Bill Wade, Post-Gazette Steve Vinson, president and CEO of Robert Boyd Ward Home in East McKeesport, holds one of the drum and bugle corp medals won by Evin Johnson, 17, a resident of the home. Click photo for larger image.

Restraints in group homes and treatment facilities too often are provoked by two words:

Power and control.

Psychological power over teenage residents, and physical control of their aggressive behavior.

Dr. Mary M. Carrasco has seen the power trip mentality firsthand.

She recalls meeting one worker who enjoyed restraining youngsters.

"He brought a child in for evaluation and told me the kid was out of control. He told me with great pleasure how he would restrain this girl. He would lie on her for 20 minutes to half an hour. He was a big guy," said the doctor who founded "A Child's Place," a Mercy Hospital program to evaluate abuse victims.

"For him," she said, "it was about power and control."

Carrasco and other experts say it doesn't have to be that way. The experts say restraints can be avoided, and there is a model program in Allegheny County that proves it.

A first step in preventing restraints is rejecting workers like the one Carrasco met.

Those are the kinds of applicants institutions need to screen out, said Ronald W. Costen, an attorney who teaches at the Temple University School of Social Work and serves as director of the Institute on Protective Services there.

To reduce restraints and prevent injuries to staff and children, Costen said, institutions must choose the right workers, hire them in sufficient numbers and train them properly.

He said it is critical for group homes to select workers capable of dealing calmly with challenging clients. "From a psychological point of view, they can't get off on beating up children."

That approach shows up at the Robert Boyd Ward Home in East McKeesport.

"Here, it is mellow," said 18-year-old Desmond Simmons, a former resident.

Mellow means no restraints.

Ward Chief Executive Officer Steve Vinson brought that philosophy with him when he arrived three years ago.

To avoid restraints, he said:

"You treat kids with dignity and respect. You give them space. You find ways to put into practice de-escalation of kids."

It helps, of course, that his is a relatively small program, serving 25 teenagers at three residential locations.

And it helps that Ward can, and does, reject psychotic youngsters and those with histories of violent aggression.

Still, it cares for teens who have been restrained in other programs. And Ward workers manage to keep their hands off them.

"The first word is respect," Vinson said. "If you treat a kid with respect, he will treat you with respect. If a child is out of control, you go the extra mile to show the kid how much you value and respect him."

The second word in Vinson's philosophy is relationship. "You build a relationship. It is kind of hard to be abusive to someone you have a quality relationship with," he said.

The final word is teaching. Ward teaches youngsters the skills they need to make good decisions and get through tough times.

That's not what the teens necessarily experienced elsewhere. Because of that, some anticipated being restrained for certain behavior. But things didn't turn out that way at Ward, Simmons said. He recounted Ward workers telling agitated teens, "I am not here to hurt you. I am here to help you."

As Simmons said, "It makes you feel safe."

Ward Program Supervisor Blake McNally said that at other programs where he had worked he'd seen hundreds of restraints. For the most part, they were power struggles, he said.

Costen, the Philadelphia attorney, said institutions must ensure sufficient staffing, because if there are enough workers, they can safely restrain a client without injuring themselves or the child in the process.

"If they need three staff to one violent individual, and they have two staff [members] and one floater, then the staff can only do what they can to protect themselves and others," he said. "If the kid puts his hand through a glass door or has a knife, you must do something right now. You can't wait for the floater staff."

And, finally, he said, institutions must properly train the workers in restraint procedures that minimize harm.

Daniel P. Hunt, chief executive officer at Bradley, which operates three residential treatment facilities in Western Pennsylvania, agrees with the importance of training, but says it can be tough in a field where there is such high turnover.

The average 20-percent turnover rate is a result of low pay and high stress, he said. Though a college degree or experience is required, the positions often pay only $10 an hour, just about twice minimum wage.

Often these workers are idealistic new college graduates, Hunt said.

Frequently those young people have the most contact with the children, he said, but "you cannot expect a 22-year-old to know how to handle a crisis."

When crises occur at the Ward homes, though, Vinson said, the teens already know "we are hands off."

Ward is a place, Vinson said, that puts into practice this principle:

"Children who already have been manhandled in life should be shown a different way."