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classic texts

Primary care in secondary settings — Inherent strains

Henry W. Maier

To call a piece of writing a ‘classic’ suggests that there is something about it which endures through time and a changing world. In this sense, this chapter, written some 30 years ago has become a classic in the field of group care of young people. It has influenced the evolution of the field since its first writing.

The ever present struggle of reconciling primary care requirements of children and young people living in group care facilities with the program’s secondary organizational demands, finds its expression and potential balance in the daily work of the child and youth care staff. Actually, workers seem to be serving two masters. The following account of a staff meeting at a prestigious child care agency serving forty severely disturbed elementary and high-school age youngsters has all the symptoms of the aforementioned strain. I submit that the underlying themes are inherent in staff deliberations almost anywhere.

Let us look in on a typical one-and-a-half-hour staff meeting. Forty minutes have been taken up with general announcements, enquiries, administrative admonitions, and 'success proclamations'. Finally, the main topic of the particular staff session was raised in which way can we strengthen the group care components of the residential program? This topic was introduced and interpreted by the group life supervisor expressing the need for more precisely tailored individual approaches to the residents’ therapeutic requirements. One worker immediately elaborated on her idea that she could do more for the children if she were to work solely on weekdays. It seemed that the children with whom she was the most involved tended to be away on weekends. Additionally, she pointed out, on Mondays and Tuesdays these children were apt to have their difficult days, coinciding with the time she was off-duty. Numerous other valid suggestions were brought up, each one involving potential alterations in each worker's investment in time or personal energy. Workers also volunteered specific program suggestions for selected children and recommended different care practices for a particular sub-unit. These latter suggestions created both excitement and frustrations. A member of the administrative staff, in the midst of this lively discussion, wondered with serious concern whether or not these valid suggestions may not lead to a kaleidoscope of practices and potentially a separate group care program for each resident! Another worker quickly added that the administrator was right; the suggestions would result in a unit with extremely poor organization. Someone else added ironically: ‘These kids could then get up at any hour of the day. Maybe then the evening shift can see how it is to get the youngsters to straighten out their rooms rather than always creating a mess’. At this point, other workers voiced in turn their readiness for more personal involvement with the children. Several questioned with sincerity whether they could muster the energy for added personal care engagement – particularly with the difficult children under discussion. Somehow the perennial request surfaced about keeping the children's play areas free of office staff cars so that the children and care workers could play unhampered. This concern was pushed aside with embarrassed laughter and the meeting continued as before, by more or less acknowledging all input but dealing with none.

Towards the end of the allotted meeting time, a residential worker recommended a trade-off in more time with the kids in exchange for less paperwork. This suggestion, which received an affirmative sigh from many workers, reminded the agency director (who chaired the session) that he was about to take up the issue of recording with the care staff. He wanted their assistance in finding ways the agency could more effectively manage their recordings and to verify the residents' progress. He regretted that time had run out too quickly for this ‘lively and productive’ staff meeting. The issue of alternative ways of recording was recommended as the major topic for next month’s staff meeting.

What happened in this staff session seems to be merely an echo of what happens on the front lines of group care practice. In the treatment planning for each child, in the daily care activities, in the co-operation and stress of group care work, in programme planning, and in the scheduling of staff, an inherent struggle exists between provisions of personalized care and institutionalized demands for organizational accountability. We also noted that the primary care issues, though central to service delivery and the agenda of this particular staff meeting, still remained sandwiched between organizational concerns. The scenario offered above articulates the major thesis of this chapter, which is that provision of primary (personal) care within a secondary (organizational) care context always presents a difficult course but it can also offer challenging opportunities.

Primary Care within a Secondary Care Context

Care in everyday life
The care received by children growing up in their own families is directly impacted by the quality of care rendered to their immediate care-givers. Infants have their parent(s) ‘at their command, families to protect the mothers or alternate caregivers, societies to support the structure of families and traditions to give a cultural continuity to systems of tending and training’ (Erikson, as quoted in Maier 1973: 89-90). It is common knowledge that the quality of care and training of children is directly related to the sense of well-being experienced by their care-givers. Emien's reminder, ‘if you care for children, then care for parents’ (Gabarino 1982: 234), can be broadened and applied to all types of primary care-givers: grandparents, babysitters, foster parents, day care and, of course, residential care workers. In fact, a decisive factor in group care work is whether there is or is not ‘ample care for the caring’ (Maier 1979: 172). Bronfenbrenner pointedly asked, ‘Who cares for those who care?’ (in Gabarino and Stocking 1980: 3).

An ecological perspective about care
Validation of the above notion was elaborated by Bronfenbrenner in his empirically grounded ecological formulations (Bronfenbrenner 1979). An ecological systems perspective applies not only to interpersonal interactions but also to the mutually reinforcing processes and events between larger and smaller systems. Interconnectedness is part of the nature and pattern of life (Bronfenbrenner 1979). In particular, we note that events in larger systems impact as much, if not more so, the nature of events in the relevant subordinate systems. In everyday life, for example, to cite Bronfenbrenner,

‘a person’s development is profoundly affected by events occurring in settings in which the person is not even present ... Among the most powerful influences affecting the development of young children in modern industrialized societies are the conditions of parental employment’ (Bronfenbrenner 1979: 3—4).

The degree of work satisfaction, working hours, and take-home pay more strongly affect the degree of each parent’s active and psychological availability and the nature of parent-child interactions than his or her personal qualifications for parenthood.

We note that much of a child’s life is determined by secondary life systems which involve neither the developing persons as active participants nor the young persons’ care-givers in their role as the children’s nurturers. Significant events occur that affect what happens in the setting which contains the developing person (Bronfenbrenner 1979: 25). It is important to note that members of the subordinate settings have little power to influence the very events which tend to influence strongly their own as well as the lives of care-receivers (Bronfenbrenner 1979: 255—56). As illustrated, working hours, salaries or wages, and to an extent, work satisfaction, are beyond the control of the recipients. The labour market, policy makers, and other settings of power ‘control the allocation of resources and make decisions affecting what happens in other settings in the community or in the society at large’ (Bronfenbrenner 1979: 255). These decisions also reach into the lives of almost all individuals within their spheres — and subsequently impact the course of each family.

Applied to our immediate concerns, the nature of primary care in any children’s centre is strongly coloured by the employment policy and the institution’s pronouncements on the workers’ roles within the total scheme. Such factors operate quite independently of the workers’ personal and professional qualifications or the staff members’ personal commitments to daily work tasks.

The ecological impact of secondary systems upon primary relationships is applicable to group care situations, regardless of whether the children are in care for part of, most of, or continuous 24-hour services. We noted in the staff meeting described above that a worker’s personal readiness to adapt her/his working periods to the requirements of a particular group of children hinged on the program's readiness to adapt to particular working arrangements. One can assume with relative certainty that the decision would ultimately be made on the basis of how feasible it was for scheduling changes to be instituted within administrative considerations, in other words ‘making the least waves’. It is unlikely that such a decision would be made on the basis of children’s and workers’ urgent need for each other.

At another point in the foregoing meeting, a clinical recommendation for greater individualization was immediately counteracted with the fear that increased attention to individual children’s differential requirements would lead to a lack of clarity in oversight and would result in organizational ‘shambles’. It is true that individualism in its extremes becomes the antithesis to organizational order, yet the reverse is also the case: organizational rigidity negates individuality, which is apt to receive less emphasis on organizational deliberations. Finally, we noted that a staff meeting, with an agenda focused upon the children’s welfare, started and ended with organizational concerns. Service factors, such as whether recording for communication between staff would allow more intense therapeutic involvement, were easily overridden by administrative concerns. The professional dilemma of increased direct versus indirect service time became reframed into an organizational dilemma; the urgency of translating service gains into measurable standards of reporting. There is an ever-present pressure to account for the program’s efficacy to the next larger systems, namely the sponsoring and controlling systems. Altogether the issue before us is that primary, individualized care concerns tend to give way to those of secondary, organizational power.

The dominance of administrative over immediate child and youth care concerns is not necessarily a peculiarity of the foregoing staff meeting. Rather it is inherent in the exchanges between two systems where the super-system or the organizational system substantially influences the norms, pace, limits, and flow of communication of its sub-systems. The sub-systems are those of the client, staff, group care, and physical domain systems. Each of the sub-systems, in turn, from time to time attempts to impact the organization. Only when persons associated with any one of the sub-systems are able to marshal sufficient thrust to counteract organizational ‘necessities’ do such sub-system efforts prevail. For instance, care workers might have collectively, and in a determined manner, insisted on a more flexible wake-up time for children travelling to a school some distance away. These children might have had their breakfast ahead of children attending the local school. The latter could proceed more leisurely, as they were also typically children who required more flexible time demands. It is possible that the straightening up of rooms could occur at varying points of the day. For some youngsters it is more important to start the day and get off to school with as little hassle as possible, whether their room is sufficiently tidied up or not. Such a thrust from the care staff might have led to an organizational change where workers were employed and supported for their flexibility and adaptability to situational demands rather than for allegiance and conformity to institutional practices. Moreover, such a thrust from a sub-unit could bolster administrative adaptability and readiness to justify to its own workers and the outside that children's centres are for adaptive living rather than providing a showpiece in housekeeping. Unmade beds at noon can represent sure signs that certain children and staff are working actively on other issues vital in the developmental lives of these particular children. (No apologies or regrets are necessary, if such conditions are part of acceptable agency standards.)

In general, the tendency is for organizational requirements to modify special individual care requirements. Such a dilemma can be witnessed when plans for children who are ready to engage in a wider range of activities are throttled when an agency does not perceive itself as being ready to branch out. Many activities beyond the perimeter of a group care centre are prematurely curtailed for fear of unfavourable public relations. Other activities within the walls, such as appropriate exceptions for some children, variations in procedures, and programmes for separate living units are discouraged, or, worse, not even considered due to fear of de-stabilizing the programme's overall efficiency. The submergence of exceptions, special considerations, or a thrust towards greater diversity, all have a slight ring of truthful imperative. Where would the children, the staff, and the service be, if the stability of the agency or programme were endangered? But is it really such an either/or dichotomy?

The very struggle between individual freedom for personal initiative and adherence to organizational norms, the desire to serve individual children while remaining mindful of what others would say; and above all, the strain to become fully involved in child and youth care activities while remaining a faithful peer to one’s fellow workers, represent mind-boggling organizational nightmares. It is not unlike the everyday struggle of being a ‘good’ parent as well as a full marriage partner; or a ‘good’ sales person who fully meets a customer’s interests as well as her/his own, as a business person. All these activities elicit conflicting requirements, a notion considered more fully below.

In group care practice it is a common occurrence that an intense involvement with one child readily creates a demand by other children for equal time. The result may be a rivalrous frown by co-workers with a possible warning against over-involvement or at least a curt reminder that not every staff member can afford such a heavy investment. Similarly, the impulse to deal with children according to the situation, viewing rules as being flexible or not applicable at a particular time, can easily be interpreted as a worker operating without standards or denying support to her/his fellow workers. It is also true that a search for common guidelines in the care of children may be continuously disrupted by the awareness that such common rules cannot apply logically to a number of children, or will not be carried out by some ‘notorious’ care worker. In another instance, the hope that a token economy can provide a reliable and objective approach, rendering personal involvement unnecessary, is somewhat marred by empirical data revealing that private, interpersonal negotiations over the allotment of a token may be more important than the token system per se (Maier 1981: 49-50).

The complexities just described spell out the interactional conflict between the individual's worker role and her/his larger system — the work group. Actually, this inter-system strain exists between all individual and organizationally-oriented processes and systems. Individual and peer group needs, situational and organizational procedures, clinical and bureaucratic considerations are in continuous interaction, meaning that one cannot deny the other. All are part and partners within the same larger whole. While this is so, in this struggle it is a fact of life that the supra-system largely determines the eventual outcome (Resnick 1980). The credence which is ultimately given to work with each child, to staff co-ordination, and to the creation of specific care procedures is not so much decided by the children’s and staff’s ongoing requirements, as by the organizations capability and status to deal with these vexing issues. Child and youth care issues, clinical considerations, and staff investments decline or flourish in the arms of the bureaucratic organization.

Bureaucratic and clinical issues

It is taken for granted that much or most of an administrator's time (director, superintendent, principal, chief, or others) is necessarily absorbed with organizational concerns and the representation of her/his organization to the outside world (its respective supra-system). It is not surprising that much of her/his time is consequently spent separated from the day-to-day concerns of the service. When she/he does devote time to any particular feature of the programme, the impact of that agency administrator will be keenly felt and how she/he chooses to assess a particular programme segment will also influence the direction and quality of care delivery of the centre’s staff. In a visit to one centre, for instance, is the administrator concerned about the number of children in service, likely to focus on whether things are ‘going smoothly’, whether the hot water supply is sufficient, or the reasons why two window panes are broken again? In another example, the administrator’s interests might focus upon the residents’ progress, and, in particular, upon the difficulties and problems encountered by the staff, especially in the most recently emerging trouble spots. The former scenario of administrative emphasis is more common. That is understandable because this dimension relates to an administrator’s working spheres. The latter foci of enquiry dip into the domain of care systems, also appropriate but more removed from the group care manager’s view. It is little wonder then that care workers sense administrators’ preoccupation with the ‘agency's’ overall management; consequently administrators’ preoccupations readily become part of the operational norms of a staff team.

The clinical aspect of group care work
Practice in group care entails clinical work – that is, care provided on the basis of actual observation of specific individuals’ {child's) requirements in contrast to a provision of group care on the basis of generalized expectations for members of a circumscribed group — a class of people. Clinical means selected care for a specific individual in terms of her/his idiosyncratic situation on the basis of the group care worker's best professional understanding and skills.

The bureaucratic sspects of group care work
Practice in group care also entails bureaucratic performance. This inherently requires that a worker fulfils and enhances the service obligations of a particular organization, simultaneously delivering such service efficiently, regularly and impartially. Child and youth care, when it is bureaucratically couched, means providing care of equal quality to all residents, without regard to personal discriminatory differences or personal whims. Bureaucratic service means performance by established norms, applicable as decreed or agreed, regardless of individual reservations or inconveniences. Both clinical and bureaucratic perspectives, considered here as primary and secondary care, have their legitimate claims for existence. While both systems may seem to be diametrically opposing forces, both exist within the same interactive field in group care practice with children. A closer look at this interlocking of primary and secondary care (or clinical and bureaucratic) systems may be helpful.

A Conceptual Look at Primary (Clinical) and Secondary (Bureaucratic) Care Systems

The individual and organizational strains and dilemmas mentioned above may be understood and explained through reference to system analysis (Parsons 1964) and, in particular, Herman Resnick's explication (1980)

Historical vestiges
Group care centres, in many ways, possess some stark vestiges of pre-industrial economic society where kinship controlled the occupational system. Members of the kinship system virtually owed their lives to their place of work, with its intense face-to-face encounters, strong authority structure, and close kinship alliances. By contrast, modem society assures economic success through mobility, loyalty to the task rather than persons, and entails de-personalization of face-to-face contacts (Litwak and Szelenyi 1969).
The interpersonal linking functions of the former kinship system are, in general, maintained by the family, but also by other modem primary systems: friendships, clubs, community groups, and group care centres. The ecological, economic, and political functions of kinship systems are now distributed over many modem structures such as government, worlds of business, the trades, and professions. This professional realm also includes the service delivery aspects of group care. The two contemporary spheres of everyday social functioning – the interpersonal and the economic/political spheres of group care practice – can be likened to a kinship economy.

Sociological manifestations
Parsons (1964) and Resnick (1980) established that in contemporary society we are confronted with two distinctly separate group systems and system patterns of interactions. Primary systems comprise face-to-face small groups in close association like teams, cliques, and gangs as well as socially engineered primary systems. Such socially engineered systems might include communes, educational classes, military platoons, therapy and encounter groups, as well as day care or around-the-clock care groups. Secondary systems, on the other hand, are organizational, usually large impersonal systems, for example: business, religious, professional, military, industrial, recreational, and other societal organizations, including group care service organizations.

Primary social systems are noted for their face-to-face association and co-operation among the members. They serve individuals and, at the same time, these individuals are fused into a common whole. Means and ends become intimately tied to one another within a primary system.
Secondary systems, by contrast, stand out as opposite but also complementary to primary group systems. Secondary group systems represent a larger whole, with an emphasis upon contractual, formal, and rational convenient relationships. People are linked with each other; nevertheless their involvement remains specialized and limited. Most striking, these systems function separately and apart from the individuals involved. Secondary settings, in contrast to primary ones, are not an end in themselves, but represent means to other ends (Resnick 1980: 29).

Secondary orientations – such as formality, rationality, and structural emphases – find less favour in primary systems. In secondary systems, correspondingly, primary orientations – such as spontaneity, informality, and personalization – cause strain and are a sign of dysfunction. It is essential then to identify and discriminate between the respective variables and demands of primary and secondary groups.

Variations in emotional demands
The expression of emotions in primary systems is expected and encouraged. Group members are expected to convey affect and to be emotionally supportive of each other. In secondary groups, a different norm is operative: emotional neutrality. The latter requires a withholding of personal emotions and relies upon an inconsequential acceptance of others. Emotional expression may deplete energy and lead to a diminishing involvement, or it may be transformed into obstacles for necessary co-operation. The norms of both systems create potential complications. In organizational settings, the demand for emotional neutrality is easily experienced as coolness or disinterest. The latter may lead to a reduction of energy input and to ‘merely attending to one’s work’.

It is no wonder that workers deeply involved in the care of children find much personal satisfaction in their practice; but they are simultaneously pulled by the need for neutrality and some may even consider deep emotional involvement as ‘improper professional’ behaviour. Other workers with greater emotional restraints are astonished to find children in care being less personally responsive to their semi-neutral behaviours, even though such workers seemingly attend to all details of group living. The administration rarely questions the performance of emotionally neutral workers’ practice; but emotionally expressive co-workers may criticize such care-giving performance as being ‘cold’ and ‘uncaring’. We observe that some workers attend personally and affectively to the children, deeming that fulfilling care requirements is central to group care practice; others conscientiously attend most judiciously to service demands, expressing harmonious caring within the organization. Such competing expectations create an ever-present strain in primary systems that have an organizational mission, as highlighted by Wolins and Wozner:

‘The logistic requirements of the well-oiled bureaucracy negated the demands of close, intimate interactions – the essence of people-changing activity ... The recipients of care become objects of the bureaucrat’s manipulations and are denied control or participation in decisions that affect re-claiming activity’ (1982: 54).

As Goffman (1961) contended, the bureaucratic model is antithetical to reclaiming.

Standardization in opposite directions
Primary group systems depend essentially upon particularistic standards. Only the person within each situation will know in which way a rule is applicable. It all depends upon the particular circumstances and the individuals involved. These notions are applicable to face-to-face interactions. In contrast, secondary group systems build upon universalistic standards. Rules apply to all in order to be fair to each. Uniformity in standards assures clarity, order, and authority of standards. Either standard – particularism or universalism – may lead to complications for its respective system. Standards purely adaptable to each situation may eventually obviate all standards, while an insistence upon general standards will deny individual requirements. This may be carried to the extent where uniform rules may eventually have little relevance for the person involved, rendering uniform regulations ridiculous.

In organizational life, particularistic considerations are immediately perceived as a threat to law and order, or favouritism unbecoming to an organization. In primary group life, universal rules are quickly resented as obstacles to individual initiative and differences. In group care practice, much energy is invested in working out applicable rules or standards for each living unit and child. These struggles, whether or not a set of rules is actually fair and applicable, can be understood by Parsonian concepts. Arguments for uniform getting-up time, for instance, are supported for their fairness, orderliness, and universal clarity for all. Counter-arguments could justify adaptive wake-up procedures citing fairness to particular children's circumstances or individual worker's preferences.

Scope of interest
Primary group systems like their forerunners, kinship systems, serve manifold interests. This multi-dimensional interest or preoccupation with many details, forges a homogeneous group prototype (i.e. a family, a commune, a friendship association, or a congenial living unit). Secondary systems, in comparison, concentrate upon specific interests in well-defined areas while serving a wide spectrum of purposes. It is not surprising that, in a case presentation for example, the organization-oriented workers can explain her/his typical work with specificity and technical detail. On the other hand, clinically-oriented persons will likely preface their remarks with the explanation that their account is ‘atypical’. They are apt to lose their audience through their mixture of details spiked with generalizations, unless their clinical accounting establishes a profile or constellation – that is a viable case report. A valid case presentation, by the way, evolves out of an interlinking of details into a generalized explanatory whole.

In another area of practice, we note that diffusion of worker or agency interests is frequently augmented by specific interests, such as an all-out push for greater physical order, for individual tutoring, or for reliance upon group meetings. Each push tends to distort the program towards the selected, more narrowly specified area. In addition, while undergoing such ‘purges’, workers and children tend to become classified according to their performance in selected spheres of interest. It is no wonder that group care programs blossom or shrivel under specialized program reforms. Much depends upon whether program changes include both inherent group care realities: primary and secondary system demands.

Status alignment
A preference for ascription – the qualities owned by persons according to their positions in life – adds stability to primary group life. This is true so long as these qualities actually define the nature of face-to-face interactions. The following instances are a few of many variations: older and experienced workers are more competent; younger or new members of staff require added guidance. Sex, ethnic, and other genuine differences are significant so long as they do not perpetuate stereotypes but represent real affirmative differences. In organizational and primary systems, achievement or accountable competence defines status. Definition of status and change of status for organizational and primary systems have relevance in relation to system strains (Resnick 1980) and contemporary struggles over changing societal norms (Maier 1969, 1974). In group care practice, a continuous internal conflict exists as to how members’ status is to be measured in their ascribed roles within their primary group position. For children, an example would be eldest, youngest, leader; or for workers, seniority, job classification, or personal achievements may apply. Competence requirements seem to encroach more and more upon primary as well as secondary group demands (Maier 1974). Then, too, awareness of sexism and racism in traditional primary group life – where reliance upon ascriptive values also perpetuated discriminatory practices – has furthered a shift towards secondary system practices. To put it another way, there has been a shift to award status by actual competence and achievements. This leaning towards competence rating in primary settings brings with it the danger of ‘hollow existence’ for staff and residents alike. Are children and workers appreciated because they are familiar in one’s life experience, because they are part of one’s heritage, or because of their accomplishments and deeds (Resnick 1980: 40-2)?

A study of the foregoing variables highlights the dynamic tension which is inevitable in both types of system, primary or secondary. Tension and repeated requirements of adaptation are particularly germane to group care settings, where organizational service demands basically rely upon face-to-face interactions. System stresses, then, call attention to either adaptation towards organizational maintenance or clearer emphases upon children’s and workers’ primary care requirements. In either event, system strains can be viewed as dynamic rather than stultifying forces.

Two orders of primary group systems
Children and workers are frequently admonished to adhere to group norms ‘for the sake of everyone’ or ‘for the sake of the group’. Frequently, it is not clear whether ‘everyone’ pertains to the group members or refers to the persons associated with the group’s sponsorship, the group’s supra-system. On the other hand, ‘for the sake of the group’ might be a shorthand expression used for the wellbeing of the individual group members as persons. Another possibility could be ‘for the sake of the maintenance of a group’ as a sub-unit of a larger system (Maier 1978: 202-05). Each of these appeals serves different demands and different masters. Group care workers have to be clear in knowing with which primary group they are aligned at various points of their ‘practice’.

If the group focus and concern of the moment pertain directly and personally to the individuals making up the group, then the interactions serve essentially the individuals’ capabilities, enhancing interpersonal relations and self-verification. Care workers then have to deal with the group members’ effectiveness in communication, interpersonal negotiations, and power juggling. Workers’ group building efforts serve, essentially, as a source of individual identity formation. In practice, this would mean that a group planning session for an evening of fun would have to include an opportunity for all group members to share their wishes and expectations, searching for common denominators and give-and-take negotiations with regard to expectations which cannot be accommodated on that particular evening. Above all, the evening of fun has to stand as a joint group accomplishment so that members may verify that ‘I had a part in our having fun’. In short, ‘for the sake of the group’ in this context reflects individual group members’ investments as well as a sense of group achievement.

In contrast, when concerns revolve around group building tasks that seek to maintain and to enhance the group as part of a larger whole, then efforts serve primarily a supra-system of which the immediate group is a part. An example would be care workers and children engaged in establishing their ‘citizenship’ credibility, posing their group as a viable unit within a larger group care centre. Concerns will typically reflect the mechanisms of control, establishment of norms, and value aspirations which are in tune with the larger system’s expectations. Adaptation occurs not so much in tune with individual members’ readiness to change but instead to the degree that everyone can stretch in adapting to the group’s standards. Workers and children are challenged to find a fit. The group forgoes personal whims, shaping up in order that the group might gain or maintain a favourable place within a larger scheme.

Care workers’ strains
The foregoing discussion of natural system uncertainties and differential but interlocking group-building factors may explain the many worlds in which group care workers operate. Yet an explanation never resolves day-to-day practice dilemmas. A care worker within an organizational context exists always in a dual world – in two contradictory systems. No wonder that ‘burn-out’' is a rather common occurrence (Mattingly 1977). Burn-out, rapid staff turnover, a high degree of personal frustration, perplexing diffusion in job descriptions as well as expectations can be traced to these contradictory work conditions. The work circumstances have inherent systemic difficulties; they have to be surveyed for their organizational facets rather than for signs of human frailties (Mattingly 1977; Pines and Maslach 1980). These complications emerge for all human service workers who are employed or engaged voluntarily to help individuals within the context of a service organization. In everyday family life, a parent comes close to such a dilemma when she/he shares in a child’s discouragement or delight over school requirements. Is the parent subsequently to respond as a partner and spokesperson for the child and her/his family or the school system? Moreover, the group care worker is continuously required to function as the clinical (individual care-oriented) worker and as the agency's (organizational service-oriented – bureaucratic) worker. Nevertheless, solutions for some of these vexing situations may be potentially possible.

Potential solutions to the strains between clinical and organizational service delivery
Child and youth care within an organizational context does not necessarily have to lurch in different directions, frustrating either clinical or organizational operations. Clinical and organizational requirements do demand different efforts. They can be conceived as dialectic rather than counter-productive forces at the point where the pull of either system constitutes a partial investment rather than a negation of the other system. In other words, clinical demands for continuous flexibility and basic care decisions in the hands of the group care workers can be recognized and carried out as basic organizational procedures. Organizational uniformity is established through decentralization of power and responsibility. Management and organizational supervision are called upon to ensure that care workers fulfill clinical obligations to their clientele. At the same time the care workers can operate amongst themselves with a high degree of variation in style within agreed care and treatment plans.

Parallel to such a clinical/organizational conceptual shift is an organizational stance which demands an overall program policy and requires care workers and others to formulate concrete and communicable care and treatment programs. Such programs need to identify specific outcomes expected (objectives) as well as the actual care and treatment activities to be pursued with individual children and their respective families. Care workers and their supervisory staff have then the opportunity and the challenge of defining their own territory and particular operations within these actual spheres of work (Bakker and Bakker-Radbau 1973). Many instances of organizational interference with child and youth care decisions can be traced to an absence of clarity about the precise nature and boundaries of group care practice, in addition to the tendency of organizational requirements to permeate uniformly across all parts of the service. Clear enunciation of care and treatment objectives and procedures could establish the extent to which group care operates as a vital part of the organizational machinery.

The above suggestion to define primary care or clinical work within a secondary system or bureaucratic operation is consistent with an organizational perspective which views the various parts as a dialectic whole. But the purpose here is not to give greater credence to bureaucratic considerations but rather to call attention to the organizational context which constitutes the supra-system within which clinical work is carried out. Group care workers may feel even greater commitment to their work with the children and, hopefully, a true identification with practice rather than yielding unnecessarily to bureaucratic demands. In reality it is the wider context – the organizational factors – which ultimately shapes and determines the nature of group care practice. Consequently, group care work has to be formulated, operated, and evaluated from an organizational perspective. It is within such a perspective that personal (clinical) care and treatment can fully proceed and flourish within a well-organized agency programme.

Responses to children's emotional demands
We postulated earlier that quality practice in group care demands close intimate interactions — the essence of people-changing activity — while bureaucratic practices are antithetical to care and treatment efforts (Wolins & Wozner 1982: 54). Group care workers tend to be caught between these opposing demands such as being fully engaged with all children and being especially attentive to children who require individual adult involvement. The daily worker’s dilemma is well known: provide a very personal ‘good night’ to all and also provide quality involvement with a few individuals. These difficult time-chores are inherent in all responsive caring and do not represent inadequacy in the organization or staff. The organizational issue is: in which way can staff be assisted to assure more quality time with the children or young people plus added time with some. Simultaneously, one needs to recognize as appropriate the children’s wish for more attention and the workers’ disappointment in not being able to deliver to everyone’s satisfaction. Organizationally and clinically, caring efforts have to be objectively reviewed for the possibility of additional or alternative opportunities for personal, intimate interactions between the children and their daily care-givers. Clinically and organizationally, efforts have to be directed towards finding new opportunities for intimate and varied interaction between children and workers. For the latter, this kind of searching may lead to such practices as provision for intimate conversations before bedtime, rather than a mere get-together snack period; reading a story rather than a TV hour; a quick tussle, or other special quality time with workers. Another example would be the worker being available in the morning as a person for protests or laughter rather than as an organizer of chores and a manager of the long day ahead.

Bureaucratically, individualized nurturing care has to be conceived as the central ingredient of group care work with children who have experienced many separations and disruptions in their lives. Nurturing is not only required out of compassion or a humanistic belief that children and young people need love and affection, it is also based on scientific knowledge that children and young people want and will learn to care for and to love others when they have experienced genuine care themselves (Kobak 1979; Maier 1982). Organizationally, then, emotional involvement has to be defined as part and parcel of the work commitment for care workers. It has to be explicitly identified in each job description as an integral part of the daily ingredients of group care practice.

Another practice dilemma stems from the continuous personal and emotional demands placed upon workers in the face of administrative expectations that they must not get too deeply involved emotionally in their work. This admonition seems to originate from organizational demand for objectivity. Emotional involvement, at the same time, is the group care worker’s speciality (Bames & Kelman 1974; Maier 1984). In many ways, group care workers find themselves in the same situation as parents who are overtaxed by children’s never-ending and frequently incomprehensible demands. In fact, care workers – in a different way – find themselves akin to ‘abusive parents’, who, as Durkin observed, ‘are chronically overstressed and under-supported, have incompatible demands made on them, and are alienated and relatively powerless to control their fate’ (Durkin 1982a: 5).
In tune with Durkin’s pointed analysis, desired change cannot be accomplished by a frontal attack on the quality of a worker’s involvement. Instead, personal stress can be reduced through institutional support and the establishment of manageable working conditions. In concrete terms, this would mean established working hours with periodic rest breaks in a location that assures separation from the work place. Also, it is essential to work out concrete, achievable care objectives rather than vague care expectations. A vague objective like ‘to help the children to manage well throughout the day’ is absurd when these same youngsters can barely manage sufficient concentration to lace up their shoes. Above all, it means providing care workers with support and supervision for their care work rather than their managerial work per se, so that their emotional involvement enhances rather than deters nurturing care. Such practices are psychologically sound, make clinical sense, and can be logically as well as bureaucratically arranged, managed, and appraised.

Standardization in apparently opposite directions
Clinical processes and organizational processes, as has been recounted earlier, commonly proceed in opposite directions as if the two should never meet. Maybe a conceptual shift can link the clinical necessity to deal with individuals and small primary units in terms of their requirements with the organizational mandate for universality. In group care practice, workers tend to stress vehemently the special needs of individuals and their separate living units, as if these needs were so unusual. Actually, individual requirements of people within their particular primary groups are derived through membership and are not particularly special. They represent merely the facts of life. Our difficulties are not so much from the children’s special needs as from our inability to formulate, communicate, and organize these requirements effectively. Teachers have lesson plans and curricula. Nurses have charts and nursing procedures (Krueger 1981: 4). Social workers, psychologists, and psychiatrists have case summaries, assessments and treatment plans with step-by-step intervention objectives and evaluations. What do other group care workers have? They have, at best, generalized statements, specifying acts of close control, unending patience, or the mandate of providing loving care. In some settings, group care workers do have precise directions about how to award points and tokens for specific behaviours, but workers are left on their own to decide how they deal with the children and their group in general. These widely varied expectations are topped by the organizational expectation to maintain an orderly, smoothly run, contented group care centre. The fact remains that from a clinical point of view there is no doubt that group care workers must have a program or intervention plan for each child in care as well as for the management of their unit-as-a-whole.

To augment general schemes, workers and their supervisors have to set up personal care programs akin to curricula in education. Such undertakings must be the universal practice of the service. The organization has to see to it that this kind of framework is maintained in order to assure fair and consistent care objectives for all. At the same time, the collective of children in care will be guaranteed, in principle, life-fulfilling activities according to idiosyncratic requirements. Personal care programs would then take up plans in the way educational plans specify the events of the day as a curriculum. In so doing,

‘the entire nature of present definitions of childcare work in a residential programme ... the grind of supervising kids ends. We are with them both individually and as they mesh together in the group. Control issues vanish and are replaced with content issues, highly relevant pieces of the total curriculum.’ (Bames & Kelman 1974: 19)

Bureaucratic verification of individualized care and treatment can be further refined by the very fact that every service receiver has individual requirements. The service deals with ordinary growth and developmental phenomena which for all children is anchored in the interpersonal interactions between care-givers and care-receivers (Maier 1984). Children are children, regardless of whether they receive family care or not. This truism is particularly relevant for the transmission of macro-systems values. ‘Children learn particular cultural values and particular moral systems only from those people with whom they have close contact and who exhibit that culture in frequent relationships with them’ (Washington 1982: 105). Moreover, an extensive study of children treated successfully and unsuccessfully highlights that the most salutary change occurred when consistency existed in meeting clients according to their particular situations and their current understanding. Such results can be obtained even though it creates for the casual onlooker situations of uneven, inconsistent behavioural handling (Division of Youth and Family Service of the State of New Jersey 1978).

Interests on different ends of the continuum
As outlined earlier, clinical considerations encompass a wide spectrum of the residents' lives. In fact, the more the styles of workers interacting in a child's life are diffused, the more efficiently workers carry out their care obligations. However, it is also true that organizationally a group care service has to be clear about its service mission and the ways in which it uses resources. Rigid adherence to a bureaucratic service mission, however, tends to stifle all those responses which seem appropriate in a creative clinical care and treatment programme for children.

There seems to be a pull in two opposite directions. In one direction there is an effort to expand and deal with more when more is needed; in the other there is a gravitation towards holding the line within the province of the available resources, that is, to manage with that which is actually at hand. In holding to their respective directions both group care workers and organizational administrators are doing their respective jobs. In fact, at times, the workers in the group care centre themselves become administrators and they themselves are apt to limit the use of resources in order to have enough to go around. But whatever the circumstances this struggle will be evoked between human and humane desires for an abundance of life and the bureaucratic necessity to control and to make do with that which is given in an economy of scarcity.

The organizational managers are commonly those who have the actual knowledge and control over the boundaries between agency and the community (just as in the living units, the group care workers have their sway). The organizational team are the ‘gatekeepers’ and the ultimate controls are without question in their hands. Having made a realistic acknowledgement of these factors, it is then important that group care workers relate themselves to the requirements of their practice and see to it that provision is made for those things they deem necessary for the children’s development and enriched living experience. They are the ones who know what is needed. Organizational limitations, never-ending demands, public relations, and limited budgets are all legitimate pressures, and clearly enunciated reminders of these issues may be offered at periodic intervals, yet the necessity for additional resources, unexpected requirements, alterations and expansion in activities, as well as unforeseen circumstances, are also legitimate reasons for service delivery. All these demands would remain unnoticed and unattended by the service unless clearly articulated by care personnel.

Foremost, group care workers have to operate throughout as the representatives of care, ever ready to interpret the care requirements of children. Organizational wishes and restraints will always become readily known due to indigenous power contained in supra-system demands. Workers’ faithful and unchallenged acceptance of this power renders them ‘good servants’ of the organization but diminishes their value as group care workers. The workers’ pronouncements on the necessities for ‘their’ children, including apparent luxuries, make them into responsible child or youth care workers, and thereby into effective members of the organization. The distance between management and care practitioners must be shortened in order to make known and to secure what is needed for a life similar to that afforded to children in their own homes. Moreover, to follow Pina’s poignant assessment, workers on the front lines are the ones who discover innovative solutions. Their concerns can no longer be treated as exceptions when, in reality, they offer continuing reminders about the need for novel and urgent solutions (Pina 1983: 3).

Status alignment
Employment on the basis of ascribed or achieved qualifications presents a dilemma either way. Group care as a profession or as a craft (Eisikovitz & Beker 1983; Maier 1983) demands training and competency achievement in terms of clinical and organizational work. The ascribed value of ‘being part of the children’s lives’ is another essential feature. The care-givers’ role as vital participants in the residents’ life development – to be the children’s or young people’s primary care persons in their everyday life – becomes a decisive variable in terms of staff selection, work, or time-off scheduling, and the workers’ place within the centre. In ascribed terms, care staff own their place in the organization while the quality of their work has to be prescribed and appraised on the basis of actual achievement in providing interpersonal care services. This achievement is colourfully described by Durkin who claimed that ‘one of the greatest joys of being a child and youth care worker is that what you are as a unique configuration of personality traits, interests, skills, hobbies and how you have fun, etc. – that is, what you are as a person – gets full use on the job’ (Durkin 1982b: 16). And it can be added that such personal qualities are used to meet the life requirements of the children as developing persons and members of a residential living-unit group. Then the group care worker will be a full professional within a bureaucratic organization: she/he can find personal satisfaction, using her/his own creativity as a professional.

Closing comments
Provision of individualized (clinical) child or youth care work within a group care (organizational) setting has been reviewed using a Parsons/Resnick ‘thinking screen’. The latter explains the counter-pulls of primary and secondary system variables and processes. Resnick’s conceptual analysis (1980) has been employed to understand some of the strains inherent in group care practice pursued as a clinical endeavour and, by contrast, as an organizational model.

Our purpose has been to conceive of group care practice as primary care or a clinical enterprise. Primary care is the essence of a group care worker’s activities, implementing the children’s developmental requirements (Maier 1984), to obtain a close attachment with the children in care, and lastly, in order to foster a sense of permanency in the children’s lives (Maier 1982). The care-givers’ work is defined as clinical, because their focus has to proceed on the basis of each child’s individual requirements rather than to deal sociologically with the children as a class or group. At the same time, we must be mindful of the fact that such care is not being provided within a primary group system — the family, commune, or kinship network. Instead, it occurs in a socially engineered group care setting – a secondary organizational group. Organizational features place primary care in a different context and bring organizational demands in conflict with clinical realities.

In the second half of this chapter we have attempted to seek out potential ways and possible solutions for accepting inter-system strains as necessary ingredients of nurturing care within an organization. In fact, for many of these inter-system strains we neither have a solution nor want to provide solutions. The system strains seem to be part and parcel of the nature of contemporary living in modem, technological societies. Moreover, while the mutual ‘system wheels’ turn, the partial intermeshing can be conceived as dialectical control processes which ‘grind’ out a viable whole of ill-meshing but salutary encounters. Organizational demands may offer their own legitimate characteristics, such as minimizing or guarding against depletion of workers’ own individual energies by yielding to children’s endless personal requirements. The introduction of interpersonal neutrality within an organizational context may assist staff to maintain satisfactory work relationships with co-workers and supervisors while they are intensely involved with the youngsters in care. An ancient proverb can be paraphrased here: Give to the children what is the children’s and to the organization what belongs to the organization! In the spheres of standard setting and diversity of interests, the strains of the system or dialectic envelopment might include a scenario which can neither be accounted for nor resolved by workers or the organization. Indeed, this kind of tension may be representative of future life experiences anywhere. It is important for workers to deal with these events as part of a child’s life experience. It is to be hoped that workers can transmit skills to children which allow them to reframe their experiences or at times to adapt to them, rather than by-pass or flatly accept restraints. This can be powerful intervention in group care practice.

Finally, this chapter brings together two spheres of life experience and two disciplines of knowledge that are rarely studied, viewed, and dealt with as one joint enterprise. This way of thinking requires that separate system-partners, by virtue of their division of labour and allegiances, become co-operators in their naturally conflict-ridden joint enterprise. These highly distinctive work approaches necessitate additional working orientations in order to incorporate the other system's realities (Resnick 1983). In other words, personal care work within an organizational context demands more than appreciating and co-operating with other systems’ demands. Viable group care practice may also require an evaluation and expansion of one’s own theoretical orientation and practice procedures. The next step is to find bridging concepts and linking practices with the immediate and wider worlds of which every child, young person or staff – indeed every living-unit however securely fenced off – and each service organization and their respective communities, are a part.


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