Douglas Magnuson and Lauren Burger
Abstract: The inherent difficulties and discontents of the life of youth workers parallel the inherent difficulties and discontents of youth under their care; some of this discontent (although not all) is a consequence of frustrated or thwarted development “not just of youth but also of workers. A vital and central goal of the work is developmental, that is, aimed at promoting the ability of youth to think and act in more complex, reasoned, and principled ways. If we want workers to do this with youth, then their supervision must institute and illustrate the practices that lead to developmental growth: role-taking, reflection, balance between action and reflection, continuity of experience, and support and challenge. Developmental supervision aims to encourage the personal growth of workers and improvement in their practice competence, using these five components, by organizing the work setting so that there is a symmetry between the supervisor-worker relationship and the worker-youth relationship.
The role of child and youth care workers in residential settings is complex and can be conceptualized in a number of ways, as Mayer (1958) pointed out when he listed the job titles for these workers: cottage parents, houseparents, attendants, counsellors, educators, supervisors, child care workers, sociotherapists, therapeutic parents, and teaching parents. There is enough anecdotal evidence, and now enough research evidence, to indicate that the work has characteristics in common across conceptions, apart from the unique characteristics within any particular model, and these may have an influence on how staff support and supervision is perceived.
We propose here that some of these common characteristics have to do with human development. It is worth considering the meaning and implications of this for relationships between workers and youth and also for relationships between supervisors and workers. When we ignore developmental issues, we overlook the roots of many supervision problems.
First, few authors of instructional literature on
residential child and youth care take seriously the existential and
personal difficulties of direct-care work with children and youth; some
who do refer to problems as training and growth issues that can be
overcome, and others call these problems “role stress” or “burnout,” of
which the worker is a victim. One who did (Arieli,
1997) studied the production and management of occupational “discontents” by direct-care workers, finding that discontent is inherent to work with youth where
unqualified, stable acceptance and cooperation on the part of his or her charges can never be gained. Such feelings of discontent may hamper or even paralyze residential care workers” functioning and/or spur them to use means of coping whose purpose is to reduce the frustrating experience as much as possible. (p. 4)
Similarly, Maier (1987) refers to the “inherent strain” (p. 161) of the work, also described in a book called The Strains and Stresses on the Child Welfare Worker (Littner, cited in Maier, 1987). Barrett and McKelvey (1980) organ ized a list of the stressors that may result from or affect work with children. Thompson (1980) described the work as a “deviant role” because of the odd working hours, the unusual job tasks, and the low pay.
Another source of stress in residential programs is conflict with other professions. Arieli and Aviram (1987) describe the tension in a residential program between the schoolteachers and the counsellors, who resent the extra status and perceived reduced expectations of teachers, and who feel teachers do not know the students as well as they do. Moreover,
The most conspicuous role component in most of the performed staff roles is that of control. Members are preoccupied with controlling and being controlled. Madrichim, housemothers, teachers, and vocational instructors control students and are controlled by members of the senior staff. The different front-line workers “those who deal directly with the students “whose official role prescriptions include varied expressive and instrumental educational functions of a formative-developmental nature report that they are constrained to reduce their performance to largely organizational functions of a custodial nature. The residential school, some of whose structural features resemble those of a total institution, seems indeed to adopt control as a central theme in the staff-inmate relationships. Even the counselor is expected to deal primarily with those who are identified as deviant or troublesome, and hence assist in the process of control. (Arieli and Aviram, 1987, p. 85)
Third, in addition to the discontents and troubles of working with youth and frustration with other professions, some discontent has to do with supervision and management. Berridge (1998) found that “staff in local authority homes [e.g., group homes] typically expressed skepticism toward external management ... a feeling that management failed to take staff views into account” (p. 129). This is more than a management problem, because it is so widespread in the field of child and youth care work. It may have more to do with the nature of the role as described by Arieli. Berridge goes on to say that “the key stresses in residential work identified by Whittaker et al. (cited in Berridge,1998] included the sense of powerlessness that staff experienced regarding young people’s behavior, particularly where they were felt to be misplaced or there was an inappropriate mix of residents” (p. 133).
One contributor to these problems is that most
programs have an inadequate socialization process, and one’s sense of
self in the work is constantly threatened, as Dobbert and Pitman (1987)
have shown in studies of student teachers. They describe a period of “liminality” when the future is particularly ripe with possibility in a
new job, but the future is also at risk; when there are unclear rituals
of status passage into the “public life” of a new job, then it is easy
for workers to develop a sense of self that may be quite different than
what their supervisors think is occurring.
Some workers find that there is “no effective supervision. To them, supervisors lacked an understanding of what workers do, they were unavailable when needed, and they did not provide the support the workers needed to be effective” (Thompson, 1999, p. 55).
There is some evidence that one element of these problems is not related specifically to child and youth work, and that it is unlikely that these problems can be solved by worrying about the “effectiveness” of supervision or by the application of more resources. Like Arieli (1997), Hardy (1990) described an inherent discontent of organizational life: the “conflict between the formal structure of human organizations and the psychological needs of human individuals” (p. 146). This is at the root of many supervision problems in a wide variety of institutional types, and it is not unique to child and youth care work. In fact, much of the formative work on supervision and management, with much the same result, was in the business field. Argyris (1957) believed that this discontent and conflict was inherent to the way modern institutions are organized; we include child and youth care institutions.
Bleak comfort can be derived from understanding that if child and youth care workers are frustrated, changing occupations is not likely to help, since they will encounter the same problems. Still, we might consider how to improve the situation, not just to make workers happier, but to improve the quality of their work. Argyris (1957) argued that work life can be reorganized and that the personal development of workers was an important element of that reorganization. Similarly, we propose that the personal growth of workers is an important contributor to quality work, although it is not the only one, and we ought to consider how best to encourage it.
Objectives of supervision
Fant and Ross (1979) say that the objectives of supervision are to
–1) provide effective service to the client;
2) aid the staff in dealing with the emotional stress of the work;
3) ensure integration [of the many disciplines] of the service;
4) aid the organization in meeting its needs; and
5) help the supervised workers maintain a high level of practice competence” (p. 628).
This is an ambitious agenda, and we need to know what happens in supervision or what methods make up effective supervision.
There is a very small amount of literature on supervision in residential settings, and it is similar to the larger literature on child and youth care work, for which there are numerous publications telling the worker what he or she is supposed to accomplish with little guidance as to how to do it or what to do when there are problems. Most of the supervision literature extends that to the admonition that the supervisor’s job is to teach the worker how to do the job, begging the question as to the best way to do so.
We propose that the inherent difficulties and discontents of the life of a youth worker parallel the inherent difficulties and discontents of a youth under their care, and that that some of this discontent (although not all) is a consequence of frustrated or thwarted development “not just of youth but also of workers. There are other legitimate goals of work with youth in group settings, but we believe that a vital and central goal of the work is developmental, that is, aimed at promoting the ability of youth to think and act in more complex, reasoned, and principled ways. If we want workers to do this with youth, then their supervision must institute and illustrate the practices that lead to developmental growth: it must nurture workers” development.
This is easy to say, but it is rare, even with children and youth. For example, Levinson and Minty (1992) report that at the group home they studied,
It was hoped that ... it would be possible to pin-point developmental deficiencies and their related needs for special inputs. It was also hoped that by making repeated assessments some hard evidence would emerge of progress and of possible “blocks” which would need addressing in order to achieve further development. Unfortunately ... staff at the home, due to pressure of work, had only been able to make developmental assessments on a limited number of residents, and even these had not been repeated, with the consequence that it was impossible to try to suggest connections between specific additional therapeutic or educational inputs and specific changes in residents. (p. 142)
Supervisors also suffer from the same pressures. Just as these employees put off assessment of youth on the very issue “development “that is the ultimate goal of their work, supervisors find that it is easy to delay the activities with workers that lead to their growth. But it is important that these be done.
For an understanding of what developmental supervision means, we borrow from the work of Norm Sprinthall, Lois Thies-Sprinthall, and Alan Reiman, who have studied adolescent development (Sprinthall and Collins, 1995; Sprinthall, Sprinthall and Oja, 1998) and the development of students and of teachers (Reiman and Thies-Sprinthall,1998) in the tradition of Piaget, Kohlberg, and Dewey. They synthesize the meaning of these traditions for the pedagogy of education by proposing that there are five conditions of development growth that must be present in the practices of teachers and, for our purposes, supervisors of child and youth care workers.
Conditions of developmental growth
According to Reiman and Thies-Sprinthall (1998), there are five developmental practices and conditions supported by research in development psychology: role-taking, reflection, balance between action and reflection, continuity of experience, and support and challenge.
Role-taking, according to Reiman and Thies-Sprinthall (1998), involves “placing a person in a more complex helping role, [in which] the person would need to construct new thoughts and behaviors to meet the new task demands” (p. 72). For youth or adults, these role-taking experiences can be formal, such as service programs, mentoring, counselling, and peer helping, but they can also be found in friendship, on sports teams, in families, and in employment. In all, this growth results from experiencing the consequences of necessary reciprocity with others, both positive and negative, from the point of view of a new role.
The growth that results from role-taking experience involves the abilities to think about the needs and interests of others, to coordinate those needs with one’s own, and to master role expectations. The movement is from think ing about behaviour as either right or wrong to understanding the meaning of one’s behaviour to others.
Typically, direct-worker positions by definition include new roles, sometimes almost continuously, as the worker moves with the youth from activity to activity and in conversation from youth to youth or from individual youth to groups. But we can also conceive of role-taking as part of the workers” interpretative work with youth. First, youth often come to residential programs with a limited repertoire of role competencies and a limited self-identity. These role competencies and identities are usually negative, at least in relation to where the community wants and expects them to be. Direct-care workers invite youth to try out other social roles that expand their repertoire and, as a consequence, their self-identity. Within the program, these may include the roles of friend, peer-helper/tutor, worker, student, athlete, or artist. All of these become new ways of acting and thinking.
Second, workers aim to incorporate in their own work a wider repertoire of roles. In this they aim to move from a focus on the concrete task of teaching youth behaviours and skills, directing and controlling youth, and activity scheduling to the more negotiable roles in relationship to youth of consultant, friend, mediator, surrogate parent, guide, co-worker, co-learner, and so forth. Workers, especially novices, have to learn new ways of thinking about their relationships with youth, they have to give up the idea that being the youth worker means only directing and controlling behaviour, and they have to take the risk that on occasion it will not work. Corresponding to these, over time youth have to learn to accept adults in these varied roles, something they may not yet have seen.
Still, these will not make much of a difference unless they can make sense of their experience. The developmental principle of reflection is a necessary correlate of role-taking.
In educational pedagogy, the idea of reflection is historically connected to John Dewey (1963), who argued that experience without reflection can just as well be miseducative as educative. Moreover, new experience makes little impact on growth unless it is accompanied by an understanding of the meaning of that experience, and reflection is a tool for constructing meanings and learning how others make sense.
Reflection is practiced in open-ended dialogue and thought. It occurs in programs through informal conversation with peers and workers, through group discussion of recent events, through journal writing, systematic discussion, and readings.
The traditional practice of group work, which incorporated Deweyan pedagogy, included the practice of reflection, especially in the form of group discussion of past events and future plans (see Malekoff,1997).
Reflection between supervisors and workers is an ongoing conversation about the meaning of the work, about incidents “both successes and failures “and about tasks and competencies. Similarly, workers sustain an on going conversation with youth about the meaning of events in their lives, youth and adult actions, problems and successes, interpretation of the past, and planning for the future. This is so important that Jeffs and Smith (1999) believe that conversation is one of a small number of essential elements of youth work. To converse is an implicit reciprocity, by itself a kind of “meaning” and privilege, and to converse about meaning is to share with and expose one’s self, as Maier (1987), Garfat and Ricks (1995), and Fewster (1990) suggest. This is more than teaching. It has to do with sharing not only one’s beliefs but how one lives.
Balance between action and reflection
Cycles of action and reflection depend on each other for growth. These aspects need to be balanced to promote effective interplay and exchange (Reiman and Thies-Sprinthall, 1998). Freire maintained that “reflection by itself leads to pedanticism while action itself only leads to activism” (cited in Reiman and Thies-Sprinthall,1998, p. 14). This cycle encourages continuity of ideas over time. As new ideas and skills are introduced and learned, repeated reflection on their meaning transforms their meaning and significance. Over time, as the worker’s competency increases, his or her ability to think about work transforms the meaning derived from it. Both action and reflection are motivational, one inspiring the other.
An “action” is different than a behaviour, a task, or a skill. Action implies intention and purpose (Magnuson, Baizerman and Stringer, 2001). Behaviours, tasks, and skills can be evaluated for effectiveness, but actions are also evaluated and reflected about in relationship to their worth. Ultimately we want youth to choose worthy goals and to think of themselves as worthy in relationship to those goals.
Continuity of experience
Dewey’s (1963) principle of continuity has to do with the reality that growth takes time and requires consistent, repeated, coherent experience and new experiences that build on previous experiences. Occasional exposure or oneshot training experiences have almost no effect on workers; neither are they likely to affect youth.
Continuity has to do with relationships, activities, places, and values. The meaning of these is not acquired quickly; new ways of experiencing and perceiving them are achieved only with great effort and with frequent mistakes and miscues; success and failure have little meaning in discrete events, but over time one accumulates a pattern of events, actions, and interpretations of their meaning.
Continuity, in combination with reflection, makes it possible to understand how one’s understanding of experience is related to that of others, reducing isolation and egocentrism. For workers, there must be continuity of goals and purposes, of youth, of co-workers, and of clinical supervision in order to succeed. This is apparent, but many programs struggle with turnover of staff and youth, with changes in program goals, and with inconsistent supervision. Reiman and Thies-Sprinthall (1998) believe that it takes teachers six months to one year for significant growth to occur, assuming a consistent work environment and good supervision; the same is likely to be true for youth workers.
For new workers, Ross (1983) suggests that supervision may have a developmental dynamic, such that during the first few weeks problems are more likely to develop around the daily life of the work. Here it is important for there to be thorough training, and Ross describes one agency that decided to organize a support group for new employees that meets weekly. After six months, problems are more typically related to supervision and to the desire for more education and training, so Ross recommends increased training for supervisors during this period so that they are attentive to the worker.
Support and challenge
The fifth developmental principle is support and challenge. In Piaget’s terms, during the knowledge disturbance of assimilation and accommodation as a result of a challenge to how a person thinks, a person's affective (emotional) processes become fully engaged (Reiman and Thies-Sprinthall, 1998), in part because of the riskiness of change. Each individual learns at a different pace, and there must be a good “fit” between the person's characteristics and motivations and the amount of support and challenge they receive (Reiman and Thies-Sprinthall, 1998). Too much support leads to stasis, avoiding new experiences, and preserving the present emotional equilibrium. Too much challenge is overwhelming, too complex for the person's current stage of problem solving. Avoiding new experiences and preserving the present emotional equilibrium is the consequence. The person may simply withdraw into the safe, current stage of problem solving (Reiman and Thies-Sprinthall,1998). Too little challenge is dull.
Unlike formal schools, most youth work settings are fluid. Schedules have to respond to relationships and unexpected events. The interests and needs of youth and staff are negotiated. The “curriculum” varies from youth to youth and program to program. Some workers and programs respond to this with rigid program expectations around a specific issue, but a balance between structure and fluidity is a productive “not destructive “tension. For most staff, supervisors are required to find ways to reduce the challenge so that workers are not overwhelmed. Supervisors aim to help workers learn not just to respond to fluidity, but to initiate it, when appropriate, and to “live fully” in and through it for the benefit of youth. This is not a skill; it is an approach to work and to relationships that is a result of developmental ability. Supervisors nurture this through their own attentiveness to the same dynamic in supervision and by helping workers recognize the pedagogical and development opportunities in ordinary, daily events and “over time “challenging workers” present understanding of the purpose and meaning of the work by sharing and showing their own.
What is developmental supervision?
There is very little literature on supervision of workers in residential settings that describes what happens in supervision, and this literature, such as the work of Fant and Ross (1979), is best at describing the functions of supervision; there is little about the content of supervision or the aim of supervision. The aim of nurturing development is not widely accepted in education. In youth work, especially youth work in residential settings, it is similarly ignored or set aside. This is short-sighted, and it is costly to youth and to the workers who care for them.
Developmental supervision aims to encourage the personal growth of workers and improvement in their practice competence, using these five components, by organizing the work setting so that there is a symmetry between the supervisor-worker relationship and the worker-youth relationship. The five components serve as standards for whether the work setting and supervision activities do in fact serve their intended purpose.
Specifically, this kind of clinical supervision increases workers” ability to
(a) learn from their experience,
(b) think about divergent points of view,
(c) express their own feelings and empathize with the feelings of youth,
(d) manage conflict productively,
(e) choose appropriate goals for themselves, and
(f) build collaborative and voluntary relationships with youth.
These abilities are associated with “conceptual complexity” (Reiman and ThiesSprinthall,1998), principled reasoning, and a more differentiated, conscientious, and self-directed “self” or “ego.”
The practice of developmental supervision
Cogan (1973) described a “cycle of supervision” for teachers that has built into the structure a combination of reflection, goal setting, and analysis. We will use a portion of that cycle of supervision to illustrate some practical strategies.
1. Establishing the supervisor-worker
As should be apparent by now, a successful supervisor-worker relationship is vital to the worker’s growth, as is the worker-youth relationship. These relationships need to be characterized by mutuality, empathy, active listening, and discussion of feelings. In and through these, a habit of mutual reflection about the supervisor-worker relationship and their common experiences should precede conversations about and a focus on the worker’s performance. Typically, supervisors control these relationships by deflecting attention from themselves toward workers, but in order to be mutual, supervisors need to accept being held accountable by workers.
2. Gaining knowledge
Mordock (1993) says that “workers expect supervisors to actively help them avoid failure experiences, actively reinforce their positive behaviours, allow for self critique and recognize the worker’s anxieties about being supervised” (p. 238). These expectations, and the associated anxieties, can be alleviated by what Fant and Ross (1979) call on- and off-line supervision. On-line supervision is for skills that are best learned by demonstration and application. Its approach to learning is essentially inductive. Fant and Ross (1979) describe five components of on-line supervision: modelling, evaluation, anticipation, directing, and providing a tone for learning.
Modelling is the act of demonstrating skills with the worker present. Evaluation, in its informal sense, refers to the supervisor reviewing actions at the time of the intervention or in the context of a supervisory conference or, as noted by Mordock (1993), by supporting the worker’s own self-evaluation. Anticipation includes a proactive component of helping the worker think through a situation or intervention before it actually happens as well as the supervisor’s role in preparing the worker for upcoming challenges. “Directing refers to the supervisor’s carrying through with the worker an instance of practice” (Fant and Ross, 1979, p. 629) “working together. The fifth component, providing a tone for learning, involves giving the worker freedom to question or criticize the supervisors” interventions with the youth and allowing them to give suggestions.
3. Developing and implementing a coaching plan
Most residential youth programs rely on pre-service training to “jump start” new employees, and the average length of time for these programs is fairly short (Magnuson, Burger and Randall, 2000), especially if the goal of establishing effective relationships precedes and sustains the goal of acquiring the knowledge and competencies necessary to do the job.
Coaching plans are a way to integrate the experiential learning cycle and the associated components of reflection, support and challenge, and continuity into work life. An instructional coaching plan (Joyce and Showers, cited in Reiman and Thies-Sprinthall, 1998) has four components: exploration of theory and rationale, demonstration or modelling, practice with feedback, and adaptation and generalization.
The teaching-family model (Dowd, Herron, Hyland and Sterba,1998) has made outstanding use of this process, because it strategically teaches workers the skills they need before they have to use them, collects data on performance, and uses that data to help the worker rather than to criticize. There are other models specific to the youth work field, such as the AS*IF process described by Garfat and Newcomen (1992), which helps supervisors and worker think reflectively.
Instructional coaching plans build on each other to help workers see progress over a long period of time, and they help workers gain confidence that the supervisor wants to help them succeed.
4. Pre-observation conferences
These conferences are one element of “off-line” supervision (Fant and Ross, 1979), in which the supervisor prepares workers for observation by explaining what actions will be taken by the supervisor, making sure the worker understands what the supervisor is hoping to see, and discusses whatever anxieties the worker has. Studies of supervisory conferences in the teaching field usually find that they are almost entirely devoid of cognitive engagement, divergent thinking, and debate (Reiman and Thies-Sprinthall,1998). But this kind of freewheeling engagement is what we want workers to do. Workers do not grow in confidence and commitment by receiving instructions, following orders, and one-way communication. When this is the case, Dobbert and Pitman (1987) found that workers developed self-identities that conflict with their occupational identities. Engaging workers about their concerns and anxieties is a fine place to start.
Observations can be done in person by the supervisor, through video and audio, and by a neutral outsider. Each has its advantages and disadvantages, but it is most important that it be done in a routine, consistent way so that workers become comfortable, supervisors make it habit, and the data and information are available. Some programs have rigorous instruments for collecting data, but most do not. Johnson and Johnson (1996) have an outstanding resource for integrating continuous improvement methods into a program, including instructions for developing observation instruments and how to use the data.
6. Analyzing the worker-youth development
There are a number of conceptual tools to help organizations understand and theorize about the work within traditions, such as the psycho-educational, psychodynamic, or behaviourist. There are also a few good resources that transcend particular approaches. Redl (1966) ingeniously describes the existential challenges of youth work and proposes many helpful solutions. Maier (1987) uses developmental theory to describe the complex interactions between youth and workers.
In education, Kohlberg and Mayer’s (1972) analysis of the differences between romantic, cultural transmission, and developmental pedagogies illuminates the consequences for youth of our assumptions about them. Similarly, the ideas of teaching for understanding (Wiske,1998) and constructivist education (DeVries,1994) show how youth learning and growth is enhanced by teacher and worker commitment to building on how they construct meanings. In fact, the common element of all of these is their value in helping us understand the meaning of experience from the point of view of youth “individually and as a cohort.
Their construction of meaning reflects a consistent, coherent social environment over a long period of time; this is true of workers as well. It is the supervisor’s responsibility to understand and respond to the meaning of the work as experienced by the workers, not by the meaning and interpretation of the supervisor. That may be where we want workers to go, but getting there requires an intersection between our own and their meaning.
7. Conducting the post-observation conference
Unfortunately, most programs do not provide ongoing feedback to workers. This is crucial to the moral and political climate of the program, because it is important that the meaning of the data and information collected be shared with the worker, that it be used to build new goals, and that its meaning be open to discussion and interpretation in conversation with the worker. Specifically, we want to take seriously the worker’s typical and normal feelings of being analyzed, critiqued, and potentially misinterpreted. This is why observations should be routine, because when they are performed as part of occasional assessment, they are often misused and misinterpreted. As part of routine supervision, an accumulation of evidence helps workers and supervisors find a common interpretation. The ideal goal is that workers be able to collect data and think more analytically in self-assessment.
8. Renewed planning and new coaching plans
The instructional coaching processes, and the cycle of supervision, lead to the joint commitment of worker and supervisor to improving their work, the quality of their relationship, and the care of youth. As the process evolves, workers become more competent at choosing their own performance goals and targets and at eliciting the help of supervisors in bringing them about. It is here that most supervisors need to be reminded that they have a dual goal: to help the worker improve the quality of the work and to help improve the quality of their relationships with workers. Each is dependent on the other.
The five conditions for growth and development “a complex new role, guided reflection, a balance between the new role and reflection, support and challenge, and continuity “should motivate us to help define the roles of youth work in caring for children most effectively. The common objection to making these conditions a vital element of work is that in residential settings, we are blocked from realizing these goals by outside forces: reimbursement obstacles, the short tenure of staff and youth, low pay, unprepared staff, the pressures of day-to-day work, and so forth.
But some of these are a consequence of how we do our work. The day-to-day demands of our work are often a consequence of our priorities, not necessarily out of our control. Other elements, such as the increasingly short stays by youth in residential programs, are certainly a serious obstacle, although some programs have found creative and exciting ways to maintain relationships with youth before, during, and after their stay in a residential program. Also, in the U.S. there is much interest, although more interest than concrete action, in residential education as an option to residential treatment. This option assumes that by focusing first on development we can avoid the later need for remedial, expensive, and often stressful short- and long-term custodial care.
Finally, in response to some problems, the
profession of youth work will have to decide under what conditions we
are still willing to participate in the system, if our longer-term
developmental goals are thwarted. What kinds of “treatment” will we
support and what will we boycott? How long is long enough? When and how
do we work with families? In response to these, some policies and
practices are not morally and practically viable, and we should object
to those. These principles of development will help to distinguish
between them. These conditions of development help us define our
normative standards for the difference between good and poor work. They
also help us begin to interpret the intersections between youth work
traditions and developmental psychology.
The Milton Hershey Foundation provided funds for the literature review as part of a residential education staffing study.
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This feature: Magnuson, D. and Burger, L. (2002). Developmental supervision in residential care. Journal of Child and Youth Care, 15, 2. pp. 9-22.