Some truly are shady money-mills, but some make serious financial compromises to provide top-notch care.