The Child Care Worker as a Facilitator of Family Treatment

1. increases human resources available to the child;
2. decreases cost by providing a ready source of available manpower;
3. enhances the ability of those most directly involved with the child over a long period of time;
4. emphasizes the co-ordination, cooperation and positive relationships between the significant persons in the child’s life.

This emphasis contradicts traditional treatment approaches which view the parent as "sick", or as a liability in the child’s treatment.
Such traditional approaches can be considered ineffective, costly, and at times even detrimental to the long term progress of the child. In the final analysis, it is the family who has cared and will continue to care for the child. If we help them continue to feel guilty, helpless and ignorant with respect to their child and his problems, the family will not be prepared to contribute effectively to the child in treatment. They will be less able to participate effectively in decision-making, with respect to discharging and/or continuing with appropriate management and follow-up treatment after discharge. On the other hand, there is considerable evidence to suggest that parents and the family can assume very significant and meaningful roles in the treatment of their child. (Hereford, 1963; Grodner and Grodner, 1975; Klaus and Gray, 1968; Gray, 1970). 
This article suggests that the family — possibly the unit best able to do this — can effect meaningful programming and responses with their children, and the child and youth care workers can make a significant impact on the family unit’s ability to participate meaningfully in several areas.

Emerging Parent Attitude 

Parents are pushing, not only for viable services for their children, but for increasing recognition of themselves as normal and competent individuals entitled to full information and participation in their child’s program. In the words of one parent:

We are parents of handicapped children. We are parents who are either intimidated by professionals or angry with them, or both; parents who are unreasonably awed by them; parents who intuitively know that we know our children better than the experts of any discipline — and yet, we persistently assume that the professional knows best; parents who carry so much attitudinal and emotional baggage around with us that we are unable to engage in any real dialogue with professionals, teachers, principals, physicians or psychologists about our children. The responsibility for monitoring our children’s progress through the fragmented service system has been ours, but the array of physicians and other professionals whom we have seen have assumed that we could not possibly understand the complexities of their trade — or that it would take too much of their time to explain it to us. Parents are the primary helpers, monitors, co-ordinators, observers, record keepers, and decision makers for the child. It is the parents’ right to understand the child’s diagnosis and the reason for treatment recommendations and for educational placement. No changes in his treatment or educational placement should take place without consultation with the parent. Stay confident and cool about your own abilities and intuitions. You know your child better than anyone else; you are a vital member of the team of experts (Gorham, 1975).

What can the child and youth care workers do? Their role is vital if an institution is to maintain a philosophy of co-operation and partnership with the parent. This is true not only in the traditional role of the child care worker as the primary therapeutic person in the child’s treatment, but also can be increasingly emphasized in treatment concepts which emphasize a flow of services into the community and home of the child. In the traditional role, the care worker is the chief facilitator of communication with the family about the child and his day-to-day needs. In programs emphasizing service outside the institution, the child care worker adds additional roles of therapist, model trainer, and co-ordinator.

Parents look for integrity and recognition as individuals apart from their role as the parents of a child with a handicap. In order to effect a relationship conducive to meaningful and positive participation of the parent, it is essential that the care worker recognize the parent in such a way as to fulfill this need.
Look for and recognize the strengths of the parent. Recognize the difficulty of the years of attempting to cope with their child’s behavior and emotions. Realize that they may be victims of non-existing or inadequate services with only criticism and condemnation for their efforts. Understand that their relationships with professionals to this point may not have been considered a positive experience. Be aware that many behaviors, feelings, and attitudes currently expressed by the parent may be the result of years of frustration and guilt and not the cause of the child’s behavior. In transactional terms, stroke the parent’s child and keep your own parent in check.

There are many roles and materials which the child and youth care worker can find effective in working with parents. It is important to remember, however, that the decision as to how a parent can contribute to his child’s program must be shared with the parents. Parents, like care workers and other professionals, do not have the same skills and aptitudes. They can not all profit by being a teacher’s aide or a home tutor, or by learning behavioral modification skills. Options and opportunities must first be discussed with the parent. The parent must be allowed to give his own input before a mutually acceptable decision can be made. Sometimes the parent will surprise you by suggesting resources or skills innovative and helpful to an entire program and not only to their particular child. The care worker can then help the parent by teaching, supporting, role modelling, or facilitating a particular means of participation in the program.

A child’s diagnostic category does not necessarily give an indication of the attitude, strengths or weaknesses of a parent. Parents of emotionally disturbed kids or MR children or crippled children are not uniformly cold, warm, hysterical, indifferent or rejecting. Their personalities and characteristics as a group do not seem to show any significant departure from the norm of the general population (Wilson, 1975). Therefore, it cannot be assumed that the parent who has a child with a particular symptom will require any one specified type of program or involvement. An individual assessment must be made for each parent. The needs and interests of the parent should be considered together with the needs of the institution. A recent study (Wilson) did show certain common attitudinal variables when parents of emotionally disturbed and behaviorally disturbed children were tested as a group. Twenty-eight parents who brought their children to a community MHMR Center for services were tested by Hereford’s Parent-Attitude Survey. Their group scores were found to be below other groups of parents with "normal" children In three significant areas:

1. Confidence — the degree to which a parent feels himself adequate to the demands of parenthood and at ease in the parent-child relationship. The parents in the study tended to score in the range which indicated they felt inadequate, dissatisfied and unsure of themselves. 
2. Causation — the degree to which a parent feels his child’s behavior can be determined by the parent-child interaction, or by parental behavior and attitudes. Parents in the study indicated that their child’s behavior was inherited or due to insurmountable causal determinism. 
3. Understanding — the ability of the parent to interact effectively with the child, verbally and non-verbally. Parents in the study indicated that they may not share in their child’s attitudes and feelings, nor did they value a reciprocal intellectual or emotional interchange.

Again, the child care worker should not assume that the above attitude caused the child’s problems but may be a result of it. In support of this, there was a significant correlation between the child’s age and the parent’s deviation from "normal" attitudes. The older the child, or the longer the parent had dealt with the problem, the more likely he was to lack confidence, to see himself as unable to influence his child’s behavior and to fail in his ability to understand and appreciate mutual interests with the child. The younger the child the more likely the parent was to be confident, to see himself as influential and to value an interchange with the child. While the implications of the above for early childhood intervention are apparent, there are considerable variations in the way the care worker intervenes. There seem to be three major areas in which the child care worker would be particularly helpful to the family.

1. Behavioral Management: This approach would include behavior modification, but in addition would emphasize good rules of management, discipline and growth particular to the child with the behavioral problem. The care worker can not only teach one of several good programs for parents, but can also serve as an effective model by demonstration at the residential facility and in home visits.
2. lnteractional Skills: An essential skill of the child care worker is his natural desire and ability to interact with other people. It is the sine qua non of the profession. Teaching parents the rules and procedures of interactions is useful in "neutralizing" interactions between parent and child. It allows for requests being made without strings attached — and resulting power struggles (Gordon, 1970). It teaches effective and efficient communication without loading both parties with emotional baggage. It helps parents to see why Johnny always blows up at each request and why "Suzy and I can’t go shopping without my having to punish her."
3. Confidence Skill: The child and youth care worker is in an excellent position to demonstrate through words and actions his confidence in the parents and their ability to see themselves as positive agents in their child’s program, other skills may be ineffective. The parent can be informed as to how parents are participating successfully in other programs; how, more and more, research substantially benefits meaningful involvement of parents in the programs of their own children; and what they can do for their child. Their ideas, interests, and participation in the decision-making process can be solicited.
    

Child Care Work in Focus, 1.1, 1976. The copyright of this material belongs to the Association of Child and Youth Care Practice, formerly NOCCWA, to whom acknowledgement is given.