Critical Analysis: BC's child welfare system continues staffing and existential crisis

Child protection in B.C.: Stop policing First Nations families and build community support

Portia Larlee (November 14th, 2016). The Georgia Straight. Retrieved from: http://www.straight.com/news/827646/child-protection-bc-stop-policing-first-nations-families-and-build-community-support

After one-and-a-half years, I left my job as a child-protection social worker in northern British Columbia at the province’s Ministry of Children and Family Development.

I left an organization in the midst of both a staffing and an existential crisis.

The two crises are connected. In my understaffed office, we did not have time to support families in a meaningful way. Instead, we policed them. I arrived on strangers’ doorsteps, entered their homes (at times without consent), pointed out what parents were doing wrong, and tried to come up with what often felt like hollow “band-aid” solutions.

From a parent’s perspective, meeting with child-protection workers has been described as similar to being measured against a checklist, with the correct answers only available to the social worker. This bombardment of questions included: “Do you drink alcohol?” and “How do you handle disagreements in your family?”

I rarely had time to build trust with families before these meetings, and they were often understandably hesitant, confused, or angry. I felt pressured to use parents’ anger against them. This anger and frustration was another check mark on the checklist, one of the reasons they were a potential risk to their children.

Like most child-protection social workers in Canada, I am a white woman. So are most of my former coworkers. The families I worked with during my time at MCFD were Indigenous, save for about three who were white.

University of Victoria professor of social work Susan Strega notes that poverty and race make for a “perfect child-welfare storm”. She explains that if you have children while being poor or as a person of colour, the state will likely insert itself in your life.

I expected this systemic racism. Naively, I didn’t expect to be blocked when trying to address it.

Shortly after I arrived in Fort St. James, three of my fellow social workers left their positions, leaving four of us behind. Understaffing meant delays in child placement. There were not enough of us to support families and build relationships. Until my exit interview, I never heard my manager address understaffing and what it meant for us.

When he did acknowledge understaffing, he outlined a vision for the work that was unfamiliar to me.  “Child-protection work” is distinct from “social work”, he said, and when child-protection workers provide supportive services, they tend to stray from MCFD’s mandate.

This was the first I had heard of this. If child protection was being reduced to policing, I had assumed it was because of forces beyond the ministry’s control. I never thought it might be intentional.

I had eight supervisors during the year-and-a-half  I was in my position. Some were cognizant of the ongoing systemic oppression and racism faced by Indigenous families.  Whenever possible, they placed children with family rather than in foster homes. They avoided removing children through gathering community members to come up with creative ways to support a family. They liaised with the First Nations bands and wielded the violent power of state intervention in families with caution and understanding, which is especially important in a context of historical and ongoing mass removal of Indigenous children.

Those supervisors were acting as social workers. I had other supervisors who acted more like cops. One told me I needed to be “more confrontational” in my work with families and blamed Indigenous communities and families for their own poverty and disenfranchisement. They called for homes to be searched, and for mandatory drug testing.

So which is it? Are child-protection social workers meant to support families or police them? The answer to this question needs to be made clear to workers and families alike.

It seems obvious to me that child-welfare structures will be sustainable and effective if they are localized and built by and for the community. Communities need the space, resources, and support to rebuild their own mechanisms for ensuring safety. For some Indigenous communities in B.C. this has meant a return to tradition.

In the meantime, while outsiders such as myself continue to fill these roles, there needs to be a more holistic and family-focussed approach to child welfare. Only then will we be able to correct the stark overrepresentation of Indigenous children in the mainstream child-welfare system.

Therein lies the bind: should we bother focusing on staffing a system in crisis? Or should we shift our attention, instead, to building new community-based organizations to support families?

Either way, management should stop leaving frontline workers in the dark. I say do this soon, before there are none left.

Portia Larlee is a former child-protection social worker in B.C. who recently quit her job.

Media: UK Sitcom about what its like to be a social worker: Damned

Damned: Jo Brand's new sitcom finds the humour in social work

Channel 4 comedy aims to portray social workers in a refreshing and realistic way, although the writers admit some scenarios had to be toned down.

Purvis, K. (2016). Retrieved from: https://www.theguardian.com/social-care-network/2016/sep/23/damned-jo-brands-new-sitcom-finds-the-humour-in-social-work

re social workers damned if they do, damned if they don’t? So suggests the title of a new Channel 4 sitcom that documents the ups and downs of a group of social workers.

Jo Brand and Alan Davies play Rose and Al, slightly jaded colleagues in the children’s services department at a local authority, struggling to deal with various personal issues – a cheating (soon-to-be ex) husband and a demanding girlfriend respectively – as well as their own exhausting caseloads.

There’s also Nitin, the constant target of Rose and Al’s teasing, and Martin, who’s been signed off sick for months but still comes into the office with a fake work pass to support his overstretched colleagues.

Damned was first broadcast in 2014 as a one-episode pilot for Sky and a six-part series was later commissioned by Channel 4. Inspiration for the series – written by Brand, Morwenna Banks, who starred in Skins, and Will Smith, a writer on The Thick of It – partly came from Brand’s mother, a former social worker.

“She’s 82 now but she still hasn’t quite managed to retire,” says Brand. “She’s like an out-of-control, ancient revolutionary.”

Brand says she has long hoped to make social workers “seem like real people” and address the negative stereotypes of “middle-class, tweedy women” and “hippy do-gooders”.

“Psychiatrists have a similar job to do; they have to predict how much harm someone is going to cause themselves or other people. But when they make a mistake ... they aren’t castigated in the same way,” says Brand. “When a social worker does a good thing, how do you ever find that out? You never do because it’s classified information. The only thing you ever find out is when it goes wrong.”

Comedy, says Brand, seemed the best medium to redress the balance. “It enables you to get across a message about something that’s actually really awful. I know from when I was a nurse that humour relaxes people,” she says. “It’s either that or smoking 60 fags a day.”

But Damned does have its serious moments and the writers were careful to strike the balance between humour and sobriety. “It was difficult to mix it, but that’s the piece we wanted to write,” says Banks. “We knew there’d be moments when it would be a bit shocking, as well as moments when it would be funny.”

For the most part, those humorous moments are reserved for scenes in the office or for glimpses into Rose and Al’s rather chaotic personal lives. The scenes where we see the vulnerability of the people Rose and Al work to help are some of the shows most poignant.

In the first couple of episodes, for example, Rose visits an old school friend struggling to look after her critically ill husband and grandchildren while her daughter is in rehab. And Al grows concerned about the parental capabilities of a couple with learning difficulties after he tries to convince them their baby is too young to eat chocolate ice-cream.

But any of the cases depicted in Damned are toned down versions of those the writers came across in their research. “We spoke to social workers and asked: ‘So, would this happen or would that happen?’ and they would come up with five things that were way more extreme,” says Banks.

“We’ve made it nicer,” says Brand.

As well as depicting some true-to-life cases, the writers wanted to the show to be topical, fair and representative of the realities of the sector.

“There’s a moment where Ingrid goes off [to have an operation] and Al is told that he will handle her caseload on top of his,” says Davies. Meanwhile Denise, the terrifying departmental manager, deals with budget cut after budget cut and secretly recruits Nitin to spy on his colleagues and report back to her with his verdict on who should be fired. “The reality of what’s going on is in there,” says Brand. “I wouldn’t say it’s a direct political message, although I have never voted Tory.”

Damned was filmed in an actual council’s office. “It was nice to mingle in the kitchen with the planning department from next door and feel you were part of a real place,” says Davies. “It felt like the right thing to do.”

The cast filmed during the EU referendum campaign in a Hertfordshire town where, Brand says, 70% of people voted to leave. “I had a row with a few people. I didn’t say any nasty words or anything but there was a bit of tension,” she says.

For Davies, the post-referendum resignation of UK prime minister David Cameron brought home the resilience and commitment of social workers to return to work every day. “I don’t want to be flippant, but none of our characters can just resign the next morning if it hasn’t gone well the day before,” he says. “They feel responsible for the people in their care and for the choices and decisions they make.”

Brand hopes that real social workers think the show is funny, and that the characters are nice. She says: “I hope they think our characters are kind, because I think that’s what social workers are.”

Damned starts on Channel 4 on 27 September

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• This article was amended on 26 September 2016. An earlier version said that the series was filmed in a council office and social workers had to move to an adjacent office during filming. While filming did take place in council offices, no social workers were moved.

Videos:

Playhouse Presents: Damned - Trailer. (June 9, 2014). Retrieved from: https://www.youtube.com/watch?v=Xpd9jbddr_k.

Playhouse Presents: Damned.  Short. Sky Arts. Retrieved from: http://www.asset1.net/show/playhouse-presents/video/damned

The Awful Office Meeting | Damned. (Oct 6, 2016). Retrieved from: https://www.youtube.com/watch?v=bDzTAhXV9UM

The Basic Rule For School Teachers | Damned. (Oct 6, 2016). Retrieved from: https://www.youtube.com/watch?v=MdtWJ7FCSDw

Getting Insulted By A Kid | Damned. (Oct 19, 2016). Retrieved from: https://www.youtube.com/watch?v=VUMsSrhJ0ks

Stressful Morning School Routines And Watering Fake Plants | Damned. ( Nov 1, 2016). Retrieved from: https://www.youtube.com/watch?v=vLyKObQBiU0

Celebrating Social Work: Social workers do standup: ‘A good laugh makes you feel better’

Social workers do standup: ‘A good laugh makes you feel better’

In a climate of cuts and low morale, social workers Debbie Greaves and Jim McGrath have turned to standup comedy to help relieve the pressure

Miller, N. (2016). The Guardian. Retrieved from: https://www.theguardian.com/society/2016/nov/01/standup-comedy-social-work-cuts.

If you spend your days dealing with family crisis conferences, child protection hearings or tense mediation meetings, you might fancy some cheering up. Step forward “Debstar” and “Jim McGraw” – the stage names of Debbie Greaves and Jim McGrath, two social workers who are turning the stuff of their working lives into standup comedy.

“We’ve got so many stories people can relate to,” says McGrath, before a sold-out show in Brighton. “People thank us afterwards, saying ‘I really needed that – I was having the worst week’,” adds Greaves, who is a firm believer in the power of laughter to help her fellow professionals maintain a healthy perspective and build resilience in difficult times.

“Putting the social into social work” is the battle cry they carry around Britain on regular tours from their Northern Ireland base, juggling annual leave and work schedules. Greaves quickly scotches any idea that using stage names is about keeping their comedy activities secret. “I just like a distinction between the professional me and the comedian.” She points out, too, that her bosses have seen her in comedy action.

“They know I won’t go over the line that will land me in the deregistration zone!”

Both comedians can draw on decades of experience for material. Now 40, Australian Greaves has spent 20 years working in children’s services in her homeland and around the UK, while 54-year-old McGrath has notched up 30 years across youth offending, child protection and neighbourhood dispute resolution.

It's cathartic doing comedy. You get to rant and rave about how rubbish things are

McGrath began performing comedy at a Dublin pub open-mic night a few years ago, while Greaves’ first taste of standup came in 2013 when she did an impromptu 10-minute slot to add a bit of fun to her local social work awards ceremony. McGrath then made contact after hearing he wasn’t alone in the world of social work standup.

“Changes in social work have had a huge impact on morale, compounded by cutbacks and ongoing pressures,” says Greaves. “Comedy should hold up a mirror to life, deconstructing idiosyncrasies to get people to laugh at the system.” And while their profession provides the backbone of their acts, broader material is woven in. “What’s happening in the news affects us as social workers, too – things like the refugee crisis,” points out McGrath.

Any talk of social work and comedy naturally brings up Guardian cartoon strip and Radio 4 spin-off Clare in the Community (see below) and the Channel 4 sitcom Damned with Jo Brand. “Anything that gets the general public talking about social work and the complexities of the job is to be invited, as long as it reflects positively on both social workers and service users – we’ve had too much ‘poverty porn’ on our TVs and condemning of social workers,” says Greaves. She speaks of being angry at “the same old churned-out stereotype of social workers in crisis and disarray ... We’ve all been in situations that have been funny, but there is a fine balance between laughing at the situation and making fun of the person.”

Greaves speaks as someone who has experienced social work practice from both sides – client as well as provider. Raised in foster care in Australia, she claims a (mostly) good experience of social workers. Yet that didn’t stop her feeling the stigma attached to being in care – and getting up on stage, she says, has helped her face inner demons. “It’s cathartic doing standup as you get to rant and rave about how rubbish things are.”

McGrath admits to using comedy to deal with stresses, such as the perils of working in Northern Ireland during the Troubles. “Social workers were expected to go into areas without police back-up because of the security threat [to the police] – but we did it because we had to,” he says. “That said, it’s still more frightening to stand on stage and expose yourself to the judgment of your peers.”

Greaves and McGrath donate £1 from every ticket to the Social Workers Benevolent Trust, which has seen increasing demand from members of the profession seeking help for problems worsened by a difficult political climate and increasing lack of job security. They are also now using their comedic skills as a creative way to work with client groups, particularly to build confidence – McGrath with recovering drug addicts and Greaves with a learning disabilities group.

So what did the punters think after the Brighton gig? “I thought it was good to find humour about the work and the office politics; people in our profession need to be very ‘PC’ when working, but we also need to let ‘real’ feelings out somewhere,” said one fellow social worker.

Greaves sums up their approach to comedy simply. “We’ll have a good old laugh and a whinge,” she says, “and then go away feeling just a little bit better about things.”

For details of future comedy dates go to the duo’s Facebook page

The Awful Office Meeting | Damned

Clinical: Trauma-Informed Care for Veterans

Trauma-Informed Care for Veterans

One way to reduce VA wait times is to train physicians and staff to think like social workers.

Hendricks Thomas, K. and Plummer Taylor, S. (2016). Social Work Helper. Retrieved from: https://www.socialworkhelper.com/2016/11/01/trauma-informed-care-veterans/

An increase in trauma-informed care leads to more efficient and effective response at every level of patient care, and thus, a reduction of wait times at VA Hospitals.

Rebecca served nine years as a Marine Officer, and had relied upon the Veterans Administration Medical Center (VAMC) for her health care since departing active duty.  She was a devoted runner trying to get back in shape, but a few months into this well-intentioned effort she found herself calling the VAMC appointment line.  Her Achilles tendon was swollen and painful, and she found herself limping through busy days. The first call to the appointment line resulted in a referral, a message taken, and the promise of a call back. The nurse who called back wasn’t authorized to book anything beyond 24-hours out, and the promise of a return call was again offered. A week later, the phone had not rung, and Rebecca was still limping along without an appointment.

Military veterans consistently report access problems with Veterans Affairs (VA) hospitals and outpatient clinics.  Patients in Phoenix reportedly died while waiting for slow cancer care.  The issue is an administrative and ethical conundrum; veteran satisfaction rates and overall patient wait times must be improved.

The solution is not entirely structural, though more infrastructure and staff would directly reduce wait times because more providers are available.  The answer to date has been the bandage of increased oversight – stipulating tighter regulation and monitoring of recorded wait times. The intention of such accountability measures is consistently undermined by employees incentivized to modify the numbers, and it is a rare whistle-blower willing to call attention to the statistical maneuvering.

If adding more directives to reduce wait times has been met with maintenance of the defunct status quo, how can we improve accountability while working within the current system reality?

The answer involves expanding the standard of care and embracing holistic wellness. First and foremost, we need to make the process of receiving care easier, more effective, and more efficient, and one of the best and most empirically validated ways to do so is to offer trauma-informed care.

Trauma-informed means knowing the history of past and current abuse or trauma in the life of the consumer with whom one is working and to understand the role that violence and victimization play in the lives of most consumers of mental health and substance abuse services, thereby utilizing that understanding to design service systems that accommodate the vulnerabilities of trauma survivors and allow services to be delivered in a way that will facilitate consumer participation in treatment. With trauma at the center of understanding, all parties – clients, providers, clinicians, and programs – will benefit.

We must begin providing trauma-informed care at all levels of care, from point A to point Z in the care cycle for our veterans, working with existing VA employees, staff, and providers. Our veterans are coming from a place of trauma, be that trauma combat or simple transition.

VA hospitals are not public hospitals. Therefore, trauma-informed care must be a requirement for any person in the VA.

 Research has convincingly shown that it is not just mental health care providers who need a trauma-informed approach, and sadly even many of those providers do not have this background. For instance, psychiatrists are not taught to account for cultural, environmental, economic, gender, or trauma history differences among clients. Social workers, for example, are exclusively trained and educated from this perspective of the prevalence of trauma and the impact of environmental factors.

How does this impact wait times?

Education of the entire staff is required, not just the person the veteran encounters after the 5th stage of waiting (multiple phone calls, an employee they encounter in the parking lot, the volunteer at the front desk, employees inside the building, the receptionist at the clinic office) because all of those stages of interaction impact how care is sought, followed up with or not, or perceived by the patient.

Part of wait time computation involves the actual time but some of it is the perception of time – sometimes a 2 hour wait can feel worse than a week long wait; it depends on how the person who is addressing you talks to you. Veteran perceptions are important and impact how they feel about care received.

• Improving the staff’s trauma-informed perspective improves wait times by improving and tailoring the environment. Frankly, this trauma-informed paradigm can be used as an incentive to the care provider because the whole process becomes more humane to them. As they are trauma-informed they address people differently.

• Trauma-informed personnel are more likely to address issues more effectively and efficiently. As empathy and understanding increase, so does efficiency because veterans come in to be treated, feel safe doing so, are being treated one time, versus becoming overwhelmed and leaving, necessitating another visit. For instance, if a veteran enters the hospital and is yelled at by the person behind the desk, or harassed by a janitor, he or she very well may turn around and leave. The veteran will then have to call in again, make another appointment, likely be perceived as disrupting the system and be chastised for not showing up for their appointment. The whole process not only may be re-traumatizing, but will add to the backlog of appointments.

• Trauma-informed care creates safer environments. Feelings of safety are fundamental to effective health care, especially effective mental health care. Thus, veterans are more likely to feel comfortable coming in for proactive and preventative care versus waiting until they find themselves in a most extreme case which then often requires more resources for a longer amount of time, resulting in more pressure on the system again.

• Trauma-informed care creates better-informed clients. Veteran patient clients, when treated with the respect a trauma-informed model demands, are well-informed at every stage of care, from administrative matters to the care itself. Lack of information leads to confusion and threatens the basic need for feelings of safety. Waiting for return phone calls that never come, or waiting in a waiting room for hours on end well after their scheduled appointment time, are re-traumatizing (and common) occurrences for veterans seeking care at VA hospitals. Trauma-informed care standards would mandate that appointment times be honored, that waiting room facilities are safe and comfortable, and that a patient is communicated to regularly and with respect about the process required to receive care.

Every single employee at a VA hospital needs some trauma-informed education and training, not just psychiatrists. Through a trauma-informed lens, any staff member can see issues more clearly and solve problems where they occur. This would mean, for instance, having a person at the entrance of the VA Hospital who is calm, clear and helpful; not an untrained, random volunteer. Having staff members who are trained in harm reduction and de-escalation techniques is also critical to trauma-informed training, education, and care provision. To shift culture, you cannot just train the leaders. All employees at the VA should receive at least a basic level of training of trauma-informed care. This absolutely also includes care providers.

We do not need more regulations and stipulations on time-frames, which are already in place and already not being followed. Veterans and the families who support them are calling for a true cultural shift in care, one that can be achieved with training and standard of care expansion.

Editor’s note: This article was jointly authored. Sarah Plummer Taylor, MSW is an established leader in the field of resilience building, holistic wellness, and leadership training. Learn more at SEMPER Sarah®. Kate Hendricks Thomas, PhD is an Assistant Professor of Public Health at Charleston Southern University.