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Case studies

What are the opinions of Child and Youth Care Professionals working in the field about reading or not reading the case history of a child of youth before entering into a relationship with them? Do you have any articles or books that support your position? If so, what are they?

Regards, Mylisa
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Personally, I prefer having only the information that is needed to know, which is often very very little. I much prefer starting new and building up the relationship together and being in the present rather than me going in to the relationship with their life in the book of my hands. To me it is a confidentiality issue as well, what do I need to know as opposed to what I would like to know to feel safe??

Mark & Tracey Robinson
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Mylisa,
Maybe this is too simple an answer... Know the history, (safety concerns) work with solutions, starting today.

Jon
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While I have no ready references to suggest at this time, I do have over 20 years of experience in the field and cannot stress enough the importance of reviewing case histories. While it is understood that such reports frequently dwell upon the most problematic elements of a client's background, thus ensuring access to needed resources and services, they do contain information to help establish baselines for behavioural analysis; point out intervention strategies that have been successful, outline progress, and suggest future treatment directions. Family information, educational information, contact with justice system, psychological, medical, psychiatric reports, likes, dislikes, etc, are also included in such histories. To not review this information, or to delay reviewing this wealth of information, is not, in my view, conducive to best practice in serving the needs of clients.

David
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I have tried to stay out of this debate because I strong views on the topic and don't want to dominate. However, there appears to be less of a debate and more of a group position being built. I believe that we must read case files as one of the ways we build a relationship with troubled youth. We must also rely on what CYW's do best; join, connect, give the youth the benifit of the doubt, reach out, assess, etc, etc, etc., But, I want to know things about the kids I'm connecting with before I go wading in with all my good intentions. I found some of the responses quite "motherhoodish" and naive in their positions that what should be created between the youth and the workers must be new, and that otherwise the relationship is some how not genuine. The case file is only a piece of the puzzle, but it's a pretty important piece. It has been said that the best predictor of future behaviour is past behaviour. To that end, I want to know about previous behaviour patterns; if only to avoid making the same mistakes with the youth that other workers may have made. I want to know about the youth's history of medication, allergies, (food, environmental, medication, etc), family history, prior suicide history. I want to know where the youth has lived, and where she goes when on home visits, to avoid everything from uncomfortable coincidences to triggering the youth's trauma history. I think not reading a youth's case file is irresponsible and could lead to devestating mistakes being made. Of course we can't read a file and think we know the youth, but at the same time if we don't conduct ourselves in a professional manner, to do the good work that CYW's are well known for, then we let the youth, our coleagues, and the CYW field down. I look forward to more and varied responses on the topic.

Andrew Buntin
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Andrew and all,

I totally agree with you, Andrew. It is possible, and yes responsible, for a practitioner to be informed about a client's history and yet, be present with the client as they move toward their future. Thanks for expressing my views so well, Andrew. As CYCs we wear many hats and we need to learn to do so seamlessly as we work with children, youth, and their families. Reading and writing reports is one important piece of our work that cannot, and should not be pushed aside for the sake of the relationship. Just as the relationship should not be ignored for the sake of paperwork; they are, for many reasons, woven together into the fabric of the good services we offer. Thanks again...

Glenys Acorn
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Andrew

Thanks for this - it reflects my position exactly. No need for me to say more - you've said it!
 
Johnnie (Ireland)
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Andrew Buntin’s views on ‘reading case histories before entering into relationships’ certainly stirred my waters! If that was his intention, then he was most successful!

I’ve been in the field for years and during that time I have heard Andrew’s comments being directed to me – i.e.- “motherhoodish” and “naïve”. I’ve often been told that I was also “too idealistic” and “too trusting”. Well, those are the exact same qualities that blend me with the people I interact with. I realize fully that my approach is full of risks, but isn’t this what our work is all about, being willing and able to risk yourselves in our numerous relationships. Having said that I also know that I need to act in a responsible and ethical fashion and be truthful to the mandate of my profession. How can I do this in relationship to “reading case histories before entering into relationships”?

As a front line worker I expected to receive “red flag” issues from my supervisor on any of the residents I was about to work with on the floor. As a supervisor I would clearly inform workers as to possible dangerous situations. As a front line worker and as a supervisor I would not be acting responsibly if I weren’t in tune with certain situations. I agree with Buntin’s “red flags”: I would think most would need to know if a resident has a history of assaulting workers, if a resident has certain allergies, if a resident can not have contact with certain people, if a resident is on medication or been exposed to ‘street drugs’ within the past 24-48 hours, if a resident is a “cutter” or if a resident is a perpetrator. However, I disagree with Buntin that I will need to read the entire resident file. Often a file is “past history”; today I am with this youth in the moment. The identification of “red flags” will be the only thing I need to know so I can appropriately meet the basic needs of this resident.

However, I do believe that if I am to behave in a responsible manner in order for me to utilize the resident’s everyday life events I will need to examine the file. For me I don’t need that past information immediately before entering the floor. Having background information on the youth will eventually allow me to have a better understanding of his/her past experiences. It will also be useful when I’m trying to arrive at activities, which fits for this youth. However for the first few encounters I do not need that “piece of the puzzle” as identified by Buntin. I never considered myself to be a clinician, I am a CYC worker, and it is my role to be with the youth so together we can engage and connect and so we can establish some type of rhythmical movements together. I personally believe that what distinguishes us from other professionals is our willingness to engage with the youth in the moment, where the youth live their lives. We are the professionals who do not detach ourselves from our youth viewing them as “clients with a file”. We are the professionals who fully engage, get in their worlds and begin facilitating movement and growth.
I couldn’t agree more with Buntin that it is irresponsible not to read the file. However, I certainly do not agree with him that we need to read that file to begin our connection. I am saying we need to be aware of the “red flags” and then follow through on the Child and Youth Care Approach.

Hugh
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Regarding reading of case histories, etc:
Having taken some time to think about this, and to assess my own responses, I come back to what was my impulse initially, that is, that I think it is helpful to have information from others. Here are some of the reasons.
— I wonder about people’s concern about separating their reactions to others ideas, from their own interpretations of the individual. This is, I believe, a skill we always strive for, and benefits us (and therefore others) as our self-awareness and understanding of each other increases. We must learn to do this, rather than avoid the need for it.
— It strikes me that there is a supervisory responsibility here, to qualify previous documentation, and to facilitate an attitude of presence in staff. Of course, everyone involved can and should contribute to this, as well.
— Reading is not necessarily believing. It does, as others have noted, let us know something about the history of the environment—other’s reactions to them, if nothing else, and possible patterns of behaviour as a result, which leads to present needs…
— How important is it to the individual to have helpers not waste time reinventing, or finding out information? It is ultimately about them, not about how we see ourselves.
— Clearly, it is important to avoid the biases of preconceptions. However, it is a given that we come into any situation with our own biases, in any case. We can open these with the ideas and observations of others, rather than sticking with our own.
— As much as I trust my own ability to understand, I have to assume that I can, and always will, both be able to learn and change, and must learn and change, as a result of relationships and experience.
— Thanks for the great dialogue—I look forward to continuing challenges here.

Yana Maltais
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Hi Folks,
 
I want to wade into this discussion in support of Andrew's position although from a different perspective. As someone who writes discharge reports I want the next person who works with that individual to have the benefit of my experience and insight. I think the hallmark of a good report is its usefulness. I want the next person who works with this kid to be able to pick up where I left off rather than having to start again from scratch.

I would advocate that people read files twice; once before they start to work with a client and again after they have spent a few weeks with the individual. The first reading prepares you to begin the work, the second reading allows you to balance the file with your own impressions.

Doug Estergaard
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Thanks Andrew!
Your point of view is similar to that of The Children's Home. The children who enter care lack the skills to develop healthy relationships. We can't wait for them to tell us what we need to know to provide treatment. The history provides us a view of the child's life from their perspective, not to pass judgment or interfere with normal relationship building that must occur. The history can only help us understand the behaviors we see daily, identify the potential sources of this "alternative" behavior, while we look to provide more socially acceptable ones. How can we avoid repeating the child's past when we don't have a clear understanding of it?

Steve
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I could not agree with you more, Andrew!!! As professionals we need to understand the struggles that a child has gone through before we can help them. Reviewing the case file helps staff understand where the child is at emotionally and behaviorally. The case history is the foundation of all good treatment. If we don't have a clear picture of what I child has overcome how are we going to help them become the successful adults that they can be.

Not reviewing a case file can be dangerous in many cases. As staff, we need to know if a child is at high risk for suicide, self-harm, eating disorders, etc. Case files also give us a picture of the family situation and provides information about the safety of the home and family environment. These are all things that we need to know to keep a child safe.

Windy Winsenberg
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It appears that most responses feel that the youth relationships should be built upon the here and now, and not by their pasts. I agree! When I was a case manager I always read the files of my primary case load only. I read these files always keeping in mind that these reports were only the thoughts and observations of other people based on their experiences and perspectives. In fact, I found case files more often to reflect information about the author, than the client.

These youth we work with grow and change every day. The person they were last year is not the young man standing in front of you today. We need to always remember this!

Tara Mitchell
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In reference to this topic I would like to share an experience that I had years ago before working in this field as a CYC, while working as a Temp. ward clerk at the Royal Ottawa Psychiatric Hospital. The nature of my work as a Temp. (secretarial in nature) was to fill in whenever one of the secretaries or ward clerks had to take time off. I had the opportunity to fill in for the ward clerk on the locked ward unit of the Hospital. The locked ward was a place where many of the patients found on the ward (like me) were temporary, having been sent for assessment awaiting sentencing or trial. The offences committed by these folks were not minor by any stretch of the imagination. The ages of the patients were 16 and up. If they were on the younger side of the age scale, it usually meant that the nature of their offence was pretty serious. As ward clerk I had access to all the files and could read the case histories to see why they were in the ward. I was pretty excited to have this opportunity especially as I loved to "study" human nature.

I must explain that this ward was not a large one and all of the patients on the ward were under constant surveillance. Many of them did not come out of their rooms. They were very much aware that everyone working on the ward knew their whole life history including the offence for which they were awaiting trial.

On my first day I found that there were four "boys" (aged 16 - 23) who would group around the chest high divider right in front of the desk. They would all lean on the divider and engage in "pleasant" conversation about anything and everything other than why they were on the ward. These boys appeared at ease after asking me some very guarded questions to see how much I knew. Pleasant exchange of ideas, thoughts and general conversation was enabled because they knew I was new and not aware of their offenses. I had the "privilege" to get to know the positive side of all four boys. I made it a point not to read the files because I did not want to have information that I knew would interfere with the pleasant conversation and enjoyable moments of "freedom" that these boys were experiencing.

These boys reminded me of my 8 year old son in their mannerisms and emotional expression. As each trial date came they were shipped off (this took place over a two week period) and did not return. After each one left, I would then read their files and while reading came to an understanding because of the nature of their offenses, that I would have been very distant in conversation with them all, especially the last one who was the oldest yet emotionally the youngest, and who had committed the worst offence - an offence that I would have been hard pressed at that time in my life to forgive. It was this last boy who thanked me for the pleasant "interlude" of conversation before going to trial. He was the one who shared a bit of his life but not all and it was obvious even before reading the file that he had very little to be thankful for or look forward to in his life experience.

This experience shaped my understanding that the "more we know the more we look for to reinforce what we know" and I find the children with whom I need to form a relationship as a caregiver, helper, counsellor etc, are better served by me if I wait before reading their files. As I follow this principle, I find that I am able to build a positive relationship with them without being prejudiced from other factors that can interfere in the building stage of any relationship.

Thanks for the opportunity to share.

Carolynn
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To everyone, fascinating discussion around the usefulness of reading files. Here are my thoughts:

I'll sign off with a quote from the intro to Paulo Freire's Pedagogy of Freedom,
"By negating history, particularly the history that engendered the 'at risk' reality, many liberals are able to safely display their presumed benevolence toward a particular subordinate cultural group that they have labelled 'at risk' without having to accept that, because of their privileged position they are part of the social order that created the very reality of the oppression they want to study...."

Cheers
Jeremy
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My view is this: I have yet to view a complete history of the background and history of any youth that I engage with as a CYC. On one occasion we requested some information and I was not surprised by the content and our team had already identified many of the issues. One writer used the word "help" regarding our interaction with the youth and I don't see my job as helping them but rather facilitating change. The youth have the power to help themselves. They need the forum in which to do so.

Yes, if there is any risk involved, certainly we need to be forewarned. But ... don't you think risky behavior is evident and easily identified anyway? Our training has prepared us for situations that may arise.

The initial meeting of the youth is about the relationship that will develop. As I go forth in my life and make new connections and build relationships, I wish to choose what information about my past I feel comfortable sharing. Most information about personal past must be put into context and to risk being judged unfairly should often (or least sometimes) stay in the past. I am more than prepared to continue my work with youth knowing that I may never read their past, personal histories. I feel confident with my training, experience, and past, present and future studies to keep me tuned in to my environment eand protect myself from harm.
 
Linda Moore
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A short snapper ... if the file is not read the very beginning and an accident occurs due to a reckless treatment intervention or lack thereof, and the relevant information was in the file ... who is held accountable to that? Seems risky? Not to take the discussion away from the competing positions of "approach versus process."

Ernie Hilton
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I do read the case files but I wonder how much is this useful if we workers are using a solution focus — is this helping us work better with the youth? Yes granted we get to know some of the behaviour that we might see with in a month or two, but honestly, the case files I read I usually forget what is in them.

Thank you for your time
Alison Kraushar
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Listening to this discussion, I am asking myself whether it is so much about the practice of those who read/don't read files, as about the quality and meaningfulness of the files we generate in our profession?

How often in our reports do we exaggerate problems (or minimise them, depending) so as to get a child accepted into a program or to draw funding? How often do we do an egg-dance around our feeling that we have failed with a child? How often are we reflecting the poverty of our own resources, seeing greener grass on the other side of the fence? A youth's file so often looks like a rap sheet rather than sober and objective information compiled in his or her best interests. How do we get to the place where we all want to read the files because we value their function?
 
B G
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Hello,
I generally do not read a file. I like to get to know a person according to them, and who they present themselves to be. Perhaps if there is something that comes up...then I naturally will read the history to better inform myself.
 
There are many camps on this subject, and of course I remain ever humble to the possibility that something or someone out there could very well change my mind.
 
Be well.
Linda
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Brian mentioned a good point about the content of the files we read. This discussion is very timely for me as I am currently writing a book about report writing and record keeping. Perhaps this discussion could drift toward the topic of actual good writing practices and record keeping practices. Would anyone care to comment on the do and don't of record keeping and report writing? The other angle I am researching is the record keeping and report writing practices in various workplaces i.e. residential (open and secure custody), hospitals, schools, private practice, children's mental health centres, day programs... the list goes on. If anyone has any information they would like to contribute regarding the practices used in each of these workplaces, I would appreciate the input. Policy, procedures, and actual forms would be helpful. Because the book will be published in Canada, I am particularly looking for policy and procedures that reflect any federal or provincial legislation, however, I am interested in best writing practices input from anywhere in the world. Thank you in advance for your help.
 
Glenys
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