Testimony to the Ways and Means Subcommittee
Dr. Whitney Vail
5/3/2013

As part of growing work we are doing with law enforcement and correctional systems across North America, we are thrilled to have launched collaboration with the Oregon Youth Authority. This collaboration is led by their Director of Treatment Services, Dr Whitney Vail, who is one of our Certified Trainers. She recently delivered the following testimony to the Ways and Means Subcommittee in Oregon:
 
Good afternoon madam co-chairs, members of the committee; for the record, my name is Dr. Whitney Vail, Treatment Services Director for the Oregon Youth Authority.
 
I am a licensed Psychologist and have been working in institutional settings with youth for 15 years.
 
I sit before you today as the Treatment Director for OYA for one primary reason: a youth whom I will refer to as Sam.
 
I first met Sam in the spring of 2010, when I was working for OYA as a Contract Psychologist. Sam was 17 at the time, and had been in OYA close custody, on charges of Criminal Mischief 1, for 4 months. Sam was referred to me for a comprehensive psychological evaluation due to concerns from his treating psychiatrist about possible psychosis. Prior to his commitment, Sam had received outpatient mental health services, was placed in day treatment and at least 3 residential treatment programs, as well as detention 10 times.
 
Sam was raised by his grandmother most of his life. His mother reportedly had a substance abuse history, and he didn’t even know who his father was. Though Sam would never speak negatively of his grandmother, they did not appear to be close and the relationship did not appear to be one of nurturance, though I’m sure his grandmother did the best she could with the skills and the resources she had. By the 7th grade, Sam had essentially dropped out of school. He became engaged with the legal system at age 14, when he first ran away.
 
I remember how oddly Sam presented in the first few testing sessions, appearing unkempt, presenting as paranoid, and laughing inappropriately. After multiple sessions and attempts at building rapport and helping Sam understand the importance of the evaluation process, Sam’s psychological testing results were deemed invalid due to him responding dishonestly, randomly, and at times intentionally trying to present as less capable than he was. I recall being frustrated with how useless the results were.
 
After analyzing the test results, I decided to pay a visit to Sam, who was in isolation after having assaulted a peer and then smearing feces all over the walls of his isolation room. I distinctly remember standing in the isolation room with Sam, careful not to lean against the feces covered walls. We discussed motivation in general, as well as Sam’s personal motivation. Sam was able to identify tasks that he was motivated to work at. However, he did not find the behavior management unit that he was placed on to be helpful in any way, and therefore he was not motivated to return to the unit from isolation, nor to move on from the unit to one with more privileges.
 
After completing my report, I met with Sam to discuss the general results and recommendations of his evaluation. Though I had used information from both the assessments and my interactions with him, I distinctly remember Sam saying, “You got all of that from our talk!” Though I found myself defensive at first, I quickly realized that he was right… I had learned a lot about Sam that day I stood with him in his isolation cell, and it was only with that information that the rest of the testing information made sense. All my years of education and complicated psychological tests could not compare to the power of a face-to-face honest conversation.
 
About 7 months later, I met with Sam to assess him for suicide risk. During this meeting, he asked me about the diagnosis I had assigned to him after the psychological evaluation. His diagnosis was one that is uncommon and marked by social disinterest and bizarre thinking and behavior, often somewhat paranoid in nature. I was concerned about how he was going to react to my response. To my great surprise, the resulting conversation was one of great depth and insight. Sam was saddened by his diagnosis and the thought of being that way for the rest of his life. This provided a great opportunity for us to discuss what this meant in real life: how others perceived him, how he perceived others, his interests and goals in life, etc.
 
Shortly thereafter, Sam requested to read his full psychological evaluation report. I was quite concerned about how someone with such a paranoid outlook would respond to the negative information in the report. It was difficult for him, but it was also a critical point in Sam’s development. Up until that point, he had relied on adaptive skills of avoidance, running away, bizarre, aggressive, and self-harm behavior to deal with distress. Sadly, he also believed that he could get financial benefits if he acted “crazy.” I will never forget the look on his face when he realized the true impact of his functioning on his future. Sam was a kid who not only lacked pro-social skills but who was truly lost in any social interaction. His best skills for managing his negative emotions were to partake in suicidal behavior, laugh inappropriately, or take his feelings out on others physically. He assumed the worst in others and had difficulty looking past the immediate. He was doing the best he could with what he had, which wasn’t much. He had many lagging skills, no consistent supports, and traditional behavioral interventions only lead to him further implementing his adaptive skills, which made things worse.
 
But now, Sam had enough insight to understand that if he continued on the path he was on, things would, at a minimum stay the same, and likely get worse. Sam was not happy with the path that he was on, but he didn’t know how to find a different path. Attempts from others to show him “the right path” only made him retreat more. Sam had not only repeatedly failed to learn from his consequences, his undesirable behaviors were actually further reinforced by the consequences. When you don’t know what else to do, or have the ability to do it, you do what you know.
 
Sam is a prime example of a youth caught spiraling in the traditional correctional system. Each negative behavior is met with a negative consequence. But, a lack of skill prevents the youth from replacing the negative behavior with a positive one, and feelings of shame are processed as trauma, resulting in the brain retreating to basic survival. In a traditional correctional system, we assume that behavioral interventions will teach these youth to decrease their negative behaviors and increase their positive behaviors. However, these interventions are highly limited to teaching basic lessons and extrinsic motivation. For our youth to be successful long-term and independently, they need to develop skills and intrinsic motivation.
 
Sam had just developed intrinsic motivation. And, it wasn’t by me dangling a carrot on a stick for him, or by threatening further consequences if he didn’t change his behavior. All of those things had been tried and failed miserably. Rather, Sam’s motivation was to feel like a happier, healthier, person. And, he came to this motivation, not by my stunning psychological testing results, but by my honesty… My willingness to stand in a room covered with feces and have a conversation with him like a normal human being… My willingness to admit when he was right and I was wrong… In Sam’s words, I treated him “like an equal,” like