6-8 pages Child and Youth care — Mapping Community Assets

The Capacity to Change and Child and Youth Care Practice: A Program Example and Framework

Sonja Radmilovic

ABSTRACT: Child and youth care practitioners are in the practice of facilitating and supporting change in individuals, families and communities. Therefore, as change agents it is important to uncover and understand the perspectives that direct one’s practice. Personal and professional experiences, as well as a multitude of theoretical orientations, merge to create a child and youth care practitioner’s ‘‘tool box’’. This article offers a brief foray into various change theories and provides examples of how these change theories direct and inform practice with youth and families at the Maples Ado- lescent Centre in British Columbia, Canada. This article suggests that systemic inter- ventions are necessary to support enduring change in individuals and provides examples of how this is actualized with families and communities at the Maples Adolescent Centre. It concludes by advocating for the use of multiple theoretical orientations to direct child and youth care practitioners’ work as change agents.

KEY WORDS: change theories; child and youth care counselling; youth, adolescent and family change; attachment theory; maples adolescent centre.

Introduction

Do humans have the capacity to change? What informs and directs child and youth care practitioners in their role as change agents? Child and youth care practitioners viewpoints regarding these and other questions are derived from their personal and professional experiences and their formal education. It is imperative that practi- tioners in the field uncover and understand how their change per- spectives direct their practice; otherwise, helping endeavours could fall prey to ill-informed, power-oriented interventions, potentially causing more hurt than healing. The aim of this paper is to uncover and make explicit perspectives on how people, intentionally or unin- tentionally, change. What follows is an elucidation of ideas about how to use certain change theories in action, especially in the everyday life space of children and youth. The implications for the child and youth care practitioner as a change agent are also considered.

Correspondence should be directed to Sonja Radmilovic, 18867-60A Avenue, Surrey, BC, Canada V3S 8A2; e-mail: [email protected].

Child & Youth Care Forum, 34(2), April 2005 � 2005 Springer Science+Business Media, Inc. 127 DOI: 10.1007/s10566-004-2181-9

Change is a journey. This simple sentence is a metaphor illumi- nating a common fundamental perspective on change. The word ‘‘journey’’ suggests the idea of prolonged travelling from place to place: a journey of discovery. Change as a journey intimates a passage, progress or process from one state to another, while perhaps some- times revisiting familiar locations. ‘‘Nothing is permanent except change’’ is another idiom that aptly describes my personal belief about change. The idea that a permanent state is impossible and that change is permanent represents a fundamental belief. In other words, change is occurring all the time in all living things. These perspectives per- meate my thinking about individual and family practice.

When examining change, it is important to discern between differ- ent types of change: development, prevention and recovery. Change naturally occurs, as a result of human growth and development. In the words of Douglas (1997), ‘‘we are surrounded by patterns of growth and decay; by processes of birth and death—which are universal experiences’’ (p. 16).

Prevention can be viewed as another form of change. In this case, change efforts are ‘‘used to stop, alter the direction, intensity or fre- quency of occurrence and to diminish selected behaviour patterns’’ (Douglas, 1997, p. 18). One of the fundamental principles of prevention is to determine possible risk factors associated with maladaptive behaviour, health concerns and developmental delays. However, pre- vention programs may not be a panacea due to the complexity of life, people and human change processes. Therefore, when prevention fails or natural growth and development goes awry, we are left with the task of recovery and rehabilitation. For example, there are many school based bullying prevention programs. These programs typically consist of a multi-facted, collaborative, comprehensive framework involving students, teachers, school administrators, families and targeted community partners. However, despite these prevention programs not all instances of bullying are curtailed. Therefore, the bully and the victim are in need of rehabilitation and recovery. In other words, they require an intervention.

Change Theories

We all have rules for living; some are implicit others are explicit. These rules, worldviews, paradigms, mental models or internal working models are a product of our values, beliefs and experiences. It has been noted ‘‘that early and repeated experiences with people who

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care for us set a foundation for our internal working models of rela- tionships with self and other’’ (Moore, Moretti, & Holland, 1995, p. 8). This is an attachment-based perspective. However, the underpinnings of attachment theory also resonate with ‘‘the constructivist perspec- tive, the evolutionary and ethological approaches, the caring-based and relationship-oriented moral development highlighted by women’s studies, and the emphasis on dynamic systems of personal meanings’’ (Mahoney, 1991, p. 169). Such internal working models Mahoney has also termed ‘‘personal realities’’ (ref same?). These models become the lenses through which people view the world and relate to it. Although, these working models are entrenched and may be unconscious, they can be altered and modified.

At the Maples Adolescent Centre, internal working models are seen as ‘‘works in progress which offer optimism about the potential for change’’ (Moore et al., 1995, p. 9). However, shifts in internal working models do not occur rapidly, nor are they always readily apparent or measurable. Rather, change may occur slowly, incrementally and sometimes unconsciously. Conversely, change can be sudden, quick and immediate. Maier (1991) proposes that child and youth care practitioners understand and discern whether they are dealing with ‘‘developmental change of first- or second-order’’ ( p. 32).

First order changes can be described as concrete actions taken to quickly stop a problem; typically the behaviour is reversible and there may be slight adjustments in the existing system. Maier (1991) states, ‘‘first-order change is incremental, a linear progression to do more or less, better, faster, or with greater accuracy’’ (p. 32). Becvar and Becvar (2000) refer to Watzlawick, Weakland and Fisch’s theory of change and state that, ‘‘first-order change occurs within the system, consistent with the rules of that system’’ (p. 104).

When I worked in the Orinoco program at the Maples, I had a therapeutic relationship with two primary youth for a three-month period. One of my primary youth was a female who before entering the Orinoco program engaged in daily bullying, threatening and physical aggression against other female and male adolescents, including her siblings. This youth engaged in this behaviour only once while in the Orinoco Monday–Friday program. I hypothesize that initially my primary youth experienced first-order change as she shifted her behaviour, but not the core values or attitudes behind her behaviour that would represent second-order change. Furthermore, a few Mon- day morning reports of her weekend behaviour stated that she en- gaged in bullying behaviour in her community and her home. Therefore, her macro system outside the residential unit did not change as readily, whereas, her micro system inside the residential

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unit and in the context of our therapeutic relationship did change. Finally, as Maier (1991) suggests, initially the interventions I utilized in the program to support her first-order change involved practice and reinforcement (p. 32).

‘‘Second-order change. . . involves a non-linear progression, a trans- formation from one state to another. The aim would be to enable the individual to behave, think, or feel differently’’ (Maier, 1991, p. 32). Becvar and Becvar (2000) state that ‘‘second order change involves a change in the rules of the system and thus in the system itself’’ (p. 104). Eventually, this young girl did experience second-order change. Throughout her three-month stay my interventions pro- gressed to ‘‘modeling, confrontation, conflict work, reframing, and most important, the introduction of decisively different personal experience over time’’ (Maier, 1991, p. 32). The concept of adding new experiences is a fundamental tenet in the practice of child and youth care counsellors at the Maples. After her discharge she returned for a visit and stated, ‘‘I used to beat people up because I was scared and insecure and this is how my family dealt with problems’’.

This young female experienced second-order change as she not only understood the dynamics that directed her behaviour but experienced a transformation in her personal reality. This second-order change was facilitated by interventions also aimed at her family through weekly family therapy and parent support groups. Maier (1991) suggests that second order change requires ‘‘greater creativity and prolonged investment of time and contact by caregiver and receiver’’ (p. 32). Moore et al. (1995) propose that ‘‘enduring change in an indi- vidual’s behaviour occurs only when there is change in the internal working model supported by change in the system(s) that one lives in and there is sufficient time, opportunity and support to integrate the new experience’’ (p. 12). Finally, as a change agent, I am cognizant that change is more often a slow process involving the person’s need to maintain homeostasis.

Changing one’s internal working model cannot be done radically or dramatically, as it serves as an integrating and self-protective func- tion. Mahoney speaks about a ‘‘self-protective theory of resistance’’ in his book, Human Change Processes (1991). This fundamental per- spective on change directs my practice by ensuring that I respect and work with individual’s self-protective tendencies. I am aware that individuals exploring or making changes must maintain a continuity of self. ‘‘When this self-protective tendency is respected and worked with, rather than against, the consequences for the individual are more likely to be positive and developmentally progressive’’ (Mahoney, 1991, p. 18).

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In my experience with females who exhibit severe self-injuring behaviours, the clinical team psychiatrist would always direct us to proceed slowly and cautiously when attempting to change self-harm- ing behaviour. When a girl went a week without cutting and then severely cut again, the psychiatrist, in anticipation of our feelings of failure, would reframe her relapse as a temporary backward move to regain equilibrium. He would further reframe the week of not cutting, as a successful attempt at trying on new behaviour. This teaching helped to formulate my ideas about the resistance to change; namely, that most people cannot simply and quickly eradicate their continuity of self, their worldview ‘‘without jeopardizing [their] psychological integrity (that is, sense of self and reality)’’ (Mahoney, 1991, p. 18). Thus, according to the change literature, in order for change to hap- pen, novelty must occur or be introduced so that individuals can experience feeling, thinking and being in the world in a different way.

Novel experiences provide new meaning and alternative ways of viewing the world. As an individual continues to experience novelty and receive information that is at variance with their world view, eventually their world view or internal working model restructures to accommodate and assimilate new and different perspectives. There- fore, novelty is an essential ingredient for human change, ‘‘as many literatures document, there can be no real learning without nov- elty—that is, without a challenge or elaboration of what has become familiar" (Mahoney, 1991, p. 19). If the girl who self-injured ceased having brief interludes of not cutting, she would have failed to con- tinue to experience a new way of being, therefore, change may have not transpired. ‘‘Novel experiences are rarely sought when an indi- vidual feels anxious, vulnerable or depressed’’ (Mahoney, 1991, p. 19). However, in the context of a safe therapeutic relationship, individuals can seek out novel experiences.

Recently, at one of the programs at the Maples, there was another female resident who expressed suicidal ideation and demonstrated self-harming behaviour by cutting herself. This youth conveyed to the psychiatrist that the staff did not take her self-harming behaviour and suicidal ideation seriously. She believed that the staff did not care. The psychiatrist put the youth on constant attention, an observation level that ensures staff members are with her all the time. I debated the decision with the psychiatrist, explaining that the staff were in fact telling the youth that they cared and that they took her behaviour very seriously. I could not understand why she distorted the verbal meaning and why the psychiatrist took the youth’s distortions as evidence for what was occurring. He explained to me that her knowing and experiencing were informed by more than just our words and that

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she did not ‘‘feel’’ cared for or taken seriously. Her internal emotional state was not being persuaded by our words. Furthermore, her internal working model was influencing her behaviour and at this point it was resistant to change, due to serving a self-protective function for her continuity of self.

The idea that her internal working model was not persuaded by words gave rise to my questioning the efficacy of traditional cognitive psychology as an exclusive means to direct and support change, par- ticularly in the adolescent population. Cognitive therapy operates under the assumption that thoughts, beliefs, and attitudes influence what emotions will be experienced and the intensity of these emotions. As we worked with this female we uncovered some of her cognitive distortions and attempted to support and facilitate her to replace them with more functional thinking processes, however, it did not seem to alter her sense of self or her emotional and body responses.

I suggest that cognitive therapy has a place in dealing with change; however, not as a sole intervention. Focusing primarily on thoughts, beliefs, ideas, attitudes, and assumptions is only one third of the change puzzle, the other two-thirds being emotions and somatic shifts. For example, a previous adolescent client was a habitual wrist cutter. She stated that just prior to each cutting episode she would feel her heart flutter and her stomach turn. These somatic feelings were ac- companied by negative thoughts and emotions. Each symptom needs to be addressed in treatment, as opposed to just cognitions. The lit- erature points to the need for bodily-felt shifts, as illustrated in the following quote, ‘‘change also has to occur at the body level. If simple intellectual understanding were enough, clients could tell themselves what to do and do it’’ (Bohart & Tallman, 1999, p. 221). Furthermore, Mahoney (1991) suggests, ‘‘recent research has documented, for example, that knowing and experiencing processes are influenced by some of the same things mainstream cognitive science has systemat- ically ignored (such as feelings, mood, context, culture, and history). Moreover, it is increasingly clear that we must distinguish between levels or forms of knowing, and abandon the illusion that ‘‘knowing is thinking (or that thinking is the main form of knowing)’’ (1991, p. 67). Not considered thus far is the willingness and readiness of adolescents to change.

The transtheoretical model (TTM) of change (Prochaska, DiClem- ente, & Norcross, 1992) is a generic, multistage sequential model of change. ‘‘Although TTM’s implication has typically been investigated in the area of addictions counseling as well as health psychology research, TTM’s empirical base and implications for client readiness for change have tremendous potential for counselling in general’’

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(Petrocelli, 2002, p. 23). At the Maples the model is used simulta- neously with other change theories, under the inclusive umbrella of Attachment Theory. The child and youth care counsellors are aware of the signs of readiness for change, the stages of change and the most effective interventions to use in each stage.

Upon entering the program, my primary youth in Orinoco was in the contemplative stage as evidenced by her willingness to acknowledge that her bullying behaviour had negative consequences and by her readiness to engage in discussions about it with her primary workers. As she let down her defenses and admitted that her bullying behaviour was a problem, her self-esteem, her bravado and her sense of self began to crumble. This is a common occurrence in the pre-contemplative stage and as a result, her observation levels were increased and the clinical team strategized around building in supports that would facilitate her increased awareness but would not jeopardize her safety.

Interestingly, even though she entered the program in the contem- plative stage it took several weeks of work utilizing some of the change process techniques indicated by Prochaska et al. (1992) before she entered the preparation and action stages. For example, two of the techniques that I frequently relied on were consciousness raising and social liberation, which involve describing, confronting and inter- preting behaviour and advocating for the rights of victims and herself by empowering her to make other decisions as a result of increasing her awareness of behavioural alternatives.

The preparation stage was challenging, as the youth needed to make a commitment to action and also needed to recognize the need for involvement from her family. Together we developed a realistic plan that the youth could attain and we informed the social worker who worked with the family around the same plan. The plan involved basic steps such as identifying emotional responses to confrontations with peers and family, developing behavioural alternatives to bullying and physical violence, environmental restructuring and rewards.

The action stage was fraught with resistance and her need to maintain safety and homeostasis. Initially, it involved avoiding stimuli that elicited the problem behaviours by environmental restructuring: avoiding peers whom she perceived triggered her vio- lent response and avoiding high-pressure situations in general. For example, she attended small classes only in the morning and did solo activities, or activities with her primary worker, in the afternoon. Once she began to feel some sense of control over her environment and her emotions we were able to introduce higher stimulus activities and situations. The parents committed to similarly structuring her week- end visits. The long-term reward for my primary youth was to be

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re-admitted into her school of choice. The short-term rewards were her choice; for example, attending a low stimulus outing with the entire unit. At the conclusion of the program, the primary worker and the youth met with a community counsellor with the goal of establishing a therapeutic alliance with someone outside of the residence to ensure some continuity of care.

During the three months that my primary youth was in the Orinoco program she did relapse. My experience as a child and youth care practitioner is that most people attempting to change do relapse at some point in their change journey. My role at the point of relapse is to help the person to renew their determination and action without becoming stuck or demoralized. The transtheoretical model of change can be applied to any behaviour that requires change. What is required is an understanding of the change stages, the counsellor initiated interventions most effective at each stage, and most impor- tantly, a therapeutic relationship.

The Counsellor Relationship with Adolescent Clients as a Vehicle for Change

In my experience in working with adolescents, change has primarily been dependant on a primary relationship with one or more adults. The Orinoco program at the Maples is driven by an attachment framework. One of the key principles of this attachment framework is that change can occur through therapeutic relationships with others, which may provide the impetus for adolescents to experience novel ways of relating to adults. The role of the child and youth care coun- sellor is to provide what Bowlby would call a ‘‘secure base’’ (Bowlby, 1988).

The counsellor must:

‘‘develop a relationship with the client that is based on security, trust, emotional support and respect for the current working model. When this is established, the relationship can begin to explore, with the intent to understand and appraise old, unconscious stereotypes of self and world and to experiment with feeling, thinking and acting in novel ways.’’ (Mahoney, 1991, p. 168)

This approach does not necessarily mean that the child and youth care counsellor sits down with the youth and engages in a dialogue about internal working models. Rather experiential learning and change takes place within an interaction or interactive process.

Experiential learning is embodied in a mantra used at the Maples: crisis as an opportunity to learn. In the context of a secure primary

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relationship, the child care counsellor and youth can reflect on the crisis or experience, discover its meaning, and explore alternative meanings and ways of being. The counsellor further supports change by providing opportunities for the youth to try new behaviour and then celebrates all successes.

‘‘Play, work, and cottage routines are viewed as the content of an overall curriculum for learning through experience. So that the meaning of experiential learning is not simply take for granted and its applicability to the work of residential treatment left unspecified, it should be noted that the concept of experiential learning includes both learning by doing and relationship learning.’’ (Barnes, 1991, p. 124)

This ‘‘learn by doing’’ approach permeates every interaction that the child care counsellor and youth engage in. Development, learning and change can occur in the minutiae of the day-to-day experiences between the child and youth care counsellor and the adolescent, whether in the community or an institution. Almost all new child and youth care counsellors wonder why, if we want the children and youth to change, we not having sit down therapy sessions with them. In response, I usually request that the primary counsellor discuss during shift change the therapeutic work they did with their youth during the day. The follow- ing story illustrates the therapeutic work done, within the context of a unique intimate relationship between one counsellor and a youth.

One day a child and youth care counsellor helped their primary youth set up a small car washing business. The youth and the worker had to negotiate finding and buying essential items to start the business. They had to make posters, distribute them, speak to staff about prices, and temper some potentially inflammatory comments about expectations related to the quality of the job. Furthermore, they had to negotiate how the money earned was going to be spent, with the explicit expectation that it would not be spent on drugs. In an attempt to pacify and redirect burgeoning hostility in the youth regarding control over his money, the counsellor asked questions related to what big item did the youth want to save for and how could the counsellor support him. The childand youth care counsellor and the youth eventually set up a bank account with a maximum amount that could be taken out at one time.

During shift change, the counsellor explained how this experience fostered a deeper mutual connection between the youth and the counsellor and how the ‘‘worker and the youngster see each other as participants in a mutual struggle over how, [please check original to see if commas were used] instead of whether, to be involved’’ (Maier, 1999, p. 401). A myriad of other learning experiences also occurred for the youth. This process built upon the existing strength of his work ethic and aptitude. The youth practiced problem solving, social skills

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building, and money management. Furthermore, this process helped to build his sense of self-esteem, self-efficacy and autonomy through a positive, pro-social engagement with an adult. Finally, this also appeared to provide new information and a novel experience to modify the lens through which he viewed and related to adults and peers.

The relationship between the counsellor and the youth was the vehicle used to experientially explore, learn and possibly change. Maier (1999) elaborates on the importance of a relationship in working with children and youth,

Most fundamentally in this formulation, effective care practice serves to enhance the development of children and youth, who are apt to acquire their values and life skills from those persons with whom they have close contact and satisfying experience. In other words, the workers who are significant to them for their personal attraction and power position in their daily lives represent carrier roles for new life’s skills and values (Maier, 1999, p. 402).

A great deal of learning and potential change occurred in the car washing process and interaction between the child and youth care counsellor and youth. This type of behavioural practice allows the youth to try on new behaviours and learn through the experience. ‘‘Behavioural experimentation in the real world can bring in corrective data or open up new possibilities, which has a much more potent, experimental effect on the client than does simple cognitive insight or explanation’’ (Bohart & Tallman, 1999, p. 214). The question then posed to the novice counsellor becomes, ‘‘how can formal, traditional therapy sessions facilitate this breadth of learning?’’ The question, within the context of the example, will hopefully be the impetus for the new child and youth care counsellor to identify the assumptions that underlie his or her ideas, values, beliefs and actions related to sup- porting growth, development and change with adolescents.

With this example, I am suggesting that the novice counsellor needs to step outside the box of formal traditional therapy as the sole means to facilitate and support change. Furthermore, although there is opportunity at the Maples to operate outside the box as a change participant and agent, I would propose that other programs and agencies should allow for the same possibility.

Systemic Change: A Necessary Component

Based upon my experience and understanding of the relevant lit- erature, I have come to believe that systemic interventions are nec- essary to support enduring change in individuals. At the Maples,

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family therapy work and parent education and support groups are built into many of the programs. One of the attachment principles introduced earlier that guides practice at the Maples is: ‘‘enduring change in an individual’s behaviour occurs only when there is change in the internal working model supported by change in the systems that one lives in, and there is sufficient time, opportunity and support to integrate the new experience’’ (Moore et al., 1995, p. 12 [ref. perhaps not needed here if introduced earlier with all seven, as I have sug- gested earlier]). For this reason, admissions to several of the programs are contingent on the presence of a parent or caregiver. This holistic and systemic principle directs the Maples’ multi-disciplinary teams in their work with families and communities.

In my work with families, my primary goal is first to establish a relationship with the parents or caregivers. To develop a meaningful and trusting relationship with parents, I have to avoid dichotomous (good or bad) judgments about the individual parents and maintain a systemic, generational prespective, which involves understanding the youth’s, parent’s, and grandparent’s experiences. Furthermore, I have to be able to understand and empathize with their personal reality. Once a relationship has developed, I endeavour to help the parents or alternative caregivers to reframe their concerns in attachment terms and to inform them that all behaviour has meaning.

For example, one of my primary youth presented as angry, demanding and controlling and was seen by the family as being intentionally bad. When we explored possible meanings of the youth’s behaviour, we came up with the conceivable explanation that the youth was insecure and attempted to maintain a connection through her controlling behaviour. Although this did not produce an immediate transformation in the family functioning, it did provide the parents with an alternative way of viewing their child’s behaviour. New knowledge and information is often the first step in producing change.

This systemic intervention can be further carried out in the macro community in which the family lives. Bronfenbrenner’s (1979) ecological theory of development reminds us that the neighbourhoods, school systems and other systems to which a child belongs shape individuals and families. Therefore, the Maples endeavours to support the com- munity’s capacity to care for young people by working directly with them. For example, at the end of the Orinoco residential cycle, child and youth care counsellors spend two weeks in the youth’s community. They visit and spend time with the youth’s school personnel, social workers, probation officers and other members of their system, to inform them of their experience living with the youth in attachment terms. Although the other professionals frequently do not share a similar theoretical

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perspective, the role of the child and youth care practitioner extends to educating and promoting awareness of the attachment perspective among the community workers. Furthermore, the care-plan, which is the product of an educational, psychological, child and youth care/ nursing inquiry and an extensive social history, is provided to all members of the youth’s system. An outreach consultant is then assigned to the youth and their family. This position is responsible for supporting the care-plan recommendations and facilitating their implementation in the youth’s community. The Maples continues to explore alternative ways of supporting and fostering the community’s capacity to care for children and youth. The pilot project Bifrost is modeled after the Orinoco program and runs entirely in the community. It is an example of a program that aims to increase the community’s capacity to care for their children and not institutionalize them.

Conclusion

My convictions and perspectives regarding change have been influenced and informed by the following theories: attachment, con- structivism, cognitive behavioural, experiential, humanistic, and sys- temic—and I remain open to new and alternative theories. Thus, I argue for the use of multiple theoretical orientations in child and youth care practice. However, in considering this assertion, practi- tioners must be mindful of the values and ethical assumptions asso- ciated with any individual theory.

My professional and personal experiences with change have con- tributed to my firm belief that people do have the capacity to change; however, change is a slow, incremental process influenced by the human need to maintain stability. This paradox constantly surfaces in my work with children, youth and families. It often causes practitio- ners to throw up their hands in frustration and exclaim; ‘‘nothing has changed’’. It has been my experience that the moment novelty has been experienced or new information is received, people begin to change. Throughout life, people are constantly changing and attempting to maintain stability. For example, in the aftermath of the September 11, 2001 bombings in New York and Washington, Cana- dian and American citizens—and perhaps people around the world—recognized that things had to change. But despite this recog- nition, we steadfastly want to maintain the same liberties, freedoms and democratic rights that we have always enjoyed.

Finally, how does one measure change? This is an important question in light of the current political climate permeating the human services

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field, in which funding will likely only be given to those practitioners and programs that can provide evidence for the effectiveness of their change interventions. In my experience at the Maples, indicators of change are often subtle and can be hard to measure. Child and youth care coun- sellors often report that the youth has changed within the context of their relationship. Perhaps, when the same change is not observable to others, it is because they are not participants in the primary relation- ship. Inevitably, there will always debate about both the measurement of change and the most effective interventions, as human change pro- cesses are destined to be as complex as life.

By articulating the theoretical and experiential bases for our work, we can perhaps help to inform and influence the processes of evalua- tion to which we will necessarily be subjected. It has been an intention of this article to contribute to this important educational process.

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