SMOKING ANOTHER TRIGGER...CHILD AND YOUTH CARE IN SOUTH AFRICA

I have a thing about smoking. I met my late wife when she was 18 years old.and cigarette smoking heavily.... I still don't know at what age she started. Issue is that smoking cigarettes contributed to a lung condition which in the end proved fatal. Cigarette packs in South Africa have to carry warning notices, "Smoking is detrimental to health". or "Smoking is .addictive"...and others. Masses of research has found all of this to be true.

Then we came into child and youth care. Young people and even children were smoking cigarettes.

Trigger, Trigger Trigger !!

One of the boys of about 17 had a hole in his heart  Cardiologists refused to operate because he was smoking. "Come back when you have given up" and again "If you don't give up now you can only come back when you are 21 years old". ( The adult  permission thing !)

Many of the young people off the streets had been smoking since as young as 7. Some begging for smokes. Giving up the addiction was far from important for them. Seeing videos of lungs before, during and after tobacco inhalation didn't  scare them at all. They just said "So what". "Stop Smoking " organisations gave presentations, nicotine patches, loads of advice...no good came of that either. Education just didn't work at all. 

A "No Smoking Rule".. " This place is a "No Smoking Facility"  just didn't work. Eventually I had to admit that a rule which cannot be enforced demanded a change of approach. So I adopted the view ..instead of going around and smoking in apparent secret, let's get it all out in the open. Then at least we can see what we are dealing with here.

First step was to allocate a smoking area. The young people chose a tree in the grounds.  Some sat under the tree and others climbed into it. If it was cold or raining there was shelter under the fire escape stairs outside the main building. I called it the "Scientific Society" because they made smoke as I remembered we did in the Chemistry class at school. If I called a meeting of the "Scientific Society" they all knew what I meant. Don't get me wrong. I was not condoning, trivialising or normalising the smoking thing as a practice for young people and children. I was getting young people and children to be open, admit and talk about their smoking so that we could include the smoking thing in their IDP's 

My experience in that facility and the first step we took to address smoking was a lesson for me when visiting Child and Youth Care Centres where the only " Programme" for the reduction or elimination of smoking cigarettes was to have a no smoking rule. I remember particularly a Continuity Assurance visit to a Centre for Young people in trouble with the law in a township outside Pretoria. Smoking cigarettes was strictly prohibited. Any number of procedures were put into place to stop cigarettes entering the facility and to catch smoking offenders. These included body searches,  and locker searches. A child and youth care worker was placed at the door of the parent's visiting room throughout any visit to to watch that cigarettes were not handed over. Television monitoring everywhere. - but not in the 4 bed dormitories as that was regarded as an invasion of privacy.

When the team went there  the very first thing we noticed walking around the facility was the large number of cigarette butts outside the dorm windows. Prohibiting smoking and with child and youth care workers required to spend endless energy on policing the rule simply didn't work. My comment, "If what you are doing doesn't work, why carry on doing it?" You need to try another approach.

Eventually in my learning and in the facility I directed, we established only one rule. This was the non-negotiable. "No-one does harm to anyone or anything ". As smoking is harmful to "self". It had to be professionally developmentally addressed. Also, smoking often stood in the way of family preservation and re-unification. Also, some parents just couldn't and wouldn't tolerate it. The household rule was the prohibition rule of that Pretoria township facility. You smoke, you don't go home ! That was tough. But sometimes a reality. Relationship relied on a smoking thing. ...Trigger, Trigger Trigger !!

I got to understand that the "eliminate" smoking goal was a different priority from one young person to the next. In most cases, building or re=building relationships loomed bigger in developmental importance that many others, Smoking had to be dealt with as a reduction/ elimination goal. The big trigger of smoking just had to be recognised, then put into perspective and evaluated in its developmental importance in the young person's therapeutic priorities.

Most usually, The Individual or Family Development Plan       ( IDP/FDP) for the reduction and elimination of smoking became individualised and phased over an agreed period of time. A signed contract . In many instances the agreement meant that the child and youth care worker held the cigarettes. There were designated smoking times and cigarettes were carefully counted over the reduction period. Pocket money cannot be denied but in an agreed contract, it can and sometimes needed to be co-regulated until hopefully self-regulated. It all mainly had to do.I think with trust building
and an understanding by child and youth care worker that this was not an emotional issue. It is a genuine task driven plan to help the young person to be more coping, more appropriate and less harmful to self