One of the early lessons I learned as the Team Leader of an adolescent psych unit is that teenagers crave limits. They hate limits. They push and push and push. . .but, in the end, they want to know what's right and what's wrong.
My first shift staff and I could always tell when another shift had been lax in enforcing the milieu's routine. The kids would be hyperactive, demanding, and making frequent visits to the time-out room at the staff's direction. A few questions here and there and we would discover that a new staff member on another shift had bent the rules, or a PRN nurse had tried to undermine the authority of the staff, etc.
Like clockwork, one of the kids would "go off." A fight would break out, or someone would start beating the wall of his/her room, etc. When verbal re-direction didn't contain the acting out, staff would physically intervene with a "take-down" and remove the kid to the special care unit to cool off. In order to discourage other episodes of acting out, additional staff from the adult unit would arrive and help us to settle things down. In a very short time, the unit was back on track and all was well.
In our Team Leader meetings we would discuss this phenomenon at length and all agree that the maintenance of milieu routine was vital for unit safety. Despite this, some staff--nurses and therapists mostly--continued to bend the rules, disrupt routines, and reveal treatment team plans for discharge and visits. In other words, they were the parents who could not say "no" and mean it. Their inability to stand up to the limits-pushing by the kids endangered the unit and our patients' successful treatment.
Another lesson I learned early on: do not hire education, psychology, sociology, or social work majors for milieu staff positions. They tended to see themselves as Messiah figures who would save the kids by just listening to them and trying to understand them. Of course, the kids manipulated the living daylights out of these suckers. Instead of hiring self-anointed saviors, I hired business majors and athletes--people who understood the need for rules and discipline but who also encouraged the kids to do their best given their circumstances. It also helped to have four or five 300 lbs. football players around when our gang members decided to "get buck."
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