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eJOURNAL OF THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK (CYC-Net) – ISSN 1605-7406

ISSUE 143 JANUARY 2011 •  CONTENTS •  HOME PAGE

CARE WORKERS

Occupational stress for group care personnel

Martha A. Mattingly1

Introduction
The traditional clinical professions such as medicine, nursing, education, psychology, and social work as well as the emerging child care profession have focused primarily on the welfare of the patient-client. While the well-being of the practitioner has long been generally and implicitly addressed in the training and supervision of human service providers only recently have serious efforts been made to identify the problems confronting these workers and to reflect on their consequences. It is interesting to note that while child care is a young emerging profession it has been in the forefront of these efforts (Mattingly, 1977a).

The concept of occupational or job stress has developed slowly over the last twenty years and efforts in this area have gained momentum with the current concern with the quality of working life. In general, occupational stress refers here to workers' physiological and psychological responses to situations perceived as potentially disruptive (McLean, 1974). Disruptive situations may be either desirable or undesirable. Such positive changes as going on vacation, receiving a promotion or raise in pay, or learning a new and more effective child care technique produce stress. However, the concern here will be with the negative stress, which arises from those situations perceived as undesirable, painful, and challenging to the ability of the worker to cope effectively.

The 'burn-out syndrome' is an extreme response to occupational pressure. It has been described as primarily an experience of exhaustion resulting from excessive demands on the worker's energy and resources accompanied by a dehumanization of the caring process (Freudenberger, 1975, 1977; Maslach, 1976; Maslach and Pines, 1977; Mattingly, 1977b). The burn-out syndrome appears to be widespread human service workers whose work requires intense interpersonal involvement (Hall et al., 1979; Maslach and Jackson, 1979; Mattingly 1979; Pines and Kafry, 1978; Pines and Maslach, 1978; Seiderrnan, Shubin, 1978; White, 1978; Yager and Hubert, 1979). In addition, symptoms of combat neurosis,2 an extremely similar if not identical phenomenon, have been identified in some teachers in inner-city schools (Bloch, 1978).

The problem of job stress and burn-out is of special concern in professional child care work. In recent years child care workers have enormous strides both towards professionalization and towards improvement of the quality of care expected for children. Advances been made in the design and availability of training. Child care workers, other related professionals and advocates have become active both in organizations and issues concerned with the child care worker's ability to render appropriate care. But if the field is to thrive and mature, it is essential that there be a substantial cadre of experienced, educated, committed practitioners. Retention of workers (The New Child Worker, 1974) and the quality of care provided by many long-term workers are well-known problems in the field. Part of this is due to rather widespread poor selection procedures, training, salaries, and working conditions. A significant contribution, however, also comes from physical and psychological exhaustion experienced by child careorkers in the caring process. The result appears to be high staff turnover, potential apathy, and frustration for continuing workers, and the loss of some especially able practitioners who are concerned with their effectiveness with children. It is important to keep in mind that there are effective long term workers who do not report serious persona damage from stress.

While the child care profession, as well as many workers and agencies, have begun to address the issues of job stress and worker burn-out, some resistance to its discussion is still occasionally encountered. Such considerations arouse painful memories, a sense of vulnerability, and issues of responsibility many would like to avoid. It can bring agencies and systems face to face with the need for changes it may be more comfortable and convenient not to confront. And finally it can bring the, profession face to face with an enormous problem requiring attention. .

The profession's willingness to confront these issues raises the hope that effective ways to cope with the stress of group caring work can and' will be found. The benefits will be reaped by group child care professionals who will be able to work with greater dignity and to mature in skills of their chosen profession. The ultimate beneficiaries will be the children.

A reflection on sources of stress in child caring work
'Burn-out' is frequently used as a catchy phrase to explain various sorts of frustration and fatigue. In order to come to grips with the problem of stress it is necessary to identify sources of stress. Each person, of course, experiences stress in an individual manner and needs to consider his/her own situation. This reflection is drawn from the literature, the personal experience of the writer, and the generous sharing of many child care workers who expressed their frustration and pain.
Agency attitudes and policies contribute to the stress experienced by child care workers. The effects of an agency as a closed system are frequently seen (White, 1978). Many agencies have enduring traditions which come from more autocratic times. Others are parts of large and cumbersome bureaucracies which have lost the ability to be flexible and responsive. Workers can begin to assess the particular structure of their agency and its relationship to the stress they experience.

An effectively closed system is characterized by a sense of isolation and rigidity. Such an agency is isolated from professional and community resources and has a major, usually unspoken, goal to remain hidden and unchanged. There is an excessive emphasis on presenting a favourable public impression, protecting the agency from criticism, and accounting for aspects of the agency which are not central to the quality of service rendered, e.g. the linen inventory, maintenance records, and groundskeeping staff. Such agencies tend to protect themselves by a screening procedure for new staff and consultants which assures maintenance of the preferred agency attitude. This may result in the rejection of sophisticated applicants as overqualified, unlikely to work as good team members, or not familiar with 'our' problems.

Events which create conflict and disequilibrium tend to be dealt with by denial and retreat to the agency ideology. Problems are identified as arising from discrete issues and persons. The ecology of the agency is not made a focus for review. A high turnover rate for child care workers may be dealt with by proclaiming that no one can do such difficult work for more than two years. Crisis management issues are considered client problems without consideration of deficits in the program of care and treatment offered. Persons who begin to raise issues related to the agency are frequently identified as inept and unsuited for this type of work. Supervision is often defined as an accountability review. The result is a rigid and inflexible setting which diminishes the role of the worker and truncates the support system an agency can be expected to provide.

Morale and job satisfaction tend to decline steadily from the top to the bottom of an agency hierarchy. Morale among child care workers is directly related to their perceived ability to influence the decisions affecting their work (Shamsie and Lang, 1976). Within agencies child care workers are frequently perceived as among the least valued of employees. The common low level of financial compensation is the most substantial evidence for this perception. Currently the child care worker may not only find himself a devalued and perhaps dispensable, easily replaced employee but is also subject to the current increasing awareness of the central role of the child care worker in providing quality care for children. Thus while being told of his importance, and encouraged toward professional associations and training, he is deprived of the economic and psychological circumstances necessary to engage in an exciting and productive career.

Workers enter the field of child care with a variety of motivations. For the most part they are dedicated, concerned persons who wish to offer themselves and their resources to assist children in their development and rehabilitation. Dedication, concern, and idealism are essential for all caring work. In fact, these qualities may be the source of the motivation and energy for difficult caring tasks (VanderVen, 1979). Concerned child care workers support the growth of each child from their own resources and talents. However, there is an inescapable stress producing conflict between the worker's commitment to give and the reality that frequently he cannot give enough. Each person's emotional resources are limited. The refreshment provided by family, friends, colleagues, and personal interests are often insufficient. This conflict is a particular hazard for the beginning worker but one with which all caring persons struggle throughout their careers.

The idealism and dedication which characterize the decision to engage in caring work are severely challenged by numerous physical and psychological assaults on wellbeing and self-esteem. Upon entering the field, workers usually perceive themselves as concerned and helpful persons whom clients and society will value. By way of contrast workers are confronted by assaultive youth, messy and aggressive children, and ungrateful families. The nobility of caring work turns out to be a myth. Successful workers develop a personal durability as they integrate the idealistic view of caring for children with the everyday realities. However, no matter how skilled and sophisticated the worker, a kick in the shins, broken glasses, an insult, and a child's lack of progress are all assaults on self-esteem which threaten workers' perceptions of their helping ability.

Experiences which enhance workers' sense of effectiveness are quite random and inconsistent. In many instances they cannot remain involved with a child for a sufficient period to see productive growth and the resolution of major difficulties. The limitations imposed by agency structure or funding sources, special client needs, and changes in family circumstances or attitudes may result in the termination of the worker­client relationship. Perhaps a seed has been planted that will bear fruit in the future. Perhaps not. The worker has been interrupted in the middle of something and is denied the rewards of a job well done.

Many child care workers still unfortunately lack the professional knowledge which would allow them to assess the effectiveness of their everyday practice. Supervision is frequently neither rendered by persons skilled in child care nor readily available. Much supervision is almost exclusively problem or deficit focused. Colleagues may also not be able or willing to provide feedback on the quality of work. This problem is likely to also be especially severe for supervisors and administrators. Thus the person is left without a realistic evaluation of the quality of work.

The child care worker also must process an enormous amount of information with great speed. In the many hours of direct child contact the worker maintains a disciplined alertness and vigilance to the children and the setting. Masses of verbal and non-verbal behaviour, the sounds and conditions of the environment, the program of the day, and the history and treatment plan for each child are registered in awareness. Situations must also be dealt with on many levels at the same time. In fact, the very basis of child care practice is the use of the everyday environment to support each child's growth while completing the tasks essential for organized living. The child care worker practises in a 'pressure cooker' characterized by rapid decision making and intense sustained interaction.

The conflict between client-care and custodial managerial requirements is inescapable and includes such things as food preparation, acquiring a good community image with well-dressed and comported children, and maintaining a full census so that the agency and the establishment can survive financially. The nature of clinical child care rarely permits the isolation of these concerns. Rather the conflict is embodied in everyday decisions and interactions. It can be anticipated that as professional child care workers have increasing participation in agency decisions this inevitable conflict will become more acute.

Daily practice is most often open to the view of superiors, colleagues, children, and occasionally to parents and the community. There are few places to hide errors and bad days. There is no tape recorder to turn off or office door to close. In addition the child care worker serves as a model for the children in his care both by his behaviour and attitudes. The children are affected by how the worker expresses anger, solves problems, has fun, and deals with the disliked carrots. The worker's task is difficult. To pretend or 'put on' attitudes and feelings is ineffective. Rather the worker is called upon to be a fully human person, honest in interactions, and concerned with personal behaviour and attitudes.

Child care workers are called upon to be empathic with a person at a different developmental level from themselves (Olden, 1953). There is a professional commitment to place one's personal experience of childhood in the service of children in need and to engage, as it were, in an empathic tension. Workers must remain fully adult, not identifying with the child or allowing the child to be an inappropriate participant in their own psychological conflicts, while being in touch with childhood perceptions and feelings. Negative emotions such as anger, guilt, and potential loss of control are almost common. These are not congruent with the image of a helper of children and frighten many workers particularly at the beginning of practice.

The worker who lives as well as works with the children served confronts additional hazards. Agency requirements vary greatly but three and a half to five days a week at the facility are not unusual. This may require continuous responsibility for the children or include interspersed off-duty periods in which the worker mayor may not be required to remain on the premises. The live-in worker's 'amorphous omnipresence' (Grossbard, 1960) provides limited opportunities for withdrawal, psychological repair, and personal recovery. Interpersonal interactions are also very intense. Living quarters may allow for the constant intrusion of children's noises. Personal phone calls and visits as well as the security of personal possessions may be severely limited. Off-­duty time is open to interruption by both children and staff for insubstantial reasons such as finding a lost shoe or confirming the time of a parental visit. The live-in worker's perpetual exposure to the stressful environment tends to intensify all the stress producing influences (Reed, 1977).

The child care worker must also sustain his professional identity with limited reinforcement from social and community sources. The common characteristics of babysitter, disciplinarian, and self-sacrificing martyr reflect the impoverished and inaccurate understanding of professional child-care work. Thus the child care worker is denied realistic psychological support from these sources and must continue to re-establish for himself 'Who am I?' and 'What do I do?'

Burn-out: experiences and signals
Exposure to potentially harmful levels of stress is an inevitable part of child caring work. A debilitating and painful response to these pressures is the burn-out syndrome which is a phenomenon of physical and psychological exhaustion. Some basic components of burn-out which occur with regularity have been identified and measured (Maslach, 1976; Maslach and Pines, 1977), viz. emotional exhaustion, depersonalization, and lack of personal accomplish- ment. In addition, each person's stress response has a unique individual pattern of symptoms, behaviours, and attitudes. Since most child care workers are young adults some of the traditional symptoms of stress may be masked (Hewitt, 1979). Thus any particular 'burning-out' worker may experience only part of what is described here.

Burn-out frequently begins as a vague subtle experience of discontent. The worker begins to have doubts about his caring work. He may feel inadequate to and overwhelmed by the tasks which confront him and feel a growing unconfortable rigidity in his thinking and behaviour. He may be irritable, labile in moods, less empathetic, and behave — on occasion — in ways which are not congruent with his values or self-image as a helper of children. This experience is frequently confronted alone and the worker often comes to the conclusion that he is unfit for the work he has chosen. A severe fracture of professional identity is a common result.

As the pain and confusion increase the worker may try to discuss these feelings with supervisors, colleagues, and friends where an attitude of denial may be the response. Some talented workers report that their clinical work, though somewhat less flexible and creative, remains of very good quality during a burning-out process. These persons seem to have the ability to isolate the effects of the stress they experience from clinical work. Their pain is not apparent and their feelings are likely to be ignored.

In response to the 'burning-out' worker, supervisors and colleagues may adopt a traditional inner psychic view and insist that the worker must deal with the personal problems which are obviously the source of the difficulties. The necessity for a critical self-reflective attitude has been emphasized in the training of the professional child care worker. Thus he may be predisposed to engage in an energy consuming self-review and perhaps seek professional assistance. This effort even further depletes the worker's already meager energy (Freudenberger, 1975). Workers report that even skilled psychotherapists often do not recognize the stress arising from the caring commitment. A note of caution is required here. Some workers have personal problems which interfere with caring work. These need to be identified and dealt with. However, the customary and uncritical assumption of the inner psychodynamic view of the worker's distress effectively excludes consideration of the full circumstances of engaging in a caring commitment. Thus many, if not most, workers are denied the support and assistance to which they are entitled from agency and colleagues.

The worker may reject the suggestion that he work on his personal problems. Then he confronts the experience that something frightening is happening. The sources he knows about are unable or unwilling to help. Many workers have expressed a serious concern about 'going crazy'. This arises from the major discrepancy between the painful personal experience and the lack of interpersonal validation for the experience.

A diminishing distinction between the time and place for personal life as well as a diminished distinction between the psychological needs of the worker and child may signal 'burn-out'. This merger between the worker and the agency is a particular hazard for young workers. The structure of formal training which frequently demands an almost total commitment and the enthusiasm of beginning workers both contribute. The staff member may find it difficult to stop working. Careful consideration may reveal that over a period of time the worker has stopped taking lunch hours and breaks. If relief personnel are available for these periods the person may just 'hang around'. He may also 'hang around' at the end of the work period and on days off, perhaps working, perhaps not. He may be enthusiastic when called upon for overtime and emer­gency duty and volunteer to provide extra services on his own time. There may be frequent requests to invite children home. These behaviours and attitudes may signal that the worker lacks the energy and motivation to develop and sustain a rewarding personal life. Thus he relies on the agency increasingly to meet personal needs. Again a note of caution. These comments are not intended as guidelines for worker behaviour. The caring commitment and personal interest may lead workers to appropriately offer personal time, skills, home, and family to assist a child. Excessive agency regulation of these matters is usually not helpful to stress management. Rather it may be a manifestation of the generally high level of stress in the agency and a lack of trust in supervisors' and workers' competence and judgment (Reed, 1977). These comments are intended to identify a hazard and encourage reflection on the personal meaning of such behaviours and attitudes.

Rigid and inflexible attitudes with a stubborn resistance to change are also part of the 'burn-out' phenomenon. As the worker's interaction with his setting becomes more stressful, personal resources are diminished and exhaustion approaches. Workers may find themselves without the flexibility needed to be confident and effective. The worker may retreat to a position in which he 'knows it won't work' or 'has already tried it before' when innovations are suggested. Attempts at change are broadly resisted. The burning-out worker literally cannot depart from the usual work pattern and experiences proposed innovations as personally unmanageable (Freudenberger, 1975).

Rigidity is also frequently reflected in the worker's vocabulary. Language may become more evaluative and distancing, with the use of stereotyped phrases and words. This is particularly, but not exclusively, evident in regard to perceptions of the client (Maslach, 1976; Maslach and Pines, 1977). Stereotyping statements can be simple such as 'quiet child' and 'disruptive child' or they can be very sophisticated such as in repeated referrals to unresolved Oedipal conflicts or separation issues. The worker is exhausted and does not possess the energy necessary to process the complex data of the situation. Partial perceptions are channelled into preconceived categories. This allows the exhausted worker to garner his psychological energy and continue to serve his clients.

Burning-out workers are also vulnerable to a substantial misevaluation of their abilities and prerogatives. Some workers grow increasingly unsure of themselves. They become overly concerned about personal deficiencies and may imagine errors in practice. They may become unduly apologetic to colleagues, supervisors, and children and request additional supervision designed to elicit approval and reassurance. These workers underestimate themselves.
Overestimation was graphically described by one burning-out worker. A serious ice storm struck the area on an evening when her group was scheduled for an off-campus activity which was particularly valued by children and staff. In spite of warnings in the news media she loaded the van and started down a long treacherous hill. At one point when the van had slid off the road, she sent a very disturbed child out to evaluate the situation. Finally after surmounting numerous hazards the group arrived safely at its destination. Only months later was this exceptionally well-trained and experienced worker able to analyze this situation. She had felt almost completely directed by the predetermined schedule which called for this particular activity on this particular evening. This well-trained and experienced worker dangerously overestimated her ability to surmount real hazards and seriously misjudged the evaluative capacity and ability of her child-helper. One need only reflect for a moment on such considerations as safety for young, retarded or disturbed children, suicide supervision, and confronting violent youth to be struck by the dangers for both child and worker which can result from this problem of misjudgement.

Trust in one's colleagues and reliance on their skills, goodwill, and ability to help evaluate one's work are perceived by child care workers as a major source of support (Maslach, 1976; Nelson, 1978). The loss of trust in other members of the working team and the assumption of a self-sufficient attitude often result from overestimation. 'If I want it done right I'll have to do it myself', 'If only Johnny had been assigned to me, all that trouble wouldn't have happened'. Such thinking further isolates the burning-out person from the support of colleagues and requires the exhausted worker to expend even more energy.

It is not unusual for several members of a work group to burn out simultaneously. The staff support system begins to deteriorate and group collusion becomes a predominant feature of staff relationships. Staff meetings may become brief and/or be cancelled frequently for superficial reasons. Meetings which are held may be stereotyped and repetitive. Participants frequently express the feeling of having attended the same meeting before, perhaps even many times. On occasion staff and committee meetings may become preoccupied with numerous details and become very long yet unproductive. Worker interactions, both professional and social, are marked by urgent, compulsive, repetitive displays of feeling. Stories comparing hazards, noble feats in the face of danger, and bizarre or amusing client behaviour are told unendingly. Short term tension reduction and a personal sense of relief may result. All of these interchanges are characterized by a non-attentive attitude in which participants do not focus on client concerns or listen effectively to one another. Collusive relationships become dangerous when they substitute for genuine concern for colleagues.

Excessive stress is also likely to be manifested in physical symptoms. With almost startling regularity health problems begin or intensify during the burning-out process. No particular health problems have been identified as closely associated with the burn-out process in child care workers, probably because of their young average age. Workers are most often just aware of an increase in illness and medical contacts. Sometimes the problems are difficult to diagnose and seldom is there opportunity for discussion about the relationship between job-stress and health difficulties. An increase in accidents and injuries has also been speculated as well as an increase in the use of escape routes such as food, tobacco, alcohol, and other mood altering or tranquilizing drugs (Freudenberger, 1977; Maslach, 1976).

Stress resistance and recovery
The caring commitment makes many demands upon the energy and resources of group care workers. It is generally thought that many effective workers feel driven from the field in a state of exhaustion and confusion. Others become the exhausted, cynical, and apathetic 'walking wounded'. An increase in workers' capacity for stress resistance and recovery can preserve their freedom to sustain a caring commitment and/or to follow the directions of their personal development. Each person can imagine a special setting and wish to be magically transported. The proverbial south sea island with its white sand, gentle winds, and waving palms presents an idyllic relaxed image. But effective stress management depends rather on a thoughtful and disciplined process. With careful attention individual workers, professional groups, and agencies can develop practical and helpful plans.

An articulated level of personal awareness is essential for all interpersonal helping work (Freudenberger, 1977). Reflection can begin with a consideration of personal motives and needs in relation to caring work. Why am I doing this? What do I need from the work? What are my rewards? Vague notions and traditional cliches, such as 'I like children' or 'I just enjoy helping' do not constitute the results of a serious reflection. It is sometimes useful to think about particular clients and situations which have been especially rewarding or unpleasant. A meticulous detailed description will highlight important dimensions which affect the worker's practice.

It is also helpful to identify and perhaps even to describe in writing areas of particular competence. It may be that there is only limited external help available for this process in that supervisors and coworkers might not be sufficiently skilled in group care work to highlight competence. Even the professional literature is limited and often not widely known. The lack of clarity or misunderstanding about areas of personal competence serve to deprive workers of substantial and realistic experiences wherein self-esteem and professional effectiveness can be rewarded.

The structure and quality of personal life is a major factor in the ability to manage stress effectively. Patterns which once were useful may become detrimental as personal circumstances change. Some unproductive habits were probably established by accident. Group care workers are frequently tempted into junk food meals and irregular eating. The ever-present coffee pot, cups of tea, or soft drinks are invitations to excessive caffeine consumption. Appropriate amounts of sleep and general health care are also important but often neglected. Nutrition and sleep habits may require additional attention when live-in schedules, rotating shifts, and split shifts result in disrupting living patterns.

Rewarding personal activities need to be identified and planned for. Often the efforts of group care workers to establish a profession and participate in training intensifies this problem. During any serious professional training period the demands are such that personal interests are frequently set aside in order to fulfil training requirements. Also the excitement engendered in a beginning period of work can preoccupy the young practitioner. Thus during an intense period of training, professional activity, and enthusiastic work involvement, a worker's participation in rewarding personal activities may have been severely limited. In seeking to restore a balance between personal and professional activity, previous interests should be considered as well as explorations of new directions resulting from personal growth and maturation. Traditional hobbies are, of course, possibilities but developing new career interests, or writing a book might also be refreshing. The possibilities are limited only by the scope of imagination.

It is a common experience for workers to be preoccupied with work­related thinking and feelings and/or to feel continuing tension long after leaving the work site. Effective transition allows the worker to put aside job concerns and to engage more fully in personal life (Maslach, 1976). The process of worker transition has received little attention and perhaps is assumed, mistakenly, to occur automatically. Each person can identify his/her own style of transition but must recognize that the same procedure may not always be effective. Workers have shared the following: settling the concerns of the day by talking about them, a rigorous closure on work which avoids any discussion of it, changing clothes, physical exercise, shopping, being along, listening to music, playing a musical instrument, blocking work-related thinking by engaging in cognitive activities not related to work, having a drink in a social circumstance. The transition process is especially difficult for persons who end the work period at odd times such as early morning or late at night and those with rotating shift schedules (Kroes, 1977). Only by developing and maintaining effective transition patterns can the benefits of personal life make a full contribution to stress-management. This area cannot be too greatly emphasized.

Group care workers frequently feel exhausted by the end of their work period. It is difficult to muster the necessary energy and enthusiasm for the physical exercise which contributes to one's general state of health and frequently provides a sense of wellbeing. Thirty minutes of vigorous exercise three times a week is commonly suggested. It is important to keep in mind personal preferences, health concerns, and the reality of what is available. Resistance to regular physical activity can sometimes be seen in unrealistic planning and the expectation that it will be enjoyable. Particularly at the beginning there will be no perfect day and it will not 'feel right'. Many workers find that after the exercise habit is instituted, it becomes genuinely enjoyable and a highly valued period in the personal schedule. In addition it is helpful to develop personally compatible and practical relaxation techniques which can be used when needed. Various practices, if properly employed, can serve this function (Benson, 1976). Formal meditation techniques, prayer and other religious exercises, solitude, listening to music, and soaking in the tub have been suggested.

Vacation or holiday time, now almost universally available to child care workers, is an important asset to be used in behalf of personal refreshment and growth. Much has been written about the difficulties many persons have in using holiday time effectively. Again personal reflection and understanding are important. Some persons prefer short vacations to long ones. Some prefer high levels of planned recreational activity; others prefer a restful, more spontaneous pace. An effort should be exerted to understand personal style and needs and then to coordinate these with family and friends.

As was already discussed, rigid and inflexible attitudes, stereotypic thinking, perceptual rigidity, and diminished creativity are part of the stressful experience. Exercises and activities which employ imaginative thought will aid cognitive and perceptual flexibility. In this regard the arts, e.g. drama, music, and painting are well known. Small personal exercises can also be developed. For example, imagine that you can fly. What would it feel like? Cold? Hot? Windy? Would you fly on a carpet, in a personal carrier, or like Superman? Where would you go? Or imagine you have just become a millionaire. Each person can, no doubt, create various exercises of personal interest. It has also been suggested that participation in a pre-constructed phantasy in which the participant is successful is useful at stressful points in the work day. Standke (1979) presents the example of thinking about climbing a difficult hill during which obstacles are overcome. Perhaps in the future workers will take 'phantasy breaks' by withdrawing briefly to a quiet, comfortable area to develop a scene in imagination. This technique, while requiring further investigation, has the advantage of being usable in close proximity to the occupational stress.

In addition, imaginative exercises can be used by personal or professional groups and agencies to facilitate the creative exploration of problems and solutions. One such exercise suggests that participants have unlimited resources and can redesign their current agency or plan a new one. Participants are encouraged to share ideas as they occur without evaluating their practicality. Some notions are refreshingly phantastic: close the agency and buy everybody a family, fund research in self-esteem transplants, buy a politician, send the difficult kids to the moon, buy a plane and have seasonal programs in different parts of the world. This exercise (Kroes, 1977) helps to free participants from their everyday concerns. Among the absurd suggestions are usually embedded kernels of creative ideas which can then be used as a basis for a second stage of discussion which addresses the issues in a more realistic fashion.

Support from family, friends, colleagues, profession, agency, and community is an important contribution to workers' caring commitment. Since there are such widespread misconceptions of group care work, extra effort is required to give family and friends a more accurate under- standing. Perhaps a visit to the agency or a planned discussion will allow them to respond more effectively. A spirit of trust and generosity can develop in colleagueal relations. Group care workers should be available to associates with an attitude of willingness, confidentiality, and concern. Even though professional workers are clinically trained listeners, the telling of intriguing tales, attitudes of denial, or uncritical encouragement frequently predominate. Each worker has the right as well as the need to turn to colleagues and expect to be respectfully heard. Co-workers should be assisted in taking earned compensatory time, sick time, vacations, and other benefits without being made to feel guilty for abandoning clients and fellow workers. To be sure, inappropriate and unreliable workers appear in agencies from time to time. These persons require supervisory attention but should not be permitted to create a distrustful atmosphere. Off-duty time should be fiercely guarded. All workers are responsible for the protection of off-duty colleagues and should expect the same consideration in return. Participation in a profes­sional association can also provide the opportunity to develop support between colleagues, keep up with new ideas, create and sustain a professional identity, and influence agency and community perceptions of group care workers.

A well-managed agency contributes to stress-management (Ayres, 1977). Job descriptions should exist for all positions. Personnel policies including such items as benefits, grievance procedures, and general agency procedures should be available. In the past many agencies were quite lax about these. Pressure from funding agencies and a general concern with accountability have resulted in most agencies having such documents available. However, availability is only the first step. These documents need to be reviewed for their reality and implementation. Do job descriptions provide accurate guidelines so that agency and workers share a common and appropriate view of workers' duties? Can compensation time really be taken by the worker who has earned it? Can sick time be used when needed? Can vacations be planned in advance with a consideration of the needs of both clients and workers? Or are the specifications of these items mere papers written to satisfy regulating bodies but with little relationship to the realities of work?

Appropriate task related policies and procedures also facilitate stress-management by freeing the worker from unimportant or inefficient decision-making and coordinating complex agency enterprises. Creative energy is then available for matters which require it. Policies and proce­dures should be reviewed in this light and revised or eliminated if they are not facilitating. Workers frequently feel that direct care of clients as well as their information and insights are not valued by the agency. Participation m those aspects of agency and client planning that are rele­vant to direct care work can provide for an appreciation of the complex caring system, a sense that caring work is taken seriously, and give the agency the benefit of the workers' knowledge and creativity.

Scheduling is another issue which is critical for agencies and also has a major impact on the personal life of workers. Group care, particularly of residential clients, presents the difficult problem of planning for continuous attention to client needs. Work patterns seem, all too often, to be determined by administrative convenience and a wish not to be accused of unfairness. The resulting patterns frequently are unrelated to the needs of the client or the client care worker. For example, excessively long periods of on-duty time, such as ten days on and five days off, may be scheduled. In this case the worker may spend most of the off-duty period simply recovering from exhaustion and repairing personal relationships. Another destructive pattern, particularly when the duty is twenty-four hours, is four days on-duty and four days of off-duty. This does not allow for any consistency of specific days of the week off-duty. Thus the worker is effectively excluded from almost all organized activities, e.g. classes, choirs, and sports groups which usually meet on regular days of the week. The rotating shift may also create additional problems of disrupted personal schedule and physiology.

Scheduling also needs to provide for 'time-cuts' which allow a brief withdrawal from especially stressful situations. Time involved in direct client contact is related to the worker's level of stress (Maslach, 1976). Variation in work diminishes the impact of client contact and if well planned such variation can add novelty and challenge for the worker. For example, direct care work might be combined with planning in-service training, ordering supplies, or participating in other administrative or case management duties. Discussions of scheduling in group care work up to now have been simplistic and little has been done with flexi-time, compressed time, and job sharing which have been successfully enacted in other areas of employment including those responsible for continuous client care (Cohen and Gadon, 1978). Creative experimentation is badly needed.

Appropriate supervision provides an assessment of work including recognition of strengths, identification of weaknesses with assistance for their correction, and a supportive forum for expressing and dealing with the intense feelings which arise in group care work. It requires a supervisor who is clinically skilled in group care work and who has a balanced sensitivity for the client, the worker, and the agency. Regular effective supervision, encompassing all these factors, is rarely available on a regular basis. The supervisory process often must be initiated by the worker (Mattingly, 1977b; Nelson, 1978). The availability of supervision is also influenced by budget constraints. Workers, professional groups, and agencies all have potential influence in assuring that effective supervision is readily available to increasing numbers of group care workers.

Professional group care workers should also be engaged in a continuing effort to identify both new directions and unsatisfactory aspects of their practice. The inadequate preparation of some workers, changes in client population or alterations in services delivered will also result in the discovery of areas requiring training. For example, the reception of increasing numbers of aggressive clients may require the acquisition of appropriate management skills. Provision of services to adolescent parents may motivate the traditional youth worker to acquire informa­tion about parenting and early childhood. Unfortunately, much reflection and supervision may only serve to identify vague problematic areas yet fail to clearly specify learning needs so that appropriate information and training can be sought.

It is important to recognize that philosophical, ethical, legal, and theoretical information are also essential to effective group care practice and should be kept in mind when formulating study plans. Workers and/or agencies can then develop specific study plans. Individual workers frequently have professional study plans which are independent from the agency. This allows the plan to be tailored to personal style and interest as well as to focus on skills and knowledge relevant to future career plans. An effective study plan must be realistic in terms of the time and energy available. It needs to be concrete, embody the principles of effective educational design (VanderVen and Mattingly, 1979), and have a timetable including a termination point. This allows participants to experience the pleasure of completion and accomplishment. Some suggested formats are: reading, asking a skilled or knowledgeable worker to teach others, a small study group, an agency in-service program, the programs of professional associations, and educational institutions.

Group care worker associations can encourage training programs to include a range of clinical and indirect skills which will allow for reasonable flexibility in choosing the type of client and setting for work. In addition, professional associations can provide a forum for the discussion of occupational stress and encourage its inclusion in pre-service and in-service training. This will provide workers with an understanding of the stressful conditions they are likely to encounter and increase their ability to cope effectively (McLean, 1974).

Conclusion
Group child care workers, along with many other human service personnel, have made substantial progress in exploring the stressful nature of their work. The topic appears with increasing regularity in in­service training and the programs of professional associations. Agencies are sometimes willing to engage in self-review and to promote appropriate discussion. Individual workers, with or without agency support, can engage in effective personal planning. Thus both workers and agencies can move beyond the isolation, confusion, pain, and help­lessness which have all too frequently characterized the process of burning-out.

The somewhat dramatic images called forth by the term 'burn-out' can, however, contribute to its use as a vague term for dissatisfaction or frustration. The systematic study of occupational stress for care givers has only just begun. The experience has not yet been fully described. The situations which care givers find distressing have not been adequately identified. Only a little is known about the conditions which aggravate or attenuate the process. Effective long term workers, supervisors, and administrators have not been studied. Further specification of the stress and burn-out process will allow workers and agencies to plan more precisely. The result, hopefully, will be an increase in workers' effectiveness and satisfaction with substantial benefits accruing for children, youth, and families.

Notes

(1) Associate Professor in Child Development and Child Care, School of Health Related Professions, University of Pittsburgh, Pittsburgh, USA.

(2) Combat neurosis refers to the pattern of physiological and psychological symptoms which were originally identified in military casualties as resulting from exposure to the severe environmental pressures of combat.

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