FANTASY AND DELUSION...CHILD AND YOUTH CARE TALK

   

There was Blom (flower) and Mielie (a head of maize}. Blom spoke into the one ear and Maize into the other. Mielie said "Just go on and do it!!" Blom said "No! no!!  - that's not you. It's not right".  

Full psychiatric evaluation showed no schrizophrenia. Sometimes Mielie won and sometimes Blom. Given a chioce, we would ask "What does Blom say?"  Where do these id, and ego and superego voices come from ...Ancestors?  Over time we all knew that Blom and Mielie were real heard voices for the boy. 

She was sat with a group of girls in the foyer. Normal girly talk complete with teenage giggles - all very light-hearted. It was comfort for her. She needed this. 

I stood at the tea-wagon. She and two others sat facing it. The rest of the group were on the other side of the coffee table and facing her. 

I say it was what she needed because she was grieving the tragic death two weeks previous of her 21year old boyfriend Len. It was a serious relationship with the promise of marriage when she turned 18 - which was soon.

 Suddenly her eyes fixed on the main door of the facility which opened up into the foyer. 

 "Len! Len! It was a deeply emotional cry. Her body stiffened, her eyes opened wide. She twisted. her body and eyes tracked from the main door to behind her and up the stairs to the girl's dormitory.

"Len! Len!: Then tears,i

'Did you see Len?" one asked. 

"It was Len. Len came. He went up stairs.

 Not one girl questioned it.

When the news came from the hospital that their mother had died, we followed our standard procedure. We asked that the body not be removed until the two were taken by the child and youth care worker to the hospital and the bediside of the mother's body . They took flowers., placed them on the mother's chest, kissed her forehead took her cold hand and said their goodbyes.

 They had to experience the reality of her passing.

Time elapsed as we waited for the family from Zimbabwe. It was a full funeral service attended by the children, with the coffin present. They again had flowers to put on the coffin before it was wheeled out.

 She was cremated and the relatives took the ashes to Zimbabwe .

 Telephone calls were made to the two children from Zimbabwe. On more than one occasion they told us, The Zimbabwe family had said "Your mother is safe with us." Meaning the ashes were urned and on the shelf above the frireplace awaiting internment.

From snippets of conversation the child and youth care worker joined the dots. The two children were living with the delusion that their mother was alive and living in Zimbabwe awaiting an internment  At the hospital, they thought that the mother was just sleeping... she looked like she was sleeping. The funeral was just something we all went to as a Home.

Hasty footwork had to be done. The Zimbabwe relatives were persuaded to bring the ashes to Johannesburg. An internment was arranged. The two children held and placed the  urns into the wall of remembrance.  They were told to tell us all what they remembered about their mother now gone forever. The cubicle was sealed with a plaque. They helped. There were tears....at last !!! Good healthy tears.

A friend brought her to the office "She has not been at all well" she said. "It seems like she's in another world...like she's not connected."  She had asked to see her children.

"Let's talk a bit while we we call the children"...structural delay.

Fear struck suddenly, looking towards the door, "They're coming! They're coming!"

"Who's coming?" 

"They are coming. They are coming to suck my blood and take me away. Only the blood of Jesus can stop them. They are coming."

 "I can call upon the blood of Jesus and chase them away" I said.

 Putting my hands without contact around her head, I said the words I thought were needed. "Out...Out In the name of Jesus.

She stiffened like a board, like a plank of wood, resting her neck on the chairback and her legs outstretched in front of her. Then she slumped into a coma. like state.

The resident nurse was called and the ambulance. Vitals were taken. They were fine.

 The Psychiatric ward did wonders and after three days she was discharged.

At the back of this episode was a true story which had an indelible effect on my practice.

A woman in a psychiatric facility for some or other condition refused to eat. This was unrelated to her diagnosis.  It didn't matter what they brought her, or what they did, they could not persuade her to eat. The doctors and the psychologists did all they could. But...Nope!!

 She was fading, wasting away and would surely die.

 A young intern was the only one who had been part of the treatment procedures asked to be allowed to try. It was agreed. "OK, you try."

he went to her bedside . She said,"Im not going to eat. They are trying to poison me".  '

"You're right he said. They are trying to kill you. They're not trying to poison you. They want yo to starve to death.'

That evening, she ate.

"What did you do?"

Our best qualified professionals tried and she didn't eat. What did you do?"

'I needed", he said "to step into her world for a moment...into her reality. Her fantastic delusion is her reality. I agreed with her reality as a start and worked from there". 

SOCIAL MIXING BETWEEN HOUSES ......CHILD AND YOUTH CARE IN SOUTH AFRICA

There was a time when it was trendy to call what child and youth care workers do, "group residential treatment". Then the word "treatment" fell out of favour as it was said to be associated with medicine, psychology and psychiatry. Then we got "group residential care". Now we talk of "development" but the group residential tag has faded. So , logically I suppose what we do in facilities is "group residential development".... and a group residential setting becomes something of a community. I have always said that this community , or group living arrangement, creates opportunity for us to design a microcosm environment that is not only healing ( therapeutic) but also reflects the world beyond its walls that we would want it to be, whilst at the same time prepares young people and children for the realities of the world that is.

No matter in which of the group living settings we work, as child and youth care workers we are developing better, more appropriate coping skills whilst creating a view of living harmoniously and helpfully together. We are agents of social change. 

It is within this context...(.is it a theoretical or a reality model?)....the building of appropriate, positive peer and adult relationships happens. The group, the setting, and the community becomes the stage, the platform, upon which developmental, (therapeutic) learning unfolds. Rather like a directed drama, with scenes, acts,and players. Child and youth care workers orchestrate the plot, as well as they can. The players are a very diverse group. Sometimes in single sexed settings, sometimes mixed sex, mixed ages, mixed backgrounds, mixed histories and experiences, mixed ways of solving problems, mixed relationship styles. It's  a complex cast to direct. From the relationship needy to the relationship destructive and everything in between. That's what we work with....we are child and youth care workers.

The social media post that sparked this week's blog asked the question.....and this is not a direct quote......Should we allow institutionalised girls in a place of safety in one unit to mix with girls in another unit.?? .

One of my very first articles published, was called "Letter to a kid" It wasn't actually primarily addressed to children. It was penned for the facility's Board of Management. They didn't get the child and youth care realities of work and concept. They wanted the children's home to be an "angel factory". It never got to them that children and young persons have a right to make choices, and in making choices to make mistakes, to be different, to choose their friends. In making choices they have a right to be experienced as  a-social, to connect, to belong, to being, and dare I say it.....they can choose to be anti-social. As child and youth care workers, what we do with children and young persons, is to explore together before, hang -in together during, otherwise empathise, partner together after.... then explore together again. They will experience the university of the world, the natural or logical consequence s of their choices. It can be, and usually is, somewhat messy. And the child and youth care group living facility is a safe place in which to do this. Child and youth care workers are the support they need to move from Act 1, Scene 1  to Act 2, Scene 2 with as little hurt as possible and with help not to repeat the same Act and Scene all over again... to help in the ever unravelling story until they can internalise the plot of "what ifs" by testing alternatives.
 Institutionalised locking away of choices, locks up learning. If this sounds like radical child and youth care, then I guess it is radical child and youth care.

The different styles of "not that helpful" relationships is for another blog some other week. What is perhaps worth exploring in this blog are the underlying thoughts of risk attached to actively disallowing, and actively allowing the mixing of young persons from different place of safety "units"..

When formal. assumed or personal policies are to disallow mixing, I have experienced child and youth care workers who talk of "MY CHILDREN". ...  The relationship between cottages/houses can be  something like that of a bad divorce.. "You don't go there, you don't talk to those girls. They are all foul mouthed bitches and BAD NEWS. Don't let me catch you with that lot" The inter house rivalry caused heightened, intense inter-house rivalry, to a point of extremely insulting name calling both of individuals and of the  house.."Whore House !". There were false allegations. Even physical property damage and violence... At the bottom of all this lies policy and perhaps the child and youth care worker, on the one hand trying to protect the young persons in the house and on the other, using an approach that is relationship destructive......what happened to the world as we would like it to be. ...and the world view of these young persons?
This was so obviously damaging , but at another level, the child care workers themselves experienced a breakdown in teamwork and staff relationships. When it may be necessary to reshuffle the groupings and shift houses... damage control becomes huge. 

There are risks that occupy the thinking of child care workers in between house mixing. Peer pressure is an obvious. What if there is a predominant placement of first time offenders or substance abusers in that house?  To what extent, they ask, will all the hard work and the IDP be eroded by peer pressure? Then there are practical issues, like dating and sexual experimentation, the borrowing of clothing and possessions between houses, Visiting, to gain advantage screen time when it is "screens off" in one house but not in another,  having made a good connection with the other house child and youth care worker.

Should children in a facility be allowed to mix between houses? My short answer is "Yes". I think that the effects of allowing children to make choices in peer relationships, in the safety of a child care setting, the opportunities for developmental learning and the  input from life space child and youth care professionals out way the so called risks. In any case if we know what the risks are, we as group residential workers can plan for them and use them to the developmental advantage of the young persons in our care.







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