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66 JULY 2004
ListenListen to this

moments with youth

Triage

Mark Krueger

Two new workers face me across the table, one Chelsea is about 22, and just graduated from the school of social work, the other, Nicolas, is about 27 with five years working for the county under his belt. I am the consultant. We are meeting for the first time. I have been here before with two other workers to discuss cases for the Inroads, transitional living program for youth 18-22.

Like most programs of a similar nature, Inroads has to make tough decisions about which kids it can help and those it can’t. The funds are limited and the challenges with most of the youth overwhelming. Despite the odds, however, some do make it. They overcome their abuse and lack of education, job skills, and stable family environment. Most of them have had several foster care placements. Chelsea and Nicolas try to help them get connected to resources and people. Right now they have ten cases, each one with a number of major challenges.

“So, how do you like it?” I ask as we wait for the supervisor, Juan, who will be a few minutes late, to arrive.

"It’s fine, but hard. These kids have so many needs.” Chelsea says.

"I like it much better than the program I worked for at the county,” Nicolas says, referring to his previous job.

“Why?” I ask.

"Much smaller. We have more autonomy, and can make decisions about how to work with the kids rather than having everything dictated and scripted. At the county they call the program, Wrap Around, but I really felt it was more like suffocating families with red tape, goals, outcomes, and a revolving door of case managers. No one really listened to the kids and families. Here, at least we can do that.”

“There is something to be said for smaller organizations,” I respond. “Large ones in many ways often begin to mirror the same problems they are trying to solve.”

"I think I can relate to these kids because I am so close to their age,” Chelsea says.

"Yes, I suppose that is helpful if you are in touch with who you are.”

“What do you mean?”

“Our experience is helpful, but only if we understand that it is not the same as the youth’s experiences.”

Chelsea looks puzzled. I look at my watch. “We can talk about this some time but we better get started... Juan can jump in when he gets here. I like to work this as a discussion. You choose a case you would like to talk about and I'll raise some questions and try to provide some insights that we can discuss together, okay?”

"Great,” Nicolas says and looks at Chelsea. “We decided to talk about Maria, a new case that has been referred to us. We are not sure if we can help her or not.”

"Let’s hear it."

"She’s 19, no kids, but living with a woman 25, sleeping on the couch and drinking. Every Thursday they get a couple bottles of vodka and drink it over the weekend. As best as we can tell, she’s gets drunk Friday and stays that way through Saturday.” Chelsea starts.

"Family?” I ask.

"Mother and stepfather, but he raped her when she was younger, and she ran away and gang banged,” Nicolas responds.

“Still involved with the gang?”

“She says no, but they live right in the hood, and it’s pretty hard to avoid without getting hurt,” Nicolas responds.

"Drugs?”

"Again, she says no, just the alcohol, but we doubt it. Besides the alcohol is bad enough.”

“Working?”

"Part time,” Chelsea says.

“School.”

"No, but if we let her in the program, she’ll have to be working and in school.”

“What about this older woman she lives with?”

“We’re suspicious.”

“Why?”

“She might be in the gang, doing drugs, and sexually abusing her.” Chelsea sighs. We are all “bummed” now. These cases are not easy to hear.

"If you decided to accept her for the program, where would you start?” I ask.

“The drinking and drugs,” Chelsea says.

“Before that?”

“What do you mean?” Nicolas asks.

“Be there and listen, hear what she has to say.”

“Oh, yeah, we've been trying to do that.”

"Good.”

“But she can’t be in the program unless she is working and going to school and I don’t think she can do either while she is drinking?” Chelsea says.

"How bad is it?”

“What?”

“The drinking?”

“Bad.”

"Does she think so?”

"No, she says it’s not a problem, she’s just bored on weekends.”

“That’s a problem."

"I know.”

Juan enters. “Who are you talking about?”

"Maria.”

"Yeah, I’m not sure we can take her. We got twenty other kids on the waiting list."

Later, I drive back to the office thinking again about how our children are growing up in war zones without the resources needed to fight the war. How we are triaging our most precious wounded. How in my role as a consultant I can offer insight and speak with the workers about the importance of listening and being there for youth like Maria. I can agree with them about the need to get her off the drugs, empathize with them about Maria’s plight, feel bad about the decision they had to make not to accept Maria in the program, but along with my colleagues I have not “earned my pay” when it comes to convincing politicians and others in our society who ignore these and the children in the countries where we go to war.

A few weeks later I attend a lecture by Amy Goodman from Democracy Now, an independent news organization I watch on public access television. It is one of the few places I can find the truth about what is going on around the world. During her speech, Goodman speaks about how the images we are shown shape our opinions and how the real images of the war in Iraq are not being shown. We do not see blown up children, or even the coffins of bodies coming home.

I think about how images of children like Maria are rarely seen in our community, and wonder if they, we, anyone would look? Would they turn off American Idol, and shift their attention to these kids who just would settle for just being cared for instead of famous.

They say we take better care of our wounded now in Iraq. We are keeping alive soldiers who died from similar injuries in other wars. Why then is triage acceptable at home with children? We have the knowledge, skill, and technology to help these children. And not just here, of course: a former student returned last summer from Kenya where he worked in a residential program and the stories he shared about too many kids and too few resources were all too familiar. All over the world we are triaging services for kids because we don’t have the will to spend on them what we spend on killing each other.

To get out of my “funk,” I tell myself that a moment of presence and listening can make a big difference. Youth often fondly remember these moments later when it is time to make a decision about the course of their lives. Maybe Chelsea and Nicolas gave Maria a few of these moments when they interviewed her for Inroads, and that even though she wasn’t accepted for the program she was heard.

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