Listen to this(Part 2 can be found here and Part 3 can be found here)
Here is the scene: You are in a case conference meeting with five other professionals. The reports have all been delivered around the table and each person has listened and formed opinions about the professional competence and technical skill of each of the others.
The Child and Youth Care practitioner is viewed as a hard-working and well intentioned person, who often bears the brunt of the unpleasant behavior that has been under discussion, and yet every other professional believes that they could do that job if they had to. The treatment strategies and life space interventions described by the Child and Youth Care practitioner seem to be based on common sense and parental attitudes, which are challenging to implement in the complex realities of group management or in-home family support, but are not too sophisticated or unique for anyone versed in human services work to implement.
Meanwhile, the Child and Youth Care practitioner, who also has opinions about professional competence, thinks smugly that there is not a person in the room who would last a day in his/her job.
What is going on here? Very few other professionals have this disconnect between how they are viewed and how they view themselves. I believe there are at least three problems with the way Child and Youth Care practitioners present themselves at case conference meetings:
How we describe Child and Youth Care treatment approaches (or even if we describe what we are doing as treatment).
The reporting formats used in our work.
The willingness to let others define our professional scope of practice.
This month I will look at number 1 and discuss the other two in November and December.
An example will hopefully illustrate my point. You are working with a youth who is struggling with basic safety issues, who is aggressive and unwilling to accept help from adults. This youth has low attachment ability, for quite legitimate reasons, and views the world as an unfriendly, dog eat dog place. There is no reason for anyone to be nice to another unless there is something to be gained. Additionally, he/she has poor boundaries, creating both victim and victimizer interactions. The constant anxiety of not feeling very safe creates inner tension, often expressed as aggression.
The usual case conference discussion will focus on the youth’s behavior, describing the problematic results and self-defeating beliefs, with a recommendation for more useful behavior, generally produced by some form of external motivation and control. This focus on responsible behavior ignores the complexity presented by attachment dynamics, boundary weaknesses and asocial logic.
The resulting treatment plan could have been written by anyone with a basic understanding of behavior modification – reward compliant, pro-social interactions and control aggressive, intrusive interactions.
In fact, many Child and Youth Care treatment plans could have been written by the youth’s mother. Every professional in the room sees the courage or perseverance required to implement the plan, but could have created it too.
Instead, picture a Child and Youth Care practitioner describing how they will join with the youth by stating, “You shouldn’t trust me, you hardly know me”, rather than ”I’m here to help you”. The complexity of letting someone be unsafe, hoard food, question any kindness and be verbally aggressive as part of the treatment journey, becomes a necessary dynamic that has to comfortably and safely fit into the life space of a group or family, with theoretical rationales and time frames for gradual change. Think about how you would describe your use of simple, everyday interactions to gradually promote cognitive confusion and the need to question an asocial world view, as you are creating small, seemingly insignificant caring interactions, designed to penetrate a hard external shell which functions as a safe barrier to keep the adult world at arm’s length. Continue to imagine the Child and Youth Care practitioner listing the “common sense” responses that will deliberately be avoided, as they won’t help, such as punishing aggressive attempts to stay safe, and needing to control the food and clothing supply available for them.
My belief is that the response from the other professionals at the conference will be, “That’s very clever, I would not have thought of that, it must take a lot of skill and training to do your job”. This is the impression that we can be creating in case conference presentations, yet we often fall short. The three issues listed above all combine to block our professional public image, and I will be continuing to address this next month.
