Thomas is a seventeen year old youth who had moved with his family to Miami, Florida about nine months ago. He was seen at the request of Central Region to assist in treatment planning. Thomas has been seen previously and the history is well documented in these prior evaluations.
Referral materials today included a Case History, a Classification Presentation, a Psychological evaluation dated 12/30/88 by Dr. Callahan, Psychiatric Evaluations from McLean Hospital, a letter from the Western Youth Service Center regarding Tom's positive tuberculin test, a Discharge Summary from Westboro Secure Detention, Educational and Medical Records.
Tom was told that I was a psychiatrist seeing him for the purpose of assisting DYS in treatment recommendations. He was told that a report would be submitted to DYS that could potentially be used in Court and that the interview would not be confidential. He was told that he had the right to refuse to answer any or all questions if he so chose. He indicated that he understood and agreed to proceed.
Tom has been involved with the Court beginning in 1985 and has been in numerous placements since that time.
His early upbringing is described as having been chaotic, with both mother and father abusing drugs and alcohol. Also, father apparently used to dress himself in women's clothes and do all the housework. Mother and father subsequently divorced and mother lived for about a year with a man who was described as physically abusive. The second marriage appears to have been fairly stable. Tom said that his family had moved to Florida nine months ago for "something new". His stepfather got a job in Florida but then quit as he has to take care of his own mother, who Tom descried as crippled and suffering from memory loss. Mother then got a job in a delicatessen., Tom's supervision was apparently transferred to Florida, however, he said that he returned to Massachusetts to visit his father and aunt and his grandmother, who he says is terminally ill.
Also, Tom said that one of the local gangs in Florida was after him because he had something from the parents of one of them. He said that his family has been living in a trailer park that the neighborhood is dangerous because of the gangs.
On return to Massachusetts, Tom was sleeping over at a friend's house. He said that the friend went to a party and stole two guns, which were given to Tom so that Tom could sell them. Tom was subsequently arrested for possession of firearms. Tom said that the reason for his crimes was that he was "money hungry".
He said that he wants to be able to keep a job and that he had a job in Florida as a cook at Wendy's, however, he spilled some chili and suffered burns on his leg. He said that he stayed out of work for two weeks because of this and "got used to staying out of work" so he never went back. He said that he had been working at the job for two months and felt good about being able to hold a job, although he also felt that the pay was not sufficient for the work that he was asked to do.
At any rate, on his return to Massachusetts, he was intending to live with his father and go to school. However, he said that his father would not allow him to stay there, and he ended up staying with friends. Actually, he seems rather ambivalent about school, describing it as "a waste of time". At this point in his life, because he has only gone as far as ninth grade, he thinks that he would prefer to get his G.E.D. Tom states that he wants to learn how to live on his own and "doesn't want to be institutionalized". However, he feels that he is already institutionalized to a point, because he is "getting used to these guys taking care of me". In fact, Tom has really spent the majority of his time since commitment in residential programs. On the whole, he has done reasonably well in most of his programs, but would get involved in delinquency when he returned home on passes or when he went AWOL.
Past evaluations have described him as being of low average intelligence, with some questions of a mild Attention Deficit Disorder. He did not appear at all overactive on interview today. Tom acknowledged use of marijuana and alcohol in an evaluation in December, 1989, but had denied this in the past, except for one incident at age 11, when he ingested a lot of alcohol with some friends and "they had to pump it out of me".
Tom said that his last placement was the transitional management program in Springfield, which he described as "not structured enough". He felt that there were not enough activities or sports there. He thought that the best part of the program was school. In 1987, Tom had been placed at Our Lady of Providence Children's' Home in West Springfield, but went AWOL from the program a couple of times, once allegedly taking a staff car, although charges were eventually dismissed. He successfully completed Aquarius House, which he said that he liked because of the school program there and because "they take you out". Subsequently, he was referred to Saint Vincent's Home, where he said he did well until he did not come home from an overnight visit. Tom said that he was upset about the length of time that he was going to have to stay there. He had also been placed at the Coolidge School, where he reportedly did well. He has also spent extended periods of time in detention units.
The history seems quite clear that Tom can function in structured environments, only to have his behavior rapidly break down when this structure is removed. In this sense, he does, in fact, appear a bit institutionalized, and his comment today would suggest that he also craves the nurturing aspects of residential placements.
In the remaining time that Tom will be with DYS, the therapeutic task will not only be to stabilize his behavior, but hopefully to build in skills needed for more independent functioning. I would see him as needing an initial placement in secure treatment, to be followed by an aftercare placement in a setting that could foster the development of job and living skills. Perhaps at some point, the job corps could be an appropriate resource. One might perhaps consider the L.E.A.P. Program which would perhaps allow more of the activities that Tom seems to crave and which would perhaps allow more of the activities that Tom seems to crave and which could, at least to some extent, avoid the regressive risks of a locked setting.
/s/
George L. Hardman, M.D.
PSYCHIATRIC EVALUATION
NOVEMBER 14, 1988
DYS CONTRACT
THOMAS L. GUDINAS
Thomas is a fourteen year old youth from Gardner seen at the request of Central Region as part of an optional referral for Secure Treatment.
Referral materials included a case history from the Region, records from Lake Shore Hospital, a neuropsychological evaluation from Wilfrid N. Derby, Ph.D., a report from KEY, a report from Aquarius House, a medical report from St. Vincent's Home, medical records, educational materials, and a court record.
Thomas was told that I was a psychiatrist seeing him for the purpose of assisting DYS in treatment recommendations. He was told that a report would be submitted to DYS and that the interview would not be confidential. He was told that he had the right to refuse to answer any or all questions if he so chose. He indicated that he understood and agreed to proceed.
Thomas lives with his mother and stepfather, who have been married for about four or five years. Stepfather is a furniture builder, mother works in a gun factory. Thomas has a sister, age thirteen., He claims to get along well with his family. He described his stepfather as easy to get along with, and enjoys going boating, fishing, hunting, and swimming with him. He also felt that his mother was easy to get along with.
Thomas' natural father lives in Billerica. Mother married him in 1972, when they were both quite young. The marriage ended in divorce eight years later in 1981. The year prior to the divorce mother had admitted herself into a psychiatric hospital for depression. Father was reported to have been physically abusive to Thomas. Apparently mother and Thomas' natural father were both abusing drugs and alcohol at the time of the marriage. Mother claims that her ex-husband used to dress himself in women's clothes, and do all the housework. According to the case history, mother worked in a message parlor for about a year, feeling that she was "in need of a man" because of her former husband's strange behavior.
In the period between her marriages, mother had a relationship with a man with whom she lived in 1978. This relationship ended after about a year because of the man being physically abusive to mother.
Apparently the present marriage is fairly stable and harmonious. Mother reportedly feels that Thomas' behavior at home has been good, but that his acting out occurs when he is out of the house and associating with peers.
Tom has gone as far as ninth grade. He claims not to have repeated any grades, but the records reveal long-standing behavioral problems in school. He has been in an alternative school program. He also functioned well below grade level. Thomas claims that he gets passing grades, and does best in math. He also claims to get along well with his teachers.
It was noted at Lake Shore Hospital, where Tom had a diagnostic psychiatric admission in early 1987, that he showed minimal behavioral difficulties in the classroom there. He had some difficulties in attention, but seemed quite easily motivated by a unit-point, privilege system and a very structured academic environment. Also, at Aquarius House, Tom averaged 98 percent on the class point system, although he was noted to be quite timid on admission to the program there, which might have contributed to his high score. As he became more comfortable, there was some evidence of provocative behavior, although I gather that the program ended before this developed into a significant pattern.
Tom stated that he would like to become an electrician, or carpenter, and noted that he has done woodwork in programs. Tom has had several prior residential placements. He said that he like Aquarius House, where he remained for about six weeks, and finished the program. He said that after he left Aquarius House, he "messed up on the street" by stealing some money from a car. He was at Our Lady of Providence at age twelve and a half, but disliked this program. His major complaint was that they "treat you like a kid," although he was not very specific about what he meant. He said that he liked St. Vincent's Home, but apparently ran away from a pass to see a friend, which he now says was "stupid." He remained at St. Vincent's Home for about four months.
Tom said that he would like to return to St. Vincent's Home to get "one more chance." Only medical records were available from St. Vincent's Home, so I could not know if this is a possibility.
Thomas denied drug use. He apparently ingested quite a bit of alcohol on one occasion at age eleven with some friends and "they had to pump it out of me." Since that time, he denied alcohol use. He feels depressed about being at DYS. He denied ever feeling suicidal. He denied ever having been sexually abused.
Thomas' court involvement has included a false fire alarm, larceny, and breaking and entering.
On interview, Thomas was a small statured youth with a deep voice seemingly inconsistent with his otherwise rather immature appearance. He related easily and showed no evidence of thought disorder or psychosis. There was no evidence of suicidal or homicidal ideation.
Prior evaluations have noted his good response to external structure and individualized attention. Staff at Westfield reported that he was on a high behavioral level consistent with those prior impressions. Neuropsychological evaluation in the past has shown him to be of low average intelligence, with no significant organic impairments. Some questions were raised as to whether there might be a component of Attention Deficit Disorder, as well as his conduct problems. Even so, however, a highly structured setting with individualized attention would be appropriate. It is fairly clear that when he is in less structured situations, such as his passes home, his behavior rapidly deteriorates, and also that he has not been able to function in regular school settings. I did not see Thomas as being appropriate for Secure Treatment at the present time. He does not present a danger to the community, and I felt that his needs would best be served in a well-structured supportive residential setting. He has shown an ability to function in such settings in the past, and it would appear that his behavior breaks down primarily when he progresses to the point that the structure diminished. I think, therefore, that it would be worthwhile to attempt to residential placement over a relatively long period of time, and to be very cautious about instituting passes, even when his behavior might seem to warrant it. That is, the history suggests that he can do very well in a structured setting, but that his behavior deteriorates when a structure is removed. I think that there would be some benefit for him to return to St. Vincent's Home if this is a viable option. That is because Tom has been described as a rather fearful youth, and there would be much to recommend allowing him to maintain relationships that have already developed to some extent. I think that it is important in teaching a youth like Thomas, to anticipate that the therapeutic process will not always be smooth, and it is important to maintain relations through all of the ups and downs that treatment will necessarily involve. If return to St. Vincent's Home is not possible, I would see tom as benefiting fro placement in a structured and supported group situation, capable of providing an appropriate educational plan, structured milieu, and supportive counseling.
