Laying On Hands

One of our kids on unit went ballistic last week; seems he was disinclined to go to bed at the appointed hour, expressed said disinclination by smacking his mama in the face with his tiny, bony fist, then proceeded to tear up the unit, flailing through the dining room, overturning chairs and pulling books, plates and sundry down offa the tables. Another client attempted to intervene and got bit on the arm for her trouble—a nasty wound, broke the skin and bled, leaving a teeth-impressed bruise she'll be nursing for a week or more.

Our staff members are trained in the Mandt system of people management. Mandt system is designed to help people keep safe and was created for use originally in mental facilities, though now is in greater use by police, prison guards and, yeah, substance abuse treatment unit staff. (Our place is a long-term residential treatment facility for women and children dealing with abuse, trauma and addictions, located in Fairbanks, Alaska. Our clients are primarily Alaskan Native: Yup'ik, Aleut, Inupiaq, Athabascan, Tling'it.) Mandt stresses using the least invasive, least restrictive techniques possible, the first level of force always being mere physical presence, body language and voice. It moves upward into various holds, lifts, supports and restraints.

I've used Mandt techniques to escort belligerent clients, even severely intoxicated clients, and Mandt support techniques to assist ill clients. Seizures are always a risk; panic attacks are not uncommon events on unit, particularly after our clients discovered how handsome and attractive the firemen at our nearest 911 response site are. I've used Mandt theory and practice to diffuse conflicts and de-escalate combative adults. It's very effective, a useful set of tools for crisis situations.

The one place I find it least effective, or way more of a challenge, however, is when dealing with small, very angry children. And, oh, so many of the children we get in our program are angry—enraged even. Some of our children have witnessed extensive domestic abuse. Some have lived with violence all around them their whole little lives. They've been removed from their homes, frequently under various conditions of neglect or abuse, and have bounced around in who-knows what-all foster care placements. They have separation anxiety, they have attachment disorders. Some have not bonded well with their species. They're fetal drug and alcohol affected, some. Or, already at the age of five, seven, nine, others have been labeled attention deficit hyperactivity disorder, oppositional defiance disorder, a veritable alphabet soup of wrongness.

When I look at seven year-old children, even when they are trying to smack me in the face, I find it difficult to think ODD, ADHD, FAE/FAS. My head always just sees "wounded" and "pissed" and Lord knows, I've been there, done that, got the t-shirt. So, J.J. is terrorizing around, screaming at the very top of his lungs (such that I know he's gonna be hoarse and sore in the morning), hitting and kicking, his fingers crooked into claws. And, like I say, he's a biter. This isn't the first time he's bitten someone on unit.

The other kids are scared, triggered by the noise as much as by his small violences. The mamas are running around hollering, which certainly doesn't help any. J.J.'s mama is just standing in the middle of the dining room wailing at the top of HER lungs. Our other staff person is a tech, a practicum student here learning the ropes, testing the water so to speak, to see if she maybe really does want a low-paying, high-stress, zero prestige entry-level position in the field of human services technology. (Ain't that a mouthful?) And she hollers, too, for me, but I've already heard the racket from the back office where I've been scribbling group notes in the client files, and my feet are flying.

Coming into the dining room, what strikes me first is that this kid, only seven but a large seven year-old, has got the entire room paralyzed with fear, anger, and indecision. Least invasive, least restrictive, my first thought, always, when coming into this kinda situation. I smile a big grin, sign What's happening to the five or six other little kids in the room. They're used to me signing to them. None of them know sign language, but they always quickly pick up a dozen or more signs just from our daily interactions.

"J.J.'s pissed," four year-old Lily informs me. "He's making a big mess." I smile even broader if possible, thinking Physical Presence, Tone of Voice, Body Language. "Yeah," I agree, "Looks like he's mad all right." I motion to the other staff person, smile at her, too, as if my mouth could stretch out to encompass the entire room. "Wanna help the moms get these other kids upstairs and into their bedtime routines?" I prompt her. She does, and they do, trailing out of the room slow-like, ganged-up, rubber-necking. Sure, everyone wants to see how this is gonna play out, everyone except me. I wanna go home and have my mama tuck ME into bed.

I still haven't made direct eye contact with J.J., but I sidle past him to attend to the mama. "Could ya lower your voice?" I ask, quiet-like, still grinning, and I shrug, arms akimbo, shoulders hunching up and out, a question mark as big as the tundra migrating across my face. Just that fast, she shuts her mouth, and her angry yelps turn into silent tears. Her nose is bleeding slightly and there's an angry red mark where he smacked her. "He's so mad all the time..." she mumbles at me, and reaches towards him.

J.J. throws himself backwards on the floor and sets into kicking at her, his feet a blur of fury and force, scrambling away, like a crab, but on his back. The mama tries to pick him up but only gets kicked at for her effort. I finally talk directly to J.J. then, asking him, oddly perhaps, "Did you eat supper tonight?"

"Not hungry," he squawks, scrabbling backwards again. He's gotten himself into a corner, bad move, and mama lunges for him, worse move, resulting in a mad scramble, her clutching at him and him twisting and flopping, slamming at her with his feet. Everything she is doing is escalating his behaviors, and I direct my voice back to her. "Maybe we should just leave him here, let him collect himself..." I suggest, but no, she's on a roll, now, snatching at his clothes and attempting to roll him over, to get a grip on his body. He scratches her face, so she's bleeding from two places now, and she's getting way out of control, as well.

J.J. twists away and leaps to his feet, dashing into the living room, mama in hot pursuit. Now we're in trouble, I think, seeing that J.J. has put himself into an enclosed space, me and his mama between him and the only exit to the room. He realizes this as I do, and at the same time I tell mama Back Off he comes barreling towards mama, screaming, face twisted. He grabs an abandoned Tonka truck from the floor, oh oh, solid metal body with oversize rubber wheels, all sharp angles, heavy, dangerous weapon, and swings it with both arms, full-force, connecting with mama, who staggers from the blow.

I slip behind J.J. and wrap my arms around his torso, pinning his arms to his side; the truck slips to the floor. Mama's hollering now, she's mad, but worse, she's scared. She tries to grab J.J. from me. I tell her to sit down, which I am surprised but pleased to see she does, like a dropped sack, plop, onto one of the couches. I sit in the opposite couch, my arms still full of a wriggling, squealing 50-plus pounds of very angry kid.

I adjust my hold, reminding myself again and again that this is a small angry child I've got here, not a big mean guy, but I admit, his screaming and hitting have got me triggered, too, and adrenaline is pumping. When J.J. realizes that he's caught, he really flies into a fury, erupting. This is very much like trying to keep ahold of a burlap bag fulla polecats. I tell J.J. several times I don't wanna have to hold him, that I am more than ready to let go, if he'll get back in charge of himself and be safe.

Staying Safe is the rallying cry on unit. We use this code to side-coach adult clients when they are becoming verbally abusive to one another as well as when they are being too rough with their children. Women and Children's Residential Program is a Safe Place. We all have to do whatever we have to do to Stay Safe, to Be Safe for others. This whole scene ain't safe.

So, I am side coaching mama, breath, breath, breath, who's gasping from anger and exertion, as well as really working on keeping my voice level while asking J.J. if he can be safe if I let him go. But, he's still wiggling and slamming his body about and it's all I can do to keep hold of him. I keep asking him, Are You Okay? to which he replies Let Me Go, Let Me Go, so I chance it, and I do release him, easing up, allowing his hands free, but BAM, just that fast he slugs me and rakes my face with his fingernails, ouch. I let go of him long enough to pull my eyeglasses off my face, which I toss over to the far end of the couch, hoping like hell they don't get crunched in the fray, then quick as can be, I wrap my arms around him again, doing a basic human strait jacket hold on him.

And there we are, pinned together in his rage, me holding on at this point just to stay safe myself, and him bucking and kicking and twisting and just screeching at me. He head-butts at me, but I've got a snug hold and have my face tucked away into his back and shoulder-blade so he can't really connect, and this is making him even angrier, I can feel, every fiber of his body working to break away from me.

Jeez, this kid is strong, and the struggle just goes on and on and on. My arm muscles are starting to burn from the effort of holding him tightly enough so he won't slip my grasp but keeping the hold loose enough that he can breathe, that his tiny ribs don't get broken. As he pushes against me, and as I tighten and loosen my hold, we start to slip comically to the floor. I keep asking J.J. if he can get back in control of himself. It's Okay To Be Angry, I tell him, But You Can't Hit People. He reaches over and tries to bite my wrist. Keeping my body parts away from his mouth, we finally, slowly, do slip from the couch, which is simultaneously sliding out from under our struggle, and we end up on the carpeted floor.

My basic goal at this point is to keep J.J. from getting hurt as much as to keep him from hurting me or his mama; I have my weight on my elbows and knees as I keep gripping him, and we do a weird version of the floppy fish, him and me. This goes on for maybe five minutes, maybe ten, I dunno, seems like a long lifetime down there, me asking again and again if I can let him go okay, if he can Be Safe, and him hollering, You're Hurting Me (which I know I am not but he sure isn't liking this) and demanding, Let Me Go, which I would love to be able to do. Are You Safe?

Then he starts calling me every ugly name he can think of, spitting words out at me, naming me, Stoop-id, Ugly Butt, Stinky Butthole, Ugly Stoo-pid Butt Face. I can't help it, I start laughing, and this makes him even angrier. But it tickles me so, this kid is as angry as I've ever seen a child be. I know he could easily murder me at this point, but in his little life, the meanest thing he can think to call me is Dirty Butthole.

Fact is, I've had a four year-old on unit call me Cocksucker, which frankly I felt was none of his business, and spit right in my face as well. The spit was much more offensive than the language. And it just strikes me as so sweet that Butthole is the ugliest language J.J. can muster as we flop about on the floor. So, I am laughing, trying not to laugh, holding him tightly enough he can't hurt me but loose enough so he won't get hurt, and time seems to stand still as he takes my inventory—Fat, Stoopid, Ugly, Butthole—and we do the floppy fish until I really think I can't hold him any longer.

I crane my neck a little and ask mama, Can You Go Make Hot Chocolate? She looks at me like I'm insane, but I tell her, Really, I'm Getting Thirsty. And she does, gets up, walks backwards out of the living room, watching us the whole time. I tell her to hurry; I am really, really, thirsty. Seems like not a minute after she leaves the room, J.J. stops struggling, just kinda melts into my arms. I ask him if he's tired. He says yes. I tell him I am, too.

I slowly loosen my hold on him and he just kinda lays there curled in my arms.

I Hate This Place he tells me. I Hate Bedtime. I murmur at him and rub his head and listen. He smells salty. He tells me he misses his uncle. He tells me he wants to go hunting. He tells me he doesn't like the school here, doesn't like the food, doesn't like all the rules. He asks me how much longer he has to live here. I debate what I should say.

I decide to be truthful. I tell him he might get to go home in time for whale season. He tells me his uncle got the biggest whale ever once. His mama comes back. She's surprised to see that the crisis is passed. We break the rules and have hot chocolate right there in the living room. What the hell. Mama is pretty quiet while J.J. yacks away about whales and boats and his uncle. Finally, I ask J.J. if he's ready to go to bed.

Okay, he says. No problem. He gives me a hug before he leaves. I watch him drag his feet as he follows mama out of the room. He looks back at me. I tell him Good Night, Sleep Tight, Don't Let The Bed Bugs Bite. He laughs, wrinkles his nose at me, raises his eyebrows, Eskimo body language for Yeah.

Today, my arms are sore, my back hurts, my eyeglasses are kinda lopsided. I think I need three coffees this morning. The snow deepens. I gotta go shovel the driveway.