Abstract: The utilization of everyday processes of living, from awakening to the last “good night,” occur while playing, working, learning, having fun, facing stress, or just being together. They are the child and youth care workers” central avenue of service. The following pages contain more than two dozen illustrative incidents of effective care practice in 16 different group care settings.
Much about care practice has yet to be learned; more of it, however, could be practiced. At the same time there is ample evidence that genuine developmental care work is being carried out throughout the North American continent. Nevertheless, numerous contemporary articles stress the need for urgent changes in our care practice (Beker & Eisikovits, 1991; Garfat, 1990; Josephison & Simm, 1994; Krueger, 1995; Maier, 1991; Wells, 1991), including the Task Force Report (pp. 1-10) in this issue. The following pages highlight a sample of desirable service models from our child and youth care service fields.
Most of these accounts describe nitty-gritty care interactions. In fact, the sophistication of care practice rests in the minute reciprocal interactions between workers and children (Maier, 1991). Genuine carework entails utilization of everyday happenings, creating regular joint interpersonal experiences for care recipients and their workers. The quality of these joint experiences is what distinguishes care work from other allied therapeutic approaches. These group care efforts are central regardless of whether they are experienced in a residential care, group care, or home supportive settings. Historically, the conscious utilization of everyday living in group, home or community life can be traced to the work of Redl and Wineman (1952), Mayer (1958), Burmeister (1960), Trieschman et al. (1969), and others. The basic focus upon everyday living experience is conceptually grounded. We need additionally to understand that developmental growth and change processes pertain as much to children and youth in group care as to those living ordinarily at home within their respective community.
From this brief conceptual explanation let’s move to descriptions of what actually does occur at some scenes of practice. Join me on a trip from the east to the west coast.
At far north-eastern Canada in New Brunswick, a 13-year-old fellow had just been returned by two burly policemen: scared, cold, hungry, and dejected from his two-day run. The group home worker not only promptly appeared but also shared his relief and pleasure over the boy’s return. He inquired what hot drink he could make for the boy as well as the policemen. He also wondered what would be inviting to eat before a good shower and a long sleep. The returnee (note: not runaway) asked whether his bed with his old pillow was still there for him. He was assured by the worker with the added comment, “As soon as you have caught up in sleep, let’s you and I fix up your room the way it will be more to your liking. And let’s explore with care staff what can be done to help you at this time to stay.”
What a relief to witness work that emphasizes a fresh start after a crisis rather than carrying over the failures associated with the running away. A “runaway” is dealt with as a “returnee.” And on a more profound level, the worker dealt with attachment developmental issues rather than widening the gulf between the youth and his immediate elders in his ongoing life. It should be pointed out that this program had changed from depriving returning “runaways” of their favorite belongings as well as implied degrading by taking away their shoes, which further detached them from the place and significant contacts.
A bit further south in Montreal, a discussion during a series of training sessions of groupcare supervisors focussed on how to strengthen care staff’s capabilities in utilizing daily routines and living experience for closer child-worker connections. One supervisor immediately observed that they themselves had to do it by supporting interactions of the careworkers. They then explored a shift in their own range of activities from that of crisis management (seeing themselves essentially as problem fixers) to one in which they themselves would take an alert interest in the workers' ongoing creativity in undertaking activities with the youngsters. Their new agenda would include how staff attends to the getting-up and going-to-bed periods, mealtime, and ever-present in-between moments. Besides appraising the place’s cleanliness, supervisors' inquiries, if necessary, would also provide suggestions and express concern for staff participation with the youngsters throughout the day. The supervisors' vision of their own work has shifted from that of wardens for a kind of control and order to a partnership with workers and children in search for better ways of living together.
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At a well-established residential treatment centre outside of Boston, care staff were asked to attend the campus school with specific children. This procedure was partially to serve as a means of control as well as for support. The practice confirmed that youngsters and workers found themselves better aware of the learning of the day and able to link it with experience in the living unit. Conceptually, learning had a better chance when actually absorbed in the presence of a potential attachment person. Or, in the succinct words of a three-year-old child: “Mom, stay here, so I can do it by myself” (Maier, 1987, p. 128).
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Several years ago at a New Jersey state institution for persons with severe learning delay and other complexities, care staff had worked with great zest in one unit to create with the children a manger scene out of sticks and scraps. This project had much meaning for the children, less for its religious symbol than as evidence of their individual accomplishments. A few days before Christmas the Christ child doll disappeared. No Sherlock Holmes vigilance could establish any trace of the babe or its abductor. One night after Christmas when all the boys were asleep the worker (the major staff architect for the manger scene) was ready to leave when William, 8, appeared out of his dormitory and took the worker by his hand to guide him solemnly to one of the toilets in the shower room. While flushing the toilet, he pointed to himself and then the toilet bowl, “I flushed down baby Jesus.” Before the worker could recover from his cultural shock, William confided to him, “I am your baby,” causing the worker spontaneously to pick him up, cuddling him on their way to tuck him into his bed. The worker’s spontaneous care interaction was confirmed when William threw his arms around his neck, and turned to sleep with a deep sigh. The worker gained his “high” by discovering that he had responded with the pertinent rather than the convoluted action.
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Time spent at a residential care and treatment program in Tampa, Florida revealed numerous critical incidents within the course of everyday group life. One of note was the simple but powerful practice of careworkers hanging around with the children in the dayroom or visiting with them in their personal bedrooms. At times when all seems to be in a rather even rhythm (Krueger, 1991, 1994), such moments become particularly opportune for careworkers' intervening with an invitation for a game together, a gentle exploration of festering issues, or just simply enjoying each other’s company.
What is so special about such seemingly idle practices? They are most relevant for fostering attachment development through joint re-assuring togetherness (Krueger, 1995; Maier, 1991) but unfortunately are rarely done within our treatment programs. Youngsters in care need even more the strength and input of their care providers at calm moments in addition to periods of stress. Workers are there to reinforce living experience, and there is a need to overcome a current tendency to isolate themselves at quiet times, only re-emerging to pronounce schedule demands or to deal with apparent turmoil.
At this particular institution one sees not only the care staff’s availability but also their genuine belief in themselves, buoyed by their supervisors' and administrator’s expressed policy that they are the primary persons for these youngsters in transition. Consequently, while standing in line at the food counter, passing each other on the spacious grounds, or sitting squeezed together on a trip in the centre’s van, workers deal with these casual contacts as vital moments for nourishing human connections. Staff is aware that their outreach has to be ever-present in order that the children and youth can make it reciprocal.
I will cite some telling illustrations. Three youngsters are quarrelling over whose turn it is to use the cottage bike, bringing all indoor and outdoor activities to a standstill. These squabbles, while very likely age-appropriate, could be limited for learning experience. Better that we offer wholesome positive, non-judgemental intervention. On that particular occasion the careworker at hand calmly stepped in: “Let’s throw fingers with one hand. The odd one has the first five minutes to spin around the campus, then the other two decide which way they want to raffle for their turns ... As soon as each one has had his turn, come in, because I need your help and suggestions for making cupcakes for evening snacks. You may want to start right now thinking what fancy kinds you will choose to make.”
This worker earlier won my attention by her unobtrusive presence in the dayroom. She sat there reading the newspaper, commenting on news items of possible interest to the early teenagers while also responding to their comments. There was no doubt she was present for all while relating intermittently to a few, although she was hardly the size of these residents with her weight surely under 100 pounds!
Another day at Tampa: it is hot, the girls and boys of the youngest school-age cottage play exuberantly around their outdoor water fountain and a gardenhose. A worker is standing in their midst watching their antics with an approving smile. Suddenly she jumped up with a scream as if bitten by a snake. A six-year old girl had doused her back with a cup of ice-cold water; a quick chase brought the offender into the worker’s embrace. Laughingly the worker explained her shock. The child had pulled a fast one! Their respect and linkage for each other were no doubt strengthened by this response.
Later after supper, with a cool breeze in the air, the same worker played tag with the youngsters and a few children of the neighboring unit. As a popular counsellor she stood out as the desired target for anyone who was “it.” (In tag, high-status persons are more likely to be chased than lower ones, considered less worth the effort.) Without any verbal input, the worker strategically placed herself near unchosen ones and cleverly escaped for the hunter to be contented with those who remaining at hand.
Workers' active participation in playing with the children or youth by joining their activities can be useful for mastering new skills. This approach opens many opportunities for mutual interactions and for directly influencing the flow of things. This reminds us of Andrew Malehoff’s (1994, p. 2) penetrating observation: “Whenever I am with a group of kids, in the midst of the swirl of noise and action, I try to imagine what is it ... all about? So often I hear the same two questions: “Am I ever going fit in?” “Am I ever going be any good at anything?” These worrisome queries have to find their wholesome answers in growth-oriented experience in the group.”
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An important hiatus in the daily routine is waiting for the next scheduled event of the day, a hallmark of institutional and groupcare life. Anticipating scheduled mealtime or the meal itself, being on hand with time to spare for the school bus or gym, waiting for an appointment, or waiting to draw on one’s own impetus to decide what to do: all these are opportunities for important carework. Perhaps these interludes are more important than the scheduling itself. How are these transitional times to be utilized? In a state institution in New Jersey, lining up 24 hungry or bored youngsters to answer or respond to the signal for proceeding to the dining room seemed less of a challenge when waiting was used as time-in for guessing games, making up riddles, or joke-telling. For a cottage at Calgary, hanging around and waiting became a special time for leafing through the ever-present pile of current newspapers, comic books, and attractive magazines. It was also a time to try one’s wit with an already started large puzzle. Workers' involvement had much to do with the pursuit of these interests. In short, waiting periods became a satisfying time for in-between moments.
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A residential treatment program outside of Cleveland is one prominently mentioned in the literature. The executive director, highly regarded for his emphasis upon “children first,” was confronted with the fact that he had an unusually gifted lead worker with a limited capacity for attending to the homemaking necessities of her unit. In order to enhance her direct work with the children he openly arranged extra maintenance assistance for her cottage.
What made this careworker almost irreplaceable? Her sensitive and creative caring can be illustrated by her bedtime work. I marveled at her tradition of a bedtime story as I sat at the stairway, listening in from the outside. The early elementary-school-aged boys and girls, each one with severe emotional stresses, in groupcare for approximately one and a half years, were sitting or lying in their pajamas around their careworker as she made up her continuous evening story about 12 small animals living together in the woods. Each one of these 12 paralleled one of the unit’s children with similar struggles in life management. I recall one evening that a resident was going to leave for home within a few days. Her story counterpart was also facing a similar dilemma. The animals had a lively discussion about the excitement of leaving and their feelings of envy and anger as well as their good wishes. The one to leave the woods revealed uncertainty about what home will be like, especially as it will be at a different location. Above all, the figure worried about “the new dad” her mother had for her. In the residence hall the children's intense attention and occasional inclusion in the dilemma was evidence that they were dealing with their own issues while soaking up the story.
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Further north in Toronto this writer had one of his “highs” while witnessing everyday carework in full operation. For most youngsters, bed-making, whether in their own home or away from home, tends to be an unwelcome chore. (“What is the use?” one hears, or “It’s getting messed up again at bedtime. Who cares!”) And for many workers it is likely a tiresome daily litany of perpetual reminders. At the Toronto treatment centre a nine-year-old girl and her worker were sitting on top of a double-decker, chatting amicably about favorite stuffed toys they had owned. Simultaneously, they tried together to straighten out the bedlinens and tuck in the ends of the blankets. Once done, they helped each other in their descent. Bed-making tends to be highly valued in most group life situations. However, the value of this routine is primarily stressed through careworkers' verbal admonishments or cajoling. Seldom can it be seen that workers themselves lend an active hand in order to share in this activity; to do so would bestow genuine value to this presumedly important routine.
Workers' direct involvement in the youngsters' lives as therapeutic workers in contrast to being merely their overseers was exemplified in their start of the day. For the children it wasn’t “getting-up time” but “meeting time.” Workers quietly announced their presence and welcomed the youth for the day. They varied in approach, suggesting that there were still a few minutes to stretch out, they were glad to be with them, mentioning what was immediately ahead of interest to the youngster (e.g., pancakes, a funny cartoon in the paper, a fallen stuffed animal personally returned, or a back rub). This kind of interventive style fosters relationships, however temporary they might have to be. Moreover, such attitudes and efforts counteract previous practices when waking and getting-up times were seen as a single event, often accompanied by an organizational reminder about certain chores or breakfast routine needing to be accomplished.
One cold winter, 12 early-teenage boys at the Lake Bluff, Illinois Children's Center had been confined to their unit for three days as a result of their joint, clearly anti-social, behaviour in the community. The indoor confinement was an administrative edict with the full consent of the unit’s carework staff. After a day it did not seem to bring about remorse or acknowledgement about their illegal deeds. Their temporary incarceration (time-out) overshadowed self-reflection and regret. They felt unfairly treated. Their anger focussed on the administrator and, to a lesser degree, on care staff on duty. The boys needed to experience that someone was on their side. With the the heavy new snow and the sun glittering, the careworkers realized that the youngsters needed a physical outlet, a temporary release for a few hours of outside activity. Once with them in the backyard, the workers thought that it might be fun to build an igloo or a big fortress out of the snow. Their ideas were rebuffed as “stupid” until one boy called out: “Let’s build the administrator’s grave!” Immediately, all hands were at work, rolling heavy snowballs for the walls and vigorously pounding the mausoleum walls. The construction of this six-foot-high tomb provided hard work in a unison never witnessed before. The two careworkers, of course, were full participants in the project. Interestingly, the same evening while the workers served cocoa around the fireplace, they were able to start to reflect with the boys on their recent neighbourhood delinquencies. Ordinary shared common life experience had proved a more ready path for looking back and appraising undesirable behaviours than accentuating difficulties via common “time-out” and removal from everyday life events.
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This emphasis upon facing difficulties in the course of living together rather than sending youngsters to isolation as “undesirable” is a practice in many out-of-the-home care programs. A different but parallel handling was observed in Springfield, Illinois at a school for children and young adults with physical and emotional complexities. A 20-year-old man with no vision and known for his boisterous aggressiveness to anyone in his way, hooked his arm into the careworker’s, demanding that he take him on a walk. For the first stretch the worker annotated their walk with the smells of flowers and bushes they passed as well as other sensual experiences, while encouraging his companion to also be actively aware as they walked. On the return trip the careworker invited the young man to share his impressions in order that they both could recognize how things seemed to strike him. Most important, the worker subsequently thanked him for sharing so effectively about ways to receive input. The worker had learned a lot! On this same theme, how often do we tell children how much they enrich our lives, including conveying our appreciation for following through on our requests and about the resulting satisfaction we feel as competent caregivers?
On occasion, intimate interpersonal experience occurs at the darndest moments. While with a group of boys at a local football game, the hometeam was about to even the score. Just as the potential touchdown run started, one boy huddled up, literally leaned on his worker’s arm, whispering confidentially: “I do not want to go home for Christmas!” The worker’s choice is to tune into this shared confidence or take in the exciting key play. The boy needed support for both his courage to introduce his anxiousness and for his personal dilemma. A rational response such as “Why don’t you ask your caseworker about this?” or “Let’s discuss it later” would have meant another defeat for the child at this point. His trust had to be immediately verified by a reassuring response and full attention by the staff member that the boy could count on this particular worker to see to it that his Christmas vacation plans received further exploration.
Previously described critical moments demonstrate that they fall primarily within the sphere of the careworkers. “They are coming from the center,” as Mark Krueger (1991) advocates, “they are where the youngsters are.” Workers are not only there; actually they need to reach out in order to convey unmistakably: “I am here for you!”
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At a well-established multi-service treatment program in Kansas City, careworkers anticipate the youngsters' return from school, a trip, or any other brief absence. Workers tend to await the returnees at the front steps or right inside their hall. They reach out and address them with a personal contact. Conceptually, workers are mobilizing impactful attachment outreach. Practically, one could hear them connecting with the youngsters: “Hi!” “Let’s share a high five!” “I have been thinking of you and school stuff all morning!” “Snacks are ready in the kitchen!” “Yes, it is something you like.” “I am sure I will be available.” “Let’s select a fun game for before supper.” “Oh, you look tired! Would a shower help?” “I am available if you want me.” These interactions are particularly remarkable for an absence of questions but rather individually tailored statements. Mostly questions such as “How was school today?” “Did you shoot a basket?” and so on are really general greetings with little expectations for reciprocal responses. Moreover, they seem to convey to the returnees that they have to perform with little criteria about what the adults really want of them. Actually, by flooding the youngsters with questions, we may convey that somehow we are not ready to involve ourselves, keeping them at arm’s length with generalized queries or small talk. In contrast, a statement like: “I am curious to know what happened in school for you!” implies a personal non-judgmental stance. Careworkers have to risk first and thereby imply their readiness for mutual linkage.
Most significant in the Kansas City examples is the workers' reaching out. In too many programs workers more likely can be spotted safely behind glass, occupied with bureaucratic impersonal tasks such as charting the “stock market” of their token economy, etc. with the expectation that the residents will come to them. Even worse, at some places communication occurs primarily via a loudspeaker system. Staff tends to emerge from their office when they spot trouble or have to announce structural or schedule changes.
In this connection, point and level systems are not necessarily of long-term value, as has been well portrayed by Karen VanderVen (in press) and in an actual practice experience in Cottage 5 at a program in Calgary, Alberta. Here, a well-thought-through regime of token economy was purposefully gradually replaced by a different response. Workers became intensely involved in the activities, thinking and affect aspects of the children's and youth’s daily lives. Residents (most of them with starkly inconsistent training and complex life histories) and their careworkers together faced the daily routines. Staff attended to everyday and unexpected life events. They were involved together in almost all activities such as playing and attending to school assignments and what had to be accomplished throughout the week. No doubt staff found themselves more taxed but also decisively more creatively challenged and committed to their work. Preoccupation with “quick fixes” (private correspondence with M. Krueger, 12 December 1994) gave way to the challenge of finding ways for impacting the children's and their families' lives for the years to come.
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At Devon, Pennsylvania in a program for youngsters with severe delay in their learning and physical capability, there was a particular point where everything seemed to be in turmoil. Residents appeared impatient and angry at each other with apparently nobody (or was it everybody?) in charge. In the midst of this confusion a stout, short careworker mounted a chair, commanding in a firm self-assured voice: “Wherever you are right now, sit down! Sit!” Momentary silence followed while she continued: “We’ll eat in 20 minutes. When you sniff the air, you will be able to guess what we are going to have to eat.... Yes, you are right.” A moment later: “I suddenly thought of this song.” She began to sing, gesturing others to join. Subsequently, she sat with the rest on the floor. A black child began to stroke her contrasting white arms. Later still her strong voice reached all as she explained that Judy had just discovered that skin colors are different. “They can be beautifully black like Judy’s, others brown, white or other shades,” introducing the idea that each person is different. She continued, asking the girls and boys to look into each others' eyes in order to discover differences in their eye coloring. A genuine exploration of diversity followed within the context of a minor but well-timed event. The children were so captivated by their mutual self-discoveries that the open dining room door remained unnoticed. The earlier mayhem wasn’t subdued with threats of “time-out” or other consequences, but with time-in for spontaneous valid experience in living together.
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At another mealtime down south in Dallas, Texas with roughly 15 young teenagers around the table, a fellow apparently accidentally knocked over his milk, dousing his plate and the table around him. Spontaneous ridiculing laughter suggested that this was a rather common event for this lengthy fellow, unaccustomed to the changing dimensions of his reach. A worker replaced the boy’s flooded plate with one with fresh food while another boy was thanked for sponging off the spilled milk puddles. With the damage repaired, including newly poured milk, one worker added casually, “Accidents do happen. What were we talking about before we were interrupted?” Most likely the boy was embarrassed over his awkwardness but felt buttressed by the supportive attention; hopefully he and the other youngsters experienced an underlying message: “Lots in life can happen which is instantly repairable.” The fellow’s sense of connectedness with peers and workers was a bit bolstered. This is quite in contrast to focusing on reprimands, or grimly expressing that the youngster has caused trouble when already he has had a life full of experiences as outcast.
At a “secure treatment center” with walls and locks so tight that it resembled a well-guarded prison, two careworkers on duty with over 30 teen-aged youngsters observed that during the preceding weeks the kids had regularly been following the TV program Jeopardy. Staff decided that it was time to break with this passive form of recreation. They introduced the idea that they could divide into two groups, each one to prepare their own Jeopardy program. Initially, the idea found a cold, hostile response. Fortunately, the workers had prepared sample items for such a home program in order to entice and challenge their interests and capacities. During my visit the youths were fully engaged, with apparent pleasure, in charting a series of answers and questions for their own game. Witnessing these presumably “rough” youngsters arguing with each other, challenging the workers' input, and essentially enjoying their differences in judgment illustrated again that much can be accomplished through playful activities. Rich interpersonal interactions between peers and their elders became the stage for some positive life experience.
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Finally we go out west to a treatment program shifting from a long-term treatment approach for roughly three years to one achieving similar changes in a nine-month period with the school-age youngsters and their respective families. For unknown reasons, new “macho” values had infiltrated the boys' aspirations. There was a sweeping preoccupation with being strong, agile, and on top of things in spheres which mattered to them. Careworkers connected with this craze by joining them in push-ups, in sweeping, or in vacuuming the floor in one continuous flow, and joined them in lively discussions about identifying body-building, healthy food items to be submitted to the dietician. Workers shifted from overseers and referees to coaches and partners in the boys' sphere of interest and behaviour.
Actually, this residential care and treatment program won much of my attention for the agency’s deliberate emphasis upon children and staff openly sharing their actual expectations of each other in their daily lives. After a time, the school-age and young teenage youngsters got the drift of risking to share feelings: hurts, anger and hopeful moments, sometimes with salutary commitments for the future, including their strong desire not to be with each other! Staff made an honest effort to explore what staff and children could do while their present lot required them to be together.
A behavioural study of this program would reveal that less energy was spent in chasing trouble and what went wrong. Instead we witnessed careworkers actively engaged or sometimes sitting around with the youngsters in the living room or personal rooms, exploring, playing, and expediting wholesome interests and conveying personal convictions that chores could conceivably be done in almost no time because there are so many more desirable plans ahead. Bedtime is not perceived as a time for achieving “lights out” but a time for private chats with the workers or just listening to their favorite piece of music, to admire once more a child's particular treasure or maybe to review the events of the day.
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Just this month (March 1995) after these years of visiting the frontlines of group care practice, a new awareness and insight dawned on me. I saw with amazement youngsters flocking to their dinner table in short but unregulated order. They started to eat the moment they were served; some served themselves. There was no expectation to begin together (neither a prayer nor a go-ahead signal). Those around the table, children and staff, passed the food readily to each other, many of them amicably engaged in conversation. Mealtime was noticeably without strain. It occurred to me that the usual practice of waiting for the first bite seems to be very much a middle-class practice. It may be our custom and symbol of courtesy but possibly outside of the repertoire and value expectation of many children and their culture. Thanks to this particular children's home for having alerted me to be aware about the implication of diverse backgrounds and meaningful expectations.
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After all this reminiscing and traversing, this continent in order to gain closer affiliation with the frontlines of care interactions over the years, I recalled that much of what I have tried to convey throughout these pages was so well summed up in the casual remark of my four-year old granddaughter Julia; an observation so plain and so on target for human beings anywhere. While getting ready for bed she commented, “Mommy, I know you love me. And you know that I love you lots; but I hope that you will always love me a little bit more than I love you!” This hope seems basic to human life. It certainly is the wish of children and youth in care.
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This feature: Maier, Henry W. (1995). Genuine Child Care Practice Across the North American Continent. Journal of Child and Youth Care, 10;2 11-22.