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Repression in Residential Youth Care: A Scoping Review (Valk, Van der Helm, Kuiper, Maas & ...
Repression in Residential Youth Care: A Scoping Review
There are aspects of residential youth care that threaten its effectiveness, and which may
also violate children’s rights. Staff members exercise power over the youth, which can be
abused to coerce, punish, or limit the autonomy of youth.
Residential youth care institutions offer a treatment environment for children and
adolescent who show serious psychiatric or behavioral problems -> children and adolescent
can react positively to treatment in institutional care and, in general, improve their
psychological wellbeing (meta-analyses). However non-therapeutic aspects of the
institutions threaten the effectiveness of treatment inside residential youth care institutions.
Although this article (UNCRC 1992, article 9.1) allows involuntary admission (as long as it is in
the best interest of the child), there are aspects of residential institutions that threaten the
effectiveness of residential care, and may also violate children’s rights. Erving Goffman was
the first sociologist to describe residential settings as total institutions where patients are
subjected to the power of the institution, limiting the residents’ freedom of choice.
The power that staff members use to regulate the youth encompasses several risks:
1 powerful people are more likely to engage in moral hypocrisy than those persons how lack
power
2 the powerful judge their own moral transgressions to be more acceptable than other
person’s moral transgressions
3 in a study by Lammers and Stapel (2011) it was found that power increases
dehumanization-stripping experience or agency from youth
Thus, the power imbalance between youth and staff member may lead the latter to act in
ways that youth and staff members may lead the latter to act in ways that youth may
experience as unfair, or may even put a youth to harm.
Studies describe various examples of punishment directed to modify behavior inside prison.
Thus, in these studies, punishment does not relate to the original penalty inflicted by the
judge but, instead, refers to punishment aimed at controlling behavior or imposing revenge.
Punishment inflicted for the purpose of controlling behavior can lead to a lack of trust, lex
exchange of information, and lower attained joint outcomes, which increases the likelihood
of aggression. Therefore, this “extra” punishment is ineffective, and can even be damaging in
the long term.
Soft power: the ability to achieve one’s end through persuasion and attraction, as opposed
to coercion or payment (hard power)
The list of possible sanctions in residential settings is seemingly endless. Another
characteristic of residential youth care institutions is that they are characterized by a certain
amount of coercion. Exposure to coercive strains, arising from the “pains of imprisonment”,
negatively affects psychological wellbeing and increases suicides. The effectiveness of
behavioral interventions deteriorates as the amount of coercion increases and it is highly
likely that coercion increases antisocial behavior and recidivism.
As stated by Van der Helm et al. (2014) coercion in a secure residential context may be part
of the structure that is necessary to set boundaries and prevent chaos and anarchy. This
incorporates safety, a predictable day structure, and effective rule-keeping. Structure and
safety in the living group are needed to stabilize youth’s behavior and to enable effective
treatment. However, the amount of coercion should always be balanced with flexibility -> if
not danger that article 37 of UNCRC might be violated.
,The main research question: what is repression in residential youth care; and, which
processes and circumstances may cause repression to occur?
Humanistic perspective
Repression Versus freedom: all living organisms want to survive and flourish. To achieve this,
an organism needs a certain amount of freedom and a minimum amount of repression.
Repression literally refers to the act of using force to control a person or something.
Freedom is a state of being capable of making decisions without external control, while
liberty is freedom that has been granted to people by external control.
Repression Versus autonomy: Sine (2008) argued that the limitation of youth’s rights and
autonomy, caused by the architectural design of residential facilities, was legitimate and
ethical when used to prevent harm and danger. In modern society, children and youth with
psychiatric problems, who pose a danger to themselves or others, are placed in residential
settings from a paternalistic perspective. It is supposed to be in the best interest of the child,
even though the child is usually not allowed an autonomous decision. Due to the pre-
emptive decision-making capacity of the youth’s guardian or the legal system, the best
interest of youth are sometimes more likely to be considered than the autonomy of the
child. Therefore, Regan (2010) stressed the importance of obtaining youth’s con- sent,
motivating them to develop problem awareness and intrinsic motivation, informing them on
what to expect from treatment interventions, assessing their understanding of the situation,
and, for example, using motivational interviewing. Every child should be allowed the amount
of freedom and autonomy that the youth can handle to promote learning and positive
development.
Humanizing punishment and control: three techniques of control are central in Foucault’s
disciplinary society: hierarchical observation, normalizing judgment, and examination.
Hierarchical observation refers to a person with more power (staff) observing people with
less power (youth). The principle of normalizing judgment is applied to correct deviant
behavior. The goal of this correction is not revenge (as in the case of the tortures of
premodern punishment), but reform; the youth should come to live by society’s standards
and norms. The examination is a method of control that combines hierarchical observation
with normalizing judgment. It elicits the truth about those who undergo the examination
(the youth) and controls their behavior by directing them, for example, to a course of
treatment. Foucault argued that disciplinary power is most effective when hierarchical
observation, and the knowledge it produces, is combined with normalizing judgment and
examination. In other words, discipline functions best when the information obtained by
means of surveillance is incorporated into a system of micro-penalties—a system in which
ranking serves as punishment or reward. Normalizing judgment in residential youth care
often takes the form of a reward or privilege system implemented by staff who must
reinforce corrective strategies (micro- penalties) and, during the process, encourage the
adoption of prescribed conducts, habits, and attitudes imposed by the staff.
In modern residential youth institutions, the relationship between staff and youth is still
grossly unequal in terms of social power. Staff is able to dictate and impose restrictions on
the movements and activities of the youth; and, the youth lose autonomy, self-
determination, and independence. Power differences can cause dehumanization of youth,
and the needs to take youth into consideration diminishes, which in turn increases the
likelihood of imposed restrictions and punishment. The combination of power and
dehumanized youth greatly reinforces the level of punitiveness by staff.
, Evil or wrongful?: evil is characterized by the most despicable sorts of actions, characters,
and events. Because it involves moral condemnation, only moral agents (i.e. humans) can act
or be evil. Evil action consist of taking pleasure in doing wrong, or some ideological drive to
harm others, although there might exist a huge gap between the victim’s and the
perpetrator’s perceptions of the act. Furthermore, Calder (2014) argued that it is an
essential property of evil actions that the evildoer intend for the victim to suffer significant
harm, while it is intends for the victim to suffer significant harm, while it is not an essential
property of wrongful actions that the wrongdoer intends to cause harm.
There are occasions in residential youth care settings that staff is acting in a wrongful
manner, without taking pleasure from it or without the intention to harm.
Coercion: in many countries, laws have been developed that allow for involuntary, non-
consensual, and forced treatment in mental health care: coercive measures can be used in
cases of crisis. Coercion is the power of an authority figure to force compliance using the
threat of sanctions and it is often used as related to episodes where youth are either
threatening, aggressive, or self-harming and where verbal interventions are, according to
staff insufficient to control the situation. In practice the judgement of the necessity of
restricting the liberty is at the discretion of the individual direct-care staff and is highly
subjective. Because of the possible negative and harming effects of coercion, many
researchers and organizations have concluded that the use of coercion should be minimized,
and only be used as a last resort when immediate harm is likely, or should be eliminated
completely. Conversely there are proponents of coercive measures who argue that, in the
face of limited alternatives, it is necessary to protect staff and other youth on the ward from
aggressive behavior.
Conclusion Humanistic Perspective: Repression can thus be characterized by an authority
figure intentionally acting in a way that harms the youth, or unlawfully or arbitrarily
depriving the youth of liberty or autonomy.
Social Psychological Perspective
Transactional Processes and Repression: Van der Helm and Stams (2012) indicated in their
research that the transactional processes of youth prisons can slide into coercive cycles
where youth’s negative behavior invokes unprofessional behavior by staff, which in turn,
causes again negative behavior by youth. When staff is unable to maintain control over the
youth, or when their authority is threatened, they become fixated on controlling the youth.
Furthermore, staff’s attitudes and cognitive distortions toward youth also influence staff’s
behavior. Staff may feel obstructed, frustrated and willfully denied in their competency,
which easily leads to rejection of the particular youth, or plain resentment and
dehumanization. The likelihood of these transactional processes leading to repression is
fueled by intrapersonal processes which are mediated by interpersonal processes. In this
way, transactional processes are active between dispositional and situational factors.
Intrapersonal processes: in residential settings, staff member need to interpret the behavior
of youth form two perspective:
A the wellbeing of the youth
B the possibility of threatening actions which endangers staff’s personal safety
Fear can rise from a continuous threat of aggressive behavior of the youth, possibly leading
to hostility bias with respect to interpreting the cues. Consequently, staff may interpret all
youth’s behavior as a sign of imminent threat and, therefore, deploy controlling measures in
order to ensure safety.
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