Listen to thisIn this, the first of two articles about institutionalisation in residential child care, Jane, illustrating her argument with a poignant case vignette, introduces the paradox of the tendency for working procedures – which are generally considered as good practice – to lead towards institutionalising life in a children's home. You can read the second article HERE
Residential child care has – justifiably in some instances – come in for its fair share of criticism over the last twenty years or so. (Shaw, 2007) There has been a growing move to view substitute family care as a better option for children unable to live with their own families. The argument made is that residential child care leads to the de-personalisation of children and to their institutionalisation. Those with this point of view argue that residential child care does not place due value on the individuality and uniqueness of children and young people.
I am of the belief that residential child care for young people can be more beneficial for some young people than a substitute family setting. I am aware that there are children and young people for whom temporarily at least, substitute family life is too threatening. In this group I include those children who may not be able to live with their own families but who feel love and loyalty towards them. I also include those who may have had one or a number of unhappy experiences in foster care. For these children I believe sensitive and planned residential care can be of great help. It worries me therefore that there are aspects of residential child care which make it difficult for those of us who work in a residential child care setting to avoid making it an institutionalising experience for the young people.
I’ve worked in a children's home for four years and one of the biggest challenges for me still is trying to “normalise” the experiences of the young people in my care. It seems to me that the policies, working procedures, legislation and care standards which are in place to may give us professional guidance but can also work to make the process of “normalisation” all too difficult to achieve (Department of Health, 2002).
Our aim for the young people who come into the care of the children's home I work in is to provide a quality of care which replicates as much as it can “good enough parenting” and to build relationships between the young people and staff based on this premise (Winnicott,1953). We try to offer care and meet the needs of the young people holistically and therapeutically while cherishing each young person's individual identity.
It has long been accepted that institutionalisation tends to de-personalise the institution's residents (Goffman, 1961). My major argument in this article is that our working procedures make it hard for residential child care workers to pull away from the process of insitutionalisation. In this article I focus on the problems created firstly by the limitations of staff rota systems, secondly I consider how poor efforts staff recruitment and staff retention can influence the quality of care provided by creating feelings of loss and abandonment. Finally, using a case vignette, I argue how what is deemed to be good professional communication can be a factor in de-personalising and institutionalising life for a child in children's home.
What I mean by institutionalisation
At this stage I would like to make it clear that when I use the
word insititutionalisation I am thinking of a wide range of phenomena
but in general I would like the reader to understand that I mean the
process in which a person living in an institution (in this case a
children's home) directly or indirectly accepts and conforms to aspects
of the institution's control to the extent that the needs of the
institution are seen as more significant than the needs of the
individual resident. For instance in this might be included the need to
look after a number of people with the least amount of staff. The
process of institutionalisation tends towards a loss of individual
identity and towards the individual’s de-personalisation and towards
alienation from peers in the wider society (Goffman, 1961).
The impossible task: creating an effective
staff rota system
The aspect of residential child care which in my view is most
influential in making children's homes institutionalised is the
necessity for the care provided to be governed by a staff rota system.
It would be easy for the casual observer to conclude that the kind of communal care provided by residential child care workers is not consistent with the idea of “good enough” parenting (Winnicott, 1953) because it can seem to be at the mercy of staff routine and staff needs.
On the face of it these doubts may be evidenced at the children's home I work in. Having up to 10 residential child care staff means that the young people have 10 different people working at different times to meet their needs. A young person in their family home would usually have two main caregivers as the parenting figures. Having ten different people giving parental care obviously increases the chances of inconsistency in the care the young people receive. Having to meet and become accustomed to so many adult figures can be confusing and disorienting for young people. In the children's home I work in we try to reduce the negative aspects of this by giving each child a special worker, a “keyworker”, whose responsibility is to focus on building up a relationship with the young person and to be an adult the young person can refer to at all times and who has specific responsibility for ensuring the needs of the young person are met. Unlike natural parents, keyworkers, do not have an opportunity to care continuously for a young person. This can mean that the young people can experience the absences of a member of staff they feel attachment towards as re-enactments of the loss, rejection and abandonment they experienced earlier in their lives and which are the principal causes of the anxieties, fear and anger they often display to staff when they are first placed in a children's home. So, at our children's home we feel it is important to ensure that a staff rota is devised in a way which tries to ensure that keyworkers are there for children on a regular basis and especially for significant events such as birthdays, parents' evenings at school and care plan review meetings. We also try to create a rota which ensures that staff are not absent for long periods of time, except of course when they are on annual holiday. During a keyworker’s annual holiday the young person is given another member of staff who has the responsibility to take on the key working responsibilities while the actual keyworker is away. With the possible and in reality probable event of staff shortages and staff illness these compensatory strategies can be stretched. This is why in my view staff recruitment is crucial to achieving a consistent and sensitive caring environment in a children's home.
Retaining staff
The anxieties created by these re-enactments of earlier loss,
abandonment and rejection which I discussed in the previous paragraph
can be made worse for young people placed in children's homes by staff
leaving the home. Retaining staff in what can often be the highly
emotionally charged working atmosphere is a challenge to those who
manage children's homes. In our children's home we have made efforts to
avoid a high rate of staff turnover and so limit the possibilities for
inconsistencies in care. We work very hard to recruit the right staff
and we are intent on keeping them. During the interview process we
endeavour to ensure that applicants have resolved or are effectively
coping with any emotional issues from their own past. We have found that
if we appoint staff who have not done this, they struggle because they
over-identify with the young people’s difficulties and so they can’t cope with the young people’s anxieties. We also attempt to recruit staff
who understand and accept young people’s needs for consistent, committed
care. Having done this, we place a great deal of emphasis on
implementing a staff development strategy which provides each member of
staff with regular supervision and continuous training in child
development and child care. We do this to show staff that they are
valued and to give them a sense of professional esteem. Appointing and
retaining staff of this calibre can be difficult. The status of
residential child care in the ranks of different professional roles is
unjustly low.
The difficulty of achieving sensitive and
effective information sharing
In a family the information about a young person is usually only shared
by two parenting figures, while the institutional necessity of having a
relatively high number of caregivers in the group living setting of the
children's home means that information about the young people is shared
by however many residential child care workers there are employed in the
home. This number is added to by social workers, teachers, health
workers, counsellors and so on. With this size of social network it is
easy for information that is emotionally significant for the young
person to be lost in the professional drive to ensure that everyone is
communicated with. Here I am not arguing against the need to communicate
but arguing that the content and quality of communication is paramount.
More importantly for the young people, particularly when they are new to
the children's home, we need to be aware at all times how disorienting
and threatening it can feel to a young person that so much of their
personal information is held by adults who are strangers to them. In my
experience young people also find it irritating and stigmatising that
(unlike their peers who live with their families) they have to repeat
personal and often painful information about their lives to more and
more adults from different professional disciplines.
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Mary |
Mary’s story is an example of how in tripping over each other to communicate information we can forget that one of our primary professional functions is still to provide “good enough caring”. In order to defend ourselves professionally “to make sure that she did not do more serious harm to herself “we were inadvertently institutionalising her by seeing her only as a physical being but not seeing her as an emotional being too.
In this article I have focussed on how residential child care work, governed as it is by staff rota systems, low staff retention and the professional need to communicate, needs to give these issues more consideration than they currently are if the care system is to provide children in residential child care with the sensitive and individual care that we promise to give them and that they need.
In a later article I will consider how official
documentation and nationally laid down procedures and standards can act
as obstacles in the way of providing “good enough” care to children who
are placed in residential care.
References
Department of Health. (2002) Children's Homes : national minimum standards, children's homes regulations. London. Department of Health.
Goffman, E. (1961) Asylums : Essays on the Social Situation of Mental Patients and Other Inmates Harmondsworth. Penguin, 1968 National minimal standards.
Shaw,T. (2007) Historical Abuse Systemic Review: Residential Schools and Children's Homes in Scotland 1950 to 1995. Edinburgh. Scottish Government.
Winnicott, D. (1953). Transitional objects and transitional phenomena. International Journal of Psychoanalysis, 34. pp. 89-97.
This feature: Kenny, J. (2007). Caring Times. Republished here with permission from goodenoughcaring.com
