The Role of the Child Care Worker
acsw. agfa. mrsh
Director of Browndale
There are two main approaches to the role and training of child care personnel in Ontario and the differences between these two approaches have important consequences, not only in relation to curriculum, course structure and attitude to the student in training, but also in the services provided for children. For this reason I would like to explore these differences in depth; and to start off I would like to ask a question Is child care work a paramedical profession?
It is important that we think about this question carefully because the assumption that child care work is a paramedical profession leads to a certain approach to child care personnel and their training. This approach results in the type of hierarchy which can be found in Ontario Hospitals and many other institutions in this province. Heading up the hierarchy is the psychiatrist, followed by the psychologist, then comes the social worker, below the social worker we find the occupational therapist, educational and other specialists, then on down through the nurse to the child care worker.
We hear a great deal these days about team work in treatment, but the hierarchical system invades the team and in most cases the child care worker remains the lowest man on the team totem pole. The team is a myth.
The hierarchical approach results in: limitations being made on the amount and type of knowledge which teaching staff and members of other professional groups make available to students and graduate child care workers a stifling of the students' creativity, students not being given the freedom to use themselves in their work; restrictions being made in the authority of the child care worker and, following inevitably from that, restrictions in the services provided for children.
The tragic end result is a further fragmentation in the services offered to children.
A child cannot be carved up into convenient segments. A troubled or disturbed child is a child first and foremost. He has all the needs that a "normal" child living in the community with his own family has plus his own special needs related to his own particular problems or pathology.
Each specialist in the mental health field has his own specific area of knowledge or experience which can be helpful in rehabilitating the child but none sees him as a whole human being. The psychiatrist perceives only a certain aspect of the child and usually only sees him for one hour out of each week, or at specific times when he is called in around specific needs. The psychologist tends to concern himself mainly with testing and evaluating certain behavior and reactions around certain situations. The social worker traditionally works principally with the child's family or directly with the child around specific problems, or in an on-going casework process.
Someone has to be assigned the role of synthesizing the services offered by all these disciplines to aid the growth and re-education of the child. It must be someone who sees the child not as a schizophrenic child but as a child suffering from the mental aberration of schizophrenia; not as a character disorder child but as a child suffering from problems that we call character disorder.
What I am really saying here is that the child in care needs someone who will take on the caring role, the parental role, the re-educative role. The logical function for the child care worker is to fill this need.
Let us take a realistic look at the role of the child care worker:
- It is the child care worker who carries the main, sustaining, ongoing relationship with the child.
- The child care worker is the person who teaches and guides the child in care as the parent in the community teaches and guides his child.
- It is the child care worker who provides the child in care with models for identification; a role filled by parents in the community.
- To treat a child effectively, the child care worker must involve himself with the child to an extent dictated by the child's dependency needs, not the needs, or time conveniences of the child care worker.
Whatever name we give child care staff let us recognize the reality that the child will relate to his worker in the same way that a child in the community will relate to his parents. Let us know this dynamic and utilize it, while being careful to recognize that because the child in care has suffered from harmful, hurtful or non-nourishing parenting in the past, the staff person must be extremely sensitive, aware and in tune with the child. He must function not just as a parent, taut as a therapeutic parent.
This is the role of the child care worker. It cannot be filled by a "low man on the medical totem pole".
Once you get away from the concept of child care work as a paramedical occupation an entirely different approach to child care workers, their role and their training becomes possible.
At Browndale we do not regard child care workers as persons employed in a paramedical occupation. We believe the treatment of emotionally disturbed children is properly a re-educative task and we see the child care worker, or educator as we prefer to call him, as a member of a creative profession in its own right. We do not see this person as a "lesser breed" of social worker but as a person who though he does not possess the technical knowledge of a social worker, psychologist, or psychiatrist, does have his own unique skills and capacity. We see him as a person whose judgement as a mature, professional and skilled adult human being will determine the success of the treatment program in which he is working.
Does the educator profession have its own, separate body of knowledge? At Browndale we believe it does: a body of knowledge that is not a watered down, filtered down version of the knowledge collected by other professional groups but is directly related to the type of knowledge that any therapeutic parent should have as outlined in my summary of our educator training program further on in the article. The manner in which this information is presented by persons teaching educator courses will reflect the real feeling attitude that these persons have toward the educator profession. We would do well to ask ourselves: how many courses in child care work in the province are taught by graduate child care workers? How many students taking their field placement are supervised by graduate child care workers?
We also need to consider what kind of responsibility the educator or child care worker should have. I believe that in functioning as a therapeutic parent the educator must have total responsibility for the child. The educator must be trained adequately so that he is confident that he can make the final decision concerning the treatment of the child and that he knows when to call in the appropriate resource persons and he knows how to evaluate their advice in relation to this particular child he is responsible for.
At Browndale we give the educator the authority as well as the responsibility for every child in his care. This is a very different approach from the one that gives the final decision to the social worker or psychiatrist.
There is no treatment hierarchy at Browndale. Instead, our psychiatrists, psychologists, social workers, pediatricians, nurses, educational and other professional experts form a resource bank of information and experience on which each educator can draw as needed and at his discretion. Children in the Browndale residential program live in small therapeutic "family" groups in ordinary houses on ordinary streets in suburban Toronto, Bramalea, Cornwall, Newmarket, Windsor, on small farms in Haliburton and in one larger residence in Muskoka.
In the majority of these locations there are four to five children and two or three educators, plus service staff. The educator who is in charge of each therapeutic "family" unit has complete responsibility for the treatment of the children in his or her unit. He also has the financial responsibility for running his house within the budget set by the fees charged for the children in his house.
The in-line authority structure is kept extremely simple with few regulatory powers retained by the central authority, the major responsibility of the central authority being staff training and setting of standards. And all intake and discharge decisions are approved and procedures are centralized at the provincial level.
Apart from these specialized functions each therapeutic "family" unit is autonomous. The head of each unit is always an experienced educator trained by Browndale. He calls in the professional consultant staff in much the same way that the head of a family in the community calls on the family doctor, or any other specialist, when required, a major difference being our professional resource bank is available to the educators twenty-four hours a day, seven days a week. And it is the educator in charge of the therapeutic "family" who, as does the head of a family in the community, decides whether or not to follow the advice of the professional "expert". Because no-one in the treatment program has a better knowledge of the child and his needs than does the educator who lives with the child and shares all his on-going daily routines and activities.
Each educator coming to work at Browndale embarks on a two-year course of training. During the whole of this time he is working directly with the children in the treatment house under the supervision of senior educator staff. The new trainee sees how other staff members act toward the children and is shown what to do by other staff members. He can ask questions and seek information directly related to the problems of the children he is working with as they occur, instead of discussing theoretical cases or "average" behavior patterns. Each new staff is also assigned to one of our senior staff members for individual tutorial training. This senior staff person might be a psychiatrist, a psychologist or a social worker.
To supplement the on-the-job and tutorial learning educators attend many seminar type courses of eight to twelve weeks duration which cover different topics plus two core courses covering normal and abnormal growth and behavior. The basis for the theoretical instruction is the knowledge that has been accumulated over the years by the various fields of sciences in the area of normal human development and deviations from the normal patterns of development.
The educator learns about the internal interaction of man in relation to himself and to the world around him: family, friends, school and work relationships. Primary emphasis is on normal behavior of children; added to this are techniques for helping damaged and inhibited children who have not had opportunities for normal individual and group activity. The educators are also taught a variety of management techniques for living with emotionally disturbed children so the child can be allowed to express his symptomology without damage to himself or others.
Each trainee is also involved in a two-year group psychotherapy program. Staff therapy is the foundation of our staff training program as it must be with any sound training program for persons who work with emotionally disturbed children. The staff person must undergo treatment himself so that he can deal with the counter feelings within himself which are inevitably stirred up by the expression of symptom-ology that the child must be allowed to express within the safe environment of the treatment centre if he is, first of all, going to be understood and, secondly, rehabilitated.
Furthermore, the only way an emotionally disturbed child can be reached is through a deep, meaningful relationship with an adult he learns to trust. If the relationship is to be a truly therapeutic one, the staff member must know himself so thoroughly that he is aware of where he, and his needs, begin and end and where the child, and his needs, begin and end. Most human beings can best reach that state of self-knowledge through a searching, introspective process under the leadership of a skilled, knowledgeable therapist.
Moreover, changing oneself is a difficult, painful process; a staff person who has undergone a therapy process is more likely to understand what it is he is asking of the child.
A person who does not wish to undertake this intensive two-year training course, but would like to work with children can play a less responsible role at Browndale for which we have retained the old term "child care worker". This person is involved in play, art or other activities with the children; he works a 40-hour week under the supervision of the educators and his salary is equivalent to the usual child care worker salary in Ontario.
A graduate from our two-year educator course on the other hand is the complete and final authority in treatment decisions. His salary starts at $6,000 and has no ceiling. He can rise as high in the program as his abilities will take him. He may function as head of a therapeutic family, as a supervisor of an area or region, as a teacher, as a therapist working in the community with hard to reach families or as an activity group therapist within our treatment program and in community programs.