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Child Welfare

Critique of Self-Care Initiatives in the Helping Professions

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Generally speaking, helping organizations view humans from two polarized lenses.  Some organizations believe that their employees are good people and will always do their best despite any barriers that exist. Other organizations operate as if people are to be significantly controlled. These organizations believe without external control, people will give less than one hundred per cent and will somehow take advantage of benefits or in any way they can.

If you consume literature from publications like Forbes, Macleans (Canada), Time, or even through social media, you undoubtedly have read about efforts of progressive companies to foster production and actually take care of their employees in a holistic manner. We now know about the benefit to production, whatever the product may be, when organizations implement wellness strategies at work and give employees menus of wellness options to choose from which briefly take them away from production to have infusions of wellness.  In fact, this opinion is no longer just an opinion.  The evidence is clear. Organizations and societies who take care of their employees fair better on every indicator of production.

In the helping professions, our organizations are often well intended when they engage us in wellness conversations and efforts, but they often miss the mark. Helping organizations often bring in “experts” to talk to us at staff meetings. This act within itself is view as progressive and helpful. Again, while well intended, helping “experts” and their products miss the mark of what is needed to increase the wellness of helping professionals.  Why is this?

Strategies and self-care models offered to increase our wellness do not fit the nature of our work.  These models are based on static and linear models of work and production. For example, ten minutes of stretching likely benefits a professional helper who works a strict schedule and sees clients in an office for treatment blocks.  One can certainly take ten minute breaks and will reap the stress reducing benefits from those breaks.  Strictly office based helpers can often also find time to exercise at lunch, socialize in the lunch room, and so on, and therefore reap the resiliency benefits of these strategies.

The problem here is that the majority of helping professionals do not work in office based environments and see clients for therapy or for some other time specific service.  The majority of us work in child welfare, children’s or adult mental health, or crisis intervention environments.  Our “schedules” change several times a day as we meet the needs of our clients and respond to our communities’ crises.  A day in the life of a helping professional in these areas of practice looks more like a dog’s breakfast.  We don’t get set break times (they are there but we can’t and don’t take them because we are too busy), we don’t eat at set times and we almost always eat in our cars while travelling from situation to situation.

We forget to pee and poop.  No really we do.  We experience the sensation to pee, but it is often an hour or two or three before we actually remember or have the time to go. To be sure, it is just not possible to interrupt a suicide assessment, crisis phone call, apprehension with the police, or the like, to pee.  Not only do we care so deeply about our clients welfare that we wouldn’t interrupt our process with them to pee, but we also get used to ignoring our bodily indicators and in fact over time we actually divorce ourselves from a great deal of our biology.

This divorce from our biology often happens with ease because we are pumped full of stress hormones which naturally serve to put everything except the crisis at hand on hold.

While I don’t mean to belabour this point, it would be negligent not to note that if you follow the logic about the physiological and biological separations we perform in order to meet the needs of our client populations, you will understand that implementing any menu option from the typical self-care menu is literally impossible.  You can’t meditate on the witness stand, during an apprehension, or a suicide assessment.  You can’t break for a jog when you spend your lunch in your care driving and eating.

Following along with the logic of this work reality means that our self-care has to happen on our own time.  After work whenever that may be.  But if you’ve apprehended on this particular day, you are likely still at the office long after closing time.  You are settling the children at the foster home and then heading back to the office to prepare your court papers.  Your family, if you have one, doesn’t get to see mom or dad tonight because work responsibilities made that impossible.  The family may not get to see you tomorrow either because you may have to leave early for work in order to pick up your court papers and be able to serve them to your client family before court.

There eventually comes a day though when you things “slow down”.   A slowdown of course refers to the day when you get to try and fit in all of thing appointments and other tasks that you have had to put off due to the crises you have been responding to.  On these days you still eat in your care, don’t get breaks, but… you likely pee more regularly.

There seems to be a general understanding amongst us that if you are in this line of work for more than ten years you are a “lifer”.  I mean no disrespect to those that get out after a few years and in fact many of use envy you and are proud of you.  We still consider you one of us if you’ve been on the front line for even a few years before you leave because you “get it” and you are therefore one of us.

The life cycle of a lifer is as varied as is a day in our line of work.  Sadly though, many of us lifers don’t fare so well in our own personal lives.  There are many reasons for this but for me based on my dedication to understanding the harmful effects of trauma, it boils down to the cosmic roll of the dice of our stress hormones, traumatic exposure both direct and indirect, and to the overall impact of our divorce from our biology and often our bodies.  Many helping professionals  get sick from our work.  We all know colleagues who have chronic illnesses that really boil down to the harmful effects of stress.  The academic literature is now abundant in this area so you don’t need me to tell you about it.

The cost of our caring is too often too great.  I know we wouldn’t have it any other way but it is also not fair and just.  Given the strength of the literature in the area of trauma, burnout and compassion fatigue in the helping professions and the clear health consequences of chronic stress, I believe we can do much better in helping ourselves lead lives full of more wellness.  This requires a change in the structures of our work, it requires a change in organizational culture, and it requires a commitment of each one of us to be brave enough to talk about the cost of caring.

Next, we need to change organizations that view employees as ultimately malignant.  People don’t choose to be sick and they don’t want to be sick.   To be clear, psychological and emotional illness is a real risk in our work.  And, psychological and emotional illness can lead to a myriad of legitimate physical ailments ranging from the common cold due to compromised immune systems to auto immune illnesses like irritable bowel syndrome.

Organizations who view employees with suspicion are using faulty logic.  Not too long ago in my province we had a Premier who successfully waged a ware on welfare recipients by convincing the population that people on welfare are cheaters and have lazy characters. This of course is not true. People don’t choose to or want to be on Welfare.  Similarly, it is not flaws in our characters that make us ill.  We are not weak, and we do not need discipline to help us be more productive during times of illness.

What we need is wellness initiatives that fit with the nature of our work. These initiatives need to be dynamic and individualized.  I believe that we need individual wellness plans which are akin to Individualized Education Plans for children in our school systems with learning needs. We need modifications at times and accommodations that reflect the true nature of the stress in our jobs.

We cannot be expected to own our wellness when by its very nature our work often leaves us exhausted and without adequate time to rejuvenate. The ownership needs to be jointly held by us and our organizations, communities, and professional organizations.  We need nap pods, we need exercise equipment on site, and we need kindness which includes life affirming strategies aimed at reducing the host of risk factors are work puts us at risk of.

We also need parity with other helping professions and service providers such as first responders – Police, Fire, and Ambulance. I’m not sure how this has happened but we have lost a lot of ground in this regard.  In many provinces and jurisdictions, Police officers now make six figures and have the benefit of early retirement at full pension.  Most urban Police stations and fire halls have onsite gyms.  I do not begrudge this, in fact I applaud it.  But, we are also first responders and we are by and large not a healthy population by any indication.

Most importantly, we have to be clear about these truths. It is surely hard to admit that our work makes many of us ill in one way or another and by the very nature of our illnesses we want to avoid talking about them and truly addressing them.  We need to adopt real risk reducing strategies such as those employed by our Police partners. Can you imagine a Police officer attending a client home alone?  Working in partners is one of the most basic risk reducers available to us but we don’t have that option much of the time.

The evidence is not just anecdotal and therefore should not be dismissed. What needs to happen now is for us to bravely open up global conversations and create global movements to address our wellness.

Perhaps ironically, we are in fact a vulnerable population who are charged with serving, protecting and healing other vulnerable populations created by our society.  Society and systems create vulnerable populations, individuals do not create vulnerability in themselves.

Leaders who are responsible for the wealth of research pertaining to the cost of caring in our areas of work need to collect and collate information regarding the positive effects of workplace culture in addition to wellness options where organizations own the efforts and reap the benefits of those efforts. And, we need to strongly advocate for the end of career benefits that our Police, Fire, and Ambulance colleagues experience.

I believe we need an organization for social workers and helping professionals, a think tank of sorts,  whose purpose is to improve our lives at work and at home.  I’m sorry to have to say this but our professional organizations have missed the mark here.  More often than not, they exist to monitor and discipline us while protecting their interests. Who will protect and nurture our interests?

Clint has recently joined Social Work Helper as Digital Marketing Coordinator and Writer. He is a Canadian Social Worker who earned an Honors Bachelor of Social Work (BSW) from Laurentian University and a Masters of Social Work (MSW) from McGill University. Clint is in his 20th year of Social Work practice with interest and expertise in macro and systems level analysis and intervention, domestic family violence, trauma, stress, and post traumatic stress, child maltreatment, and solutions to reduce the impact of trauma in the helping professions.

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Child Welfare

How to Support Foster Children

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When you choose to become a foster carer the rewards can be great. Supporting a child through a difficult period in their life, watching them grow and develop into a well-rounded individual; it’s understandable why so many choose to pursue this worthwhile vocation.

However, as with any profession, it does come with some downsides. Primarily helping some children to cope with the trauma and stress that being in foster care can evoke.

So, how can you best support a foster child in a meaningful way? One that will be beneficial to the both of you.

Listen

Feeling like the most overlooked member of society can have a damaging and long-lasting effect on foster children. Meaning that the simple act of offering them an ear to vent their worries, experiences or anything at all can be extremely positive. It establishes you as a point of reason in their life.

You can’t always solve the issues that are brought up during these moments. Nor should you try, but it is worthwhile simply being there to hear. Because, at the end of the day, your foster children deserve to be listened to.

Celebrate

Birthdays. Christmas. Halloween. Important events can often go overlooked as a foster child. So, taking the chance as a foster parent to celebrate these milestones – no matter how little or big – can be the change that a child needs. Simple things such as helping put up a Christmas tree could be a moment they will remember for a long time to come.

And at the end of the day events like Halloween and Birthdays are fun – something every child needs a little more of in their lives.

Playdates

Your support is vital, but often the support of peers can also be invaluable for the wellbeing of those children in foster care. Setting up playdates – even for older children – can be a great way to help them interact and enjoy time with children their own age.

Older children or teens may be unreceptive to you making playdates for them. But, arranging ‘coincidences’ of kids their age coming over can always be an alternative solution. What they don’t know…

This can also be beneficial for any of your own children that may also be in the house. A disgruntled foster child can be a distressing presence in the home, so balancing this out with a familiar friend and playmate is often needed to offset this. All of the children in your home can benefit from socialising with others both in and outside your own home at times,

Getaway

Sometimes life can get a little too much when you are forced to come and go through a number of foster homes, which is a reality for many foster children. A day out – not even an expensive day out or holiday – can be a bright spot in an otherwise overcast moment in their lives. The zoo, beach, museum and even the park can be an adventure.

It’s not always clear what a child is going through, nor will they always express their emotions in healthy ways. Removing them from the environment which creates these feelings can be a relief in many cases.

Help with School

On average, foster children tend to do worse academically and behaviour wise in school than other children. The reasons are often self-explanatory, but it is something which you can positively influence whilst they are under your care.

Helping with homework, actively engaging with teachers over what you can do further to help and encouraging after-school activities are some ways to do this. Goals should be set, but ensure they are realistic and rewarded when surpassed.

Overall, being a foster parent is a big task but one that can bring so much enrichment to a child’s life. As a solid figure in their life, you can help ensure the rest of their life is more positive than the start. Supporting a foster child can be a challenge, but that makes it all the more rewarding when you see a positive effect on the life of a child.

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Child Welfare

Parental Medicaid Expansion Translates into Preventive Care for their Children

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When low-income parents enroll in Medicaid through the Affordable Care Act (ACA) state expansion program, their children have considerably better odds of receiving annual preventive care pediatrician visits, according to a new analysis by the University of Pittsburgh Graduate School of Public Health and Johns Hopkins University.

This “spillover effect,” explained in a study published online today and scheduled for the December issue of the journal Pediatrics, demonstrates that the potential benefits of Medicaid expansion extend beyond the newly covered adults.

“These findings are of great significance given the current uncertainty surrounding the future of the ACA and Medicaid expansions authorized by the law,” said senior author Eric T. Roberts, Ph.D., assistant professor in Pitt Public Health’s Department of Health Policy and Management. “Lawmakers crafting policy proposals that could curtail Medicaid benefits or eligibility should recognize that such efforts would not just limit the receipt of health care services by low-income adults, but also by their children.”

The ACA provided states the opportunity to expand Medicaid coverage to all low-income people at or below 138 percent of the federal poverty level. So far, 31 states and the District of Columbia have expanded Medicaid coverage.

Roberts and his colleagues identified 50,622 parent-child pairs from data collected in the 2001 through 2013 Medical Expenditure Panel Surveys, a nationally representative survey administered by the U.S. Department of Health & Human Services that includes detailed information on family structure and demographics, including health insurance status and health care use.

They discovered that children of parents who had recently enrolled in Medicaid had a 29 percent higher probability than children of unenrolled parents of receiving their well child visit, which is recommended annually for children age 3 and older, and more frequently for infants and toddlers.

During the visits, the children are examined for growth and development and given immunizations, and their caregivers are guided on proper nutrition and child behaviors. Studies have shown that children who get well child visits are more likely to receive all their immunizations and less likely to have avoidable hospitalizations. The U.S. has persistently low rates of well child visits, particularly in low-income families.

“There are many reasons that parental Medicaid coverage increases the likelihood of well child visits for their children,” said Roberts. “It could be that insurance enhances the parents’ ability to navigate the health care system for themselves and their children, increasing their comfort in scheduling well child visits. Medicaid enrollment could be a sort of ‘welcome mat,’ in which eligible but previously uninsured children are enrolled after their parents gain coverage. It also could be that parental Medicaid coverage frees up more money to provide preventive services to their children, because even copays can be a deterrent to medical care among low-income people.”

Maya Venkataramani, M.D., is lead author on this research, and Craig Evan Pollack, M.D., M.H.S., is a coauthor. Both are from the Johns Hopkins University School of Medicine.

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Child Welfare

Systems Perspective and the Myth of the Self-Made Man

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As a social worker, we spend a good deal of time looking at systems, and systems work means we can’t only focus on what’s “wrong” with the individual in our office. Our focus can’t simply be what can this person do to move toward more emotional happiness? We need to always be considering how living in the world and engaging in relationships with other systems and other people play a large role in what this client does, how they think, and how they feel.

My job isn’t to just locate the unhelpful belief my client has about their self-esteem or retrain how they respond to a negative thought. When doing systemic work—even with just one person—I need to look at how race, ethnicity, age, sexuality, and gender play a role in my client’s life. I need to look at how that client’s family system, school system, government system, community systems, and more played a role in shaping my client.

As basic as this is, it’s important to note that It’s a fairly un-American way of going about things.

The Big Lie of Individualism

We’re taught that we should hold up the self-made man. We celebrate that guy to no end in movies, plays, songs, and stories. It’s our enduring myth.

We, social workers, see the monstrosity in that idea—pleasant and attractive though it is. We know that human beings can only grow and thrive within relationships, not apart from them. We know that nothing is self-made. We know that we are working from day one of life to attach to others.

We need to push back on the “self-made man” myth because it’s racist. It’s sexist. It’s heteronormative.

And it’s killing us.

And since I work mostly with men I want to be very direct because it’s literally killing us as the suicide rate for men is incredibly high: five times greater than for women. And we apply words like “strong” and “hard” when we’re describing masculinity? Something is missing. The weaker sex, the special snowflakes, are the ones who are supposed to need help. Not us.

Social workers disagree about many things and we have lots of ways we think are the best way to help any given client, but one thing we can all agree on when it comes to healing is that the relationship does a great deal of the work. It can begin to heal trauma, mental illness, and the “worried well.” It’s the way in, it’s the way through, and it’s the way out of suffering. It’s not the only thing, but it’s part of everything. Death is in the separateness, the lack of relationship.

And name your –ism because that’s about separateness too. We can’t fully heal a white person without moving through white supremacy together and we can’t help men without addressing the patriarchy. We may not call it out or by these names, but to connect with someone in their suffering is to refuse white supremacy and masculinity.

We need to keep doing what we’re doing, but we need to go further. We’re healing the people without healing the system and we can only thrive so much within a sick system.

Moving Ourselves Toward an Ego Dystonic State With the World

In a mental health session, our work is often to connect our client with other people. Often this happens through the therapeutic relationship with us first, but ultimately, it’s done so they can connect with the other people in their life. Doing this on an individual level is important, and as difficult as it is (and it is difficult), it’s really the bare bones of our work. Because what we’re doing, if we stop there, is helping people build up coping strategies to survive in a broken system.

So we have to stop and ask ourselves if in our work we are challenging the system that our clients live in and, not for nothing, that we’re living in too. Now, this can be a controversial stance for some people. It sounds “agenda-driven” and done unskillfully it is just that. But for those who feel they are thriving in this patriarchal, white supremacist world, do we have any choice, ethically, but to aid them in shifting their lens?

For too many of us, we have come to see this world as ego syntonic and we need to push toward discomfort in ourselves to see the world as it is. And that will move us toward change.

A Child Welfare Example

Let me take my work in child welfare as an example. Most of the parents I’ve worked with over the years are well-meaning and loving people. Many of them are involved in child welfare because they had hit their children in order to discipline them. Many of them feel this is ok. Many of the child welfare workers think it’s ok to physically discipline a child. We even have different words so we separate “abuse” from “physical discipline” and we jump through hoops to try to define “excessive corporal punishment” as separate from “physical discipline”. Many parents have no hesitation telling me that when their child gets out of line they need a slap, a spanking, a something that lets them understand limits, but that this is discipline and not abuse.

And in the course of this conversation, I usually hear the inevitable, “It happened to me and I turned out ok.”

And right there is the thing that I’m talking about with these systems. You “turned out” in such a way that you think it’s ok to hit a child, your child. And this is the proof that you didn’t turn out as “ok” as you think. You grew up with something violent being normalized.

But that’s our society. That’s the society that collectively calls sexual assault “locker room talk” and elects a president. That’s the society where powerful, talented men are allowed to produce and direct movies for years without consequence for their sexually abusive behavior.

Systems work is helping people see that things they take for granted could be wrong. Knowing

  • That there are not simply two genders.
  • That race is not encoded in our DNA.
  • That women are not genetically more nurturing.
  • That there are no such things as boy and girl toys.

Knowing all that means we have to fundamentally shift our way of thinking, our way of feeling, our way of living—day to day—in this world. And we may need to fundamentally, though not radically, change the way we approach therapy.

Merging the Therapist and the Advocate

Great things can come from our work with individuals, couples, and families. We can support people in relieving a lot of pain and finding healthier ways to interact. We move people through trauma, out of depression and anxiety, and to better navigate relationships. We help people live within our broken world—which is no small feat. Part of our happiness can only come by becoming more open to uncertainty which is all we really can be certain about.

But can we do more or does our job end there?

I believe we can. Not by “pushing an agenda” or preaching, but by becoming grounded in a strong analysis of the patriarchy, in racism, and in anti-oppressive work. With this analysis, we understand ourselves differently and we understand others in a new way. We see more easily how reactive our clients can be while not realizing they’re being reactive. We are so skilled at reaching for feelings or for picking out the latent content. We see through all of the mental healthy stuff, and we bring it into our work. But, we can see through the racism, the gender norms, the patriarchy, the homophobia and bring that into the work as well? The stronger we are in our own analysis the more able we are to help clients see when they’re reacting to a system instead of their own desires or someone else’s needs.

Most of us just aren’t so good at doing it yet. So many of us separate this work: “I’m a therapist in the office, and I’m an activist when I’m outside.”

That’s great. It is. But we need to find a way to merge the two. To make them inseparable.

Can we repair an airplane while we’re flying it? Can we change our systems while living in them?

Well, first off, we have no choice. We can’t step outside of it because it’s the air we breathe.

With everyone we meet, whether client, friend, lover, or family we need to be grounded in our awareness. We need to support the people we care about, our clients or otherwise, and do all the great engagement and interventions we learned in social work school and beyond—but we have to have an eye on the system. The system they’re in. The one we’re in. The whole shebang.

We need to not preach. We need not be so agenda driven that we miss the humanity of the client or clients sitting in our offices and their suffering. Our need to end the patriarchy cannot be at an individual client’s expense, of course!

But in session and out, we need to be on the lookout for moments to open our own and others’ eyes to the sickness that we are living in. The sickness that lies and says this is the only way to be.

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