No Easy Answers

Meg Kissinger, a reporter for the Milwaukee Journal Sentinel, has a story that involves the death of yet another foster child. This comes on the heels of an ongoing series of articles by Crocker Stephenson regarding the death of Christopher Thomas, a baby boy that died in while under the care of Bureau of Milwaukee Child Welfare

The story about the foster girl, Angellika Arndt, is, in a sense, much harder to deal with than even Christopher's death. In Christopher's death, the murderer is clear, and his aunt/caretaker will be tried on the charges. The failings of the Bureau is also much easier to track and the failures stand out quite clearly.

With Angellika's story, the lines are much more blurred. Angellika, or Angie, according to the story, was killed while being put in a restraint hold by staff at a treatment day program. More on that in a moment.

I read the article several times and there are so many things that disturb me, I hardly know where to start. The story reports that Angie came into the system when she was three due to suffering serious neglect and physical and sexual abuse. Even though I tried to remain relatively calm, sexually abusing a child is more than I can take sometimes. Even though it's been over seven years since I worked with kids, the sexual abuse cases still haunt me. I've had to be asked to be taken off of one case because I couldn't stomach looking at the father who had allegedly raped his own daughter. I knew that if I had to work that case, I would have said and/or done something that would have gotten me in big trouble.

The next thing that bothered me about the story was this:

She had significant psychological problems, including post-traumatic stress disorder, reactive attachment disorder, bipolar childhood disorder, attention deficit hyperactivity disorder, anxiety and oppositional/defiant disorder.

Angie took five or six psychiatric medications daily and received mental health treatment and special education.

I think that the doctor(s) involved in this case had over-diagnosed her. The ADHD, anxiety and oppositional/defiant disorder could have all fit under PTSD and reactive attachment disorder. I don't trust the bipolar childhood disorder either. Bipolar disorders usually don't show up until late adolescence at the earliest. (Since the rules were changed regarding mental health care and insurance coverage in the 80's, hospitals and treatment facilities have found ways around this, usually by exaggerating symptoms or by coming up with new diagnoses. This is just so they have something to give the insurance companies so that they can keep providing the necessary care.)

I also have concerns about giving a child that young so many psychiatric medicines. While some kids do need medication for certain disorders, like ADHD, six different medications seems to be just too excessive.

Most hospitals, treatment centers, and other similar facilities have their employees trained through a program called Nonoffensive Crisis Prevention/Intervention, which was created by the Crisis Prevention Institute. Most of these techniques are safe, if used properly. But even innocuous techniques, like the basket hold, can end up with tragic results if not used properly.
I still my training to remember that the holds should only be used as a last resort, and should be stopped the second the person is able to control their own behavior. Waiting until they thought the child was "asleep," as they did with Angie, is way too long.

Now, with all of those criticisms offered, I will contradict myself a bit.

Given the hell and the physical and psychological torture that poor girl had gone through, it does not surprise me in the least bit that she was a difficult child to care for or work with. As I stated above, I have worked with a few children with similar background stories. An adult would have a hard time coping with the things that these children have experienced. A child does not have the same level of cognitive functioning or copings skills that an adult has from a lifetime of education and experience. The child has no way to deal with this, and thus end up acting it out, often for the rest of their lives.

Since they don't have the same coping skills and internal controls that anyone would need to deal with this, sometimes outside influences are necessary to keep them from hurting themselves or others. These outside influences include chemical and physical restraints. In other words, sometimes the child will need medicine to help them deal with the emotional pain and scarring. Likewise, sometimes it is necessary for the caretaker to step in and stop the child, by physically restraining them, to keep them safe.

The calls to remove these care options strike me as being a knee jerk reaction, and a bit irresponsible. Especially given the fact that the advocacy group doesn't offer any alternatives that would allow the child to safe with themselves or with others.

When dealing with certain situations, there are no clear, easy answers. There have been many times in my professional career where I've had to take actions and/or make decisions I wasn' t happy about and struggled with. However, I also know that had I not made those decisions or taken those actions, the consequences would have been much worse.

In the case of Angie, I think that the judge put it best:

The report notes that during sentencing, the judge remarked that "there were a lot of other people who made decisions that led up to her death."

There is no one person or organization to blame in this case. There are many people and agencies that failed Angie, from her parents that abused her, to the doctors that may have made bad treatment decisions, to the child care workers that held her down too long.

And I don't know if there is a way that we could fix it so that this won't happen again. All we can do is try to prevent this sort of thing, by going through continuous training for the workers and having responsible oversight over each step of the way.