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Transcripts of some of the discussions on CYC-Net's email discussion group

Earning home visits

Looking back on recent postings ... Peter asked about home visits having to be "earned" by having enough points. This idea has really worried me because it appears to contradict basic integrity in the relationship as well as the ethics of our work? If a program is willing to grant a home visit, then clearly they have no basic objection to the visit. To then withhold the visit (which is surely a key element in the whole treatment plan) on the grounds of insufficient points, seems manipulative and vindictive. That's my personal reaction — maybe someone can explain.

Mike
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I am not sure that there is an explanation other than justification for being manipulative and vindictive. Why should kids have to earn treatment?

Peter
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Just a few thoughts on the subject an as ex- care worker at Boys Town South Africa. For the majority of boys at a Boys' Town there will be no doubt that their interest will be best served by efforts to sustain or create links with their natural families. Contact in the form of personal meeting is generally the most common for both families and children and the most satisfactory. Furthermore, contact reassures the child that he has not been rejected at separation which helps him feel to secure within his placement. The underlying ethos is that if the child sees his parents regularly, he will have an increased understanding of why he cannot live at home, which helps to minimize fears of rejection. This participation of the parents is actively encouraged at a Boys' Town. The exchange of photographs, letters and gifts between the family and child is a useful way to keep memories for the child. However, what is more important is to find a way of helping the child and the parent in more real relationships with each other. Maintaining links with the family and family reconstruction work has become an important aspect at a Boys' Town. Placement at a Boys' Town is seen as a necessary and effective way to treat both family and the child, so as to restore family function so that the child can return to the natural parents. Frequently when a child is admitted to a residential programme, the referral agency and its social worker exclude the family members from continued involvement with the child. The basic value-laden assumption is that the family and parents in particular must have failed, or are inadequate as parents because their child is in institutional care. Home visits must be seen in terms of the child's integrated treatment plan which considers the following:

a] to minimize the alienation of family members whose child has required admission.
b] to include family members as equal partners in the treatment process.
c] to empower and encourage the family to learn effective ways of meeting their responsible towards their child.

Finally, family visitation at a Boys Town is not seen as a privilege but as a non negotiable right.

Tom
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We have parents that totally reinforce our program, which is based on points. If the youth is not getting the points based upon their behavior and participation in the program then the parents don't want them home. It is their wish to see the youth working in the program and generally when the youth sees the home visit as a reward for hard work they tend to buckle down and participate in the program in the week leading up to the visit and they see success. From experience this success carries through into the home visit as well and the interactions of the family seem more positive than if they were to go home on a lower level with behavior exhibiting that level.

Neil
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I clearly disagree with point systems. I worked in a group home once that did point systems. I would not do this and one time I nearly got fired. But what I found (not purely based on point system) is that the kids trusted me more, I did not hold points over their head. And I am not saying that is what your program does, but the workers at the program I was at seemed to do that. I read an article on the CYC-NET website about point systems, the article was called" The Case Against Point Systems and Grading in Behavior Programmes"...I am not sure but I think it was written by Karen VanderVen. I also agree with Mike on the home visit issue.

Jennifer
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In Scotland, it would not be possible to restrict home visits as a result of any reward system etc. — national standards and inspection systems ensure that this is not permitted. Home visiting is vital to the care plan of any child or young person in residential care, unless this is specifically proscribed because of risk. In addition, abuse scandals within residential care have been associated with enclosed environments, in which the outside contacts the child has have been limited. Home visiting has a protective function for the child in such situations. Limiting home visiting for any reason other than the protection of a child from an abusive home is a dangerous practice.

Meg T
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The whole idea of earning points to visit your own family is one of the reason I feel residential programs should be shut down (not all) . I find it difficult with the knowledge we now have that awarding visits due to good behavior is still even considered. Residential programs and residential staff need to make some serious paradigm shifts when it comes to working with families. I think programs should be looking at how to use parents in their programs on a daily basis that allows parents to make decisions for their own kids and the type of program that best suits their needs. Please don't read into this note as residential bashing, there are many excellent residential programs out there that encompass the whole but I do have concerns when I hear of these types of treatment modalities.

Jon
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Here's a thought to ponder when it comes to "home visits" Just a change in mindset from a child being considered a visitor when they come home. Is it not instilling a further sense of institutionalisation, if the child is considered a "guest" on a "visit" when they come home, or should we not just say they are simply living at home for those two days (or whatever the time frame). As far as earning that right (to live at home for a short period of time), I find it very hard to maintain the parent's commitment to involving themselves in the treatment of their child. If we only send them home when they are doing well, how do we help the parents practice dealing with them when they are not doing so well. It would seem that we would be providing them more of a service if we were to send them home during the trying times and offer all kinds of support to help them get through it. I have seen cases where the child going home was dependent on their behaviour and see an increase in negative before the visit in order to get out of going (especially when there was fun activities planned on the weekend, or if their motivation was not high to go home in the first place).

Curtis
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I agree with all — treatment shouldn't be earned (right on, Peter), home visits shouldn't be dependent on having enough "points", and point systems are.... well, Jennifer mentioned my article. There are a few more too — let me know anyone if you want the references.

Karen
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Hi Mike, I can see how earning points for a home visit could be seen as a means of incentive; however, what if this goal is unmeasurable to the client? I personally do not believe in withholding a visit from a client — imagine how you would react if your visit was cancelled due to poor behavior. (Sometimes the visit is the only thing they look forward to.) I'm sure this "intervention" may appear in some policies but not all. In this home I worked in, a client's home visit was shortened on one occasion and another cancelled. I had mixed feelings on this as the whole point of this client being in care was to eventually return home. What I did see between the other staff and the client was a constant power struggle — I mean this child had a hard time following any directions and when redirected, he would explode. Knowing this and seeing how desperate the staff were to give him a consequence I began to feel this intense power struggle and this was a means to end it and send a message to the child as to who was boss. I know you were looking for a contrast reply but I totally agree with your points!

Stephen
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As a director of a facility that has a point system for home visits, it has been interesting reading all of the responses about the subject. We work with older teenage boys and in most areas of the program we are focused on building successes wherever we can get them. Earning a home pass is just another success that a resident will experience twice a month. Rarely will a resident fail to earn his home pass points. The system is measurable and the points are graphed everyday so there is never a question where a resident is. Points are earned for doing normal things that we all take for granted, but may not be so for the residents. Getting up on time, brushing teeth, washing hands before a meal, eating a meal, doing chores, getting to bed on time, etc., are all point getters. The system is important in motivating a behavior that can become a habit for the future. We do have demerits; however, we try to handle any problems outside of the home pass point system. And we always offer opportunities to earn extra points with extra duty. If a resident wants to go home, he can. However, there are times when a youth will not want to go home and we are not aware of his feelings. He will self-destruct and fail to get his points so he will not be allowed to go home. But this action is often healthy. It gives us a springboard for counseling, which under these circumstances often yields good results. We are able to find out home problems that we never knew existed and be able to help the young man learn ways to deal with his problems without missing his home visit. As with any approach to working with youth, the system is not as important as the child care workers that enforce the system. When a child care worker looks at a point system as a way to help youth achieve successes, that worker will be looking for ways to reward youth. But if a child care worker looks at a point system as a way to exert power on a youth to get him/her to do what he/she is told, it will ultimately fail. If you love the kids, most systems seem to work. If you don't love the kids, I don't have any idea what system will work.

Brian M
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In this discussion on `earning points to go home', Peter raised the question, "Why should kids have to earn treatment?" I think this question raises the discussion to a broader level than just ‘going home’. I wonder how many other ways there are in which we require `good behaviour' from young people in order for them to access the very things they need in order to overcome some of the issues and struggles in their life? What about the young person who could benefit from learning a particular skill, but is not allowed to join the activity (e.g., basketball), or go to the course (e.g., music lessons), until she `behaves'? What about the young person who is excluded from community participation because she or he doesn't know how to behave in the community'? What about the young person who is not allowed to continue with an academic activity at which he or she does well, because of poor behaviour in another area of the school? Or what about the young person who is expelled from a social skills group because of poor interpersonal skills? And how does this fit with the child and youth care goal of helping young people to learn to live their live differently, in the areas of their life in which they experience difficulty? What happened to teaching? It seems to me there are numerous ways in which we exclude young people from many of the areas in which they are, or could be, successful because of their problems with behaviour. Usually the justification for these actions is something like, 'she/he has to learn'. I would be curious about other peoples thoughts about this process of `taking away things therapeutic' in the name of treatment. And why we choose this approach.

Thom
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Responding to Thom:  Although I am involved in a program that revolves little about "taking away" for therapeutic purposes I am wondering about the value, if any, in the approach. I also need to understand my reaction to such an intervention for treatment before I can manage it properly. As a youth care worker if I do not try to be great at my profession I can be fired. (Job taken away). As an "abusive" parent I can have my child "taken" away. As someone who speeds in my car (very rarely :0))I can have my licence taken away. The tornado that rips through my town can take away lives and property and dreams. "Taking Away" is part of life as is "Giving". Why do I not have things taken away? Well my care givers didn't have a point system, I wasn't spanked, I experienced a healthy amount of "guilt and shame", I was nagged to death, I was loved even though it didn't seem fair sometimes in what it looked like. I am not a fan of eliminating ways to love anyone. Having said that we don't have a phase or point system (anymore). When children and youth leave our programs that have a point system lets hope they go into a program or home that has a point system because what happens if things are not so clear? Or love is defined/expressed differently? Lorraine Fox rings in my ears when she said to us "give the kids something they can really take with them when they leave". "Behaviour", I believe, is neither good or bad it is just behavior. How I internalize the behavior of others creates the reaction. My gratitude for the gift of the experience of the behaviour will create my approach. Learning and experiencing "Giving and Taking away" will occur for children and us whether it be in a program or not. Utilizing either for treatment for purposes of creating change is a position of privilege and power and responsibility. Experiencing your own program is often fun to do. Stay a night or two or a week to find the value in your treatment and approach. Experience yourself?

Ernie
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What I have missed in this very interesting discussion on "points" are some crucial developmental considerations. One is the generalised application within a program of a behavioural/points model across the whole client population without some clear discrimination being made between those who may benefit from such a model and those who might have moved beyond the need for the model. Any externally mediated system of stimulus, motivation, punishment and reward, must inevitably be moving towards a youth's self-determination and internal locus of control. I can understand the use of "unusual" approaches to engage with a particularly unsocialised, barricaded or destructive kid. But the questions which now arise are:

(a) how do you define the point at which the unusual approach must give way to a more normative approach, and hence,
(b) how can a whole program be run on external control approaches rather than being strictly confined to individual kids' plans?

BG
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I am the program supervisor of a small 18 bed treatment center for adolescent male offenders. We are a very short term program, 4 to 6 months. We provide family therapy and other family oriented services which all families are expected to participate at some level. The bottom line is that a home visit is a treatment issue not a privilege that a youth can earn. Yes they do need to demonstrate the ability to be safe and legal in the community so all first time home visits are house arrest home visits and are determined some what on program behavioral expectations. You can not earn or lose home visits. they are arranged based on specific treatment issues. We find this much more productive and alleviates the anxiety that comes with earning a home visit. Years ago kids could earn a home visit but then they could lose it the day before they were to leave also. If a home visit is not tied to treatment and objectives and goals associated with treatment I believe a great opportunity is lost. Also it brings the family into treatment. Every home visit has a parent youth contract which has both privileges and responsibilities built in along with a means for obtaining feedback from both the parents and youth. Over 70 % of our families are involved in family work and having the home visit as a part of treatment has had very positive results.

Larry
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I am struck by several points (no pun intended) that Brian M made.

1) If, in fact, the home visit "points" are so easy to earn, why have them in the first place. Just how many hoops do we need to have our kids go through?
2) I would want to know what the program is doing to help the child use his/her voice in order to express feelings and thoughts about home visits as opposed to creating a system by which the child feels they need to "self-destruct" in order to not go just because he has the points to do so. This is a common error with level systems. Often the youth does not want the privilege associated with the level they are at so they feel a need to exhibit behavior which will drop them a level and therefore remove the reward which they never wanted.
3) In regard to the system creating habits for future functioning ... Where will the child be going to where there will be such a clear and complex system of points and levels. Most of our families will be unable to duplicate such a system at home and the real world is never quite that clear cut. When we create point systems in our facilities, aren't we just training the youth to excel within the program with no connection to the outside world. I would like to know what the program is doing to help the parents ensure that the child gets up on time, brushes his teeth, washes his hands, etc...
4) And with all due respect... I do not feel as though the degree of love one has for a child is in any way an indicator as to how well someone will use or misuse a point system. Some of the worse staff out there are ones who truly believe that all a child needs is love.

Peter
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BG raised his concern about "... the generalised application within a program of a behavioural/points model across the whole client population without some clear discrimination being made between those who may benefit from such a model and those who might have moved beyond the need for the model." Are you suggesting that this is where we should begin with all children? Start with points and phases and then go beyond it?

Karla
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Replying to Karla who asked whether "points and phases" is where we should begin with all children. 
This IS where we start with all children in normal families. With little kids we do bargain, cajole, reward, threaten ... but by the time most kids are five or six they have already moved to what Kohlberg called the second stage of moral reasoning. That is, instead of complying to avoid our wrath or to respond to our external control, they comply because they value us and our approval. They reach a level of interpersonal identification and trust which they value.
 
Our problem is that most of the kids we work with have not experienced trustworthiness, consistency and reliability from the adults in their lives. So they are often not amenable at an interpersonal level and we find that we have to re-do some of the wheeling and dealing which parents do with "the terrible twos" or threes of fours. So for such kids we may well have to begin with: "If you want to go to the movies on Saturday you have to earn that by ... (make your own shopping list here)." What we are doing here (and this is crucial) is realising that we need to "lend some ego skills and strengths" to kids who don't have enough of their own, while we are busy working with them on the (re)building of their ego. This means reflecting and acknowledging and building their sense of worth as individual people ... to put this another way, building a relationship in which they feel significant ... so that they "buy into" our socialisation role because they value us and our approval. They reach a level of interpersonal identification and trust which they value. They get to Kohlberg level 2.
 
But then we have to stop the points and levels thing. Developmentally we have been busy moving their locus of control from the external towards the internal. By the end of adolescence they should be well into Kohlberg's Level 3 in which they operate within their own tried and tested set of values — this is the task of adolescence. This is the preparation they must do for young adulthood, the time of risk and commitment.
 
This is what I meant when I said that I missed some developmental aspects of this discussion on "points and levels". An essential task of child and youth care workers is to work out where the new kid is developmentally, what perceptions and strengths he or she has for autonomous function and responsible behaviour ... and to plan what we must do as the next sensible thing in building this. Often this may a temporary and "unusual" intervention. We need to be careful about trying to build the third storey of a building before we are confident about the first and second storeys. We may have to go back and re-build the first or second story. (This is what I meant when I said that I understood the use of "unusual" approaches to engage with a particularly unsocialised, barricaded or destructive kid.) The central act of child and youth care work, namely building the relationship, is precisely our attempt to help a youngster move from Kohlberg's level 1 to level 2: to reach a level of interpersonal awareness, trust and sensitivity, to negotiate the "latency age" work of working with trusted adults in building their own world view and personal set of values with which to enter their (delayed) adolescence and then adulthood.

BG
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Asked to clarify my previous point: What I meant was that when children have not had the opportunity to engage in the whole developmental journey through their involvement with satisfactory parent figures, we often have to "go back" and re-do some of that work with them when they are older. We are familiar, for example, with children who have had poor attachment experiences in infancy, and with whom we may have to build basic trust with "attachment repair work" when they are ten or sixteen! Such reassurance and bonding work will seem "unusual" between a care worker and an adolescent, but is no less essential for that. Paradoxically, we establish close bonds of trust so that the youngster can "leave us" more safely. It is often said that to achieve a good independence a kid needs first to have achieved a good dependence.
So with a youngster who, for similar reasons, has made no progress in socialisation, in experiencing the give-and-take of inter-personal relationships and responsibility, it may be necessary to establish this by "unusual" means. One such method might be a "points" system. Paradoxically, this aims at getting the kid to take internal responsibility for hisdecisions by imposing external demands and conditions. In fact, there is not much difference between points systems and logical consequences - so long as the process is intended to help with development and to teach internal control. You say that in your program no-one ever gets off the points system. I would say that such a system is not helping development but is simply maintaining external control. It's like forcing a child with a broken leg to use crutches for the rest of his life. The crutches are "unusual" but are only used to help the child to walk unassisted again. And the use of crutches is specific to one particular child and his treatment; to make all children walk with crutches all the time is ridiculous. So with a "points" system.
In teams I worked with we never used a "points" system which limited a child, which reduced his standing or prevented him from participating in anything. We occasionally used "points" (for dry nights) privately with enuretic kids with whom we had tried everything else - but these were celebratory, achievement-based points, not the same thing we are discussing here.

BG
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