NUMBER 141 • 29 OCTOBER 2002 • LEVELS OF INTERVENTION
INDEX OF QUOTES
Child and youth care authorities around the world are agreed that any treatment action should be characterised by the principle of minimal intervention, also termed least-invasive intervention. Any therapeutic intervention should be “only as much as is necessary” and should take into account the client’s existing personal strengths, and his family and neighbourhood context and social support networks — within which he or she will in all probability have to continue to live.
An important principle is that we commit enough (time, energy, resources) to our treatment effort to make a difference, but not so much as to reduce the on-going responsibility of the client.
Child care services often face a dilemma in this regard. A child may be referred for residential care and treatment, and we accept the child into a program because this seems better than leaving him where he is. Perhaps because of the ‘residential’ emphasis of a program, we may consider that the food, shelter and basic care justifies our work, but we do not in fact succeed in making a difference with the problems for which the child was referred. Admission implies our ability to offer at least minimal adequate treatment. Organisations in this situation are challenged to make some serious choices:
Understand the accountability implied by accepting (or rejecting) the referral in the first place;
Where this may be appropriate, acknowledge (to the referring agency, the family and ourselves) that we do not really have all the skills or resources to tackle the presenting problems, and that treatment goals may have to be modified;
Recognise the continuing demand on us to continue developing our services — which may include widening our knowledge base, learning new skills and methods, and maintaining adequate staffing resources.
Not too much
Doing too much for a client can be as bad as doing too little. By refusing to admit a child whose needs we cannot meet, we may be sending him back into his own environment for a time where at least he continues to face the realities of his life. By over-protecting and/or reducing too much his responsibility for short-term daily tasks and longer-term developmental tasks, we may be weakening him and jeopardising his ability to function in his own environment. Unnecessarily long-term care and treatment militates against a youngster’s reintegration into his family and community.
A useful analogy is that of finding yourself swimming at the beach when a youngster near you gets into difficulties in the strong current. You have three choices in deciding the level at which you wish to help him:
Take his hand and draw him back to shallow water. When his feet touch the ground he will regain his confidence and will have learned a lot from a scary experience. Then leave him, go on, and enjoy your swim
Recognise his very specific learning need, and arrange to meet him at the swimming baths for a few afternoons over the next two or three weeks to teach him to swim. Then let him get on with his life .
Sweep him off to the penthouse suite at a posh hotel on the beachfront and keep him there in the lap of luxury for five years where he can be protected from the awful currents and dangers of the sea!
Intervention 1 happens spontaneously day by day in thousands of encounters between people, and even when individuals consult professionals. Intervention 2 is seen as the ideal model, certainly in our field of child and youth care, since it is short, purposeful, and leaves the child in touch with his own life. Intervention 3, exaggerated as it seems, is disturbingly near to many long-term and over-indulgent treatment placements.
Hoghughi’s Problem Profile Approach stresses the sequence of Management - Care - Assessment - Treatment (his so-called ‘MCAT’ model), and this powerfully illustrates the need for preserving the momentum of a client through a helping program, leading clearly to the ‘exit door’ when the identified treatment tasks are accomplished.
Gannon, B.C. (1994) Theories, approaches and principles of education and treatment. Pretoria: University of South Africa