HOW ABOUT PRIVATE PRACTICE?...CHILD AND YOUTH CARE WORK IN SOUTH AFRICA

A spurt of social media posts came as something of a surprise. There appears to be child and youth care workers in South Africa who are thinking about Child and Youth Care Work as Private Practitioners.

It's like travelling into uncharted waters for us. The call is for job descriptions - What do we do as private practitioners? How are we paid? Are private practitioners recognised? "We need National Association of Child and Youth Care Workers (NACCW), and  South African Council for Social Service Professions (SACSSP) recognition", they said. Is it an area of speciality like it is for Social Work? .....OH WOW????
Quite right! The questions are quite right because it feels like preparing to enter the wilderness right now. I know of only say 3 child and youth care workers in private practice right now. I wouldbe interested to know of any more. I call myself one. I am registered with the SACSSP on the strength of proof provided of my being independently employed. My registration certificate does not make reference to private practice. There is no area of speciality for this. In applying to SACSSP I wrote my own job description. I was asked to provide letters of reference from persons and organisations who had received services from me as an independent child and youth care worker. These together with an affidavit to confirm that I had been and am working as self employed.

On the scope of practice there was one comment from a social service practitioner colleague that much of what I do sounds like consultation, education and training. I think that expert subject and practical experience used to empower and capacitate quality child and youth care work can be part of what private practitioners do.

I do accept work as a subject and practice "expert" This leads to things like Quality Assurance (QA), policy and procedure development, learning materials development, learning assessment, the design of frameworks as developmental tools .  I also design innovative models of child and youth care practice.

Then there is the job description component which my social service practitioner colleague believed spoke perhaps more of what is associated with child and youth care work.

The key performance areas for parenting challenging situations, positive parenting as life-space intervention and support in family settings. This involves the daily event scenarios that are intimately associated with professional child and youth care. I get calls for help from  parents, "My child is on drugs"  "My child is cutting"

To the question in the international arena " What do child and youth care workers in private practice do? There were several responses.

QUOTES:
Shawn Douglas Ward.......I provided, in the moment, skill development for parents on how to manage disruptive behaviour. While working with a child, I would be teaching skills and emotion regulation, assertiveness, distress tolerance and interpersonal skills.

Caroline Giter .........I provided in-house support. I had one on one sessions with the child and would meet the mother to normalise and plan next steps. I also supported them at school.

Donald Budd.........During my initial meeting,I address my child and youth care background.  I provide emotional support eg to children, team and families

Charlene Pickrenn............I address individuals/ team social and emotional intelligence, coach, consult and present workshops......

Then came the issue in South Africa of recognition of Private Practioners. Who acknowledges, recognises child and youth care workers in Private Practice?" As I said, I was registered by SACSSP with a private practice job description. Social Work has an Association called SASWIPP  Private Practitioners have to register with this association and meet certain criteria. Social Work has Private Practice as an area of specialisation for which, also certain criteria have to be met. As yet, child and youth care has no separate categories of specialisation. I suppose, given time some areas of spesialisation may be decided. 

It is my personal view that in child and youth care in South Africa, we should avoid having a multiplicity of Professional  Associations. Perhaps we can think about different categories of membership with some criteria attached......like for example, at least five years experience and a specified level of qualification.

Frequent requests for an example of a scale of fees has reaped no definite firm set of fees for services. Who pays? The client pays. From what I understand there are laws which prohibit competitive fees among people offering the same service. I understand that to ensure regularity in this, Medical Aid rates are charged. And so the dilemma for child and youth care workers aspiring or providing private practice. Child and youth care services are not recognised for medical aid payment We have no scale of fees.This is where. it seems, the Professional Association and perhaps others need to work together sometime soon.

Don't talk of child and youth care as an emergent profession. We have been around for centuries. Emerging though, is a cadre of experienced child and youth care workers who, being unemployed in organisations, perhaps also retirees, veterans, for whom private practice is a way of providing child and youth care services.

 Much can be done now to build a foundation in anticipation of the movement 

Communities already know the value of child and youth care workers in their homes because of their experience of the community based work done by Isibindi. Medical Aids are ignorant. Some form of regulation needs to be drafted to ensure goals and standards and to avoid instances of exploitation. We CAN learn from Social Work

It's going to take time, focus, advocacy and energy to place private practitioners where we should be in South Africa and in the child and youth care system

A LUTA CONTINUA












   

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.   







  
















  

WE GOT RIGHTS... RIGHT ???..........CHILD AND YOUTH CARE IN SOUTH AFRICA.

Masud Hughoghi always spoke of "social order". Then he would ask, what constituted a disruption of social order? It was when individual behaviour didn't allow society to preserve some  tolerable level of smooth functioning. The question in this context , is, what is tolerable and what is intolerable ?

A young person is sitting at a bus shelter. On the bench next to him is another person. They talk. The adult makes the comment "You're  a bastard"  The young person takes offence, shouts "and you're a shit." (moderately tolerable). He kicks the other person (not tolerable). He kicks the wall behind the bus shelter ( tolerable).He stands up and moves away from the bus shelter ( tolerable and COPING no disruption to the social order). 

I always remember Brian Gannon saying," We are not an angel factory"

It's our work as child and youth care workers to co-regulate.to shoulder to shoulder young people as we use our professional knowledge and skills to help move such behaviour from intolerable...disruptive to the social order...to at least some level of good-enough coping,...tolerability. Again, "We are not an angel factory and we dont work with angels. It's what we do.

I used to call the process of supporting young people toward alternative, more tolerable ways of dealing with stress moments; "Exploring alternatives and rehearsals" It's coupled with the "What if"? approach. Lets imagine, "What if he calls you a bastard?"....and then? "What can you do?" "How about?"......Role play. REHEARSE, REHEARSE, REHEARSE.

So he calls you a "bastard, a fat bitch, an idiot" We really don't have an option!!  Modelling, we HAVE to walk away....Later when things are more settled we can come back to it."Let's talk".Go over the whole scenario again and maybe again. Consistency, in itself, is shown to be a therapeutic life-space tool, As professional agents of behavioural change, it's what we do. Not tolerable and moderately societally tolerable, a-social and even anti-social behaviour is what we EXPECT as child and youth care workers. We work with traumatised young people 

The question on social media was "Do we have rights as child and youth care workers? Then, "Management always supports the children and young people and we don't get support. But we get bullied Where do we stand,. Do we have rights?"

I guess it's an employment dilemma for all social service professionals. More so perhaps for child and youth care workers in the moment to moment life-space of young people with troubles.
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I was encouraged by Brian Gannon to move from one residential facility in which the young people were initially "out of control" to trouble shoot another where the young people were perhaps more out of control. He wrote me a letter. I treasure it. He voiced his guilt at moving me from one now settled facility to trouble shoot yet another. His conclusion. "But you are an intelligent mature adult. You knew what you were doing when you made the choice".

It's true.

I knew. I made the choice. I am responsible as a mature educated intelligent adult for the choice I made to work with troubled young people. I knew what to expect.

Time to straight talk .Time to talk RIGHTS  Do we as child and youth care workers have rights? - - Here's the dilemma

As citizens of South Africa, we have rights. As humans we all have rights. Child and youth care workers most often quote their rights to property. "what's mine is mine" Others quoted are the right to be safe from injury and the right to take judicial action against an offender of my rights. In society, socially disruptive intolerable  behaviour takes the "remove/ punishment "response to restore social order.

Again the dilemma.

Children being vulnerable have more rights than adults. As we approach children we have as the supreme law, the South African Constitution. This requires any action with children  to be "in the best interests of the child" Then, children and young people in care or detention have additional rights. As do children and young people in "alternative care.". As child and youth care workers.we work within what we have come to call, a "child rights culture"
This pervades our philosophy,In practice we live this out as a reclaiming culture of development, discipline  and restoration  different from societies culture of removal, punishment and revenge. This leaves us as life-space professionals, ourselves to "be the world we want to see. 

I must however say that I have experienced some incidents when the "best interests"  learning tool was decided by the multi-disciplinary team's considered thinking, to be the formal judicial route.In some instances it was inevitable.

Firstly, a member of the public lays a charge. Best we could do was to approach the public prosecutor to somehow trust our facility and its child and youth care practice. Public prosecutors can think  in terms of suspended sentence, diversion, community service or delayed charges. A court appearance became a window of opportunity for some useful child and youth care work to be done. It's NOT IDEAL, but it does happen. It gave us a the primary support worker to say, "I don't approve or accept what you DID, but I will support YOU through the court proceedings every step of the way."

 I recall an incident. A boy climbed the drain pipe to the first floor apartment of the residential remedial teacher's flat. He stole a box of cash savings. She and her husband rightfully felt intruded and robbed. The husband decided to lay charges. He was not in our employ. Court proceedings followed. He was given a 6 month sentence suspended for 2 years.In-house procedures clicked in. A restorative conference. It involved all affected parties as well as the boy's father. The father was moved to express his feelings... how all this affected him. I'll never forget. He expressed shame and embarrassment. He said he felt the family name had been tarnished. Well, for the first time we saw genuine guilt, remorse  in that young person. Even tears.   The boy undertook to repair the paddock fencing with a wire-puller, L,Income from the labour repaid the lost cash. Goodenough in-house justice had been somehow restored. The staff member and her husband chose to continue in the facility. 

For a manager when it becomes an issue of losing a staff member or losing a child over an issue of rights, i becomes a huge dilemma. In many such cases the child or young person has really no where else to go. Restorative justice remain.

Young people will kick against the system. They WILL kick against US as they launch themselves like a backstroke swimmer into unknown and unfamiliar waters. It's very scary to change habitual behaviour acquired over years. As challenging as it may be. as child and youth care workers , we WILL feel that thrusting kick off against us. We provide the firm platform, the foundation.

We don't lose our rights. We will hold off as we co-regulate young people to self-regulation, more tolerable and better coping ways.

Having said all of this. Managers have to support us in the difficult work we do. It's not a matter of favouring the child over the professional. It's a matter of  partnership as  a fellow co-regulator and agent of change.

 It's the most difficult work in the world. It's our work. It's what we do.

HELP !.....WHERE'S THE PROFESSIONAL.......CHILD AND YOUTH CARE WORK IN SOUTH AFRICA

The question  on social media was, ..in child and youth care work, do we have a need for external professionals or occupations to provide a service to children and young people..... professionals who are untainted, uncoloured by residential relationships with the children?

The question brought the whole 'Medical vs Developmental models to the front. Couple that with holistic care and integrated case management, and "Hello!", ......space for talk!

 Over the long years I lived through various models, the shift in the South African experience has a long story to tell....especially maybe, the shift from the medical to the developmental model.

In 1983, there was little doubt. The children and young people in care were "sick". They needed to be "treated" to make them well. The facility I inherited was based on a hospital model which heavily underscored this thinking. I was the "Supervisor" as in Medical Supervisor. There was a Matron and the child and youth care workers were called "Sisters". (there were no males). The children and young people had complex daily and weekly schedules. The  children were transported to Sex Therapist/ Psychologist/ Psychiatrist/ Social Worker/ Occupational Therapist/ Remedial Teacher/ whatever. Scheduled medication was administered daily. And all this was called the "programme". Actually ALL professional intervention was provided by external professionals. The idea of child and youth care workers as professionals in the "other 23 hours" was reduced to routine care.

 By 1986 there was some shift to this medical/ treatment perspective. It came as a result of the National Association of Child Care Workers ( NACCW) offering training, done, then in "blocks". Couple this with in-house training and there was some move toward a more life-space therapeutic approach. Behaviour wasn't then, always ...."send the child to the social worker" at the slightest provocation. ( who may have, in any case, referred the child to a 3rd level professional practitioner as an external professional).

Nonetheless, the more affluent child and youth care centres employed their own battery of, so called, higher level residential professionals.....Psychiatric Social Workers, Art Therapists, Play Therapists, Psychologists. In the facility I directed there were 3 permanent Social Workers. Every young person in the facility was allocated into individual casework and a plethora of groupwork groups which justified such a team.

In this time, the "block" NACCW training was formalised into a    2 year Basic Qualification in Child and Youth Care Work. A move was made to have a child and youth care degree at the University of South Africa ( UNISA). UNISA is our premier distance learning University, which, not withstanding the apartheid sanctions, was an internationally  recognised University. As a first step toward this, a 2 year university certificate was instituted. (This finally became a three year university diploma and then a Bachelors degree........the sadly, abandoned by UNISA)....shoooo! Politics, politics, politics!

Anyway, couple all this with extensive in-house training, much of the need for child and youth care to ship children and young people off to the residential social worker at the slightest behavioural irregulity, or to external other professionals reduced to a point, where, over time, only one social worker was needed. Occasional external referrals were made.

What had happened?.... We had shifted from a Problem Profile Approach (PPA), to a strength based approach. Holistic developmental work with children and young people took hold in our practice  Individual Development Plans (IDP) started to look quite different. A "programme" was shaped more and more on the "who will do what, by when" design. Child and youth care workers, were competent to help children to move developmentally from where they may have "stuck", or did not have goodenough experiences, to become more coping and more age appropriate.

WE had not yet fully arrived, but the shift from the medical/treatment model transition was almost a natural shift.

EXAMPLE: The reason for referral is hardly ever the REAL REASON for coming into care. Quite spontaneously, one evening, the 12 young people in a group home, had an after dinner discussion. One might almost say, argument. The topic?..Is sexual abuse more painful for boys or for girls?  The silence was broken. It turns out that of the 12 young people in that group home, 8 had been sexually abused and the child and youth care worker was the trusted person . The discussions formed themselves into something of a group. Ooops!.. Change of programme!. I was providing the so called "supervision"of the child and youth care worker. I must say. She did VERY WELL! 

SEE. Groupwork with a level of risk can be done by child and youth care workers.

I have told this story before, but it's worth a repeat telling.

One night. a doctor in a large hospital went up onto the the roof of the hospital building to catch the night air and the view over the city. Sitting on the wall of the building, silent and still, looking out over the city lights, was a young medical intern.
"What are you doing here?"
"I've come here to reflect and to celebrate something of myself" said the intern. "Yesterday I was approached by a surgeon. He said, " I have a heart operation scheduled for tomorrow. There is a delicate procedure involved. I want you to perform this procedure. I'll be there., but I want you to do it"."I felt at the same time somehow trusted but anxious about the responsibility. I'm out here, because I'm celebrating something deep inside me. I needed to quietly reflect on what happened. ...I DID IT!... I performed that delicate risky procedure and the patient LIVED."

And that is what happened to us. Perhaps, over time, somewhat cautiously and with some personal lack of assurance, WE DID     IT!  We performed delicate professional procedures in our practice and the children and the young people in our care experienced therapeutic developmental help and support

What I think I have seen over the years is .....professional child and youth care workers move from practicing "no risk"interventions with children and young people to interventions with "some risk" and now, interventions "with risk" Don't please, let us sell ourselves short. Professional level child and youth care workers  can and do perform delicate third level therapeutic developmental procedures in our practice. (in the life-space and in the moment events of their lives). 

There is obviously a need for outside professionals as part of a multidisciplinary team, but not any where near as much as there  used to be.

ALUTE CONTINUO
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