Opening Our Arms - Helping Troubled Kids Do Well

Kathy Regan. Boulder, Colorado: Ball Publishing Co., 2006. 331 pages. Price (USA) $16.95 (paperback)

Opening Our Arms is the true story of a child psychiatric inpatient hospital unit in Massachusetts. Kathy Regan became the nurse manager of the unit and following in the footsteps of Dr. Ross Greene's The Explosive Child, tried to convert the unit from a dysfunctional, chaotic environment to one that supported the complex needs of behaviorally challenged children. Kathy found the staff fearful, untrusting, and resistant to change, which became one of her first and most significant issues. Part of this work describes in her own words and from her unique perspective the many challenges Kathy faced in implementing sweeping changes in the unit's structure, therapeutic environment, crisis management and, inevitably, staff turn over.

A significant portion of the book is dedicated to telling the stories of several children who were hospitalized on the unit during the transitional period. On many occasions, Kathy and her staff were tested by some extremely challenging behaviors from kids in desperate need of help. Using the A-B-C method - each behavioral incident is categorized as "A" for any behavior that was considered truly dangerous and requiring immediate intervention, "B" for any behavior that could be managed collaboratively between the staff and child, or "C" for behaviors that could be ignored - the unit staff soon began working as an effective team that saw marked decreases in restraints, PRN medications, and "melt-downs".

Two of the cases mentioned in the book were of children with developmental disabilities. While this should not be considered a book about developmental disabilities, many of the techniques described in this work could and should be employed by people providing services for children and perhaps adults with developmental disabilities. The A-B-C method of assessing behavior is an excellent system for helping to promote consistency among staff members, which is a common problem among staff caring for people with developmental disabilities, and as a method of reducing emotional reactivity in the face of difficult behaviors. I would strongly recommend Opening Our Arms to any organization or individual who is responsible for the care of people with behavioral challenges, or to any manager who is struggling through the process of change.

John Boisseau, MSN, APRN, BC, CDDN
Clinical Nursing Faculty
Regis College