TEAMWORK ...CHILD AND YOUTH CARE IN SOUTH AFRICA

The soccer coach was a teacher at the school. Playing for the under 13 team he positioned me as 'centre half,  Every match - "centre half". One day we passed in a passage. "Why do you always put me at centre half? Why not centre forward?" "Because", he said "you don't have a strong enough kick to score goals. It's your job to pass the ball to him". 

It was an aha moment. In my head I said "Why didn't you tell me before?" I had always thought that if you played soccer, the idea was to score goals. Right?...and this was always my game plan.

I could dribble well, but not kick powerfully. It was a lesson for life. In some situations... I had to pass the ball.

 A comment was made on my blog on child and youth care work in private practice. More or less - "Child and youth care workers may find it difficult to work in private practice. They work in teams and in private practice you work on your own"

We are team workers. It has to do with what we do in practice with the children and young people in our programmes... develop potential from strengths. We set goals and tasks with them based on their strengths.

As for them, so for us.

There are very good programmes available designed for adults and for children and young people to identify their individual gifts and strengths and to build up an individual strengths profile. This seems to be the starting point.  "What are my strengths and gifts?" ( I can dribble but I'm not a very  powerful kicker). 
The Dependable Strengths Institute (Seattle, USA) has a really good programme on dependable strengths. There are equally good programmes for the identification of strengths for children and young people.

Self awareness, self honesty, the opinion and observations of colleagues, friends and family, a recollection of what you have done well and felt good doing... these all help when building up a professional strengths practice profile.

There's a teamwork exercise which seems helpful in gaining insights into 'team',... how and what we each contribute. It's called, Build a Tower with Drinking Straws and Pins. The exercise is for a random group of 5 child and youth care workers to be given drinking straws and pins. They are told to build a tower of straws, use the pins tor attach the straws The team with highest unassisted standing tower after a fairly short set time period, wins. They will get a small prize each. "Go!". Usually some towers are sturdy, but short. Others, tall but cant stand unassisted. Some stand for a fraction of time then fall. Discussion follows  "What did the winning team do to make it work? Who did what  ? What did they, we observe about their working together. What happened in your team?"

What I learnt from this exercise is that the team of 5 who spent at least a few minutes before starting on the tower to discuss  who would do what and to plan a basic structure, a foundation, a plan to get hight and strength - these teams invariably did the best or won the chocolate bars. They did encourage each other as the went along .

It had to do with a child and youth care worker volunteering to undertake a particular role and tasks, agreed leadership    ( the visionary), agreed organizer, agreed manager, agreed resource provider, Agreement. They did make suggestions to each other as they went along. One usually volunteered to be a time-keeper. They did give mutual support during the exercise. As a team they achieved more than any one could achieve as an individual.as they recognised each other's strengths.("You're meant to pass the ball to him. He will kick at goal").

"OK, Time's up. Hands off "... they collapsed or could stand only a while.  Competing leadership, taking an unexpected individual initiative almost impulsively to get hight and without team agreement... collapse !,    

It gets more complicated for us because we practice in teams as child and youth care workers, then we work also in multi-disciplinary teams. We, child, young person, social workers, teachers, psychologists, health workers, parents, significant others, sometimes religious leaders, psychometrists, domestic workers, local shopkeeper, neighbour - each with different approaches and expectations, philosophy and  methodology. 

That pre-straw and pin discussion becomes now a critical sharing, each to declare, understand and respect the others role in unity and synergy for the sake of the child or young person.  ( Coach !..Why didn't you tell me before?)

She was of biggish build, not doing that well at school in a class for those who struggle. A psychometrist's  test results showed that she should be fine for employment in a trade.  She had a leaning toward hairdressing and catering. Teacher and principal of the school were sure that she would be retained for at least a further year before ready to enter the secondary occupation and trade school. They had evidence of this based on her school performance in Language and Mathematics. Child and youth care workers reported her strengths and style of relationship building and her resilience. The psychologist added a personality assessment which included a professional psychological opinion on the effect of a further year in the primary school. The social worker gave a comprehensive socio-gram with the quality of her connectedness  and support systems. 

Staying at school for another year was regarded by all including, of course, the young person that staying at primary school for another year was not in her best interest nor her best way forward.

In my position of Director, I asked for an appointment with the Chief Inspector of Education in the city.  On the strength of the evidence of the multi=disciplinary team he granted a year of constructive delay. This was,I believe a first in the country. The social worker arranged that she work at the local hairdresser as an assistant and at the Home for the Elderly as an assistant in the kitchen. The teacher and the principal agreed to give her a time-table to attend classes in Language and Mathematics only until she went to the secondary occupation and trade school.

The multi-disciplinary tower of straws and pins was high and strong. It stood.

This young person is now of middle age, regarded as one of the best hairdressers in the city, sought after and has her own business.

Teamwork build towers. 

Lives: tall and sturdy.  
      





















   

BARGING-IN...CHILD AND YOUTH CARE IN SOUTH AFRICA

It was an early Saturday morning role call required before  boys with weekend leave of absence were allowed off the facility. The six units formed up in groups on the forecourt. Any general announcements were made. The allocated boy took the unit role call and answered "All present and correct"  or the names of those AWOL (absent without leave). 

There was a lot of chatter among the 25 boys in a particular house. 

The formalities ended  with the usual "Enjoy your weekend... Dismiss!"

At that, the whole of that house ran full tilt to another house close by. The large double door was closed and locked from the inside. They gathered in front of the door loudly threatening to break it down to get entry. I got myself there, my back against the door. "OK, guys what's going on. Someone please explain". 

 The story was, they alleged, a boy from that house had stolen one of the other boy's leather jacket and locked himself in the house for safety and protection. They were determined to get in, get him, beat him up and recover the jacket.  

"OK, let's talk. We can sort this out. There are other ways of doing this". The threats continued. "OK, let three of you come and talk........ The sentence went unfinished. A very large male child and youth care worker, an ex security officer, "barged in" in front of me. He stood firmly between me, my back still against the door, and the boys, covering me altogether. "Get to your house" he shouted loudly. "Get to your house". "Get to your house". They slowly dispersed mumbling ,grumbling, gesticulating, angry.

"I was handling this".
"You needed protection".
"If I needed you I would have called you". 

I had not felt the need to be physically protected at that moment. I thought that "negotiation" and problem solving as well as group de-escalation was underway. 

Privately. "Please don't do that again. You can ask if I need help. If I needed you I would have said". 

The intention, I think was probably good. The display of power above my authority and my professionality left me feeling, undermined and disempowered.

I called this "barging-in",

He was 14 years old, highly intelligent, articulate, trying to find himself a direction for his life ahead. It was especially difficult for him as at age 14 he could not read. He was held back at school to be in a grade with children of his reading age. Being a fairly tall boy. he was noticeably out of place which made his situation even worse.

 I cannot remember how this started. It seemed to come out of nowhere. We were sitting side by side on the couch watching a movie in the TV room. Just him and I in the TV lounge. Maybe something in the movie triggered it. He stood up and faced me. I remained seated. "What do you know about us teenagers? You know nothing. You just do this because you get paid. Do you think that you understand us?......

The person who walked into the lounge at this point had been in child and youth care settings longer than I. and... hello... repeat 'barging-in' story. ..She stopped, stood between the 'on the couch' me and the boy. "Don't you talk to the Director like that! You can't talk to the Director like that ".  

He went into the dormitory.

"He was just being a teenager" says I. "He has to do that. I was dealing with it".
"He can't talk to you like that". .. Walks out.

Privately. Same conversation as with the ex security officer child and youth care worker. Power based 'barging -in' making me look professionally ineffective.

The pulling of rank or length of service, the status of the child and youth care worker...auxiliary level or relief worker, does not justify 'barging in' . It's just not professional teamwork

When, in South Africa Child and Youth Care became a recognised, registered profession, we had for the first time a code of ethics and a code of conduct. I thought that this 'barging-in' thing was Supersession. The as yet, uncirculated Policy Guidelines for Child and Youth Care Workers Reggarding Profeaaional Ethics and Behaviour  South African Council for Social Service Professions (SACSSP)  defines Supersession.

C6 Supersession and Delegation
In cases where a child/ family is already in receipt of child and youth care services, it would be regarded as Supersession if another child and youth care worker assumed services in that instance.

Sounds as if my 'barging-n'thing could be interpreted within this definition. I was told that in practice it is not. It is in the instances as set out in the Guidelines of where Supersession is permitted that it becomes somewhat clear that Supersession has to do with "taking over a case without multi-disciplinary team agreement or in the unencouraged absence of the allocated child and youth care worker.

In whatever way the definition is interpreted, I'm convinced that 'barging-in' behaviour is unethical.

The SACSSP Act of 110 of 1978 with amendments and the regulations contains the code of conduct and ethics for child and youth care workers. In looking at Behaviour Towards Clients and other Professional Persons. 

Again a direct quote
6(2) The casting of reflection directly or indirectly upon the probity, professional reputation, skill, competence, knowledge of a colleague or of such other person.

Seems to me that 'barging-in' would be a breach of professional child and youth care worker ethical practice. It's not team-work and must not in any way be interpreted as such. 

    

REHEARSAL...CHILD AND YOUTH CARE IN SOUTH AFRICA

It was one of those fairly frequent calls. Dusk and darkening. "Please come and fetch me"  My 'weekend off' had taken a typical turn.

Story was...(I don't know what led up to it)... Mother chased her out saying "Get out. Get back to the Home. ... You're a slut". Daughter's retaliation, "At least I can get it! You can't even get layed"...Deep hurt, pain and degradation. The big put down. 

Critical Incident. What now? The risk? No hope of reconciliation. Permanent no speak. Separation mother and daughter for ever!

What then? Time to breath, time to recover. Not to repress the anger and hurt. Just to gather the courage to, and the wish, to talk. Time to prepare for rationality and possibly the healing between mother and daughter.

In the mind of the child and youth care worker circle the words  " Restorative Justice, Role Play, Role Reversal,  Repetition, What-if?, Confrontation, Carefrontation." 

There will no doubt be some discussion on 'role' at this point. The 'who is to do what' discussion. In South Africa, apart from the child and youth care worker's required practice to be an equal professional member of the multi-disciplinary team (MTD), there is a move toward the Integrated Case Management  (ICM) approach. It means that case management itself is a shared responsibility. In any case, the child and youth care worker cannot but be included in the process that follows an incident like this. 

In the book A Child and Youth Care Approach to Working with Families edited by Thom Garfat (2004) a case is made  for child and youth care workers to have a particular role in the reclaiming of family . In the Introduction (p1) is quoted Carl Carstens ".....When the child comes into  care, the family comes with it. ...By such means reconstructive and recreational work becomes possible, the child does not stay away from her family any longer than is necessary, and there is ample time for her adjustment and follow-up". (italics mine) 

Following the MTD and ICM models, the child and youth care worker and the social worker will visit the mother in her home ...her life-space,.. for a life-space interview (LSI). Child and youth care workers are especially trained to conduct a LSI. It explores the moment by moment detail of the incident and explores possible ways forward. The social worker will explore  the family system and the broader social systems, their impact on life as it is for mother and so for the daughter. There may well be work to be done in the social macrocosm. Child and youth care workers tend to focus on the incident and seeks understanding of its effect on the mother and the daughter. Both work toward "What can and needs to be done now?" Hopefully, through something like the Bronfenbrenner Biocological Model of Development , or some other shared model will provide guidelines for tasks for holistic,    ecological , relational family reclaiming.

Ideally, an agreement is reached to hold a family meeting in the safety of a multi-disciplinary team, all of which is explained. A neutral venue may be chosen if needed.

 Back in the facility the child and youth care worker leads the LSI process with the young person.

Once both parties agree, there is a period of preparation, for what is hoped will be a process of carefrontation rather than confrontation. Carefrontation: "I care too much about you not to tell you that , when you ................... and want change to make it come right".  Carefrontation is, dare I say, ...'love.

This is where rehearsal comes in.

I'll focus on the child and youth care role with the young person. Support to the mother will be provided by the social worker.  The child and youth care worker encourages the young person to explain the  physical arrangement. Where it will happen, who will sit next to whom, who in the MTD supports whom. Then the child and youth care worker explains carefully the purpose of the family meeting and his/her role as the primary care worker.... the child and youth care worker. Things like advocacy, emotional support and if need be, with permission, the occasion to speak what the young person may ask to be said for her.

Now the real rehearsals begin.

"OK, let's pretend we are at the family meeting. Your mother is sitting there, you here and I next to you. Your mother speaks first.The chairperson will ask her to say what happened from the very start of everything until you said what you said and went to the neighbour's house. If mom find it difficult to say the social worker might help her or say it for her. 

 Now its your turn. You have already told me , but pretend you are at the family meeting. What will you say...tell your story, and let me hear."

 The young person relates the details of the incident. She may need help to get things in the right order or issues of time perception, and to express her feelings at each stage of the incident 

"OK< now mom will say what she would like to happen and what would have to change 

Now it's your turn. Say how would you would like things to be after the meeting and what has to change ... even things that you and your mom have to change. If you both want the same things that's good. If not, we will all talk more to try to find agreement.

Tell me, just like you will say to your mother, or to the meeting, what you are prepared to do to make change yourself . Are you prepared to say sorry for anything? Tell me what you will say?

 Oh, oh, it looks like some changes need to be made by you, and some by mom.. Now we will talk about who will do what, who will help who do what and set aims and set agreed times by which we will do them. It's called a FDP...Family Development Plan.

What do you think mom should do or be helped to happen?" Lets practice what you will say to her.

"Now what do you think your mother will say that you need to to be helped to change if it is needed?

The meeting should reach an agreement. It will be written down and we will all agree what each one of us will do and by when.

Now let's go through this again... I'll play to be mom " (role play).

Rehearsals are repeated again before the actual meet. Sometimes child and youth care workers put in a few surprises to deal with the " what-ifs" The young person is rehearsed until we all feel comfortable and reasonably confident.

A family meeting is not the only moment in the child and youth care programme and in our work with children and young people. Rehearsal may be needed in many, many more situations in our work. It is part of our professional practice as child and youth care workers.

Rehearsal is supportive, confidence building and relational. 

Rehearsal is part of what we do. 

     

CORONA SCHOOL ESCAPE...CHILD AND YOUTH CARE IN SOUTH AFRICA

Volumes of text on social media dedicated to the Corona virus, especially when and after the first case was reported in South Africa. A 38 year old man  had returned from Italy, felt the symptoms and went to the doctor in the Kwa-Zulu Natal Province. Both were quarantined in their own homes. The schools of his two children suspended classes as were all extra-mural activities. The search for the other 10 people in the Italy party has been completed and one other is positive.

You know the signs of panic. Straight talk - "we're in trouble", lack of trust in the South African Health system, coupled with jokes. Jokes always accompany deeply felt seriousness and fear.

Corona virus, they say, can mainly affect the elderly and children. As professional carers of children it must be assumed that programmes and facilities are gearing up in case of epidemic. It goes without saying that transmittable conditions and diseases in tightly bedded dormitories and group homes for example are formulas for their spread. 

Experience of young people's attitude to transmittable conditions was to do with their potential to " escape school". Head-lice required a 'no school' period until the district nurse provided a certificate of clearance. Young people with head-lice would collect them in a bottle and sell them to an eager market.  Guaranteed, ..infection and no school. One young person with pink-eye sells rubs on the affected eyes.  The purchaser then rubs on his/her eyes with the contaminated hands.  No school again.

Can Corona become a saleable commodity to escape school?

The approach to German Measles was somewhat different. In childhood it is fairly mild whilst the adult version in pregnancy is said to have an adverse affect on the unborn child. When German Measles appeared, the deliberate spread among the girls was ignored as it provided its own immunity against later contraction. 

Measles itself once brought the facility into quarantine. The local health authorities, once the number of measled young people reached a certain proportion, declared an epidemic and put the whole facility into quarantine. I seem to remember that it lasted 14 days, (similar to the Carona virus quarantine period). The building was ribboned off with warning ribbons, the entry gates similarly. No-one was to enter or leave the except the doctor or the district nurse. Deliveries of food and goods were deposited at the gate. A member of staff went to collect them. We had resident staff, so the problems of quarantined staff wasn't that much of a problem.In a live-out shift system, staffing would have been have been another issue.

If, with the Corona virus, one young person contracts, full quarantine is a given. Could be that now, contingency planning and thinking needs to happen on the " What If " scenarios. Social media shows Europe supermarket shelves to be empty as people make contingency plans. The panic is shifting the usual into the extra ordinary. 

In the early days of the Hiv/AIDS pandemic especially in sub-Saharan Africa and particularly in South Africa, the statistics were and are still, scary.  The number of children and young people with the virus was estimated into the millions. Child-headed households were predicted as young parents died of AIDS related diseases. 

The 'gearing up' then in South Africa was widespread, well strategised, well orchestrated. Prevention was ABC, Abstinence, Be faithful and Condomise. But once born with or contracted the spread through body fluids instituted 'universal precautions'. Child and youth care workers were a target for education and training throughout the country. The community-based national model known as Isibindi was devised and rolled out to provide professional services to the children and young people affected of infected with the virus. It still does. I remember child and youth care workers saying" Hiv/AIDS..Isibindi. Hiv/AIDS..Isibindi,..Hiv/AIDS..Isibindi.. I'm tired of hearing about it".

There was an opinion that education didn't help. I think it did.

Let's talk then the Corona virus on our door-step in South Africa and extensively in some other countries. We are in an early enough position in South Africa to 'gear-up' in child and youth care now.

By now, followers of social media have been exposed to the universal precautionary measures that are said to restrict the spread of CVID-19 and protect ourselves. I saw on set of illustrations showing how to wash the hands with soap for 15-20 seconds. Guess it's like the demonstrations we would give of fitting a condom to which child and youth care workers were exposed and which were made available nation wide. We were trained to teach children and young people the universal precautions in the avoidance and cleaning We taught the young people in our care all that we knew.

The point is that South Africa is forewarned. South Africa is on the launching pad and needs now to prepare for take=off in the world of child and youth care. By "take off", I mean the launching of programmes in our facilities based on what we learnt through Hiv/AIDS . Programmes and facilities are advised to 'gear-up' and make contingency plans just to be on the side of caution.

Child and youth care workers, because of our unique life-space contact with children need now to be educated, trained and supported. Children and young people need to be educated, trained and supported. 

Gear-up... Plan before Corona is yet another school escape plan.  







     

WHO KNOWS? THE GROUND SHIFTS...CHILD AND YOUTH CARE IN SOUTH AFRICA

This was to  have been a stinging blog on the lack of knowing by decision makers in the social services about the serious  situation of child and youth care workers in South Africa and so the serious situation of Child Care. I had two questions. Who knows our plight? The other, who knows what child and youth care IS, what we DO and the importance of our profession. 

But there is good news...and hope. The ground has recently shifted. 

In the first meeting of a delegation of the South African Council for Social Service Professions (SACSSP) to the Parliamentary Portfolio committee for the Social Services, I was led to understand that the committee asked "What is this? We know of Social Work , but Child and Youth Care...Whats that? 

This has changed. A meeting directly with the Director General and then with the Minister addressed exactly that. Not only who and what we as child and youth care workers are, but also the seriousness of the situation we are experiencing. 

So it was that at the second meeting with the Portfolio Committee of Parliament attended by the Minister, a full presentation on what is Child and Youth Care, the need to recognise the profession and its plight was given by the National Association of Child Care Workers (NACCW) The SACSSP also made a presentation. Major high level decision makers said.. "A most interesting two days".

Again recently, the National Department of Social Development held talks to develop a National Human Resources Sector Plan. Expressed there was the need to renegotiate the Occupation Specific Dispensation (OSD) and Conditions of Service.

The Registrar of the SACSSP attended a meeting of MINMEC Which is the Minister together with her relevant  Members of the Executive Councils of the Provinces. ..a door opens to an ideal platform for information sharing on the social service professions.

Again recently the Registrar with a team from the registration Department of the SACSSP met with Social Service professionals in the Western Cape. The meeting, I was was very well attended vibrant,and concerns were discussed.

The answer to my first question is that the ground has shifted and will continue to do so.

Now for the second . Who knows what child and youth care workers DO?  What is the national value of the field its professional practice, its knowledge, skills, use of self and its literature. Not in the form of heavy coursework, but in broad strokes with enough to allow a grasp of the professional field. Some of this has been presented in the foundational ground shift but I think we have work to do on a wider scale now.

Let's stay with the high level decision makers for a while. The what do we actually DO and the success of what we do in the reclaiming of young lives would be useful to be heard in forums such as the Provincial Departmental Heads, Heads of Programmes, and Child and Youth Care Facilities. Better perhaps to say Employers, Managers and some Supervisors. All to frequently we see in the advertisements for Child and Youth Care posts, a misunderstanding if what it is we do. Here we cannot rule out the Non-government Organisations. When job descriptions trivialise our practice, the salaries are equally triviaised. I can go so far as to say that I have seen some advertisements for posts where there no clue as to what the child and youth care really is.  

It would be hoped that an awareness campaign would cast its net wide enough to encompass the other social service professions also. And I'm talking about a need to know among all the helping professions Including Education , Justice, Mental Health, Health, Correctional Services and Psychiatric Services.
 I sat next to a stranger in the airport recently. He asked me what I do. He said he had never heard of that. Social workers.. yes, but child and youth care workers..No. A whole spectrum of people with a need to know opened up for me. The public, the parents and even the young people we serve as well.

What I think we have not done well is to publicise ourselves as a profession through the media . We seem to get little coverage in newspapers, on the radio and TV. social media. We have not really made use of  every available resource and every available opportunity to build awareness about what we REALLY DO. 

We obviously need a strategic plan. An awareness campaign
The big question is who will do this. One simple on the ground response is that we must all be involved in some way. It will take a planning and leading and it can and should no longer wait. large scaly awareness about the field and what we Do needs to happen.

The ground has shifted. This is an ideal moment for us to make our work as professional known

Let us grasp the moment.


    

RUNNING DESPITE FENCES...CHILD AND YOUTH CARE IN SOUTH AFRICA

It is said that we are wired to flight or fight. 

There are any number of running stories. It's difficult to choose among illustrative examples.

The Board of Management expressed surprise, when, at my very first meeting, I reported the 'absconders register'. It's a requirement, but  they had never previously heard it reported. The biggest surprise for me and for them, was a young person who ran away 52 times in a 30 day month". Always to his mother who brought him back.  I said to mom "Keep him, he's a very unhappy chappy" She said she wouldn't. 

 The lone runner: This is Petrus. First indication of a stressful incident or a stressful incident and ...djip! He was gone...just as he was. No planning, no packing. Just gone !! Usually in three days he would walk back in.

Generally, 'runners'  don't like running alone.' They tell others "I'm planning to run - come with me. It will be an adventure.. Clothes are packed and the time of making the run carefully planned. 

Three girls did this. We found out later.They first ran to a house in the neighbourhood which advertised itself as paying girls as 'models'.  It meant stripping naked for photographs. They then hitched to Durban. When it got really very hectic, one gave herself up to the police and they were placed in a 'Place of Safety'. A carefully planned adventure turned sour and dangerous.

 This planned runaway pattern was mainly used among the girls. Incidents happened every now and again. Problem is, running can be something like measles - it's catchy. It's also an offence to harbour a run-away.

A non- governmental organisation ( NGO ) had a programme to support parents in the event of a so called  "missing child". It was good. Photographs were taken of each child. Personal descriptions were recorded. If a child went missing you notified the organisation which put out alerts with the information they now had on record. It started a procedure with us that we took pics of each child and young person as they entered the programme.

Apart from the fight or flight neuronal syndrome, there is another theory.  This one -  bio-chemical . It is said that when children or young people are reared and live in situations characterised  by constant drama and hightened negative excitement, the body produces adrenaline. I've heard of the 'adrenaline rush', but the theory is that the body retains an unusually high adrenaline level. When life changes and the constant excitement is removed, the body needs to raise its adrenaline.to its accustomed level. To 'top up' as it were. The young person craves excitement and creates situations of hightened drama to obtain it. I called it "Making a movie". This could explain quite a lot of the behaviours we experience in our programmes and might well explain some incidents of 'running'. I used to call the 'running ' excitement "walking on the balls of your feet" , having to survive in situations of risk raises the body to the required levels of adrenaline. Thinking... Structured adventured activities may help. 

"Running always brings to mind Alan Paton's book  Diepkloof - Reflections on Diepkloof  Reformatory. originally published in 1996 , an edition by Clyde Broster. Put simply, Alan Paton became the Administrator of the high fenced barbed wire Reformatory for sentenced young people in trouble with the law. He reached a point in his experience and in his  programme and in the midst of considerable opposition, he said "Fences do not hold young people, the programme does" He removed the fences.  If I remember, he had one runaway who returned.  The book is very descriptive of the relational practice of the programme, the levels of responsibility given to the young people and the activities which held them. The need and the desire to run was contained by the effectiveness of the programme and relationship.

"Fences don't hold children, the progranne does". 

Issues of care arise when having to deal with running.  As the Alan Paton story clearly showed, there are issues that can arise from the programme and relational practice that need to be integrated.

On return the young person may well need de-briefing, talk about the programme itself and whether it met the needs of the young person or not. Was the young person running from the programme? 

The experience of being 'in the streets' or 'taken in' with all the risks has to be considered in case there are other measures that have to be take medically or legally.

 The re-introduction of the runner into the group.  Runners, I found were often were often given hero status - all work for the child and youth care worker.

 One problem I encountered was when we admitted a habitual runner. On at least one occasion, I was rectant to do y, but had to say that care in the programme can't be provided if the young person was never there. Bottom line, Young people must want to be in the programm
.
I agree with Alan Paton.It would be great if we had the courage  to remove the fences but I yet agree with his dictum " Fences do not hold children. The programme does". 









    



  

BEDWETTING...CHILD AND YOUTH CARE IN SOUTH AFRICA

Three bedwetting memorable moments...which surely, only a child and youth care worker will have !  

A visit to a dormitory facility for about 50 girls in a township setting in the Eastern Province. It was early days for me in child and youth care work.  Against the perimeter walls were lined up about 15 mattresses drying in the sun from bedwetting the night before. The Director said that the bedwetters were mainly 15 to 16 year old. The number overwhelmed me.

My very first exploratory visit - the "do I want to work here?" visit. Sitting in the foyer I heard the whack whack whack of a cane and a girl crying out in pain. The child and youth care worker came down the stairs kweperlat  (quince stick) in hand.
Me "Why did you beat her?"
She "She wet her bed last night and didn't take her sheets, rinse them, didn't make her bed and it's 3.o clock in the afternoon already". 

Boy's dormitory. Child and youth care worker frog-marched a 12 year old to the toilet, pushed his head into the bowl. "Sies man, You pissed your bed last night. This is where you piss. See! ..not in your bed" Then she flushed the toilet on his head.

All three incidents raise questions about bedwetting and child and youth care work

The first, I guess is frequency by age. Accepted statistics appear to more or less agree: up to 3 years 4 months - 1 in every 2 children wet the bed (50%). At 5 years 1 in every 5 children  At 8 years 1 in every 20 children. At 15 years 1 in every 50 young people.

The girls in that dormitory facility were way above the normal pattern  A social worker in a dicussion on bedwetting. its prevention and reduction said, "Unless you can deal with and reduce the young person 's anxiety, you wont prevent bedwetting".  She got me going.!  Was there something in the girl's  facility's approach or tone which hightened anxiety?  Was there a style of interaction going on that increased anxiety rather than help young people to self-regulation.. a pervasive culture of adversary, perhaps? As a visitor I was not allowed to see, but I do know that in some programmes, child and youth care workers used to walk around with rulers in their hands, as then did teachers.

Apart from stress, anxiety, night fears and the like, there are other possibilities or reasons given to explain bedwetting. Obviously the possibility of a physical condition. It's always useful to first check out the possibility of an underlying physical cause. Listed is: diabetes, urinary tract infection, urinary tract stones, anatomical abnormalities and sleep apnea.   

The sleep apnea story is interesting. Had one 10 year old with disrupted sleep. Apnea woke her up then she would wake up others She was put onto a medication which literally knocked her out at night. She then, what is called "flooded". Not just a patch on the mattress...sheets, duvet, pillow, the works.

Then comes the usual list of prevention methods. Nothing liquid for an hour before bed-time. Reduce the coffee intake    (coffee is said to be a diuretic and increases urination), To be woken up at night ans accompanied to the toilet, pills which are anti-diuretics, the bedwetting alarm...a cover on the mattress which sounds at the first drops and star charts. A 'social reward' system was said to be effective. It meant "go without wetting for say 3 consecutive nights and you are given an age appropriate  'social reward' Its not a physical reward...not sweets nor money, but a an appropriate activity usually with others that fits the social developmental stage of the bedwetter. Child and young people are quite good at suggesting what it might be.

Child and youth care workers say that this is all very useful but offers no guarantee of working. They are right. I rather like the 'social reward 'idea coupled with some of the others

Then we tackle the "What do we do when in the morning or in the night bedwetters wake up and we find a wet bed?" Certainly not the head in toilet routine nor the quince stick. Most thinking is that the child or young person should take some responsibility for wet bedding. Which reminds me, It caused a problem when I insisted on a plastic sheet across the usual bedwet area of the mattress.  They would take it off saying that they were being singled out to be babies  I then only used fully plastic covered mattresses throughout as standard equipment.... no discrimination and no singling out.
Taking responsibility varied from rinsing out sheets themselves in the bath to simply stripping them off and putting them into a laundry container...the least fuss the better. Mattresses do have to be aired if they are not plastic covered but the child and youth care workers made this as discrete an exercise as the possibly could. Making any kind of fuss, clearly doesn't work.

Techniques and procedures aside. Good child and youth care practice in any programme, aims at reducing any psychological stress and anxiety. Reduction of anxiety, confidence building, learning to feel good about themselves, a culture of acceptance and predictability go a long way. I have seen bedwetting considerably reduced through good child and youth care practice