The Role of the Child Care Worker

DEBORAH BROWN,

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:

1. It is the child care worker who carries  the  main,  sustaining, ongoing relationship with the child.
2. 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.
3. It is the child care worker who provides   the   child   in care with models for identification;  a role filled by parents in the community.
4. 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.