Discussion: The Human Services Profession

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A Phenomenological Study on Meaningful Professional Experiences for Human Services Professionals

Saundra Penn and Hannah Baartmans

Abstract Human services professionals are a relatively new addition to the realm of professionals in the mental health community. As such, little research has explored how human service professionals make meaning out of their experiences with clients. Thus, this phenomenological study explored the defining professional experiences of human services professionals providing direct care to persons with mental health and/or developmental disabilities. Findings related to the intensive role of the human services professional, intrinsic rewards, client connections, barriers to service provision and professional development, self-care, and ethical issues are discussed.

Literature Review The human services profession emerged in the 1960s. As communities transitioned from

institutional mental health care, the need for associate and bachelor level community-based professionals grew (Neukrug, 2017; Woodside & McClam, 2015). Often, human services professionals are referred to professionally as case managers, generalists, and direct service providers. Many are responsible for coordinating, consulting, counseling, planning, problem solving, and record keeping (Taylor, Bradley, & Warren, 1996; Woodside & McClam, 2013). As generalists, human services professionals are often capable of performing their roles and duties in many settings and expected to support a range of client populations and demographics (Neukrug, 2017; Woodside & McClam, 2015).

Human services professionals are often accountable for client care in two primary ways: direct care of clients and managing and coordinating services for clients within the community (Neukrug, 2017; Woodside & McClam, 2015). In many cases, this creates a “dual role” as human services professionals are both providers of care and brokers of services. At the micro- level, direct service providers are empowering their clients, providing support, and intervening in times of crisis. At the macro level, they are creating a community network of supports for clients as well as managing and facilitating these services (Taylor et al., 1996). Several researchers have explored the challenging nature and complex roles of human services professionals and their workload (Taylor, et al., 1996; Woodside, McClam, Diambra, & Varga, 2012).

Woodside et al. (2012) examined what time meant to 46 human services professionals. After completing thematic analysis, the researchers discovered that these professionals had a “never-ending pace,” highlighting the agencies’ demands, the intensity of client care, and the lack of time to accomplish it. Moreover, human services professionals admitted that indirect roles such as recordkeeping and documenting offered a greater challenge than other professional tasks. Several research studies show that mental health workers were found to be high risk for burnout resulting in exhaustion, compassion fatigue, and a negative professional outlook (Morse, Salyers, Rollins, Monroe-Devita, & Pfahler, 2012; Schaufeli, Leiter, & Maslach, 2009). Similarly, providing direct care for persons with developmental disabilities places human services workers at risk for burnout, especially if they support clients with challenging behaviors

Sandra Penn and Hannah Baartmans, Human Services Studies, Queens University of Charlotte. Correspondence for this article should be sent to [email protected].

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and are unable to maintain positivity related to the clients they serve (Kile, 2014; Lunsky, Hastings, Hensel, Arenovich, & Dewa, 2014). Chronic burnout leads to an erosion in professional values and places human services professionals at-risk for behaving unethically (Corey, Corey, Corey, & Callanan, 2015; Neukrug, 2017).

Woven throughout the literature is an acknowledgement that the human services profession is an extremely demanding and time intensive field (Kile, 2014; Lunsky et al., 2014; Schaufeli et al., 2009; Taylor, Bradley, & Warren, 1996; Woodside et al., 2012). However, to date, there is a scarcity of qualitative research that examines how human services professionals draw meaning from their complex professional roles. Human service students and educators could benefit from reading about participants’ social, cultural, and historical interactions within the profession. Further, they may learn more about professionals’ subjective accounts on navigating and negotiating their human services career. Therefore, the purpose of the current qualitative study explores defining professional experiences of human service practitioners providing direct care to persons with mental health and/or developmental disabilities.

Method

This article is based on a qualitative research design relying on a social constructivist paradigm where the researchers explored the lived experiences of human service practitioners supporting clients with mental health and developmental disabilities. A social constructivist paradigm with phenomenological underpinnings was selected as a means of understanding human service practitioners’ subjective views and interactions within the profession (Bevan, 2014; Creswell, 2013). In phenomenology, the number of individual interviewees varies depending on the phenomena being explored. In some cases, the number of individual interviewees ranges from 3 to 10 (Creswell, 2013), while the number of focus group participants averages 6-10 (King & Horrock, 2010). Using individual interviews and a focus group, the researchers delved into the lived experiences of human service workers supporting clients with mental health and developmental disabilities. Thereafter, the interviews were analyzed for latent themes (Creswell, 2013). Participants Convenience and purposive sampling strategies were used to recruit participants from a southeastern metropolitan city. To recruit participants, e-mails and flyers were distributed to non- profit and for-profit agencies that specifically served clients with mental health and/or developmental disabilities. To be eligible to participate in the study, the practitioner must have worked in the human services field for at least six months, served clients with mental health and/or developmental disabilities, and have not received an educational degree higher than a bachelor’s degree. Focus group participants had the opportunity to win a $40.00 Visa check card and all other participants’ names were added to a drawing for a Kindle Fire.

Participants were given the choice to participate in focus groups or an individual interview. The focus group was slated for one and a half hours while each individual interview was scheduled for one hour. A total of 13 participants were recruited. Eight human services professionals participated in a focus group and five completed individual interviews. Of the participants, nine worked for privately-owned for-profit comprehensive agencies serving adults and children with mental health, developmental disabilities, and substance abuse needs. Two

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worked at government agencies supporting young children with socio-emotional and development needs, while two of the participants were employed at a non-profit agency for teens and families in crisis. Seven of the participants self-identified as African American males; three identified as African American females. Three of the participants were white females. Of note, participants’ ages ranged between twenty-five and forty-five. Participants reported being in the human services profession between two and 12 years with bachelor’s degrees in several majors including Biology, Communication, Marketing, Political Science, Psychology and Sociology. One participant had a high school diploma. Participants signed an informed consent document and completed a survey prior to the interview. Data Collection

Structured questionnaire. Prior to the focus group or individual interview, each participant completed a brief questionnaire and informed consent document. The structured questionnaire solicited information about the human services professional’s gender, age, race, population served, job title, years in the human service field, highest degree awarded, hours of supervision received monthly, and hours of supervision provided per month.

Interview. Adhering to phenomenological interview guidelines, two data collection approaches were chosen, individual interviews and a focus group (Creswell, 2013). The focus group lasted one and a half hours with eight of the participants. This timeframe aligned with the suggested length of a focus group (King & Horrock, 2010). The other five human services professionals were interviewed by the first researcher for 35 to 45 minutes in a place of convenience and comfort including their homes or private office settings. The length of the individual interviews contrasted from the typical one-hour length; still, interview protocol was followed regarding rapport building and the development of questions (Creswell, 2013; King & Horrock, 2010).

The interview questions were limited to allow space for participants to freely express themselves (Bevan, 2014; Creswell, 2013). The structured questions were broad, open-ended, descriptive, and imaginative. The questions were: If you had to choose an animal to describe your experiences in the human service field, what animal would you select? Why? Can you describe your job responsibilities? What has been the most meaningful part of your career in mental health and developmental disabilities services? Describe the ways that you have grown in your career in these populations? Describe some of the biggest challenges you and other professionals face in your work with this population? The participants were encouraged to explore beyond the questions presented and introduce salient topics or ideas. The interviewer also used active listening and clarification skills when respondents were vague or unclear. When the interviews ended, each participant was thanked and encouraged to contact the first researcher if they had further questions or additional comments. Strategies for Trustworthiness

Several techniques were used to validate data sources and data analysis in the study. The decision to use a combination of individual interviews along with a focus group was based on data source triangulation and the desire for a spectrum of participants (Carter, Bryant-Lukosius, DiCenso, Blythe, Neville, 2014; King & Horrock, 2010). Because human services professionals handle sensitive client information and function in diverse organizational structures, the ability to

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select their preferred interview method was significant as it tends to relate to the type of information shared (Carter et al., 2014). Also, of significance, the coders for this study were licensed professional counselors with experience in phenomenology utilizing a semi-structured interview. They discussed potential biases and assumptions influencing their interpretation of participants’ statements. Because advanced degreed licensed professionals often supervise human services professionals in the respective state, the coders felt it compulsory to converse about their clinical and supervisory experiences (Creswell, 2013). Ultimately, both coders felt that it was impossible to set aside their human services experiences but believed that by bracketing (critical self-reflection), they could remain focused on the participants’ phenomenological experience. Data Analysis

The phenomenological data analysis process adhered to standards described by Creswell (2013). Following the interviews, the data were transcribed verbatim and the first researcher along with an outside coder read through the data several times before meeting. In the first meeting, the coders had already identified preliminary significant verbalizations. They engaged in horizontalization of the data by continuing to explore significant statements that reiterated how human services professionals drew meaning from their professional experiences. Initial coding evolved into latent themes analysis identifying underlying ideas and assumptions which resulted in textual descriptions (Braun & Clark, 2006). Verbatim examples were found that reiterated participants’ lived experiences for each theme (Creswell, 2013; Vaismoradi, Turunen, & Bondas, 2013). A structural description was independently written to reflect on the context in which these human services professionals found themselves.

Findings

The participants described and discussed several professional issues impacting their work with clients with mental health and developmental disabilities. The emergent themes were a) a varied and intensive role, b) an identity shaped by intrinsic rewards, c) professional development through client connections, d) barriers to service provision and professional development, e) self- care plans to balance life roles, and f) encountering ethical issues frequently. A Varied and Intensive Role

These human services professionals provided an array of services to a wide range of populations highlighting the variation in clients’ needs. They worked with elderly, adult, and child consumers coping with a single or a combination of emotional, physical, and developmental issues. Some worked with individual clients alone while others worked in team settings with clients. Other professionals highlighted their work with clients and their entire families. In addition, participants outlined their work schedules where some indicated being on- call 24 hours a day for seven days a week. In addition, some participants found themselves working additional unpaid hours to ensure that they completed all their tasks. They provided in- home services, facility services, and community-based services throughout one or more counties. They had administrative responsibilities in addition to a long list of specific direct services benchmarks they were expected to meet with their clients. As one participant describes:

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You’re constantly on the go. You might spend several hours in court just waiting to get in. You could be in an IEP meeting that took three (3) or four (4) hours long. You could be at the doctors’ office with a family helping them explain the recent behaviors that could take several hours. There’re a lot of competing priorities that eat up a lot of time.

Another participant reiterated: “I am a jack of all trades.” An Identity Shaped by Intrinsic Rewards

The participants were cognizant that the human services profession demanded a lot of their time and energy and offered low pay. Most of the participants have been in the human services field an average of 10 years and reported fluctuating salaries. Some discussed their experiences losing their jobs when private for-profit companies closed within the state. Despite these challenges, they were unable to imagine working in another field. As one participant said:

For me it’s always been a sense of feeling blessed to be able to help others and get paid for it. There are a lot of hurting people out there and anything you can do to help minimize some of that hurt, pain, stress, what have you, I think it’s an absolute wonderful thing but to be able to get paid for it, is icing on the cake, that’s a sweet deal in my opinion.

And another participant shared:

If I come in and I’m the only positive thing they see, they begin to look at me as a leader. I can’t describe the feeling but it’s just a good feeling you feel when you have been able to connect with a family in hopes of re-establishing some of those broken relationships.

The participants shared a belief that the strides observed in clients, no matter how small, were an intrinsic reward within their profession which often superseded financial gain. Professional Development Through Client Connections

Another collective idea among participants was that their professional development was a direct result of the challenges presented by their client populations. As such, they reported that careers within the profession called for constant flexibility and preparedness for almost any scenario. As one participant asserted:

I would say that in this job you learn so much from each case that you’re working with because I had no idea about anything with Di George syndrome before I got this child’s case. And I said okay, I’d better learn about this because I’m not going to be very helpful to them if I have no idea what the syndrome is or what’s going on with it.

Similarly, another professional echoed: Meeting people that have such a vast wealth of knowledge, being able to observe and

learn and process some of the things they say, teach and do has helped me to be

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introspective and retrospective of who I am and how I can do what I’m doing better.

Because of the diversity of clients served, participants reported a propensity towards professional growth. Barriers to Service Provision and Professional Development

The participants have witnessed many changes in the profession. With the privatization of mental health and developmental disabilities services in their state, participants discussed the challenges with uncertainty in human services positions and roles. One participant disclosed:

I think it’s depending on who is, I guess, in the position of power in the state of … and how they view how mental health services should go. Seems like things have come full circle in some respect because years ago, case management was working directly with children and families but then that role was extracted and isolated to primarily coordination of services as opposed to direct provision of services. Now it seems like it’s coming full circle again, with intensive in-home and foster care having the case management component built in it.

Another notable barrier was the high volume of administrative tasks expected in their roles. One participant explained:

So basically, you have a lot of lists. We have a white board at our desk. You have a lot of check marks making sure you meet deadlines, spreadsheets, you know, things like that. You really have to find your way of being organized. You have reminders on your computer. You have reminders on your phone, and you have your calendar. It’s constant because sometimes when we are sitting at our desk and were like “I feel like I am caught up” that means something is wrong because you’re actually not caught up.

Collectively, participants also reiterated changes related to agency practices where human services professionals clashed with their supervisors. Participants believed that while their supervisors may have the education and credentials to provide clinical oversight, many supervisors were unprepared for the demands of the job. One participant commented:

Currently our new team lead, I’m not sure what her previous experience was, but I’m pretty much teaching her everything. For instance, she didn’t know how to put an authorization, so I have to do all of that. And she delegated that we do the Person Centered Plan and the One Child One Plan forms at the Child and Family Team meetings. I feel like having been in the field for ten (10) years, I should be able to move up, but the fact that I don’t have that extra degree stops me. I have a Bachelors in Sociology and have been in the field for ten (10) years and I can train a lead therapist. That should stand for something.

Participants identified many barriers to their professional development but among the more salient were agency changes and organizational demands.

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Self-Care Plan to Balance Life Roles

While participants described their daily routines as full of activities, they collectively reported that having a good self-care plan was essential for optimally working with challenging clients and families. One participant stated:

You need to sleep well, because every day you have to be mentally prepared for what’s going to come and going off of four (4) to five (5) hours of sleep, I’ve tried it. It’s not going to work. You’ll have a short fuse that next day. And that’s for the younger people coming in, you’ve really got to get your rest, you have to be prepared for that next day.

Another participant reiterates the same concept stating:

Particularly, because you impact and shape and mold the thinking of a lot of people, like a teacher, it’s a huge responsibility shaping and molding minds, and if you’re not in a good place then I think your advocacy when working with children and families will be reflected in that.

It appeared that the volume of work responsibilities did not supersede their commitment to self- care and self-preservation. Encountering Ethical Issues Frequently

The participants consistently explored the frequency of ethical quandaries they faced. While all reported they would consult their supervisors when boundary issues emerged, participants shared a belief that agency practices seem to limit the scope. For instance, one participant stated:

I know at my previous job the level of education was much lower and we were doing the same job that we are doing here, and it didn’t seem that they had enough background information on how relationships should be formed with clients before venturing out. We go to people’s homes, and there is a real danger of crossing boundaries there.

Other ethical issues related to agency practices included those related to the high rate of turnover in the human services field as well as enduring invisible costs that the job does not cover including mileage and personal car usage. Participants openly shared some of the ethical and professional challenges they faced, and despite such challenges, they remained committed to working within the human services field.

Discussion The intent of this qualitative study was to explore human services professionals’

subjective accounts of their work experiences. Similar to prior research with social work students, these human services professionals had an intrinsic desire to serve others and felt rewarded when clients made progress (Osteen, 2011). Their lived experiences also linked to the professional discourse on characteristics of human services professionals including flexibility

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and competence (Woodside & McClam, 2015; Neukrug, 2017) and prior qualitative research on the never-ending work demands and pace (Woodside et al., 2012). The “never ending pace” and intensity experienced by human services professionals appears an accepted professional norm.

The professional acculturation process for many human services professionals begins within the confides of the classroom (Neukrug, 2017; Woodside & McClam, 2015). Yet, the experiences of these professionals were unique because none of the 13 participants self-identified as having either an associate or bachelor degree in human services; yet, thematically their professional experiences eluded to a professional acculturation process where they learned to deal with ethical quandaries, balance work and family responsibility, and engage in self-care (Corey et al., 2015; Moriarty, Manthorpe, Stevens, & Hussein, 2011; Woodside & McClam, 2013).

Implications

The phenomenological experiences of this group of human services professionals reiterate the complexity of professional acculturation. Without formal classroom education in human services, supervisors might benefit from understanding the development of new human services professionals as they gain competence in role acquisition, supporting diverse client populations, identifying available resources, and managing professional and ethical dilemmas (Bernard & Goodyear, 2014). Another area for consideration relates to interprofessional understanding within human services and other helping professions. Human service educators might reflect on professional orientation related to interprofessionalism, specifically role differentiation and collaboration among helping professionals. The combination of these items tremendously impacts service delivery and ethical client care.

Limitations

The use of a small, convenience sample is not a limitation of this research design. However, similar to other phenomenological studies, there are constraints to the generalizability of this study. For instance, these human services professionals were more seasoned African- American human services professionals solicited from a metropolitan area. Eight human services professionals participated in a focus group while five others were interviewed individually. Thus, individual interviewees may have opened-up and shared more, while participants in the focus group were at risk for not sharing their original ideas. However, the use of two data sources may help with the validation of the data sources (Creswell, 2013). While researcher bias was addressed, member checks were not provided to solicit input from the participant after their interviews. In addition, longer interviews may yield different results. Also, the individuals that chose to participate in the interview process may differ from the common experiences of other human services professionals who opted not to participate.

Future Research

Much discourse has focused on the formal educational trajectory for students and professional legitimacy for human service practitioners (Neukrug, 2017; Sparkman-Key & Neukrug, 2016; Woodside & McClam, 2015). However, the results of the current study reiterate that additional research is needed to understand the professional acculturation process of persons transitioning into human services careers without formal education. Of note, supervisors play a

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critical role in successfully integrating human service workers into the profession. Therefore, a follow-up study might include a qualitative study with a phenomenological approach to better understand role acquisition of new professionals transitioning into the human services field without formal human services education. Also, the current study is culturally specific to a metropolitan area; thus, a parallel study with a more racially diverse group or in a rural area might yield different findings.

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