THE CONTINUUM: A STAFF CARE ISSUE.....CHILD AND YOUTH CARE WORK IN SOUTH AFRICA

 Last week's blog talked of our rights as child and youth care practitioners. compared to the rights of the children and young people we serve. It came to a point where it was said that we do have rights, but we  "hold off" so that we can professionally help young people from not tolerable,to more tolerable, and to positively tolerable  coping behaviours. The conclusion honed in on the responsibility of Managers in this dilemma.

Child and youth care workers do have rights. The therapeutic environment, is in  many instances, best serving the children and young persons by " holding off"  our insistence that they be upheld, especially in the criminal justice system. All this makes it more critical that Management safeguards and cares for their child and youth care staff. ....as staff and as human beings. 

It all brought me to the practice principle of "continuum of care".
Continuum of care is an essential principle against which the quality of our systems, facilities, child and youth care practice is assessed evaluated, measured.

What's good for the goose is good for the gander". If we must have a well considered system of a continuum of care for the children and young people, then there must surely be, equally, a continuum of care for staff.

Let's explore that. First the continuum of care as it applies to the young people in our care.

I visited a facility recently. It's programme is the rehabilitation of young people abusing or addicted to substances ( drugs).

For the first time in my life. For the first time ever, I stepped into a padded cell. It was situated in the detox unit in the medical section of the facility. On the door was the label, "isolation room" Inside the padded cell was nothing.nothing but padded walls and door with a small observation window.  I was convinced that the room and its environmental design was needed and in the best therapeutic interest of some very high young people in withdrawal. It had one on one eyeball to eyeball staff supervision.

I once slept two nights in a lock-up cell of a young person detainee at what was then called a "Place of Detention". It had a bolted down bed, a metal toilet and wash hand basin. Again a small observation window. I was locked in for the night. Unbolted in the morning. 

I've been in isolation rooms, mattress only.  Large observation windows. I can remember having to transport a severely psychiatrically disturbed 18 year old girl to such a facility. She really was a risk to herself and others and in need of chemical behaviour management until she could be stabilised. Staff stationed outside on immediate standby and call.

There have been times I have heard of young people placed in a facility when on admission it was essential that he/she be stripped of belt, shoelaces, anything which could be used for self harm

In South Africa the child and youth care system has a basic working structural, practice system. It is that placement must be made on the basis of assessment into the most appropriate "level"of care . It ranges from programmes which are the most restrictive, least empowering to programmes which are the most empowering, least restrictive. It is a continuum of care. As young people are helped to demonstrate various levels of trust and responsibility. As they are developmentally helped to move from having to be regulated to co-regulation with staff and then self-regulated and coping, so there are programmes which are designed to give the children and young people less restriction and more empowerment. 

The two facilities I directed were "open" facilities. Notwithstanding the nature of the young person's referral, there were no walls, no gates no lockups no isolation rooms. In a facility such as this, the staff and the individualised  programme and not the building "hold" the young person as the child and youth care workers support the young person developmentally through the transitions towards self-regulation, semi- independent living and then independent living in the community.

It's the child and youth care  practitioner's work to provide young people with the psycho-social, emotional wherewithal to move from one programme to another. The idea always was, since 1995, that young people be assessed, observed, placed, the be helped to move within a continuum. We were always told that if a young person "moved backwards", Then,"Look at yourself". "Look the system, not so much the young person". "You are not providing what the young person need to move form the more restrictive to the most empowering". 

In a continuum of care designed for children and young people,   Again, what is good for the goose ...........

In a continuum of care for young people we have to look at a continuum of care for the child and youth care practitioners. This is a Management responsibility. 

Let's start with staff/young person ratios. Way back in the 80's the Meyer Commission of Enquiry Report made well considered , realistic recommendations. The troubled child 1/4. Four child and youth care workers per child at all times!!!  In Germany, in one facility I visited, the ratio was 1/1 One worker for each child at all times.
Less problem ridden young people, The de Meyer Commission recommended 1/8 at all times. The most empowered young people 1/12. It has to do obviously with the level of supportive intervention and supervision the individual young person needs for safety, growth . 

This leaves Management with the same responsibility in the same way for staff. Not only safe, realistic staff ratios at all times, but also an efficient and effective back up and call system . This in almost any of the phases of the continuum, but especially in the most restrictive, least empowering programmes. In "those days"we used radio, push button messengers. Each child care worker wore one.... standard issue.I'm sure that in this digital age there must be simple call systems that can be installed/ carried.

Argument is that the multiplicity of different individual programmes and environments can't be provided in one facility. In the bigger thinking of the Draft Transformation of the South African Child and Youth Care System, the various levels of a continuum were set out. Careful planning and implementation for individual young people can make for quite a wide range of levels of programme in one facility. However the idea was that children and young people would "move"from detention-like facilities to less restrictive environments or less restrictive facilities if need be.

Whatever which way we do this, management responsibility is to give the same careful level of planning for child and youth care practitioner staff as is given to the young people's continuum. It is a human employment right. Let's think  also of the best interests of the child and youth care practitioner equally with the best interests of the child. The two are inextricably linked  One suffers, so does the other.