Humanitarian response and stress in Kenya: gendered problems and their implications

ABSTRACT

Stress-related conditions such as burnout and post-traumatic stress disorder are a growing concern in the humanitarian sector. Aid workers themselves report not only that mental health problems are common, but that the support they receive from their employers is insufficient. Problematically, the experience of the international aid worker – particularly those who are white and from the global North – is often foregrounded in explaining what constitutes stress and related mental health problems. This indicates a wider problem of what is required of ‘the perfect humanitarian’ – a personality that is gendered and racialised – and how this influences the different experiences and treatment of national and international staff from aid agencies. This article explores the organisational culture and working conditions of humanitarian settings and their impact on the mental health and well-being of staff. It argues that there is a structural dimension to stress that is less to do with external security threats and more to do with the specific infrastructure, policies, and practices of humanitarian operations, with implications for aid workers which cut across dimensions of race, gender, and nationality.     

Explaining fathers' involvement in childcare: an ecological approach

The study was conducted among a sample of 113 Israeli fathers, and aimed to examine the variables that explain paternal involvement in care of children between the ages of one and six. Based on Bronfenbrenner’s ecological approach, the study examined the contribution of variables representing three ecological systems of the fathers: the ontogenic system – the fathers' background variables, and their childhood experiences with paternal involvement; the microsystem – children’s characteristics (age and temperament); and mothers' characteristics (education, hours of work outside of the home, and fathers' assessments of maternal gatekeeping); and the macrosystem – type of community of residence (rural or urban). Maternal gatekeeping most significantly explained paternal involvement in most of the domains of childcare that were examined. Fathers living in urban communities who assessed their wives' maternal gatekeeping as high tended to be more involved in the domain of physical care than their counterparts living in rural communities. The child’s temperament explained paternal involvement in the domains of showing love and playing with the children, whereas the fathers' childhood experiences with paternal involvement were related to their involvement in the domain of physical care. The implications of the findings for families and communities are discussed.     

The prevailing cultures and staff dynamics in children's homes: implications for training

This paper is about training, and the learning needs of residential child care staff that training should address. It takes as its starting point research that focused on what happens in children's homes, as described by residential staff themselves. It depicts the tasks which staff carry out in relation to their overall goal of benefiting the children and young people in their care, and considers the ways in which staff work to develop and maintain viable and effective teams. Distinctive cultures emerge when working in staff teams, and the paper shows how these are related to the kinds of practice that can be achieved in residential settings. The knowledge base, practice skills, and personal qualities required to work within residential child care are detailed. The paper closes by addressing the implications which this research has for training residential staff to work effectively in group settings. It argues that fundamental to training competent residential staff is a commitment to developing an ongoing culture of learning in workplace settings.     

‘Who do I turn to if something really bad happens?’ Key working and relationship-based practice in residential child care

ABSTRACT

This article explores the psychodynamics of relationship-based practice from the perspective of young people in residential care. This research involved qualitative semi-structured interviews with 10 care leavers, aged 18–24 years, who had been in residential care in Ireland. Drawing selectively from that research, this article reports their views and experiences of key-working and how relationship-based practice acted as a reparative method within their experiences of care and aftercare. Similar to previous research, this study underscores the necessity to ensure that children in care are cared for and supported by a trusted adult. In addition, based on this study, the role of a key worker appears capable of providing this ideal type of supportive relationship. It also highlights the importance of the care system working to provide consistency and support for the young people and confirms the importance of relationships with trusted adults, such as key workers.     

Planning and implementing group supervision: a case study from homeless social care practice

ABSTRACT

Effective clinical supervision is increasingly recognised as essential in supporting staff who are working in the field of social care. Using a case study approach, this paper illustrates the processes involved in planning and implementing a group supervision pilot with a team working in a homeless service. The supervision models used to inform and guide this initiative are described and the style and structure of the supervision sessions are discussed. The paper additionally provides a reflective analysis of group dynamics and group processes observed during this work. Subsequent conclusions identify the key features of this process and may provide guidance for other practice settings.     

Managing the process of change in residential child care: A consultancy approach

This article explores the impact of a consultancy undertaken with groups of residential child care staff within a large local authority who were experiencing considerable changes in their working environment as a result of a review of residential care structures. The authors were invited to engage directly with staff on an individual and group basis to help them work through the barriers they perceived to changing their approach to practice. The theoretical underpinning for the work was Charles Handy's [1993, Understanding Organisations (Harmondsworth, Penguin)] belief that change is more likely to have a positive outcome when staff have an investment in and contribution to the change processes. The model of change utilised within the sessions with staff was Kurt Lewin's three stages of 'unfreezing', 'change' and 'refreezing'. The consultancy raised a number of issues about the process of change and how this can be achieved within the residential child care context. In particular, it highlighted the problems of assuming that change is a linear process which can be directly controlled and managed in the flux and uncertainty which characterises this sector.     

“A heart with skill to listen”: Consultation to a child-minding project

Abstract

This paper describes a consultation to a child-minding project. It has implications for the development of day care for children, and discusses the importance of support to workers in relationship work, particularly in the management of feelings.     

Life Planning Services: Helping older placed children with their identity

Life Planning Services for Older Children is a time-limited and intensive approach for working with youngsters who are or have been in the American foster care system. The program is designed to help children and adolescents explore the way in which their life experiences influence their selfimage as well as to examine the availability of family membership for the present and the future. The program staff work to strengthen existing family connections or to help youngsters look at alternatives. After examining the impact of identity on placement, the author describes some of the methods used by Life Planning Services staff to help placed children meet the challenges of adolescent identity development.Sheila Merry, Kay Donley, and Betsy Cole are thanked for their helpful comments and suggestions.     

Achieving Permanence in Foster Care for Young Children: A Comparison of Kinship and Non-Kinship Placements

ABSTRACT

A number of child welfare policies have reinforced the use of kinship care as the most preferred placement for foster children, reflecting the philosophy that maintaining children within their own extended family system contributes to their stability and well-being. Given the growing utilization and legislative emphasis on kinship care along with the push for an immediate implementation of permanency plans for children in foster care, this study examines how the permanency goal under the 1997 Adoption and Safe Families Act (ASFA) is being implemented and achieved. The reunification and permanency placement (adoption or legal guardianship) outcomes of children in relative and non-relative care are analyzed, focusing on the experiences of young children. Based on public child welfare agency data from 2000 to 2003, child, case, and placement variables are explored to identify which set of factors best explains case outcomes. The present study identifies the total length of foster placement (kinship and non-kinship), the length of family maintenance services, and the number of placement changes as the most important variables in determining family reunification and permanent placement (legal guardianship and adoption) outcomes for young children.     

Psychotropic medications in child welfare: From federal mandate to direct care

Background and objectiveChildren in the welfare system are prone to uncoordinated and unmonitored mental health care, including psychotropic medications. To address these issues, federal legislation mandated that state child welfare agencies improve the coordination and oversight of psychotropic medications. However, there is no clear guidance on how to improve these practices, particularly at the level of direct care. We aimed to identify specific areas for improvement through state-wide surveys of four groups.MethodsWe surveyed all known members of four groups working directly with children in foster care in one small northeastern state. Respondents included 209 foster and adoptive parents, 169 child welfare staff, 84 mental health therapists, and 33 clinical prescribers. Survey items addressed practices and perceptions related to sharing of information and cross-system communication and monitoring of medication effects and side effects.ResultsNearly two in five foster and adoptive parents reported not regularly receiving information about the purpose or side effects of psychotropic medications, and they disagreed among themselves on who was primarily responsible for monitoring safety and effectiveness. One-third of child welfare staff and two-thirds of mental health therapists reported that information about psychotropic medications is not regularly shared with the child's provider team. Half of clinical prescribers reported not regularly communicating with child welfare staff.ConclusionsWe identified specific areas for improvement related to communication, sharing of information, monitoring, and role clarification. Strategies to improving these activities are key to ensuring the safe and effective use of psychotropic medications in this population.     

Coming Out Issues of Gay and Lesbian Mental Health Professionals in Voluntary and Involuntary Settings

Abstract

Mental health professionals are increasingly called upon to provide consultation and treatment in settings different from the traditional outpatient and hospital inpatient settings. This paper provides an overview of the unique problems posed when considering self-disclosure by gay or lesbian mental health professionals working with institutionalized populations. A review of literature concerning self-disclosure to patients in outpatient settings is provided and applied to institutionalized settings. Benefits of, as well as cautionary notes regarding, self-disclosure of homosexuality by mental health staff are reviewed.     

Between love and behaviour management: the psychodynamic reflective milieu at the Mulberry Bush School

ABSTRACT

This article presents findings from a qualitative research study of the Mulberry Bush School (MBS), a therapeutic residential primary school caring for children with severe social, emotional and behavioural difficulties. The article notes the challenges of working with children who have experienced traumatic relationship breakdown, and reviews ideas and practices developed at MBS to support the children’s development. There is a discussion of the research study’s methodology and main findings. The researchers argue that the therapeutic milieu at MBS maintains a creative tension between a secure, playful context and one where emotional disorder and disturbance are not suppressed. The study describes how a particular psychodynamic model of reflective practice has been successfully instituted at MBS to create a ‘staff therapeutic milieu’ supporting the group living and group learning through which therapy principally occurs. The article closes with comments on the applicability of this model to residential child care practice generally.     

Reclaiming complexity: beneath the surface in residential child care

ABSTRACT

Residential child care is an inherently distressing and multi-layered endeavour undertaken by staff who are often poorly trained and supported. In addition, the children, and the adults who care for them, can provide a convenient receptacle for the split off negative feelings of professionals, politicians and the public. The complexity and difficulty of this work is often unrecognised and a simplistic response based on a programmatic, behavioural framework, reinforced by performance-based management and an audit culture, is common. This paper argues for the usefulness of a different approach, drawing on psychoanalytic and open systems thinking, to provide a more nuanced understanding of what is happening in these volatile settings that can guide interventions which match the complexity of the work. Alongside advocating the use of key psychoanalytic and systems concepts to improve understanding, it argues for the importance of providing a containing and reflective environment for staff.     

Remembering,Apologies, and Truth: Challenges for Social Work Today

Abstract

In 2003, over 41?000 families with accompanying children throughout Australia were assisted by homeless services. Sole fathers with children in their care who are homeless are a minority group within this overall population of homeless families and, as such, little is known about their experiences of homelessness and fathering. The present paper reports on an exploratory study of sole fathers with children in their care who were homeless in the Australian Capital Territory. The study identifies the fathers’ pathways into and experiences of homelessness, and the fathers share their stories of what it means to be a sole father. The paper identifies the issues fathers may experience when dealing with homelessness and fatherhood. An increased understanding of these experiences can contribute to the development of further research and improved practice with such families.     

Empowered inclusion: theorizing global justice for children and youth

ABSTRACT

This paper argues that contemporary child and youth experiences of globalization call for retheorizing global justice around a new concept of empowered inclusion. The first part of the paper examines three case studies in globalization – child labour movements, child and youth migration, and young people’s organization around climate change – and shows how, in each case, young people, through their struggles against injustice, are simultaneously disempowered and empowered by their deep global interdependency. The second part proposes new theoretical advances in global justice that better respond to child and youth experiences through a childist concept of the empowered inclusion of both children and other marginalized groups. And the third part advances some preliminary suggestions about how a more child-responsive conception of global power and justice might be operationalized in practice across global policies, institutions, and culture.     

Exploring the Climate for Overweight and Obese Students in a Student Health Setting

Attitudes and beliefs of health care providers, in conjunction with a nonthreatening physical environment, are important components in establishing a constructive and supportive climate for care of overweight and obese students. Objective: The authors explored providers' attitudes about obesity and assessed the physical environment in a student health clinic to identify areas that may be detrimental to the care of overweight and obese students. Participants: Eighteen direct care providers participated in the project. Methods: The authors conducted focus groups with direct care providers and assessed their experiences and perceived challenges in working with overweight and obese students. The authors also conducted a walk-through assessment of the physical environment. Results: Direct care providers expressed discomfort in deciding how and when to discuss weight with students. The authors found that elements of the physical environment could present barriers to care for overweight and obese students. Conclusions: The authors make recommendations for improving the health care climate for overweight and obese students.     

Views from the Frontline

Abstract

Through in-depth interviews, Kentucky welfare case managers compare their experiences working under Temporary Assistance to Needy Families (TANF) with their experiences working under Aid to Families with Dependent Children (AFDC). Interviewees unanimously agreed that TANF is more ambiguous, complex, and stressful than AFDC, both for clients and managers. Although case managers embrace the self-sufficiency goals of TANF, the strict work requirements, overwhelming paperwork and limited education and training opportunities create conflicting goals and barriers that frustrate case managers, leading to suggestions of a return to some rules of AFDC while retaining the TANF goal of independence from the welfare system.     

‘The extreme end of a spectrum of violence’: physical abuse,hegemony and resistance in British residential care

While researching the history of traditional child care institutions – children's homes, orphanages, industrial schools and reformatories – the author was impressed by the similarities of regimen across the spectrum of traditional care. Underpinning all forms of care was a severe discipline which often became abusive. Sexual abuse was also reasonably common. There were differences but it is the similarities which are stressed in this article, which seeks reasons for the perceived sameness. Children in care came mostly from the same deprived social background, and no matter what the intentions of the carers, traditional care involved a confrontation with cherished working class values which many of the children were bound to resist. Resistance was met by severe staff reaction; hence the violent undercurrent. Copyright © 2001 John Wiley & Sons, Ltd.     

Touch in residential child care: staff’s bodies and children’s agency

This paper concerns the significance of touch in the everyday life of those living and working in residential child care. Public and professional awareness about child abuse has focused attention on the bodies of children and their vulnerability – but the same cannot be said of the bodies of staff members who touch children. This ethnographic study of a Scottish residential child care unit shows such touch to be central to the everyday participation of children and young people in care. On the basis of participant observation, the paper analyses how care workers influence the agency of children and young people by bringing their own bodies into their relationships with them. Based on a relational understanding of care, the paper elaborates on how tender and restraining forms of touch form part of care workers’ professional repertoire of actions. The analysis of various instances of touch in terms of sociology of the body shows how staff members can help to shape children and young people’s opportunities for participation with their own bodies. In conclusion, the paper therefore argues for a professional and reflexive engagement with bodies rather than a general avoidance of touch between care workers and young people.