Reading clients' files?
My name is Ashley and I am a second year student in a Child and Youth Care Degree in Alberta, Canada. I have recently started my practicum at a Residential Treatment Center for youth who are of ages 12-18 that have had a history of sexually intrusive behaviors. I, along with some of the staff, have decided that I not read any of their files of offenses and previous behaviors until I build a relationship with these youth first. This was mostly a personal choice, as I didn't want my own bias affecting the treatment and counseling that I can help provide.
My question is, when/if ever is the appropriate time to read a clients past history of offenses? Do you think that by not reading them, It will hinder my success and ability to aid in their treatment? Any help, opinions, or related stories are welcome!
I would say if it essential to equip yourself with as much information as possible to enable you to best support the young people in your care. Hold in mind that the reports you read are based on opinions and perspectives- in some cases things may turn out more complex and young people may not be the same as their paperwork describes. However, you would not let a doctor operate on a patient to fix them without seeing their medical files so how can we possible expect to fix children without all the information?
I like the discussions going on but I am making an appeal that we be cautious about the language we use. I am against descriptions such as “fixing children”. We rather assist or support them in their growth and development.
I spent time working at a closed custody facility for male youth who have been charged or convicted of a crime under the YCJA. I chose to read the files immediately as how I conduct myself around the youth may change from working with a youth charged with petty theft compared to a youth convicted of murder. The key for me was there was no bias, I treated each youth with the same level of respect, commitment, and interest, but being aware of their capabilities better prepared me to manage specific situations with the individual youth. The important part is that you let your opinion or thoughts about the youth be determined by your direct interaction, not his or her history with others.
There are two perspectives on this. Some people feel that reading the files are critical and that the background information is needed to develop appropriate interventions, etc. Some believe that the background reports provide a biased view and is not needed.
I am of the opinion that background reports are not that useful – most of the time. So I advise practitioners (especially those working directly with children and youth) NOT to read the file unless they have to do so, or to wait as long as possible before they do so. I believe that with the high degree of labeling and “amateur diagnosing” that happens in the field, I prefer to formulate my own opinion based on my interactions with the young person. That also gives the child a chance to start over with someone who has no expectations, positive or negative, about him or her. Practitioners who may be working with the administrative side of things may have to read files and reports, and that is fine. I prefer to have a fresh perspective. I have just experienced far too many cases where reports about children were incorrect, inaccurate, biased or exaggerated – for many reasons. Sometimes reports are exaggerated in order to get a child admitted to care….. it’s bad but it happens.
So if you do have to read reports, I suggest you keep a VERY open mind about it and work hard not to be influenced by someone else’s opinion. Imagine if you as an adult have a “file” that goes with you in every new relationship you enter…. Sometimes we just need to start over.
Just my two cents….
What kind of relationship will you be building when overlooking a significant aspect of who they are? If they feel bad about having “offended” I would think they would feel worse when we decide this part of them is not something we want to get involved with when getting to know who they are. And if they don’t feel bad, we give them further permission to ignore this part of their life by ignoring it with them.
It’s interesting that childcare professionals don’t view themselves as having the discretion to filter information without tainting their view of a child, i.e. the information will de-humanize the child for them making them respond from a base of fear rather than empathy.
Hopefully all those who come into the child caring profession have a child’s best interest at heart and understand that they are working with human beings and not human doings(behavior).
I believe in the reading of files if you’re well-trained in or at least have a basic understanding of attachment theory, and the impact of developmental trauma. It would be helpful to know what the child’s strengths and interests are to tap into those for building relationships. If not well trained, I would recommend reviewing the file with someone who has the training and expertise to help make sense of how the youth’s past is affecting his/her current functioning, possible triggers, ways to make a connection with the child and ways that would be helpful in de-escalating the youth when they become overwhelmed with emotion.
We of course have to use our discretion to filter the information provided due to often times having inaccurate, insufficient or a biased report. Also the circumstances of the child has changed when they enter a safe environment where they don’t have to act out as significantly to have their needs met, although they will until they know they are going to be treated differently from the past. The information may help us determine does this child do better in group or individual activities, how do they respond to touch, are there textures, tastes, sounds that might be issues for them. If read for knowledge and understanding of ways to meet a child’s needs the information can be invaluable.
Knowledge is powerful when used appropriately, contrary to an old adage, what you don’t know can hurt you or at least limit your ability to effectively help a young person.
There are several brief videos on attachment by Dr. Dan Seigel and others free on you-tube as well as many excellent books. There are many articles, books, etc. on the impact of developmental trauma, some free materials at Child Trauma Academy: http://childtrauma.org/ Bruce D. Perry, Maia Szalavitz, The Boy Who Was Raised as a Dog, Karyn Purvis, The Connected Child, Beyond Consequences Institute, Beyond Consequences, Logic and Control - A Love-Based Approach to Helping Children with Severe Behaviors, Bessel Von Der Kolk – The Body Keeps the Score is an excellent read.
One other thought – becoming aware of the impact of your own early attachment issues, early childhood difficulties would be truly helpful in your own health and in your desire to help. Physician heal thyself is an accurate old adage and there are a lot of ‘wounded healers’ amongst us.
Just a few thoughts .
The age old dilemma. Might I suggest forming your own evaluations from onset?
If you are fortunate to personally know the author of previous reports, and you respect them, then I would think it carries more weight.
People are often misunderstood by quick armchair analysis, and that can create a bad foundational relationship, and one's reading could easily be misinterpreted.
One example is a young woman is wearing chipped nail polish and her
hair looks a disarray. Then it is noted she has low self esteem, and is
When in fact, she has no nail polish remover and she really just needs a proper hair cut and to learn how to create fashionable or appealing hairstyle.
Often workers case loads are too cumbersome to have the time to
actually engage a child and make a connection, or an accurate
With all that said, with time and true effort in place, and you feel you are not making any headway, then certainly, the chart notes could be useful.
Best of luck, and I hope this offers some insight.
From my experience in the US, case records are generally filled with a narrative of negative behavioral incidents. These are simply the observations of behavior that get the attention of social workers. Very seldom are positive incidents noted in the record. This is in part the result of “human nature,” in looking for problems to “fix,” and the accelerating trend of attempting to identify “mental illness,” which can be “treated” by private or governmental insurance. Given how case records are slanted, direct care staff without significant experience do not benefit from reading this material prior to admission or in the early stages of building a relationship. There is certainly no reason to not inform these inexperienced workers that because of the negative nature of the record this material will be shared at a later date.
On the larger concern of the necessity of labeling, pushing back against this trend by noting significant gains in educational achievement and/or self-management in the record can often result in the loss of payment, in effect “punishing” foster parents or child and youth care staff for their good work. While there is no simple answer to this dilemma, every program and every care team needs to have an ongoing discussion about how to manage this concern.
A nice way to consider this situation is to think about how you hope the other would act if you were the client. Would you hope they read your file first or would you hope they met with you first?
Here are my 2-cents: Reading official files can be a crucial part of care but don't allow yourself to define the individual by what has been reported by others.
I believe not reading client reports borders on criminal and negligent, making us less than professional. I know we all want to have a fresh opinion about a youth and that's great. Yes, there are the diagnoses (labels) which could be way off, and I've seen that. They are not that important. What is important and imperative is knowing the social history. We need some idea of what happened, which helps us, especially if a youth refuses to disclose true reasons that got him/her into residential. Most importantly, for example, if something was crucial in a social history report, like a no contact provision, with say a younger family sibling, because of a previous incest encounter or some other type of sexual aggressive behavior, and a youth care practitioner allowed the visitation to occur that would be horrendous. And if another incident did occur, who ever allowed this hypothetical situation to play out would be held totally accountable. Even if nothing happened, it's still poor professional practice – by putting everyone at risk. There could be so many other types of information in social reports that is crucial for the child care professional needing to know, such as if the youth had a peanut allergy that could set off anaphylaxis, etc.. If the information is wrong, the youth care professional can then go about trying to correct that - which further exemplifies the professional credibility of the child youth professional.
What's worse, the child/youth care profession, World Wide, is trying to promote itself as a true profession. We are not a step-child of the other helping professions (therapist, special education, nursing, case workers, etc.). I can only imagine what these other professionals would conger up if they even got wind of this type of discussion: "they cannot fully read or comprehend what is in the......., they are too lazy to.......... they're incapable of......, etc." This will set up systems of "we have to tell them.....because they don't.....". I believe that child/youth care professionals should not only be reading client files, they should be reading whatever else these other professions have written about a youth in care. This is called peer review, whereby all the professionals are critiquing everyone else, a very healthy child centered process. I have been in team meetings whereby a youth worker has found error with a report from the "other professionals" that had to be corrected. Sadly, in some few cases this was taken as a form of resentment, as in "how can they be telling us?... we are the professionals........" How bad is that? As professionals we all have to work together. This process only makes for a solid treatment team for the youth in care.
Finally, we should not allow inaccurate client files to make us biased. If we see firsthand the true nature of child in our relationships which is in conflict with a file, we should have the professional ability and strength to follow our true instincts and overcome this and not be afraid of what reading file will do to us. If the file is in error, it is in error for everyone, and not just the child/youth care worker. True professionals need to challenge inaccuracies and set the record straight if possible. Child/youth care professionals must be leaders, and nothing less.
Gene- Well written.
I have to agree with Gene – for safety reasons and everything else Gene mentioned. When I was ‘younger’, I thought you should have a ‘clean slate’ when dealing with a youth. Now not so much... The safety issues are too important- both for the child/youth and yourself. How I incorporated this knowledge in to practice was to know the ‘professional story’, then getting the ‘youth’s story’ from the youth themselves. After building a relationship, asking the youth- how they got “here”. The formal report may state that the child was “out of control and aggressive”. The youth’s story may be “I just asked them to leave me alone for a bit but they kept getting in my face. I just needed time alone but they wouldn’t listen.” Poor example, but I hope you get it. This is also a great way to put into context, advocate and understand and possibly put their perception in to the context of their lives.
Thank you Pati for your comment – safety is paramount. And to add your thread Pati – not all reports are bad or biased – most are on the mark.
As you mentioned: ......After building a relationship, asking the youth how they got “here” .........to follow up on that – when the professional CYC gets some semblance of what's going on, they are to write this information into reports going forward. Yes, good CYC's build good files. Never know how useful that documentation can be for the next setting for that youth. If I were emotionally or medically ill, I sure as heck would want that health professional to have and read all my records – and I would sign all releases for them to obtain such material. What is most scary to me is if some traumatized/depressed youth came into a program and reacts to certain stressors in harmful ways (such as self harm or even suicidal thinking) and no one knows about this. It would be imperative that this information be read and known. (I should preface that some agencies may have regulations that interns or temp staff may not need read files, but must always work side by side with a professional CYC – never alone.) Sorry to say, if individuals don't want to read records that contain such vital information for some ideological or philosophical reason – they should not be working in this field. Our jobs as CYC's are too responsible and critical for the youth in care.
Wow, it is the first time that my opinion has been called near criminal or as not being that of a “true” professional. What would other professionals think if they even got wind of this discussion? Well, I guess in some ways I am an “other professional” and I think it is a perfectly good discussion to have. As an “other professional” I can tell you that this discussion is not unique to the CYC field. Discussions like these are important and opinions are important, whether we always agree with them or not. Context is also important, and opinions come from different practice contexts, so keeping that in mind is also important. I stand by my opinion. I think it is important that someone on the team is fully informed as to the child’s past, but I don’t think it is necessary for everyone to know that. I don’t think anyone should be excluded from access to such information, but I don’t think someone who prefers to work without it is necessary wrong. I think everyone should work together, and I think different teams find different ways of working that works for them and for the children they care for. I think there is room for more than one way of working.
When you are a student in a new environment you are taking in a lot of new information. Everyone has been in this boat once. I personally feel that you will know yourself when it’s the right time. We let students take in the atmosphere, get to know the lads and staff first before reading the files. Maybe a few weeks. This is a good discussion. It could also become a good opportunity for learning...so one could ask the client and a discussion can create an opportunity to learn. Of cause discuss it with your mentor first and be supported in it.
I can see how this could be a super interesting community meeting – again depending on context, settings etc.
Just thoughts of another professional....
Everyone has a right to opinions and you do as well, and that is
good. I respect you for that. And Werner, I can’t agree with you more,
yes, we should have our discussions – and by all means our opinions and
context are all important. But it is my opinion that if a child in care
is harmed or injured because of our poor practice, which could have been
prevented, that is not acceptable, and I will always stand by that.
Agencies have been closed for such poor management practice, and
rightfully so. Society pays a great deal of money for us to care for
these vulnerable youth and we are responsible for them (maybe they
should even pay us more, but that is another matter).
As you most likely know, we are a 24 hour / 7 day per week/ 365 operation, with lots of things going on. Everybody on the team needs to know what is going on – not just some of us. I can’t see setting up a system whereby only some of the staff know the complete picture of the youth and others do not. Who would be the “do not know” staff – the evening crew – the weekend staff? Would we pay them less because they don’t know everything? For example, what if a child had a no telephone contact order from certain peers because of dealing in illegal activity, such as drugs – or even worse, a no visit order from a parent or relative because of past harmful events – and on a particular night or weekend this call was approved, or the non-approved visiting person arrived for a visit because the staff who didn’t know this vital information allowed all this to happen? I am sure the family would be upset, not to mention the funding agency, court and others involved with the youth’s placement. We are the professional care givers and should never allow this to happen. And who decides if a staff person doesn’t have to read all this vital information? The individual CYC professional? I know reading files can be tedious and boring, but it is part of the job. Yes, as you say, we should all be working together as a team. And the team should work enthusiastically, in team meetings, dissecting all the information in the case file, along with their current observations and opinions to create a greater picture. We should not be a step child of the other professions because we have less capable staff, or maybe I should say capable staff that decides not to be so capable. We are better than that.