Family-centred service delivery has become the "new paradigm" in both residential and non-residential agencies. The authors present a comprehensive model for assisting both agencies and practitioners in the implementation of this approach.
Those who are closest to children and spend the most time with them — parents and child care workers — have the least power in the human service system. This statement, too often true, provides the rationale for providing special attention to the role of the Child and Youth Care worker in the new paradigm of family-centred residential care: If we are to empower families, we must also empower the Child and Youth Care workers, those who indeed spend the most time in direct client contact, to deliver to families, as they do to children, the unique components of the Child and Youth Care profession.
For this to occur, it is necessary for family-centred agencies to systematically support the refraining of the Child and Youth Care worker role from child-centred to family-centred practice. The Child and Youth Care workers must be specifically prepared to utilize the core functions of their field in a family-centred approach.
This paper will present a comprehensive model for preparing both the agency and the Child and Youth Care workers themselves to implement family-centred delivery approaches. Central features will include:
Training alone is insufficient if the Child and Youth Care professional
is to become a major and effective player in the provision of family-centred
services. The following premises need to be addressed to provide a context
that will support the appropriate inclusion of Child and Youth Care workers
in family-centred work.
Recognition of the complexities of implementing a family-centred model
The institution of a family-centred model in a group or residential care program automatically increases complexity by introducing more elements in the delivery system. Rather than direct interaction between staff and children only, safely within the walls of the program, the introduction of other individuals and family members makes more complex the network of relationships. The staff must relate not only to the child, but to the parent, to the relationship between the parent and child, and to the other staff members who also are relating to both child and family. In addition, since the real life of the family extends far beyond the confines of the group setting, staff must become more knowledgeable of and skillful within a wide range of community and family environments.
Recognition of the fundamental and unique role of the Child and Youth Care worker in implementing a family-centred model
Traditionally, the family, where it has received attention at all in residential settings, has fallen within the domain of other professions, most notably social work. The Child and Youth Care field in recent years has made substantial strides in articulating its knowledge and skill base. In each area, the Child and Youth Care worker can provide not only an applicable, but a fundamental, full range of supports required by families. Child and youth care workers, adapting their knowledge and skills to families, can provide unique services that are not often addressed by other human service professions.
Recognition that attitudinal and structural changes will need to be made throughout the agency in order for a comprehensive family-centred model to succeed
A family-centred model by its very definition must surround the family with the complete range of supports and services needed to help the whole family, not only the individual child, as the client. Segmented and provincial service classifications impede this holistic view of family needs. Each staff member potentially has something to offer in this mix, and it is the nature of the family’s needs, not traditional hierarchy, that dictates whose role is most important in this context. Family therapy alone cannot meet these needs any more than therapy can meet the variety of social, recreational, developmental, and other needs of the child in care.
For this role and attitude shift to occur, the following aspects of the agency need to be examined:
Family preservation and support
Family preservation — maintaining valuable connections, functioning effectively as a family and child-rearing unit — is the driving value of the current notion of family-centred practice in any setting. While embracing this perspective, it is important to recognize that there are some families for whom full preservation is not possible, and which may not be able to fully reunify. Nonetheless, even in these cases, the maintenance of the "optimal level of connection" (Warsh, Malluccio, & Pine, 1994) for the child or youth in care remains a goal.
Varied family patterns
Although it may seem like stating the obvious, it is important to reiterate that in the last decades, family configurations have become so varied that the traditional nuclear family — father, mother, children — is often the exception, rather than the rule. It is important that practitioners in all roles recognize that there can be many strengths in these families (Elkind, 1994) and be circumspect about viewing a "different" family configuration as "unhealthy." Stepfamilies and extended families can be valuable resources, even when they do not represent a full-time family alternative.
Multicultural and generic perspectives
A significant component of training for all professions in family-centred practice is both the generic and multicultural aspects of values, communication, expectations, activities of daily living, and the like. The challenge is to recognize the commonalities that unite all human beings in organizing their lives along with the variations characteristic of various cultural and ethnic groups. A particular challenge is respecting variations in child-rearing practices that are culture-specific, yet challenging those that are damaging to human beings, no matter what cultural group they belong to. A high degree of skill and respect for differences is crucial.
The role of the Child and Youth Care worker
Are they viewed as simply there to take care of the children and youth when none of the other "real" professions "want" them? Or are they seen as playing a central role in the entire treatment process? Or, as is most often the case, is their role somewhere in between, in which they participate as team members but are restricted from certain functions — often any but the most incidental contact with families?
We contend that for any family-centred model to be effective, Child and Youth Care workers must be prepared for and be expected to fully participate m family-centred work for the following reasons:
Hiring criteria and job descriptions
Criteria for hiring Child and Youth Care workers must include appropriate activity with families; similarly, job descriptions must be developed that reflect the agency family-centred model and the functions within it. Clear definition of the areas in which Child and Youth Care assumes and shares responsibility for families with other professions is critical to avoid harmful boundary and "turf" disputes. Similarly, job duties and functions that stress social control instead of behavioural teaching, custodial care instead of active life-skills education, and corrective instead of appropriate developmental focus weaken the ability of the Child and Youth Care worker to effectively relate to families.
Given the various capacities, levels of maturity, stage of professional development to amenability to working in a family-centred model (VanderVen, 1988), it could be suitable to have differentiated roles of Child and Youth Care workers, with some expected to assume more family-centred activities than others, who would be primarily child-focused.
What is the role of Child and Youth Care workers in the team process: Are they full, contributing members, offering information, observation, ideas and contributions to decisions? Are they present but essentially ignored in developing treatment plans and making major decisions? For a comprehensive family-centred model to work, obviously a full partnership must be achieved. The capacity of the group care setting to model true teamwork is imperative if family members are to feel connected and empowered.
Educational level of Child and Youth Care workers.
Child and youth care workers with college educations, or, as is increasingly the case, specialized preparation in Child and Youth Care work, are often versed in and open to the concepts of family-centred practice, and thus it is appropriate to offer them this specialized training.
The organizational design, or hierarchy in an agency, both manifest and latent, showing who is responsible to whom and lines of communication, is centrally related to the success of a family-centred model involving Child and Youth Care workers. If they are at the bottom of a traditional multi-tiered organizational hierarchy giving line authority to traditional clinical professions, it will be all the more difficult to implement a true family-centred model, for it will perpetuate the dynamic mentioned above that "those who spend the most time with the children and youth are the least empowered."
Thus a training model oriented towards Child and Youth Care workers in a family-centred model must address both contextual (agency-wide) factors as well as specific needs for knowledge and skills of the child care workers.
THE TRAINING MODEL
Implementing a true family-centred model of treatment in a residential or group care program requires not only training the line Child and Youth Care staff for full involvement in the model utilizing the particular functions associated with their role, but also both training the other disciplines and providing a structure for integrating them into the total team approach. Derived from the preceding premises, the following areas should be addressed in agency-wide orientation and training:
Child and Youth Care Workers’ Issues
These issues are posed to encourage awareness of factors that are germane to the success of Child and Youth Care family-centred work. They are attitudes and points of view that must underpin the service, rather than specific competencies of practice, and should be infused throughout any specific curricular content. (Some of these are derived from VanderVen, 1991.)
Identifying with families
Child and youth care workers cannot be effective unless they first learn to separate their feelings about inappropriate behaviour from their capacity to unconditionally care about the child. Yet this is often much more difficult to do when one considers the behaviour of parents and other adults. Nonetheless, Child and Youth Care workers must learn to do this, and to identify with and value families in the same way that they do children. The degree to which they are able to do this may depend on their general maturity level and stage of personal development. Those workers who are themselves parents, or who are old enough to have resolved their own issues with parental authority, are most likely to value families positively and consider them their clientele.
Meeting parents’ needs simultaneously
The parents of troubled children are themselves more likely to have been inadequately parented. Thus, even though they are adults, they have many unresolved needs and issues reflecting their own childhoods. Expecting them to be solely invested in their children, to place the children’s needs primary, is usually unrealistic and an exercise in futility unless they are nurtured simultaneously with their child. For example, a parent who had few play materials and opportunity to play as a child will have difficulty actively enabling play in his or her child, and may even unconsciously envy the opportunities for such activity provided the child. In this case, the parent would be provided playthings and activities first. When she or he felt gratified, then the focus could shift to the child. When the Child and Youth Care worker thus uses his skills to enhance the development of both parent and child, parent resentment and resistance is often bypassed.
Relating to the parent-child bond
As the Child and Youth Care worker shifts identity from the child to the parents and the child’s family, the worker needs to take care that he or she does not fall prey to the pitfall of triangular relationships: that is, relate primarily to one party, be it child or parent, while excluding the other and the relationship between them (Anglin, undated). The creation of an "us against them" scenario mitigates against attainment of the ultimate goal of the family-centred approach: a positive relationship and bond between both parent and child.
Similarities and dissimilarities in the parental and Child and Youth Care worker role
This relates to the "substitute parent" issue frequently discussed in literature on Child and Youth Care. Child and youth care workers do most closely approximate parents in their function, in such roles as "house" and "cottage" parents and providing primary care to children. Despite this, they are, of course, not the child’s real parents for a lifetime. Helpful approaches to exploring the dimensions of this issue are recognizing the differences between parents and professionals (Katz, 1984), and viewing the Child and Youth Care worker as an "impact player," who, as in a football game (Noble & Gibson, 1994), comes in for a short time to contribute additional support and energy to make a difference. The shift to a role of supplemental and supportive ally from that of substitute parent is often a difficult, yet critically important one.
Competition between Child and Youth Care workers and parents
Placement of a child or youth in care lowers parental self-esteem, almost by definition. Parents may hold a strong sense of "having failed" or being "the cause" of their child’s problems. When they then observe Child and Youth Care workers having greater "success" with their child, they can often feel even more inadequate. Likewise, the worker who takes pride in a strong relationship with a child can feel threatened by the child’s feelings for a parent. A model of this process is well articulated by Garland (1987), who points out that having the worker directly engaged with the parent as well as the child cuts through this negative cycle. Parent and worker are partners, not adversaries.
The meaning of the family to the child
Although many children and youth may come from families that agency staff feel are woefully inadequate, rejecting and punitive, all staff need to be extremely cautious about demeaning a child’s family to him or her. Similarly, even in those families for which preservation or re-unification is not an option, staff can do whatever possible to support "family connectedness" (Noble & Gibson, 1994) to enable children to maintain optimal contact and involvement with their family, including siblings. The meaning of the family to the child must always be recognized and the strengths of that relationship nurtured.
Utilizing Child and Youth Care Worker Core and Family-centred
Family-centred work for Child and Youth Care workers can be described in two domains: adaptation of generic, core, Child and Youth Care work competencies; and specialized training in targeted knowledge skills and attributes.
Core curriculum areas have been well defined: for example, for the emergent profession of Child and Youth Care work, Principles and Guidelines for Child Care Personnel Programs (VanderVen, Mattingly, Morris, Kelly, & Peters, 1982), and for family-centred Child and Youth Care work, in VanderVen (1987, 1991). These areas comprise and support all developmental and therapeutic goals and are translatable directly into a family-centred model.
Core Child and Youth Care Competencies with Adaptations to a Family-centred Model
Caring and nurturing
These are skills in responding in an accepting empathic, supportive, encouraging way in all of the domains of practice; for example, in verbal and non-verbal communication, activities of daily living, or environmental design. While the impulse to "care" may arguably be seen as innate, the skills necessary to show caring and to nurture effectively are clearly learned. The Child and Youth Care worker’s model of these skills is critical.
Sharing information in ways that allow messages to be accurately heard and interpreted, both verbally and non-verbally, is a core skill of the Child and Youth Care worker. For a family, for example, knowing "what and how to say it" with reference to such situations as conveying bad news, talking over the telephone, or clarifying procedures is an important part of imparting consistent messages to the child.
This is the dynamics of establishing and maintaining relationships and the process of separation: the therapeutic function of relationships; for example, asking parents about their individual interests and responding energetically or engaging parents in discussions and conversations that are not exclusively focused on problems or issues with the children. The perception by parents that they might share a relationship with another adult, irrespective of the professional relationship with their child, can represent a major breakthrough in establishing trust and motivation to change.
This encompasses the use of activities reflecting "the culture of childhood," such as hobbies and play, other age-appropriate domains of activity like sports, art, crafts, games, food preparation, music, drama, and writing to achieve developmental and therapeutic goals. Activity programming is particularly pertinent to family-centred practice. Many families under stress forget how to have fun together, to relate in any other way than in a crisis. Activities provide ways for families to rebuild balanced and rewarding relationships.
Activities of daily living
This includes structure and scheduling of the general day; and handling of such areas as bedtime, toileting, dressing, eating, and transportation. Here again, these skills have a strong family application. Families of children in care often are driven from moment to moment, with little coherence in the day. Child and youth care workers can play a key role in working with these families to devise a workable structure and schedule and handle daily routines in a positive manner, and in identifying the life-skills needed by the child.
Environmental design embraces the establishment of a physical setting that conveys positive messages and supports developmental and therapeutic goals; furniture selection, decoration, equipment accessibility and maintenance are all aspects of this function. Valuable lessons for families are available in the design of the residential life-space, but these need to be identified and acknowledged before they can be taught.
Group process (including stages of group development, group dynamics such as the integration of new members and the like) is a core domain of Child and Youth Care work. As Child and Youth Care workers interact with groups of children and youth, so will they interact with family groups both individually and collectively. Parents can greatly gain from experience, not only with their child, but with his or her peer group as well.
Child and youth care workers in some settings are responsible for connecting their youthful clients to appropriate community activities; for example, recreational and club facilities, and supporting them in their activities there. With families, this function can be extended, to the engagement of both child and family in productive community networks and activities. Especially in the transitional phase of the child returning to the community, it is important that parents be given as clear an understanding as possible of the local services and supports that are available to them.
While not always recognized, every community has organizations that employ direct-care professionals who share much in the way of experience and expertise with the residential Child and Youth Care worker. Forging relationships and a better understanding of community resources can benefit workers and family members alike.
The development of the human being throughout the life span
To work in a family-centred model, a practitioner must of course be familiar with development of persons of all ages, in a life-span perspective. This includes intergenerational issues: the nature and texture of relationships between people of different age groups.
The concept of family preservation and support
Family preservation — its rationale, characteristics, and applications, including identifying strengths that can be used to mobilize and reunify families — is perhaps the fundamental current concept and value underlying the transition to family-centred work. Understanding that not all families can be fully reunified, and the factors necessary to assess and maintain the optimal level of connection in each case, is also critical.
Ecological and systems theory is a crucial concept for Child and Youth Care workers’ knowledge base (VanderVen, 1991); patterns of relationships and interactions are understood in this context.
Varied family patterns
Single-parent families, kinship families, extended families, gay and lesbian parents, teen age parents, and many other family patterns exist; both strengths and areas to support must be recognized.
This is a compendium based on earlier work by VanderVen (1988, 1991), identifying functions and related skills for family-centred Child and Youth Care work. Although not formally cast into a stage model of professional development, these skills are arranged from lowest to highest in terms of requirement of specialized knowledge.
Observation means being alert to opportunities for gathering information on the child and family at significant times that the Child and Youth Care worker is privy to. For example, noticing that a father is particularly nurturant when coming to pick up a child, or the upset mood of siblings constitute important pieces of information that often go unnoticed.
It is important to be able to describe, in way appropriate to child and family treatment plan, information on the child or youth; for example, interests, activity, or current status.
Monitoring family contacts
A practitioner must be able to provide an appropriate context for a child’s private visit with his or her family; for example, physical setting, greeting and saying goodbye to family, or helping child rejoin the group. Handling the transition time when children and families meet or the child is returned from a home visit, is particularly significant and a function most likely to be performed by child and youth workers (Noble & Gibson, 1994).
Mediating family contacts and conflicts
Mediating family contacts assumes a more participative role, in which the Child and Youth Care worker actually would interact with the child and family members around a particular issue.
Modeling positive ways of interacting with children is an important skill. It should be pointed out that the modeling will much more likely have an impact if the Child and Youth Care worker has a relationship with the parent, and if the worker is self-aware of the skills he or she has learned and the process through which these skills were gained.
Formal parent education and support
Providing individual and group parent education and support (Anglin, 1987) is an emergent and highly pertinent role for Child and Youth Care workers. To implement this requires not only content knowledge, but also appropriate delivery methods, such as designing, training, and handling group discussions and effective adult teaching strategies.
Parent involvement facilitator
This category encompasses implementing and facilitating, as well as designing and developing, family involvement programs "on site" — for example, family activity nights, special ceremonies, family child "clean-up day," sibling groups, and the like — as well as other events such as field trips and family outings.
Off-site family functions
Among the functions here might be arranging, and accompanying families as a unit to, community activity functions, just as they would arrange and accompany children, and making home visits. In fact, home visiting — to assess, aid in transitions, provide modeling and other interventions such as helping a family set up a meaningful schedule, and follow-up — is increasingly emerging as a primary function of the family-centred Child and Youth Care worker.
This is a category of family-centred work that is appropriate for the most highly prepared Child and Youth Care worker. These are comprehensive, multifaceted services that embrace a family-centred philosophy, as performed by a clinical practitioner, that is, family therapist (VanderVen, 1991). Interestingly, domains of Child and Youth Care work such as play and activity are particularly appropriate for adaptation to the highest level of family intervention; for example, the conjoint play therapy model developed by Griff (1983).
To prepare effective Child and Youth Care workers in a family-centred context requires an appropriate pedagogy that encourages transfer; that is, that the knowledge and skills "taught" within a more formal program of either training or education is actually applied effectively in direct practice. As stated earlier, training, no matter how full and diversified cannot accomplish this alone. Program rules and structure need to also be adapted to assure that skills can be utilized consistently.
The following approaches are recognized as contributing positively to transfer:
The availability of information describing the knowledge or situation is given, through lectures, tapes, readings, and the like.
The skill to be developed is demonstrated by the instructor, perhaps utilizing participants in role plays, as well as by utilizing videotapes and other graphic teaching tools.
Examples of applications are provided in order to show participants the many ways a particular knowledge or skill applies in an array of contexts and situations.
Relating to own situation
For training to transfer, trainees must be able to connect what they are receiving to their real life work and to be able to see parallels and applications.
This is the crux of ensuring application in a "theory to practice" situation; that is, a classroom-type training that prepares practitioners for in situ work. Trainees must be given the opportunity to formally practice and apply their new knowledge and practice under the guiding eye of more experienced and knowledgeable practitioners.
Two important concepts to facilitate this are mentoring and coaching. Mentoring is the pairing of a less experienced worker to a more senior practitioner so that the senior person may provide a model, guide, and support the newer worker in an overall process of professional development around a particular domain. Mentoring has much relevance to promoting a model of family-centred Child and Youth Care. The fact that mentoring encompasses a personal relationship between mentor and mentee is particularly empowering to the mentee who can experience professional growth without the perceived threats of formal supervision and evaluation.
Coaching is a less individualized form of guidance as practitioners apply new knowledge and skills in the direct setting. In coaching, appropriate colleagues actively teach and provide feedback to practitioners before, during, and subsequent to practice applications.
It is important to encourage Child and Youth Care workers in the new paradigm to be "reflective practitioners" (Schon, 1983); that is, to be able to review their work and interactions with families, to relate this to what they already know, to generate out of it revised practice principles, to apply them in new situations, and to continue the process.
The time span for the training must be adequate to fully inform, nurture, and develop a competent level of skill in family-centred work. Similarly, the agency "culture" regarding the role of Child and Youth Care workers must, if necessary, be given time to change; an agency should not abandon its attempt to develop a family-centred program with the crucial involvement of Child and Youth Care workers.
Legitimacy refers to the degree to which the content of the program is comprehensive: covers all the knowledge, skills, attributes needed to provide the service. In this case, family-centred Child and Youth Care are congruent. It actually allows Child and Youth Care workers to meet the needs of children, youth, and families served by a particular agency.
This refers to the degree to which a training program is not only necessarily individualized — to meet the particular needs and timing of an agency — and standardized, but is derived from, and relates to, other training and educational programs and formal guidelines for their development and implementation.
Transferability. Transferability refers to the degree to which the training can be adapted not only to other client groups in other settings and contexts, but also the extent to which it is "portable" — that is, it can be recognized as a legitimate qualification by other programs the practitioner may work in.
Family-centred approaches offer new opportunities to strengthen and support, not merely to substitute for, families. In doing so, they move the therapeutic and developmental interventions of our residential care system into the very new and exciting domains of the child’s "real world" of family and community. They allow the strength of the residential setting, its ability to surround clients with care, to be applied in the same way to support family connectedness. They allow the Child and Youth Care worker, the resident expert in teaching through the events of daily life, to develop new and valuable specialized skills. Finally, they create new opportunities for the development of the direct care professions, and for families to benefit from their unique skills.
This paper has presented a complete model for the utilization of Child and Youth Care workers in family-centred models of residential care. It posits that without their full inclusion, the agency will actually replicate the dynamics of a dysfunctional family. The information contained here should support any agency in getting started, and prepare Child and Youth Care workers, as well as other staff, for this crucial work.
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This article is reprinted from The Journal of Child Care , Vol.10 No.3, 1995, pages 13-26