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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