ISSUE 63 APRIL 2004 BACK

practice

Discharged for the same reasons as admission?

Lesiba Molepo writes from South Africa

It is good to see that child and youth care workers are becoming more and more part of the admission team. This inclusion affirms the central role that child and youth care workers play in intervention work during the young person's period of stay in the programme.The inclusion not only confirms the status of the child and youth care worker as a professional but also gives the worker a perfect opportunity to understand more deeply the type of young person that he or she will be dealing with. The assumption here is that the reports presented by the outside referring agencies are a true reflection of the young person's situation and challenging behaviours - i.e. neither exaggerated to secure the placement nor understated due to fear that the placement will be turned downed. (Some organisations, of course, might use these reports as an excuse not to admit the young person.)

According to Brendtro, Brokenleg and Van Bockern (1990), trust develops over a period of time in three predictable stages. During the first few days, weeks or even months - the casing stage - the young person is likely to behave well to the extent that the child and youth care worker may doubt some of the information shared in the admission reports. As time goes on, the young person may start showing some worrying behaviour - the stage which is referred to as limit testing. This is the period when the worker needs to demonstrate not only his or her skills and knowledge but also an awareness of self. The worker needs to be aware that the way he or she makes meaning of things (interprets behaviour in this instance) may to some extent be part of who the worker is. McMahon and Ward (1998) warn that we may sometimes also bring to the situation feelings derived from our own personal experiences. They further suggest that we need to understand our own inner world as a child, adolescent and adult if we are to appreciate the world of a child with whom we are working. Therefore, the worker needs to be consciously asking the question: Which part of me is dominant in making these interpretations? Is it my own values or experiences? Finding an answer to these questions will hopefully help the worker to realise that not everything that is happening, such as the behaviour of the young person, is about that young person but may also about the worker or other aspects of the youngster’s environment.

Should the worker reach this level of introspection, the chances are that the young person will continue to be cared for. Through this process, hopefully the young person will reach the final stage of trust called predictability. By this we mean that the young person will know what to expect from the worker, and the worker will know what to expect from the young person. It is at this stage that the real intervention work can take place - even if it means the young person displays the “worst behaviour” ever imagined. This “worst behaviour” should not be viewed in isolation. Rather, the behaviour occurs within the context of what has been happening through the casing and limit testing stages during which we have "come to know each other," and it should also serve as a reminder of the reasons for admission. This behaviour needs to be seen as part of these themes, and our responsibility as practitioners should be to help them build new themes. Durrant (1993) noted that a new theme provides a different description of the situation, which gives it a different meaning and so counters the previous sense of hopelessness.

But not all of the adults in the organisation are able to easily move into this difficult stage of the work. Some may have the over-simplified expectation that in stages 1 and 2 the young person should have been "fixed" and can now behave "normally" and "positively“.

While our hearts go out to children who hurt, when their behaviour disturbs others, concern can be quickly replaced by blame. Such youngsters are given fault-finding labels like disruptive, disordered, and disturbed. The most seriously troubled kids are often treated as damaged goods to be discarded. (Brendtro, L & Du Toit, L, 2003)

The organization may now be challenged by the question should we discharge the young person as a result of his or her behaviour? And, if discharge is considered as an option, the question is who failed “the organisation or the young person?

My wish is that before any discharge can take place, child and youth care organisations will ask themselves whether they are not discharging young persons for the same reasons which were given for admission! My greatest wish is that someone in the team, preferably the child and youth care workers, if they are part of the discharge team (which I believe they should be “but I sense that child and youth care workers are likely to be wished away at this emotional stage), will speak on behalf of the young person and remind the other team members of why we admitted the youth in the first place.

References

Brendtro, K. L, Brokenleg, M., Van Bockern, S (1990): Reclaiming Youth at Risk: Our hope for the future, Bloomington, Indiana, National Educational Service

Brendtro, K. L, Du Toit, L, (2003): Response Ability Pathaways: Handbook on Reclaiming Children and Youth at Risk, Circle of Courage

Durrant, M. (1993): Residential treatment: a cooperative, competency based approach to therapy and program design. New York, London, W. W. Norton & Company

Ward, A, McMahon, L, (1998): Intuition is not enough: Matching Learning with Practice in Therapeutic Child Care, London and New York, Routledge

THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK (CYC-Net)
Registered Non-Profit and Public Benefit Organisation in the Republic of South Africa (031-323-NPO, PBO 930015296)

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