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Camp review shows restraint's gray area

Evaluations after a boy held down by a counselor dies uncover the fine balance the procedure requires.


© St. Petersburg Times, published March 6, 2000

A boy at a wilderness camp becomes hysterical, hitting himself in the face with his fists, pulling at his hair. So counselors hold him on the ground for an hour. When they think he has calmed, they let him up for two minutes. But his wild behavior resumes, and a counselor restrains him for another 45 minutes.

Another youth kicks a lantern at this camp for troubled boys, located deep in the pines of Ocala National Forest. A counselor asks the boy if he did it on purpose. After he says yes, the counselor holds him down for 25 minutes.

The death last month of Michael Wiltsie, 12, after a counselor at wilderness Camp E-Kel-Etu restrained him on the ground led to a flurry of investigations and an internal re-evaluation of the camp's restraint procedures.

But even after all the reviews are complete, the issue of the proper use of restraints will remain a delicate balance of safety and control for those working with the troubled and often violent children in juvenile justice programs across the state.

Restraining unruly youths in the manner used at E-Kel-Etu, a camp near Silver Springs run by Clearwater-based Eckerd Youth Alternatives, is necessary and safe, say experts who developed the measures.

"There's nothing innately dangerous in the technique," said Martha Holden, the project director of the residential child care project at Cornell University that developed the technique the counselor used on Wiltsie.

"It's when things go wrong, and it's not used appropriately," she said.

A grand jury ultimately declined to charge the counselor in the Wiltsie case, Joseph C. Cooley, saying he was following the procedure he had been taught.

But doing what he had been taught apparently led to Wiltsie's death. The grand jury's report said "The medical examiner determined that the weight used during the restraint, given Michael's size" led to the boy's death from compressional asphyxiation.

Cooley weighed 320 pounds; Wiltsie weighed 65.

The grand jury said that in future training in the Therapeutic Crisis Intervention technique, as it is known, counselors should take account of such weight differences. But Holden said that already is part of TCI training, as is an emphasis on not putting weight on the chest or upper torso, which could restrict breathing.

All this suggests the need for further review of the restraint techniques Eckerd has had in place for more than a decade. That review should be complete within 30 days, Eckerd said.

While the question of responsibility in the Wiltsie case remains muddled, this much is clear: Restraint of campers like Wiltsie was not an unusual event at the Eckerd camps.

A review of records shows that last year, the staff restrained youths more than 50 times at Camp E-Kel-Etu. Counselors also regularly restrain youths at the four other camps operated by Eckerd around the state. Wiltsie's case was the only death ever to occur at the camps because of the restraints.

Eckerd says it restrains youths to prevent them from hurting themselves or someone else, never as a penalty.

"We do not use restraint as a punishment. Punishment is not a part of the therapeutic milieu," said Andy Anderson, an Eckerd spokesman.

Eckerd is far from alone in its policies. State-run and other juvenile programs also use restraints regularly. Eckerd stresses in its training that physical restraint may only be used as a last resort after other measures have failed.

Some officials in the system say it is necessary for a counselor to step in and forcibly stop youths from hurting themselves.

"What are you going to do if two kids are choking each other? You've got to get in there," said Gary Battane, a University of South Florida instructor who trains workers in juvenile facilities on the proper uses of restraint.

The Eckerd youth camps, founded by Jack and Ruth Eckerd 32 years ago, are designed to help youths turn around their lives, learn how to become responsible and build relationships with their families.

The camps are among the most established juvenile programs of their kind in Florida. The Eckerd programs have won superior rankings from the Department of Juvenile Justice and are generally well-regarded by independent child advocates as well.

Campers' conditions can be harsh -- they sleep in tents they help build, live in campsites with no electricity and take wilderness trips that can last three weeks -- but the program is different from boot camps and some other camp programs that feature screaming drill instructors and a punitive atmosphere.

But even at the wilderness camps, fights happen. In fact, Wiltsie was getting ready to fight with another camper when Cooley stepped in.

And campers do sometimes hurt each other, records show. One camper on Nov. 6 threw a plastic bag full of glass, cans and other trash at another boy, causing minor cuts. A boy on May 20 landed a punch on another boy's eye that required nine stitches. A boy on Jan. 13, punched a tree until his knuckles started bleeding.

Still, the most common causes of injuries last year at the camp were when kids hurt themselves with tools or during recreational activities, according to the reports.

It's not just the boys who come out swinging. A 12-year-old was restrained last year at E-Nini-Hassee, the wilderness camp for girls, three successive times because she was kicking and throwing dirt after she was released each time.

As many as four counselors have fully restrained one child who pulled a counselor's hair, records show. "All four counselors held (her) because she was struggling and attempting to bite" a counselor, the incident report said.

Even when no other kids are in danger, a camper can be restrained if he tries to hurt himself.

That was the case of the boy at E-Kel-Etu last Nov. 12 who was hitting himself and pulling his hair, leading to the lengthy restraints of an hour, then 45 minutes more.

Last year at Camp E-Nini-Hassee in Floral City, two counselors restrained a 13-year-old girl because she was scratching her arm with a stick.

The counselor "lay across her upper body to stop her from hurting herself. This lasted 30 minutes," according to a report.

Although all counselors are taught the same set of restraint procedures, there are many variables that they must take into account before initiating the technique. Counselors need to decide almost instantly whether a situation is serious enough to warrant a full restraint and calculate whether a child can withstand a restraint based on medical history. They also need to consider the difference in size between the adult and the child.

After a restraint, the counselors are required to document the action. Supervisors review the reports and can indicate whether the restraint was necessary.

In a few of the reports, it's not clear whether anyone was in imminent danger of being hurt, one of the prerequisites for restraining a child.

For example, there's the incident in which the boy kicked the lantern at E-Kel-Etu last Dec. 13. This happened after he had been "making disrespectful comments towards other campers." A counselor known as "Chief Dan" had drawn the boy aside to talk.

"On the way there, (name deleted) kicked a lantern. Chief Dan asked if he kicked it on purpose and when (name deleted) said yes, Chief Dan restrained him for about 25 minutes," a report on the incident states.

Asked about this case, Anderson said it was more than a case of a cracked lantern. "The kid was acting out and carrying on," he said.

Another boy last November started walking away from the youths at the same camp. The counselor warned him that "if he continued to walk away from the group, it could lead to a restraint."

Anderson said the youth had a history of running away and also had discussed suicide. "You can't just let a kid take off and head out to the woods," he said.

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