Ernie Hilton has recently been involved in the process of overhauling existing programs and developing new programs for specific client groups in Nova Scotia. Brian Gannon talked with him about what we can all learn from his experience.
Work on new programs is always an opportunity for the field as a whole, because it signifies that someone is doing some thinking - about problems and solutions - and is making enough of a commitment to start moving some furniture around. That ripple of activity always creates energy. Tell us what you are doing.
The process started with a complete review of our existing programs, which included a collaborative approach with our department of child welfare to understand what they saw as present trends and needs of children in care in our specific region. After this needs assessment, we took the next step of philosophically rooting ourselves in a treatment approach that included a multi-disciplinary component to integrate effectively with child and youth care workers in residential settings.
Although our organization is about 25 years old, we have never seriously conceptualized and articulated our approach to working with youth and families. So far this has proven to be one of the most effective parts of the review process, as it has begun to create organizational clarity and accountability in all that we do.
Another essential component was the drafting and
adopting of our organizational code of conduct. Finally, we created
organizational themes that must show up in all we do. Our organization
seemed to have grown very large and very quickly, during which we had
several leadership shifts as well, so it had become essential for
significant role clarification, organizational flow charts, clear job
descriptions and other administrative policies and procedures to be
Redesigning existing programs always involves some strategies which are different from those needed in developing new projects. For example, of the seven programs that we operate, not one was built with consideration being given to the importance of the physical environment. Our realities, as no doubt for everyone, are the funding dollar and political will. Much depends on what the government of the day wants to buy. Recently our government has been facilitating the creation of a secure care program, and they're building it in consultation with professional child and youth care workers who are considering the impacts of the physical layout and design on family treatment.
As far as our therapeutic approach is concerned, we stick pretty close to the characteristics of the child and youth care approach which make for an effective program. In all of our seven programs we use a relationship-based approach to change. All child and youth care workers are identified as the treatment agents responsible for facilitating healthy experiences which provide the opportunity for lasting learning. Moreover, all programs are becoming more family focused and "systemically aware". We have identified that we are no longer just caregivers or caretakers, but are rather evolving into therapeutic interveners.
So in our organizational rethink, "team" has been very important to our organization. We believe strongly in understanding individual and group approaches to treatment from a team perspective, and also that an effective team has diversity in every aspect of that word, including academic, cultural and gender diversity, as well as representation of various professionals. We place significant emphasis on leadership competencies and accountability in relation to the effectiveness of the team. We also paid great attention to writings on the stages of phases of child and youth care workers' development by such people as Marcia Hills, Thom Garfat and Jack Phelan.
I hear you placing considerable emphasis on generic aspects of organizational and resource management independently of the kind of kids and problems you work with.
My experience is that child and youth care workers in the various categories of "new", "novice", "beginner", "first year", etc., tend to operate from their own frames of reference and personal contexts. While their own self-awareness may often still be rudimentary and while they may often be limited in terms of theory, knowledge and experience, a program expects them to be able to be effective in whatever intervention is appropriate in the moment. I therefore insist on clarity in areas like definitions, approach, mandates, systems, policies, procedures, codes of conduct, etc. This gives the new worker, maybe caught in a difficult situation at 2.00 am on a Saturday night, the guidelines and boundaries to operate safely and effectively - both with regard to the client and the new workerís own confidence. Effective leadership shows up in the beginning by shaping the structure and maintaining safe practice while not stunting the creativity and passion of the new worker.
It is essential for all who participate in programs to be heading in the same direction, however different their perceptions and skills may be. Discussing and agreeing on the themes that will characterize and pervade any program is an important "brick" to be laid. More senior workers will usually understand the global themes while new workers are more involved in the minute to minute experiences. Also, supervisors and managers may become more worried about things like funding and food budgets. This is often why the management and employee lines can start to go in different directions. New staff haven't taken the same "hits" as more senior staff. Seniors who are able to find congruence between their work lives and personal lives tend to stay committed and effective longer (I once read); newer workers can sometimes approach their work from a very ideological standpoint, which can be refreshing, but without integration with the realities can see the new worker becoming disillusioned and frustrated. The leader must be aware of all of these developmental aspects when growing a new program.
Work with families is another foundation I hear you laying. How hard is this in practice? Very often youth arrive in our programs only after extensive (and unsuccessful) work has already been done with families.
Staying committed to our mandate, recognizing the limitations of residential settings as being but one of the services within a wider continuum, and responsibly referring certain situations on to other service providers and professionals, are all ways of continuing to advocate for families, even if our own approach is not creating the desired outcome.
We often get such a short snippet of time in the lives of families that we might be setting ourselves up for failure, especially when our expectations are not realistic.
One of the characteristics or "themes" that I like in a program is about "Being where people live their lives," as Krueger (2000) wrote. For me that means if the family are not inspired around reunification, then their needs are going to be different and therefore our interventions must fit their present needs. If the families' "needs" shift then we will adjust our intervention plans. "Attending to the needs of others" is one of our organizational themes, not "Attending to my needs as a professional." (Ricks, 1992)
You are considering two "specialized" new programs. However desirable to focus on a specialization, are there not problems? How would you manage these?
In our region the "Review" identified two needs: a program specific to working with youth with addictions, and another for youth who are "runners" So we are working towards this since our Board, together with the Province of Nova Scotia, have accepted these goals.
Specialisation always has ups and downs. One problem is that needs and resources donít always match: we may develop a program focused on addictions and have two spare beds - but have a child and family with issues other than addiction, so we stay with two vacant beds? Another obstacle, of course, is that by the time we make the shift and develop a new program, the "trend" in our region may have changed!
However the benefits of such programs are great too. In a specialized program, staff are well trained in specific practice areas and know what to expect in the way of client behaviours and these no longer represent an unknown or a fear for the team.
Also, we are trying to be proactive in facing the difficulties. Linked with specialization is always the make-up of the rest of the continuum of services. My experience has taught me that when there are huge gaps in an effective treatment continuum then we must expect frustration at the political level, at the level of treatment effectiveness and at the level of the treatment agents (social workers, child and youth care workers, administrators, etc.
I believe that youth and families are the barometer for any region. If you have a continuum of healing that is full of holes, then you will be challenged by behaviours that reflect those gaps. Our response needs to be realistically balanced between the claims of healing and the claims of financial accountability. Outcomes will be shaped by how we achieve that. Lasting healing is expensive in the short term but the job gets done; penny-pinching can look good in the short term ("Look how many youth we have in this program or that program.") yet generally ends up being more costly as unhelped young people go out into their lives.
In the mean time, I believe it is realistic for us to develop programs in the areas of youth who run away and have addictions, as these are needs at this time. These are not "new" concepts in treatment.
What specific treatment approaches will you use with runners and with kids with addictions? How did you select these, where did your "buy" them?
Like you, I am of the child and youth care way. I believe that, as you have said, laying a foundation of a very competent child and youth care approach is the way I am most comfortable shaping programs. Our experience suggests that very often we find that kids, whether runners or kids with addictions, coming into a positive, rational and "hygienic" environment, will improve anyway and likely not need the specialist approach. Our way of being with children is unique. We interact with people where they live their lives - rather than focusing on one piece of their lives, on one of their behaviours. I don't believe that just getting someone off drugs is enough; nor that just getting someone to stop running is enough. Our work is more holistic, more systemic than meeting simplistic goals.
Nevertheless, we who work in residential settings do need to seek support by shifting our thinking into new areas. I will mention three:
One of these is consultation. Residential settings without clinical expertise is limiting. This is not to say that the child and youth care approach is not precise or well thought out in its interventions, but rather that clinical expertise in specialist areas is a necessary resource. We need to consciously integrate clinical knowledge and methods as a part of residential settings. There is no need for us to demonstrate our incompetence by failing to use other specialists.
Two, we must also change our thinking so that our services are not riveted to working with clients only in residential settings. Outreach, after care, preventative in-home crisis intervention, are all necessary. I have mentioned that our organization is presently shifting to a more family focused approach versus working just with the child. We have committees whose purpose is to ensure that the concept of "family" is present in all interventions and all interactions. Until we get this right, our theme of working "where they live their lives" will remain just a dream.
Three, I have already mentioned the need for an intact continuum. Care-givers must have the tools to keep children safe. If a child who is on cocaine, unable to stop on his/her own and residential settings can't keep her safe, then we need to look to our continuum and its effectiveness. What is standing in our way to not be able to service this child? There is some pressure for residential settings to work without secure care mandates, to be able to manage all situations. Realistically, this just isn't possible. I believe there needs to be a flow of connected services in our province, and secure care as a link to residential settings will prove very effective for our province.
All of this depends on people. We talked earlier about the tendency for experienced staff to move away from direct practice, and for front line and administration/finance to move apart. How do you reconcile these divergent themes?
Human resources make for a crucial leadership task. I think that I reconcile the divergent themes by recognizing them and accepting that they will always exist. If I accept that the stages of development of emergent practitioners are always in a state of change, then I can mange my reactions to that fact. Overnight, we can have the core staff of a facility make decisions to leave the program to go back to school, try other facilities, try other professions, etc. There is a reality that within six months, an effective program could lose the reason why it is effective - its staff. At the end of the day, leadership has to be brilliant at understanding the stages of developing teams, utilizing developmental plans for workers, understanding in your sleep about the effective frameworks of practice and the characteristics that create effective programs. It is possible that a "hurricane" can come straight through an effective system and collapse it and leadership needs to realize this and plan for the inevitable.
In addition to the leaders' attentiveness to new employees, we can integrate the effective and more senior workers as "advisors" for newer team members. We created a visual for the new worker of the focuses we work on. We did this so that we as leadership can pinpoint quickly where we need to invest and at what stage the worker is at and where we must intervene to create the clarity they need to evolve effectively - or they will regress or stand still and become frustrated.
The same work is needed between the program staff on the one hand and the managers and funders on the other. An effective strategy here is intentionally and proactively sharing the organizational vision with the funders and other group who need/want the service. Having others feel that they have ownership in the process I have found to be effective. We start by understanding the funders' and administrators' "needs" and accepting that often they are concerned about financial matters primarily over effective treatment concerns. Accepting that we can be righteous from a treatment standpoint as much as we want, but without funding we will find ourselves in a phone booth rather than a residential setting. We as leadership need to incorporate this financial perspective early on in the development of new leaders and new employees to avoid a collapse of perspectives.
References (all viewable on this web site)
Garfat, T. Developmental Stages of Child and Youth Care Workers: An Interactional Perspective CYC-ONLINE, January 2001
Krueger, M. Central Themes in Child and Youth Care CYC-ONLINE, January 2000
Phelan, J. Stages of Child and Youth Care Worker Development CYC-NET
Ricks, F. Without the Self There Is No Other CYC-ONLINE, April 2001
Hills, M. The Child and Youth Care Student as an Emerging Professional Practitioner CYC-NET
Ernie Hilton hails from Nova Scotia, Canada. After achieving an undergraduate degree in Sociology at Dalhouse University, Ernie has been a child and youth care worker since 1987. (He has only become reasonably effective since '94, after effective supervision). He has worked in residential settings providing services for youth and families, safe houses for juvenile prostitutes, assessment facilities, and other long term care facilities. He is presently the Coordinator of the Youth Care Approach responsible for helping shape the Relationship Based model used in six residential settings in Halifax and Dartmouth. His most precious sanctuary is his love of nature and all that it teaches him. He loves to bring a spiritual element to the work.