feebless

The Chifd GareWorker ssN @sr*lez
Vol.l1 No.lOOctober1993
fhe
AfiIJilcarcworfier
PEACEIN SOUTHAFRICA
TOM GUNSTONATTHE8TH INTERNATIONAL
FOSTERCARECONFERENCE
MEERVANDIEWES.I<RRPSE
SEMINMR VIRI(NDERVERSORGERS
AIDSUPDATE
RESIDENTIAL
WORKANDSUPERVISIOiI:A DTTCHVIEW
CUREOR HEALING?A MEDICALSTUDENTDISCOVERS
11
PARENTSAND CHILDREN:ATEACHERBECOTIESA LEARNER
12
ALESSION DEPRESSIOII:
HOPEFORTHEHELPERS
TRIESCHMAN
ON DEPRESSIO}.I:
A CHILDCAREWORKER'SWAY
13
SOL GORDON'S1I-POINTSURVIVALCHECK.UP
16
Cover Pldure: Laureft Reburc -
Jqrnd dthe
NationalAsddon
of
Chlld Carc Wodrers
NACCW
APlNeuwweek. *e Editorial on pge 2
15
Thereare thingsin our Innd whichare
worthanyeffort...
I shall probably get into all
sorts of trouble from
Newsweek,Associated Press
and photographer Laurent Re
bours, bnt ljnst had to tse
that photographforthb
month's @ver. For it pttts in a
sirgle picture (folget the thou
sand words!) the grim prit>
tag of our failure to achieve
reconciliationand peace in
Sonth Africa.
It is a pictureof a Muslim
yourBsterrunninga'sniper
gauntlet' in the Croatian city
of Mostar.lt could be one of
your kids, or mine, caught on
the wrorg side of some racial
or religiors divide which
somehow turrred into an
abyss of hatred and unfrcrgiveness.
This is already the experienc€
of milliors of people in our
country. With each failure to
come to tenns, a tomonow
comes closer in which it could
be the experierrceof all; with
each act of rejection or re'
venefe,there b another bullet
hole in the fabric of our society; with each piece of cheap
political rhetoric and each accusation and counter-a@usation, another breach is blown
in the bridges beirg so pairstakingly built by sorne - and
more kids will be runnirg in
the strcets.
TACCW
NANONALEXECUNVE
Chalrman'AshleyTlrcronsn
(SvUBA (Hone),NHCRCC,MICC.
68 Wendtlandt St. Farow
7500.Tel. (H) u21-Q.-276.
W) 02 1-462-3960. Fax 021461-0114
Treasurer:Ernie Nightirgale
NHCRCC
DiptAC(Bus.Admln).
Dip.
Fers.
Men.,
ACB,AICC.PO.Ebx
28119, Malvernrt055.Phone:
031-44-6555. Fax: 44-1106
Memberc.'ElanieLodge
(Irarsvaal), Lionel Woldson
(Wes-lGap), Linda Darlow
(Border),Cecil Wood (Eastern Provine), Zeni Thumbadoo (Nata)
fucucugtlg
Vol.l1 No.10 Oclober 1993 Page 2
The tragedy of the cover picture is that it reflecG a situ
ation whbh, after all this time,
is rpt gettirg arry better. "You
think it can't get any worEe?"
said a UN official. "Just watch
what happers in central Ebsnia ... " A Mtslim soldier:
"Bosniawill be like Lebanon,
the never-endirg war."
Child care workes, more than
most people, are skilled at
brirgirg hope where there is
despair.
The startirg point of ourwork
is the separation, failure, loss
and conflictsr.fferedby children and families,and we
manage to help people regain
trust and rebuildtheir ft:tures,
When we en@urage people
to let go of their obsessiors
forwinning battles,and to
work, rather,at winnirg
peace, we speak with the experierrceand krrcwledge tfnt
tlrcse thirgs are possible.
Every one of us needs to communicate this message, day
by day and to everyone we
meet. We know the necessity,
and the value, of buildirg safe
environmentsfor children.
We hear these echoes of Bosnia and B€inn,and on W we
watch helplesslythe realityof
these 'never-endingwars'. lt
cannot be that South Africars
will also be so damned stupid
STAFF
Director: Lesley du lirit an
(Soc.Sc),Hons BA (SW), Hons BA,
Ms(ccA,urcc. PO. Ebx 2&323,
Malvem 4055. Tel.031-46$
1039. Fa,r:(031)44-1106
Asslstant Dlrector (Admlnb
stratlon and Flnance):
Mlcc.
Roger Pitt oip.Theot.,
Assistanl Dlrector (Prof esslornl Services).' Jacqui MiBA FVD (Hq|s),
chael BASoc.Sc.,
Admin.PO. BOX
Adv.Dip.Br.sineos
751013, Garden Vtew 2047.
Tef: 01 1-8+1512 Fax 8*
2928
PROFESSIONALCONSULTANTS
Natal: Dudu Mofokeng al
(Nursins).
PO. Box 28323, Malvern 4055. Tel.463-1033
as to want to win their small
battles - and so bse the
whole war.
Waron a secondfrnnt
Dr A.E. van der lvbrwe of SANLAM wrote the editorial in the
latest issue of AIDS Scan, and
his nnssage b the sarne, but
on the AIDS front - Sorrth Africa's 'seond fnont' at thb
time. Will we allow, he asks,
an urpontrolled AIDS epidemb to destroy all of our
drearns to achieve tfe education, the horcing, the employment which our people need?
See pqe 7.
ChiA care wodeercdo
it in their life-spaces!
As I write I am reminded that
in this issuethere is a graphic
exampleof how child care
workers can achieve the
seemirgly impcsible with
theirown very special meth
AlTiwhrnan
ods. At the end of Prcfessor
Alessi's second feature on depression, we have publbhed
on page 15 some smallextracG from the writirgs of Al
Trieschrnan,ore of the great
feroes of our profession. Do
read his characteristically
'child
care', orestepat-atirne, rnethods which help us
deal with problems that even
the rnct skilled cliniciars
stnggle with.
ls tfere somethirB here we
can learn from - something
with which child care workee
can make a difierence?
The PG Foundation has sponsqed thls loumal ln 1993.
NACCW staff aN memberc erpress thelr apredatlon.
P
THE PG FOUNDATION
@
A PUBLICATION SPONSORSHIP
Publietions Deprtnent
Brian Gannon BAHms),MA,
rucc,PO.Elox23199 Clare
rnont 7735. Phone/Fax @178&3610. ElelteleA2rc.
REGIONAL SECRETARIES
Transvaal: Val Lodge, Box
751013,Garden Vtett 2047.
TeUFax:48F-r298.
NaEl: Anre Piene, Box
19194,Donneton4O15.Tel:
031-28-4187
Bqd*: Sarah Burger PO,
Ebx 482, Kirg Willians Town
5600. Telephorn: O433-21932
Weslern Cape: Dave MacNamara, 3 Waterloo Rd, \{rr
berg 78O0Tel:021-633 18e
Eadern P rovl rrce: Christine
Wilson, Nerina,Thornton
Road, Port Elizabeth6001.
Telephone(041) 43-22@
CONTACTA IN OTHER AREAS:
Suld-l(ap.' Echrin @llant,
PO. Ebx 3591,GeorgeIndtstria 6536
N amaqualand: Fr Anthorry
Cloete, RC Sendirg Kin
derhuis, lGmieskrmn @A1.
Telephorn: (@57)608
Kmberlry: Derek Swartz, Private Bag X50O5,Kimberley
8300. Tel. (0531) 73-2321
The lntematirnd Fcdcrdion of
EducativcCommur*fics
>wJ
t&
Thc IntcmdionC Aseocidion of
Workcrs with Troublcd Childrcn
In a report of considerable interest to cll involved in the child ccre service in
South Africa, Cape Town Child ldelfcre Society's TOM GUNSTON picks out the
highlights of a recent visit to Dublin, Irelqnd, during which he was a delegate to
The 8th Internattonal
FosterCareConference
This conference carne at a
very opportune time for our
team of foster care specialists
because we lnve been wrestling with the problems of how
to provide effective feter care
servicesin a third world settirp, i.e.,with high caseloads,
a shortage of workers and a
shortage of morrey,and our
team fns, over the past two
years or so, been developirg
a model of ficster carc s€rvbes that seemsito meetsome
of tfrese challerges. Howevei
we reeded expert feedback
on whetheror not our rnodel
b valid in terms of the theory
of fcter care, and is applicable in any other situtiors
tl'nn our own, as well as on
how it can be improved and
made more effective.
This conference has also
corne at an opporturn time
for our agency, as we are
grapplingwith serious prob
lems of worker overload and
are lookirg for newways of
approachirg ourwork so as
to alleviatethis situation.
There are ideas that come
from tfre conference which we
think can felp us in this way.
However,at arry time it is
stimulatirg, refreshirg and
cfnllerging to attend a conference like this where ore not
only gathes new ideas and
confirmation of cunent prrctice, but experierces support
and solidarityfrom being with
hundreds of people from
around the world who are
wrestlirg with problems similar to one's own, ard for
whom one's specialityis also
the focus of their work or even
of their life.
Slovenija, Germarry,the tlletfF
erlands, Finland,the uSA,
Canada, Uganda" the Camerouns, Horg l(org, At"stralh,
and the UK. These delegates
included foster children,foster
parents,child care workers,
social workers, psychologists,
psychiatrists and academics
who focr.s on fcter care and
related arcas.
Each day sarted with a plenary session, nircty minutes
in lergth, d s'hich three
speakers preseriled: an ae
demic, a prominent practitioner and an ex-fosterchild.
This was just one way in
which the value of really listen
ing to all parties involved in
the fostering situation was ernphasized.
Durirg the rest of the day
there were three workshop
sessiors, each an hour and a
fnlf in lergth. Cttoosirg which
workshop to attend durirg
each sessbn was m easy
matter. Firstly, because during
some of the workshop sessiors there were over 20 worksfiops from which to choose,
and secondly, becausethere
were a limited number of tickets available for each workslrop (suppliedon a
f irst-come-first-served basis).
Some of the most valuable
times were the times of informal sfnrirp durirg the cotfee
breaks and meals. Not only
was this an opportunityto
make friends, but one felt ore
receiveda glimpse into foster
care in other lands.
It was indeed a thrillirg experience! Tryingto sfnre this is
difficult- somethirg like trying to O*"r:."
sunrise!
The Conference
The confererpe was held in
Dublin,lreland,on the campr.rsof the UniversityCollege
of Dublin.lt was attended by
10O0delegatesfrom 36 countries, ircludirg Russia,
For this report I have chosen
to focr-rson a number of emphases of the conference and
referto speakersor workshoP
facilitatorsin the process.
Lluentg
Vol.11 No.10 Oclobcr 1993 Pagc 3
The value and lmportance of
teamwork
The value of co-operation,
plannirg bgether and really
lbtenirB to all parties irwolved
in the foster care experierPe
- foster children, biologiel
parcnts, bster palents, social
vrorkee - w6 emphasised
many tirnes. Foster parents
and ex-fosterchildren vrerc included with world hmous expeils on bster care, as
plenary speakes. Sorne of
the worfshops w€le cor>
ducted by socittlrvorkers together with bster parents or
biological par€rts. At the
openirg oEt€rnorry,Charles
Confer, Presldent of the International Foster Care Organis*
tion, gane credit to psychi*
trbts, psycfngbts and social
workers, hr said that the
place where tE best therapy
takes plm br the foster child
b in the foster horne its€lf.
Foster parcrts and natural
parents and foster cl'tildren
qre to be respected and taken
Ceriouslyand really lpard, s
well as involved. The values of
this include the followirg:
1. Biological par€nts are less
likelyto feelporerless and/or
angry, and are less likely to
witMraw, and so foster children are les likely to have m
contact with their natural parents and feelthe devastatbn
of abandonrneril;
2. Elatterdebbrs are rnade
in resoect of the child;
3. The foster child feeb less
like a "case" or "number" and
more like a person who b of
value and b cared about;
4. The likelihood of the return
of the foster child to her bio
logicalfamily is enharrced;
5. Foster parerE and prospective ficsterparents can improve (and ease for social
workers) the process of
screenirg and trainirg recruits for fosterirg if social
workers errcouragedtheir Par-
ticipation in these tasks (self
assessment could be part of
the screenirg process);
6. Foster children would often
be rnore conrfortable beirg
taken frora nredical examination by an adultthey krnw
well and tnst.
Speclal needs of the loder
chlld
Appeals to take these reeds
serbr-sly and foctts on them
in the trcatrnent proglamrne,
werc rnade on numetous oc!
casiors. The fcter child must
be placed entrestage in foster carc seruices. Sorne of the
special reeds emphasised
were:
"roo\"
1. To develop strorB
'\rirgs"
(a sense of conti-'
and
nuity and a fppe forthe fu
ture). Robbie GillQan,senior
lecturer in SocialWork, Trinity
College, Universityof Dublin,
stressed thb, and added that
lack of early secure attach
ments do not condemn orp to
a life of poor self-rrorth; foster
care can rnake a difrererrce.
Howeve[ children's links with
their own families are vital.
2.To develop self esteemand
to solve (or alleviate)self esteern-related prcblems. Gilligan nnntioned Rutter's
assertbn that it b protedive
to have a strorg serse of
orn's own worth asia Peeon,
and corfidence that one can
cope with lib.
3. To develop sociability and
relatiorship skills; these children have usually had poor
role rnodels in respect of.
formirB and rnaintainingcorr
stnrtive relatbrs hips.
4. To develop self efficacy,
competerrce and a serse of
resporsibili$.
5. To corne to tenrs with lcs
and separatbn (but preferably, of @urse, to lnve cotl
tad with bblogical parcnts
and siblirgs wherever pcsible).
6. To ns@verfnomabuse. Dr
Alice Swann, Manager of a
multid isciplinary team treating sextnlly abused childrcn
in Belfast,while recomrnending several treatrnert ap
prorches, said thatthe
therapeutic effecG on the
child who wc abrced Prbr to
foster cane,of simply livirg in
a bster horne in which therc
b rp abuse, should never be
underestimated.
7. To deal constrrc:tivelywith
anger.
The ctrallenge of dlsruptlon
and breakdown of loster
placements
The terms disruption, failure
to achieve the specific aims of
a particular placement, and
unplannedterminationof a
placemeril, have replaced the
term 'breakdown' for some,
but, as one foster father re
marked, tfe severe serse of
failure and treartbreakexPerienced by thce at the centre
'breakof th's, makes the term
down' more approPriate.
A realistic approach was
taken towards breakdown it b to be expected! ObvioLlsly,this is not an attemPt to
minimize the negative resultls,
and every etfort should be
made to prevent breakdown.
BrJtit is recognised as Part of
the reality of foster care.
Breakdowns c€ln be Pre
dicted. The cl'rarpes of breakdown in a foster placement
are enhancedwhen:
1. The foster mother is under
40 years of age;
2. There is an own child in the
home approximately the same
age as the fcter child (or urr
der 5 years of age) and the
same sex as the foster child;
3. The foster parents are irexperierrced (tfrereare 4 times
the number of breakdowtls
amorg foster parents with
less tfnn one year's exPerF
ence);
4. The foster child is separatedfrom her siblirgs;
5. The foster child lus to
cl'nrge sclrools when comirg
into tfe placement (this dou
bles the breakdown rate).
On the other hand, breakdowns can be redrced if, fror
example:
1. Childrenare placed in a
residentialsettirg prior to
long term foster care (rather
tl'nn beirg transfered directlY
from home to the foster Plaement, orfrom one placement
to arnther);
2. Clnnges and separatiors
are kept to a minimum when
childrenmove;
3. Childrenare in care on a
voluntarybasis ratherthan un
der court order;
4. There is frequent contact
between the social worker
and the biofogicalparent(s);
5. Contact exists between foster children and their own parents.
The importanceof the social
worker-fosterchild relationship was again emphasised in
furry,crlrg
Vol.11 No.l0 Oclobcr 1993 Pagc 4
this connection. When there is
rp natural parent contd (as
with 75% of our children) and
the bster plrement breaks
down, then (f therc b m
meaningf ul social rvorker-fcter child rehtiorship) the fcter child may have rp one!
Some suggestions vYene
made in respect of ratirg the
success of foster care in con
crete tenrs. Questbrs strh
as tfrese may be asked: 1. Did the foster child pass at
school?
2. Did he find a icb after his
foster care experience?
3. Does she have a "family for
life" (is her foster family committed to herforthe rest of
her life?);
4. ls she inrclved with drug or
alcohol abuse?
(Well-beirg scales and Satisfaction scales were refened to
and tfrese fnve been ordered
from the UK.)
Much rtone etfott Into ptuventing rcmoval
Therewas a plea to help children at risk in less drastic
ways tfran renrovalfrom their
naturalfamily,that b, to put
more effort into preventbn.
Current problens at our own
agerrcy could be alleviated if
we could find ways of re
sponding to this plea, but
most importantof all, children
could be sparcd the devastation of separatbn and lcs. Dr
Vera Fahlberg and Anrs
O'Donnell,among otfer
speakers, verbalised this corr
cern very eloqrcntly.
One method of preventirg removals, preserted at the con'
ference by ttn Banrside
Fosterirg Resource team, is
Thb irvolves the
FosrERsFlARe.
recruitment, selection and
trainirg of Fctersfnre famF
lies who will link up with families where them are children
at risk,thts providirg a sort of
safety net or support system
fortfrese families,and tht-s
hopefully preventirg ernoval
of the children. These fostershare families are NOT bster
parents or e\ren emergency
carels, and so they are free to
give support to familiesat risk
wheneverthis b needed and
to promote the care of the children by their own family.
They can also model for the
family at risk how a stable family functiors.
A secondary vah.rcof this Fostersfnre plan is the prevention
A commifrrcntto tLc chiW
for W... it refenvdb as
love-tn-fltffiot-wrut"
of fcter care breakdowrs (a
Fosterstnre family can be a
support system to a frcster
family and so prevent burnout
and breakdown).
lleatment lor the ernotlonally dlsturbed and dellnquent adolescent In a lartly
rettlng
The Pp-Teen team of foster
cares presented at serrcral
workshops their pbreerirg
work started 5 years ago in
lcnt, Enghnd. Their new
model of spcialized foster
care fns been evaluated Periodkally and bund b be of
value. ftey abo rckrnwledge
problens hornsUy. Tteir
book, Frec to b futyself s
rpw available.
Pro-Teen irvolves very dose
eoperatbn within tfE bam
of fcter parerts and social
workers, and dns d tb srccessful rcturn tprne of tle ficster child and/ortln yourg
p€rson'sdevelopirg so that
she can cope with the realities
of adult life.
Elementsof Pro-Teenwork irr
clude:
1, A definite contrrct beirg ne
gotiated and agreed on be
tween a/l parties (it b sigrnd
after a $wek trial perird);
2. A commifnent b the child
ficr life (thb irrcluds after
carc, prbon vbits and surpgate grandparentlood, and b
referredto a "love'ncmatterwhat"!);
3. A bahnce between giving
the emergirg aduft independerrceand standirB by
them in trouble;
4. Loyalty to and aceptarrce
of the disturbed child so that
Fe realises,sonretirns for the
first tine in his life, that there
b sorneone totrallyommitted
to him;
5. \,bry careful screenirg of
both prospedive fcter children and parents;
6. Verystrorg support (even
respite care) for foster parents, by colleagues and social
workers;
7. Acceptance of bster parents as full members of the
team (thls irnludes adeqtnte
remuneration- approximately R5O0Oper child per
month);
8. A termirntion contract any party wartirg to terminate
the placernert must give at
least a month's written rptice,
ot.ttlinirgthe problems and
reasons frcrtheir decision.
It was interestirg to rpte that
the rnethods of evaluation
used frcrevaluatirg the Pro
Teenliodel are difierent from
the traditional rnethods of research and evaluation These
methods are mlevant to a dynamic, orrgoirB phernrne
rpn. This could be of help in
evaluatirg our Sable House
model of foster care services
and the material b beirg sent
to us by Prof. Yelloly of Tavistock who led in the evaluation
of the Pro-Een i/lcdel.
Work wlth angry tcenagers
Relatedto the above was ar>
other stimulatirg workshop
condrcted by Charla Confer,
a social uprker from the USA
and the Chairman of the International Foster Care Organizatbn. His approach in work
with teenagers is cfnracterized by three techniques:
1. Lbtening without sayirg a
word, and yet simultaneously
fulcrrul''g
Vol 1 1 No 10 October 1993 Pagc 5
conveying (rorverbally) that
the listener is totally with the
angry teenageq and that the
listener b not judging or criticizirg him;
2. Agreeirg with sornething
the argry teenager says (this
may be a small part of what
he says, brJttfe agreemert
must be horest and withod
preterse) and not beirB d all
defersive;
3. Givirg them resporsibility
forfindirg a soh.ilbn to the
sitr,lationthat b rchted b their
anger (frorexample, askirg,
'What do you think I can do
about this? How can I
charge, do you thirk? How
do you think we can work together on this?') and so hdf
ing them to move to a
positionwhere their reasoning
ratherthan their emotion is in
control.
Transraclal losterlng
One of the workers from the
Netherlands shared wfnt had
occurred in her country wfrere
trarsracial fostering fras been
practised and wfere seriot-s
probhms are beirg experierped. lt appears tlnt they
have found that it is not
ernugh for the foster parerts
to love their fcter child of a
difierent race and culture;
they must understand, respect and take into corsider*
tion this culture in their
relatiorship with the child.
The worker refened to above
fras been assigrnd the task of
recruiting foster parents of the
same race and culture as the
children in reed of foster
homes.
Foster carc In developlng
countrles
It is apparent tl'st not only in
countries of Africa but also in
countriesof EasternEurope
(Romanie Slovenia,Croatia,
for example)and of Asia,
those committed to foster
care servbes are stngglirg
with problemssimilar to our
own and are seekirg a model
of fcter care services which
will arswer these problems.
f\4anyof these countries have
apparently rpt reached as far
alorg the road asiwe have in
developing an effective model
of fcter care services. However, we fnve mt^chto teach
each other. ln sorne of tfpse
countriessubstittie care provides for the pl'rysicaland
medical needs of children in
care, but rpt their emotional
and saial reeds.
Prof. John Triseliotisreported
thb from his experierrcein Rornania Accordirg to Charles
Trlhabe, tJganda Foster Care
and Adoption Association.,
over20OOchildren in uganda
today need asubstitute farni[, hf they expecnto be able
to amarBe for about only 5O
children to be bstered per
year.
It ws possible br me to give
a summary of the rnodel of
beter care services that b beirtg developed d Cftild WeF
fare Society in Cape Town to
serreralrcadembs and prrctitioners wfp are either servirg
in the abovernentbred couittries or well acquainted with
conditbrs thet€, and to discr.rssthe rnodelwith them.
Apart from the feedbrck received at the confererpe, further feedback lus started
comirB through the mail. The
positive response to the
model has been rnost errcouragirg, and the suggestiors
helpful. iArreover, it has been
very gratityirp to learn that the
rnodelwe are developigcould
be helpful in countries other
than ourown. Apart from the
irsQfrts recsived about prob
lems and progr€ss rcgardirg
foster care servies in developirq countries, the arswets
we have rec€ived about our
own model have been most
helptul. This was ore of the
mdn reasons ficr attending
the Confer€rpe.
More etfectlvo seMceg for
the blologlcal parents of foa'
ter cfilldren
The importarrceof involvirp
the parents muctt tnonein the
plannirg frcrtheir child, both
before the child's lenpvaland
as well as
during plreme(
in allotfrer plannirB, was
stressed in several workshops. Factors included in the
presentatiors and discussiors were:
1. Social workers need to
grasp morc fully the crbb of
filial deprivation;
2. The relatiorship between
social workerc and bblogical
parents beforc and at the re
moval of their chifd can contribde to their hostility,anger,
feelirg of powerlessnessand
theirwithdrawal (and even disappeararrce),and can there
fore contribute to the aban
donmert of their children and
of
to the traurnaticexperierrce
lcs and separationof the foster cl'rild;
3. Spe shouldbe created
br the biologbalpalents,
theirviewpointshouldbe lbtered to, theirstggestionsre
spected;
4. Th€ disappeararrceof the
biologknl parents,s vrells
theirapdfry, b a rnairr pob
lem in rnarrycomtri€s;
5. Theemlmors serse of
guilt of fte biologbalrnother
who lre failedb carc br her
own child,mustbe nnre fully
recognized.Particularlyirr
si;ltful in thb r€gardwe the
presentatbnof PhillitJaSar*
bridge, Dircctorof the Fost
AdoptionCenfrein london.
6. Fewcl$ldnn would ctpose
to livewith parentsotherttan
theirown:
7. A child'sgreatestreed is
forsecureand stablerelationships- e\r€ryrpve b trau
maticfor a child (DrVera
were
Fahlberg'sprcsentations
especiallyhelptulin rnakirg
thb dear - her publbatiors
incfude HelpingChildren
when they Moveari Janmey
throughFosterC*),
8. Thercb a needbr supportive per groupsfor bblogical
parcrtscwell aaHan&
W d FosterCarcespecially
for biologknl parents.
Fogter c.o. cen makc e dlfferencc
Theoptimbmof bsbr care
specialistsfpm arcundthe
rvorldstill remairswith rne
weeksafter returnirg b the
pressuesof work.
While it b trrc that if the foster
child do€snot lind afamily
that b ommitted to herfor life
and lovesher "rp rnatter
what", then,for her,foster
care servbes harrefailed,
it b also true tlnt we must
rpver underestirnatethe therapeutb valueto the darnaged
child of a stable,commi$ed
foster horne.Dr AlioeSwann
rnadea movingcall br ueto
help damagedchildrenrnain
tain their expectatiotsthat
can
thev
r':'
,
The Conbtgrpe t?llori,€d the
"A Journey through
therne
Fosterirg". YVew€rB taken
over the 'Rocky Roads'and
the 'Hills and Valleys'.But we
wef€ also shown 'NlewHori'
zons' and the 'Rainbows'!
Nog tmc bydrae by dle onlaqgse PralS
aangebledla
Sendnaarwat deur dle NVK r lUec'lGapo Forum
vb. wre. Voorlen, 6 'n seun
ors inr[tirB verlaat,ws ek
versekervan'n brief,rnaar
rpu sal ek nie eersdie sem
herftenas ek hom weer rno€i
raakloopnie.
Ek het gevoelkindercorgb 'n
ls, en daar is geentoekorns
vir my in die prcfessienie.
in Kindersorg
Myondervinding
by
Ek b'n kinderversorger
HuisBonnytoun.Ebnnytoun
funksbreeras 'n plekvan be
warirq; daarreem ors velskillendeseunsop met
veskillendeverwysirgs.By
di6 inrigtinghet ons 'n
span,wat
terapeutiese
bestaanuit sielkundrges,'n arbeidsbnape@rnedise suster
Die
eook kinderversorgers.
oog van die span b om die seunsse aanpasirgasooksy
gedragsprcbleme
en sy positiewehoudirg uit te beelden
te evalueer.Ors bied ook vervir die
skillendeprogramrne
seunsaan, bv.geestelike,
sciale en
opvoedkundige,
sport.
Aargesienors inrigtiq, oorheersrvordrnetveralseuns,
kanhierdieprogrammenietot
sy reggekied nie. Dieterpaeutiesespan kon ook a.g.v.
dievinnQein en uit bareging
van die seuns,nieten vollesy
funksievemb nie.Assesserirg kon ret tot'n mindere
mateplasvind.
Dit hetalhs rng verergernnt
dieskielikeopnamevan
Xfpsa sprekendeseurs. Dit
het nryskoononkantgevarg,
sowelasvir die anderseuns.
Die)(lpsa sprekendeseut
het nurvevesorging rnetodes
na \rorehat kom.Vir hulle
was dit ook 'n aanpassirg om
by Hub Bonnytoun op aaft
houdirg te vYees.Ander
problerne het daarvolgers
ontwikkel.
Konmunlkaele
Omdat ors nie Xfpsa spr€kend b nie, was kommunil<asie'n groot probleem.
Daarvan kon effektiewe kindersorg nie geskied nb. Dit het
'n rnoedeloosheid en
gespanrn atmosfeer by die
seuns laat ontstaan. Die be
hoefte aan Xhosa sprekende
kinderversorgershet dadelik
by hoofde se aandag gekom.
Asook die behoefteaan'n kursus in di6 taalvir nb)(lrca
spre kende kinderversorgers.
Dit het die probleme
gedeeltelikopgelos.
Aanraklng op versorger
Dit was iets nuut wat sy kop
uit gesteek fpt. Dit het alles
gegaan oor die seuns se fnstrasie,sy args en sy orr
bekende situasie by die
inrigting.Dit was al manier
wat hulle kon gebruik om ons
te laat weet dat hulle orseker
b van hulsake by Huis Ebnnytoun. Die gevolg was dat'n
vesorg ingsbeampte aartgerand was so dat seurs kon
dros. Ors drostersyfer het
ook geweldig gestyg. Die
meeste van die aanranding was gedoen deur
ouer seuns. Hulle is oler
as wat hulle voorgegee
fret op die Hof. Di6 volwasse mars was die
wortelvan rpg ander
kwaad: bv. opstokery
bende aktiwiteite, tatoe6rirg.
Dit het nie net by die
Xhosa seuns nie maar
ook by dieander
plaasgevind.
Ek dinkdit is 'n situasiewat met
jnstisieuitgeklaar
moetword.
Dievinnigein en
uit bewegirghet
ook bygedradat
ors plekvan be
warirBnieten
vollesy funksie
konverrignie.
furrerl'fg
Vol.11No.10Octobcr1993Page6
PereoonllkeIndruldte
DieskielikevinnigebeurcgirBs vanseunshet nryas kin
denrersorgerbaiegeraak.
Effektieweversorgirgkon nie
geskie<lnie.Ek, G mert was
uitgeput,en kon die druk
voel.Wanreerek huistoe
gegaanhet w6 dit rnoeilik
om van die inri;ting situasie
af te skakel,want die span
nirg waste fpog. Dieadmir>
btratiewetake kon rpoit
voltooiword nie.Sodoende
be
hetek in die rnoeilikheid
land by my supervisor.Die befpefte aanverhotdirg bou
net die seunsws daar,maar
kon ret niegeskiednie.Dit
was 'n traumatiesetydperkvir
my.F{cetraumatiesrnoetdit
nievir die seurs weesnie?
Die krimirelestprna wd aan
'n plekvan bewaringkleef,
het oor lcu as mensse
gerroelers'nkmu gegee.Jy
kon nie doen soos iru hart
voel nie.Ek hoopors kan in
die toekons weer m die dag
terugkeerwaardaar'n beter
verhoudirgtussenseunen
Wenr vlr dle toeltomr
Ek sienuit om meerveseker
te weesvan 'n brbf as 'n seun
ors inr[ting verlad. Dat
ir^stbieors (Bonnytoun)'n
larger tyd gee om die funksie
van E}cnnybunten rolle in
rverkirgte kansit. Om
kwaliteitversorgirgaan die
seunte gee. Om ook die seun
'n bebr ircig van die nuwe
SuidAfrikate gee,wantors
kan nieweg van die bit dat
die politiekesituasiein ors
b vir die
landverantvvoordelik
skielikevinni;e bercging by
HuisBonnytounnie.
Posltlewc opmeddng
Vrleersdie vinn(7ein en uit
beutegirghet ek as kinderuersorgerg€groeiin die sin dat
ek mu tot beterirspte
gekom het om onveruagsE
gebewtenbserneertakt\tol
kanaanpaken ook in die
prosesis om derdetaal rnagtg te word.
Daarhet ook 'n nuw€h.rsvir
kinderversorgby my ontvhm.
ng
Assesseri
Die doelvan asseserirB is
om vas te stel of die kandidaat geskik b vir'n irriTtirB,
en ook om daaruolgers 'n
behandelirgs phn op te
trek. 'n Multidisiplir€respan
wat deel uit maak van maatskaplike werkes, verpleegkundQes,
ve rsorgirBsbeamptes, onderwysers sook die
e ksterne rnaatskaplike
werker kom by rneloarwaar
die geval besprcek vrord en
idees uitgeruilword.
Wanreer rnoontlik kan die
kandidaat se ouets ook
inkom.
Elke komponent van die "m'n
span" stel voorop
gestelde verslag op rndat
hulle in onderhoudvoerirB
met die l€ndidaat was, en
dit word dan ter tafel geE tyders assesserirg.
Na affEndelirgvanvetshglesirg word die gevalb+
spreekten eindevaste stel
of die kandidadgeskikb vir
'n inr(7rtirg.Tenlaste nord
die behandelirgsplanop
getrekna aanleidirBvan die
kandidadse problennwat
gelei het bt opnamein die
veiligheidsplek.
Aanbevelingsword mk ge
rnaakindiendie kandidaat
kirr
rE'n nywerheldskool,
derhub,plegsorg, d terug
hub be npet gaan.
Dieeksternernaskaplike
rruerker
se phgverderb om
rekorstdcsie ruerktudste
gaan lewer.
'n DaturnYir'n oprclg
asesserirB word ook dan
vasgestelwenrer die span
danneersalrcrgader.
- HubVrcdeluc Span
/drllcltti4qtgtrs.
b A/DS Sca/?
Futurc AIDS Care
ln Scufh Afrlca
Editorial in NDS Scan, Seg
tember 1993,$ Dr A.E. van
der Merwe of $t'll4tt
Sincethe late 1980'sSouth Africa fras experierrcedthe corr
sequences of an ever
increasirp AIDS epidemic.
Lookirg back at past experience, several pertinent lssues
requireour attention.
The first issue is whetherwe,
as Sor.rthAfricars, have
learnedfrom what has already
l-nppernd, and if we as a society are implementirgallthe
necessary precautionary
measuresto limit the impact
of this disease? Loglcal reasonirg predicts that arry resporsible society will take
notice of the potential disastrots effects of an utrcontrolled epidemic, and try to
prevent it wherever possible.
Unfortunatelyour track ecord
in this respect leaves room for
improvementbut it will serve
rp purpGe to blame past errors. We canrpt change what
is history howeve[ the future
belorgs to r.rsand the future
is our resporsibility.
All Sonth Africars must ther+
fore take up the challenge
and accept personal resporsibilityto preventthis disease.lt
is in the interest of everybody
to contain this epidemic as far
as possible. This b regarded
not as a matter of choice, butt
as a matterof survival.
A further question that currently remairs unarswered, is
whether we realise what the
full extent of the fr.fturefinan
cial needs will be for the AIDS
fulrrcurlg
Vol.l1 No.l0 Odobcr 19S! Pagc 7
epidemic and its consequences. Finarcial requirements forthe medicalcare of
AIDS victims,forthe social
care of dependants, and for
the care of AIDS orphars will
have a significant impact on
available moretary resources.
Only when one starts to qr.rarr
tify these finarpial effecB
does ore realbe hor urgent
resporsible action by society
has becorne.
Accordirg to human nature
we would like to give the best
possible care and support to
unfortunate AIDS victims and
their dependants.Howevef
the realityof South Africa's
economic ability to pay for all
th's will unfortunatelybe the
determinirg factor.
The aim will be to managethe
AIDS epidemic and to provide
carc and support according
to the same standards that we
see in first world countries.
The reality, howeve[ is that unless we can increase economic growth in South Africa
to levels where a msitive real
GDP per capita growth can
sustain real increasedspending on health care and social
suppoft, very few of our
dreamswill materialise.
o The messageto allof tts
is clear.Withorlt realeconomic growth we canrpt expect to implementfirst world
standardsnorwillwe be able
to apply first world criteria
with respect to AIDS in South
Africa. We will have to develop our own standardsand
criteriawithin the finarpialcott
straints tfnt we face.
o All AIDS related matters,
be they medical treatment,
testing and screenirg requirements, hospital c€rre,coursellirg seruices,edrrcatbn
prog rElmrnes,social support
rne€rsures,
etc. will be subject
to the economic reality and
the ability of our country's
economy to pay for it. Orpe
we fnve come to terms with
this Fnrsh reality, many of the
issuescunently surroundirg
AIDS will take on a rew perspectiveand highlight new priorities,and the dfficult bttt
essentialdecisiors tfnt we
will fnve to face up to will become obvious. One of tfpse
will be to improve the current
negativereal GDP per capita
growth of 4.3% to substantial
positivelevels.As lorg €rswe
try to gnore economic reahty
or prctend that financial con
straints do rct exist, it will remain impcsible to find
workable solutbrs for the
AIDS problem and related issues.
South Africa needs education
for its children, it needs hottsing for its people, it needs job
creation for its workers and it
reeds the moretary r€sources to financethis. Will
vre allow an uncontrclled
AIDSepidemic to destroy our
dreams to achievethis?
The willto achieve real economic growth and the will to
preventAIDS from destroyirg
this will be two essentialelements in obtaining a better future for all.
.llnov tour
Parencrt safer
scx Suldellne noe
helpful In
rcduclng rlslr cf
cxPcsurc In
collcgc students
Heafthexperts are increasinglycorcerned about HIV in
fection amorg college
students because students
are corilinuirB to engage in
high levelsof ursafe sextnl
behaviourtfnt puts them at
risk for infection.In America
there already are appreciable
levels of HIV prevalence
amonefcollege students. In order to reduce the amount of
unsafe sex exhibited by marry
college students, it is necessary to understand the dynamics associated with their
unsafe sexual behaviour.
This study employed foctts
group techniquesto explore
the dynamics of freterosextnl
college students' safer and urr
safe sexual behaviour.The results strorgly indicated that
respondents have a well developed and generallyaccepted set of ideas regardirg
which potential sexual partners are risky and which not.
From findirgs, it is clear tl'nt
college students appear to
judge the riskinessof sextnl
partners based on characteristics tlnt are not related
objectively to HIV status specifically,whetherthey
know and like the partnerand
whether a previottslyun
known partner lns certainsu
perficialtraits. Perceived
relationships amorg characteristics, sttch as the perceP
tiontlnt a partnerwhom one
knows or who is from a small
town is not risky, are called implicit personahtytheories.
Clearly,college studentsare
using an implicit personality
tfreory to determinethe riskiness of sexual partners, rather
tfnn corsistently practicirg
safer sex.
Implicit personality theories
are often adaptive, even if
they are not entirely accurate,
because they allow people to
interprettheir social world.
However,the use of an implicit personahtytl'eory for ascertainirg a partner'sAIDS
risk is extremelyunreliable
and potentially fatal. Because
the only way to accurately determine someone's AIDS risk
is through knowledgeof tfnt
person's HIVstatus,the use
of any other cues to assess
risk will often providea dangeroLls,false serse of secu
rity. Therefore, health
education efforts to reduce
AIDS risk behaviouramong
college students (and perfnps others as well) must expose the ineffectivessof their
tse of implicit personality
theories to assess the riskiness of partners or potential
partners.Furthermore,it must
be emplnsized tl'nt, in the absence of specific knowledge
regardirg the partner'sHIV
status, knowirg one's partner
and beirg monogamousdo
not corstittfte safersex.
lronically,one of the safer sex
guidelinesthat has been
widely promoted in many
large circulationpamphlets
such as the Surgeon General's Reporton Acquiredlmmune DeficiencySyndrome
(US Department of Health and
Human Seruices,1986)is the
"krnw your
exfrortationto
partner." Althotgh this guideline is intendedto referto
knowirg one's partner'ssexml history (and, of @urse,
actirg on tlnt krnwledge),
college students,and prob
ably many others as well, ap
pear to have misinterpretedit.
In effect,they are usirg the
guidelineto strergthentheir
beliets tfnt they are not being
unsafe if they know their partners, even if the ways in
which they know them are entirely inelevantto AIDS risk.
Furthermore,even if one does
consider one's partner'ssex-
r.ralhistory it b dangerousto
infera regativeHIVstatus
froma rpn promiscupr.ssext.talhistory.Clearly,the "know
your partner"guidelineshave
backfiredand shouldbe abandoned.
Evenlesscrypticsafersex
guidelinesstrchas the advice
to "take precautiorswhen
everyou havesex outsidea
long-termmonogamousrelatiorship' createproblems.Collegestudentsseemto
m'sinterpretsuch aclviceto
meanthat morpgamyitself
corstitutessafersex,evense
rial nrcrogamyin the abserrce
of objectivekmwledge regardirgone'spartner'sHIV
status.Therefore,str.dents
oftenappearto be usirg such
advioeto bolstertheirbelieb
tfnt they needto rse condomsonlywithpartners
whomthey do not know.Unfortunately,pamphletscontainingthe "knowyour partrnf
and "tiakeprecautiorsoutside
a lorg-termmonogamousrelatiorship'g uidelinesarestill
beirg widelyused.
ZlmDabvean
studt amcng hlgh
schccl students
hlghllghts nccd
for beeter
teacher tralnee
prcerammcs cn
adclescena
scxualltt
Followirg various educational
strategies by governmental
and rnrgove rnmental organisatiors to educate youths and
schoolteachers about HIV infection and prevention, this
KABP (Krnwledge, Attitude,
Behaviour and Practices) survey w.rs lsed to evaluate the
results.
The study sample of 478 high
school students was drawn
from four randomfy selested
schools in Mashonaland and
Matabelelandircludirg hrgh
and low dersity, government
and mission co-educational
schools. The sample was ran
domly selected and stratified
to represent sex and grade
level.The KABPself administered questionnairewas used.
The paper analyses the relatiorship between the knowledge aM datirg pattens.
Generallyrespondentsdemorstrated a 5O%to 8096accu
racy of factual krnwledge. Of
fulnIcnl'tg
Vol.l1 No.10 Odober 1993 Pagc 8
the pupils who dated (66%
Forms lto lV), 3O%preferred
only sexrnlly involved relation
ships and a small number con
sidered the possibilityof
HIV/AIDSinfection. A tleoretically based tripartite coalition
involvirg the scfrool, the family and health care servbes
for edrrcation, guidarrce and
support to promote resporsible behaviour throughout
childfrood was suggested.
Reascns fcr laclr
cf ccndorn uso
amcng hlgh
schccl students
ln laeal
This exploratory q ml itative
study was undertaken to identify barriers to condom use
among high school studerG
in Natal. Phase 1, a group discussion with 5Ohigh schml
students of all races from 10
schools, revealedthat 17
(34%)were sexully active,8
(47%) of these had used a
condom at least orrce, but
none I'nd used condons in
every sexual encounter.
Phase 2 comprised 36 focr.rs
group discussiors involvirg
about 650 black high scfrool
students. These discrlssbrs
confirmed the finding of
Phase 1 that high schoolstu
dents were not usirg con
doms to arry significant
degree.ln their opinion,con
doms limitedsexual pleasure,
indicated a lack of tnrst in the
partner's faitfrfulness,challerged the mde ego, and
wer€ associated with sexttally
transmitted diseases. Their
contrru ptive prope rties were
viewed with strspicionand
corsidered undesirable by
those teenagers who wished
to prove their fertility.In addition, condom use was rpt strfficiently well understood and
condoms were not accessible
or availablewhen required.
The authors rc@mmend that
condom promotion strategies
should include an adeqtnte
explanationof how condoms
work and detailed irformation
on their local availability.They
should be availableat a gove rnment-subsidised prbe
through more accessibleoutlets; popularfigures and recognised leadersshould be
encouragedto support antiAIDScampaigrs and condom
use, particularlyin the public
media.
N,ATlO,tlALASSOCIATION OF CHILD CARE WORKERS
1. Liaisonand
Manager
Communications
M4q tastarnas lncftdc: Liabon and retvrorkirg with natbnal and regbral lrlGO's; represert NACCI / d seminas,
conbrerrces and meetirgs of orgmbatiors with uhom we are
dfi lbted ; corsultarrcies ; corrse eordination ; traininglof spe
cblised @uses
Ddalls:
r To Sart Janmry 1994
r Full-timepo.st
r Salary negotiableaccordingto qualifications& experience
r 1Sh cheque
r Based at NationalOffice, Natal
r Requiredto travel nationally
r Requiredtohave own transport
Qttdlt c:lttotp rqulredl: Degree in social vrcrk; qualilication
in child ard yorlh carc; a mirtmurn of 4 yeae direct experierce in the child ard yorth care field; registeredas a child
and yor.rthcarc probssbnal
NaAild Olfrcr
Apf,lc:d,ncnlqnt tc atrlilailelrctmthe
andtfier $ould b rcnnlrldtoTlto Dlrdor, |{/,CCW
aplle
4055 Clalng &efq
P, O W,2gt&,llatyqn
tlon:30 Norrr.lDpr tggt
2. Professional
Consultant:
Transvaal
tt$q tasf areas lnclu&: Marnge the regional office;
dan, coordirnte and adminlster MCC\ / counies; teach cfild
md yor.rthca€ @urs€s; offer corsultation to child care organisdiors; liaisewith and support @brnl Executive
Detalls:
r To slart January/February1994
r Hours negotiableaccordingto qualifications& experience
r 13h cheque
r Requiredto travelthroughoutTranwaal and to Kimberley
r Orn transportessential
Qudrr/rrldorrs.' tvbtricdatbn certifbate ; q uallfication in child
and yor.rthcare; regbter€d ctild and yottth care profussional;
a minimum of 3 years direct experierpe in the child and yotth
carc field
Prcterencr wlil b glrlan totlp follurhrg: bst matric qualilicdion in child and yor.rthcar€, socialwork, psychology oredu
cdion; experierrcein addt educdion; a workirg kmwledgeof
Sotho
&pilcxiilon lqnrs arc awllaile lrom the Trwpvad dlle q
tltp NaUqlpll dlb
and rlpttld b rrttmdtoThcAsC+
tant Dhedor', Messlottd
Servfces, M,CCW P, O. Bq,
751013, @rden Vlew, 2U7. Clclng He fq afl/c:dorc
31.12.19!R
NACCW
THE NATIOI.IALASSOCIATIOI.IOF CHILD CARE YVORKERS
lS AN INDEPEND€NT iION-RACIAL ORGAI,|IS TION
WHICH PROVID€S THE TRAlNltlG AND INFRASTRtrcruRE
TO IMPROVE STANDARDS OF CARE AND TREATMENT
FOR CHILDRENlN RESIDEiITIALSETTINGS
Thlr addrcss wae dellveredat an FICEllay ConfenonGlIn [uHlana,
Slownla, by Dr Feter van den Bef$ ol the Oentn for Spec{d Educatlon and Chlld Carc at Lelden thlyerstty In the t{ethedandr
Residential
Workand
Supervision
At pleent t€m'and tern
work'ale erinl conepts in
residentialchiH and youfl
carc in the hleherbnds. Teamwork b rnorcttnn just the
sum total of tfe rvorkof the irr
dividualrnembeeof a team.lt
rnearEthat fF uhole team
mrst be bctJss€don the
goalsof an oryanisation,and
tfnt pesond interestis of
lesserimportarrce.
Thb paperwillfocrson supervbion of tl'e teamof ctrild
careworkersin a rcsidenthl
irstitr,rtion.Ore of the waysof
supportirpthe bam of residentialcate rcilers is supervbion. I would liketo begin
withtwo rernarks.
First,we mustrnakeclear
what b meantby the word 'srr
pervision'.In dealirg with residentialgroupcale workers,
supervbbn is a prooess
focr.ssedon betterpofessioral workingwithchildpn.
Whenyou don't bearin mind
the perspectiveof their prob+
sbnalwort, sr+erubbn be
@mes menesersitivity
trainirgor thempy.SuperuF
sion,thor.rgh,
does indude epectsof courselling,of
guklane and of self-reflec'
tion. In a residentialirstitntion,
supervbbnb bcr.sed on the
self-edrstbn of the residen
tial socialworfier.
Se@nd,I am speakingspe
ciallyof supervbionin residen
tiel cfiild car€. ib\retherless,
the prirpiphs of supervisbn
in thb fieldcan be gercraF
isedb arrywork sih.rdionin
ctrildcare.
BeforeI ontirue this papeqI
rvouldliketo sketchthe on
text of rcsidertialcarc in the
f\btfprlands, beause it b
sornetirns ditfpult to understandeachourtry's cfrild
caresysilem.
Resld€rillalchlld care ln the
Nethcdandr
In the hletherlands
we havein
gernnalfour typesof child
cale:
fuIlctcrl'g
Vol.11 No.10 Octobcr 1993 Page 9
1. NnEHrory cqu. Withthb
typ€ d carc the child emains
in hb mnnalervipnrnert
usualf withthe hmily, and
rnay lnve appoinfinerftswith
a therapbt
2. Dayoare.Thechild attends
a day care irstitr.rtionregularly
for part of the day.
3. Residentialare. Thechild
b plred in an irstitntion
wheredayand nigfrtcarc b
given
4. Fcter are; A bster hmily
takescare of a child.
llow do chlldrcn ome Into
the chlld carc eystem?
Ebforeplacernentin a rcsidential irstitr.rtion
or fcter cane,
therehavetsually beenvery
manyproblens in the yourg
peson's sittatbn. ttlostly,am
bulatoryhelp or daycare
havebeentried. f tfs€ kinds
of help don't woil(,then ple
rnentin a sefrirg otfer tfnn
his own famitywill be corskF
ered.I will estrict rnyselfto a
discr-ssbnof residentialcare.
ResidentialCarecan be dlvided in fow categodes:
1. Theso called'rprmal'institutiors: thb rnearcthatthe irr
tellQenceof the childrenmust
fall irtrothe mrmal rarge.
2. Treatrnentirstitr.ftbrs :
theseservbes havernore
therapistsand rnoresocial
workersin the staffgroup.
3. Z.l.B.'s,whichareirstitu
tbrs offerirp \bry Intersive
Treatrnent'.
4. Stateirstitr.rtiors.
As you can seo,tfpse irstitu
tiors havebeenlbted in ccendirg orderof severityof
probbm behaviour.
Plrerneri in residentialcarc
can be on a volurilaryor on a
judicialorlegalbesb.The
Dr.tchjwenile justbe sysbm
restson tvropilhrs: civil law
and penallaw,bu by tnadition
the systemas a wholeb best
charrclerbed by a care and
protectionphilosopfry.Theiuvenilejt-sticesystemb based
essentiallyon a welfare
model.
All decbbrs conemirB
yourp offendes, be it on the
basbof peralorcivil law,ale
taken'in the bestintersts of
tlF cfiH'. Thb rnens tm it b
rpt so mucfi the rct or the ofbrrce commitbd, bU also tfE
psycfrologbaland edue
tbrnl circunstarcs, tlp farnily bad<grcund,etc.,which
will dect dbcr.ssbrs and decbiors on howto handlea
c6e.
Both policeand public prGe
cuior rnakefrcqmrt use of
the possibilityof dbmbsirg a
cse and refenirBthe child
conerpd to the Child Pnotctbn Courpil,especiallyin
c6ea uf,ere there is a problemdb socialbrckground.
In its tun the Child Protction
Courcil imrcstiTds the situ
dbn and issls a SocialIn
quiry Reponto the jurcnile
court judge. The rcport can
take the brm of a te@mmerr
datirn b tnndle ttn case by
civil prcceedirBsand b order
a rrcur€ of child prcbctbn.
14and 17years.
3. The averagelengthof stay
at a sirgle reidential facilityb
12to 15 rnontts.
4. The rnaprnyof yourgsters
in residentialcarehaveexperierped at lest orn prcvior.rs
plrennnt
5. Br€akdovvnsin fostercare
reunt br an irrcreasirg
numberof admissiorsto resid€nthlcarc.
6. lt/lorctfEn O% of children
in rcsidentialcarehavernanifsdy seriousbehaniourproblernsand havemultipledisadvantagedfamily backgrounds.
A can 'pec*age'
In recert yeamthe provbbn
of altenntivesto r€sidential
cane,srrchas independentliving undersupervbbn,phcernentat horne,or day carc
centr€s,hs incresed.
At presentgreaterattentionb
givento the prcoessof admission to rcsidentialcare.Thb
has irduded the introdrction
of irtake teans, intakerneetirBs, and preparatoryintervievrcwith papnts and
childten(lGprth,1S7, \bn
denBeqh, 1S1).
Slowlywe are anivirg at an irr
tegratedserubewhereambulatory day care and
reidential care irstitutbrs
are irtegrated.Atthat point
w€ can talk about multi-furp.
tiorEl irstihrtbrs.
Thereis abo a growirg tecognitbn tfnt rckjertialcarc can
only be efbctive when it b
paft of a padrageaimedat
Numberu
Bdreen 1978and 1987there
helpirBthe family6 a whole,
was a edtrtion of 47Tcin the
and where parcntsale irr
overallcapac*tyof msidential
vohpd in all spects of the
irstih.ltiors.In the Nldherlands car€ Prooess.
todaytherearc aboutten
Firally therels a corsiderable
thocand young peoplein
conoErnaboLtthe needto
providedter carebr cl'rildren
resldentialcare bsuse of
psychosocial problens. The
and theirfamilies(Smit 19S),
rnaloritylive in privatelnstitu
tiors which are apprcvedand
Tho terk.nd tuncllon ol
subskJbedby tfn gov€rn
nddontlal calr wotlren
"Cf*ldrenin rcsidertialcarc
rnert A small nrnber of
yourBstes ate remrtofave severcpsychesochl
prcbbns; a spcific ap
dated in state irdildions.
proach b rnessary to rneet
Th6€ arc regardeds a
'sdety rnt' br the rnct diffr
tfs€ poblerns and to create
cr.rltor dbturbed yourBsters.
rel possibilitiesbr develop
Sornechamderbtics of ow
rnerl and grcwth.lt rcguircsa
residentialcfriH carc serui:s:
reidential socialnorfier who
1. ln our psidentialirstitu
can act with expertbeand re
tbrc the distributionmrdlledbn, and s'ho tEs hb
irg to sex b @% boys and
heartin the rpm plae. Thb
girls.
4O96
mgil qede a kindof a paradox the soclalrvor*erb
2. The largestcategoryof
yourg peoplein residential
facedwithtte tck of develop
and*.
care (60%)b aged between
irg a wellthonght-out
counbcl-'fortreatment plan;
but in its executbn he should,
a mrch as pcsible, break
'planrnd' way of
through the
workirg with the children and
be as fhxible as possible.
(l{omp & Van Oeffelt, 1978).
Fbweve[ in recent years the
idea has gained ground that
tfese two approacfns arc rpt
opposed to each other: phrF
nirg and goal-oriented aclion
do not exclude creating a
home environrnentthat b as
natural a possible. Jt/lcrcover,
it b true that plannirg and
goal orientation are rnoessary
bsr.resin order to justity the
social Yvorker'sinterventiors
aftenrards (ct Bryeq 1988;
Krprth & Smit, 1990).' (p.
9/10, Klomp & lfnrth, 1W).
The heart of residentialwork,
of helpirp people by sharirg
their daily lives, lies always in
a unirqueencounter between
human beings. The central
task of the residential care
worker is the personalcare
forthe children and the daily
contact with the children. That
care is realisedin a group of
children.
For the group, a livirg situ
ation is corstituted. Hence,
the residentialsocial worker b
tfre key-figurein the residen
tial care proc€ss.
Eleveloprnents
There have been several de
velopments in the context of
the residentialcare worker in
the t\,letherlands:
1. The number of residential
care workers in a group has
increased from two to 4,5 social workers per group;
2. The size of the group has
decreased from 3Oto (on average) 10 children per group;
3. The edtrcation of the residential care worker has grown
over the last 30 years. Formerly the residential care
worker was untrained; at present the residentialcare
worker is at the middle hvel
of professionaltraining and
some of them are at the high
levelof professionaltrainirg,
Summarising,we see in the
Netherlandsa morc and more
professionalised residential
care worker with a limited
number of children in the
group.
But in this context, let me not
keep from you two recent empirical resultrs(Van der Ploeg,
1s2):
careworkFirst,theresidential
fulanwq'tg
Vol.l1 No.10 Odober 1998 Page 10
ers are spnificantly dysfurrtional when the residential irr
stittrtion has a strong
authoritarian org anisational
strlrclure;
Second, when the children in
the group perceive the group
climate 6 rpgative, the residential care worker furrctiors
very irnffectively.
Why supervlalon?
To arswerthb question, I can
list rnany theories, especially
tfeories of organbational de
veloprnent. But br np there
are three main reasons.
1. The work of a residentialso
cialworker is mostty intuitive.
The disadvantage of acting intuitively b tfiat it b not easy to
explainyour workirg methods
to other persors. Also, if the
workirg method fails, it is very
difficultto analysethe situ
ation and to find othersolu
tiors.
2. Empiricalresearchpoints
out that too littlesupport
within a team leads to dysfunctionirg of the team. The
furntionirg of the team is pcF
tively inlluencedwhen there is
a social network of colleagues
on whom one can build.
3. The problematic behaviour
of the child is an importantfactor. In a large-scale study (Van
der Ploeg & Schotte, 1988)a
comparisonw€tsmade between the characteristics of a
representativegroup of con
temporary inmatesof Dutch
child care homes for mirprs
with psychosocialproblens,
and the cfnracteristics of residents of similar homes ten
years earlier (Vander Ploeg,
1979).One migfrt summarise
the findings by sayirg that in
recent years young people in
children's homes have be
come more problematic,notiably in relationto more
pro blematic family situatiors,
rnore problematic relatiors
with significantothers, and
longer and more traumatic
case-histories.This is not exclusivelya Dutch trend. Nevertheless, in spite of this,
residential care is corstantly
threatenedby financialcutbacks, sometimes clouded in
masked terrns such as 'substitution', that is, replacirg expersive, intrusiveresidential
care with less expersive and
less intrusivealternatives.At
the same time, the need is felt
for a more systematic ap
proach to residential treat-
rnent (lGprth & Smit 19S)
and there b at the sarne tirne
great pressure both to irnprove the qulity of rvork and
to demorctrate its effective
ness.
In corrclusion we can say that
residential group care for children with psycfnsocial prob
lerns b a field under stress.
Socialworkers have to deliver
a quallty producl, whereas
they arc forced to do their
lobs with ever-decreasirg finarpial rneans. (Van der
Ploeg&Smit, 1S2).
Modelg of superulelon
Workirg with children in a residential irstitr.ttionrequires
morc than irsiTht into tfe
problens of a child. The goab
of the self-educatbn of the
residentialsocial worker can
be classified in:
1. Theorybuildirg, with respect to the problens of children;
2. Skillstrainirp, in child care
methods:
3. Personalgrowthand personal education of the residerr
tial worker beirg an important
resourae and influerpe in contacts with children. (cf. Kok,
1973;Klomp,1$4).
Supervisionhas to be linked,
in my opinion, to these three
goals.
From this we distinguishthree
roles or models of supervbion:
1. The expert model or role ;
2. The problem-solverrnodel ;
3. The coursellor model.
I shall describe these roles
briefry.
The erpert rcle
With regard to content, thb b
an advisory model. The supervisor shows wl'nt should be
done. "Here speaks the expelt".
Methods r.rsedby the supervisor are:
lnstructing the team. The su
pervisorsays: You should do
it in this manner.
Convirrcingtlp team. The su
peruisorsays: lt is better to do
it this way.
Adrrisingthe tam. The supervisor says: In your phce I
should do it like this.
&rggesting ideas and alterrntives. You could do it this way,
but it is also possible to do it
anotherway...
The problem eolver rcle
The task of the supervisor in
this model is to promote the
Tlu luart of
rcsidcntiolworh of
lulping peoplcby
sharhg tluir daily
lives,lies alwaysin a
unw encounter
bctweenhwnan
behtgs.Tlw central
task of the rcsidentiol
care worloerii tlu
personalcorefor tlw
children urd tlu
doily contactwith t re
children. Tlrat care
is realisedin a goup
of chilben.
-
probssionalism of the residen
tial socialworker. So the su
pervisor fras to develop in the
team a self critical attitude.
How do you tackle a prob
lem? You reed a'birds eye'
vbw - a higher perspective
on tfe problem.
Methods used by the supervisor are:
$rdegic thinking around the
problem: diagncis; planning
(the strategy); treatnent;
evaluation
Functional analysis of pr&lem
atic situatioruf; a means of strategic thinkirg. What b the
problem; what b trp history of
the problem; in which situation; under what circumstances; - how can it be
tackled?
Realttytes0rp; often it b rpt
clear what the real aclivity or
practice method of a residen
tial vrorker is. The workes
have poorly defired impressbrs of each others'furrction
ing whicll can lead to
mbunderstandi rgs. Fler€,
tfese impressiors have to be
verified.
The counrllor rcle
The residential child care
worker must rvork on hb own,
supported by tfp team and
the superubor. Supervision at
this st4e can be individual or
individual-withintheteam. A
certain kind of self-rellection b
the bcus - upon yourself as
a peFon.
Metfpds r.rsedby the supervisor are:
lnterprcting
Cutfrofting
Refleding
Lbtening
Thes€rnodebor rolesof su
peruisionoftenrcprcduceor
followthe development
stagesof a team.Theyare cyclics+ages.
As an ilh.rstntbn,I
shallgothroughthe s@es of
the developmentof a team,
andthe divbbn of supervisbn intoerch of ttese stages:
1. The ognltlvr tage
At this sbge tl'e team seelcs
its own sfucture. Oftenthere
b
- littlecohesionof the team;
- irsufficientand ursatbfac.
torycommunintion;
- m clearruls for adirg
withthe children.
Theteamb lookingforcognitivesafety.Herethe supervisor hasto be an upert.
2. The affec{lw and rclatlonal dage
At this stagethe team develops an interpersonal
solidarity.Teannrorkrequiresrnt
onlytunirg intothe goab of
the irstitr.rtion,
but abo irnprovernentin functbnirp together.
Theintenadbnbetwen the
groupmembes b th€ rnainfocr.s.Atthb stagecorflicts betweengrcup rnembeeare
tsml-andaconflictbof
positivevalupin thb sfi€e.
BrJtthe gloup canlpt rcrnain
in thb orfiict - tfny must
rno\reon b work on their
t6ks. I'brc the zuperulsorb
ttc prdemsolyer
3. The perconal,aulononlou. Cagc
At this shge the cornmunication tas cfEngd. Thegrcup
clirnab b rpt domirded by
deferrcernctnr*sns. There
b a reognifnn of own iden
tity in rspect of erch of the
teamrnembers.Thereb an
reptarrce of erch other.
Herethe supervisorb the
counsellor
Conduslon
Thegoab of supervbion,and
the roleof the supervisoican
charge in tirneand frequency.
Gercnallytheyare dependent
on the goalsof the residertial
irstitution,the stageof the devebprnerilof the bam, the
levelof probssionalfurptionirg of the team,and the n*
tureand diagrnsb of the
problenstheyare norkirg on.
-dfrlclcnttg
Vol.11 No.10 Odobcr 1993 Page 11
Jonelhrn Pego is a medial
studentat UCT. ln ttpir Human
Eblqy @urse, frrst-yearstudenb lpve thc un,queopprunrtyto resclardra q*ifrc
comnttnity, and /r,terto prticipatein a'handgon'cr. simukrtim during wfik*, they learn
sontethingaboutpaple in difriculty and ttn organiations
whidr etve them. The enptnsrei, on 'patienb* paple'
aN of furcfnmlity in families
and cotnrntnities - as agahst
patlnlogy.
H--
LUre
the largest role to play arc tfe
family, in particulartfe parents.
Inthe handlirg of aDown'sSYrr
dprne cusre,the parerts arc the
sirgle rnct important element.
Withorlt their support, any form
of corstnrdive prqress b almct impcsibfe.
Otrt of thb came the realisatbn
of the need for edrcation frcr
dodors - edurcatbnwhbh will
enable them to help set the parents inthe rightdirection:tolink
them with organisatiors which
may be most helpful.
It was, howercr, rcalisedtl'nt tl'e
fpafth vrorkershould not simply
act as a refenalservice,washirg
his or herlnnds of the caseafter
the refenal. An interest should
be maintaired in the case, mt
onfy to provide nrotivatbn for
the parents, but also because it
willsenreas a learnirg cunrefor
future cases.
We also discovered that the
services provided for people
with Down's syndrornewerc not
adeqtnte. And from this carne
an understandirg of the difficulties imotred in the practice of
medbine in a third world e@rF
orny, where priorities harc to be
decided accordirg to economb
pararneters,and rpt reessarily
accordirg to the reed of patients.
Often it b tfie mentalhealthservices which have suffered,sirpe
government aid is not easily
forthcomirg.
But as rnentioned before, it b
not the doctors, social norkers
and state or private organisatiors who are of rnost importarpe; it b the parents.
The parerG are the primary link
with the patient; they represert
aficrcewhich,when put into ntotion, can accomplishrearly anythirg.
The reeon frcrthb is that they,
out of everyone else in this
world, really care about the patient. The bond between parert
and child is ore of the basic
necessitiesof life,withorltwhich
rnthirg can be accomplished.
The most important lesson tfnt
we feel we leamt durirg this proiect is about the rolewe will fnve
to play as ftlture health care
workers.
Our rolewill be limitedby a rulmber of thirgs: econombs, time,
lack of facilities - and the fact
that we will not always be able
to cure a patient.
We fnve to rept
tfat sorne
thirgs are rpt curable, bU that
thirgscan be'made better'.Our
or
healing
Upon enbrirg tE fpafth serubes field,I S$nkffi aeryorc b
touchedwith tE Lrtopianbelief
that withpur rnedioaltrainirg,
you will fn\re the abilityto cure
- anybodyard anythirg. And
whd ou grouplearntdurirBthis
tine b tH thb b afallacy.
Ou grorp had the opportunity
to study Down's syndrome,
ttme whosrfrerfnomthe disorder and tfpse whc work with
them.
Doiln'ssyndronreb sonnthirg
whbh canmt be cured r.rsirg
arryform of rnodernnedicirc.
The only thing that can be
cfnrped b the dtitrrde of the
peoplesuromdirg the person
concerned,thereby ersurirg
the integrationof that person
intosociety.
Unftrrtunately,
wfntwe as heath
servbeprofessionals
can do, is
so limited.Thepeoplewfphave
role may be, rather, to prepare
and support the the people surroundirg patiert, and to help
thm with tfis reSarrce.
\Ah leaned thatthe people surroundirg the patieril back home
are more important than any
brm of npdical servi<-s wl'rich
vre had to offer.
Puttirg thd into simple terms,
we learned that our scientific
trainirg is limited, and thd we
should accept this. We must
statt from there,especiallyin the
rnanagemertof a personsuffering from Down's Syndrome,
which is not curable in any way.
The only thirg tfat is curable is
the often negativeattitude of the
people comirg into contactwith
that person.
llllilflllflilllll
lfll lilflflfilt iltr
trll ll[milsr
l
l
l
t
t
a
r
t
1111iiirr
rr !
,, ,
L
l
,
r
a
U
0r,
Mongolism(or Down's Syndrome) is one of the few conditions for which there is a
loown c.luse for a specifiable syndrome. The chromosomes of a male mongoloid
child are shown in the illustration. The presence of an extra chromosome on the
twenty-first pair is the causalive factor in most cases of
this abnormality. Sometimes
the trisomy o@urs on the
twenty-secord pair. The
twenty-third pair is the normal male sex chromosomes.
Facially, mongoloid cfrildren
characteristicallyhave small
skulls, slantingeyes with a
vestigialthird eyelid at the inner comer, small ears, and a
llat nose and face.
Many mongoloidchildren
show an atfectionateand
passive disposition.
Thei r intellectualdevelopment generallyreachesan
lQ level ol30 to 50, which is
oonsidered moderate retardation.
Their tendency to develop
physical disorders, induding
cardiac problems, makes
their life span limited.
strcl'rconditiors.Yet,sorne
rewt or reclusivecrayfshwas
alwaysthere,apparcntlysatbfredand healtiry.
LastYveekwe rad about bats
froma bookon rnamrnab.
Theadhor spelcs bnderly of
the creaturs, makirg it diffF
cult to believetfpse are the
same rnamrnalstH have
populded honorslpws br
gernratbrs. $definbhedthe
cha$er and Yventoutside,
wherewe beane arpther
shdow amorg the fir and
hemlockirnagesthat cut the
clearsky irilo pleces.
\ fe wetchedte familiardivs
of our rcsidert batswith new
vbion.
,
n t sornepoirt, rnct terct>
Aers borne studenB learrr
ing fiom tfse puprlsthey are
hiredto irstnrci. I sr^spectit is
similarbr a parert wten he
orshe begirsto let a childbe
tle leader.
Peoplehaveencouragedme
to s(;n Hallieup for gymrnstics."She'sso agile,"tltey
say. Becauseshe seens to
dare to sorneinrer music,
frbnds havesuggestedpiarn
lessors.
Tothe offer of bnnal irstnr*
tbn she s!8, "Ilo tlanlcs,
i/lom,"and prceeds to bwy
her handsin the garden,lookirg forearthwonrsand soF
dier beeths.
I'm iru'sirgly drawninto
nrydaughte/s*orld d dirt
and irsects.I'm irtrQued by
the spiderufio pEtiendyand
pesbtently buildsher web. lf
it sfpu{d be bm or destroyed,
she begirsagain.lwatchthe
ants labow over crunbs of
food,oftenlargerthantfeir
own bodies.Tfny rnoveaF
npst imperefliHy bruard. I
reist assigrt'rBlurnan emotbrs b tlem, hl I am errcouraged by their tenrcity. I use it
as a rnodel.
$.Nf
Followm g a
Child'sLead
I
t\ /lY daqghter, Hallie, has alI V lways prebned rpntraditional bed-time stories. At bur
yeas old, she would veerto
the left of the low shelves that
held children's books and aim
forthe pile of rnagazineson
the round table where we ate
and paid bills.
Four out of five tirnes, she
woufd slide the latest National
Geographic from the pile and
slap it agairst her thigh as
she leaded fortfe only comfortable pia:e of furniture we
owrpd, 'qtheblLe chair". We
uiould sqLeeze in together
while my son, Dylan, lourged
lankily acrGs one of the urr
furrlerJ|g
Vol.l1No.10Octobcr1998Pago12
cornfortable pia-s of fumitute, "the old brown sofa". As
I read aloud about historic villages situated rprth of ns, I
was sure every third word was
perplexirg to the children.
Sometimes,I would stop and
explain a phrase.
So it was that my daughter be
gan to use words like "interpret," and "alchaeology". "lt's
a perceptbn," she said, 'qthat
you don't like to @ok." "lt's
my pereption, too," lsaid.
Flalliehas taken ourfamily
alorg with herthrough habitats so old and damp that we
scarcely odd believe arrythirg would be able to live in
I ast weekend,we hikedour
Lfavor.nitetnailona cape in
the Facific.l\tlydaWhterwas
in the lead.Shespotteda
smallpotatobng. Llsmlly,she
wouldbendto examinethe
markings.Thepotatobtrgson
thb trail havea differentpattem fromthosein ow garden.
Butthb dayshe fad already
examiredseveral.Sheonly
pausedto bok bad( to Dylan
and rne."Bt€," shesaidand
pointedwith srch authorityto
a certainspot in the dirt,that it
oAtsorme
pnl
nost teaclpn
becomestudenB
lcarningfum
tlnse Wpilj t tsl
are hirvd to
ins/lrtrct.
I swpectit is
simibfor a
Pqrvrt wlpn rre
or stu bgfis n
lct a chiWh tlv
Ieoder.'
I
rrould haveblt lil<eintent-bldllb sbp on thatarea
Beinga family b aboutsr.rp
port and irrtructbn; it also
s€ers to be abod kJentifyitB
@mmongound and leamirB
to apprrciate difbrerps about krwirg whento terch
and ufien b get out of the
way of learning- wfpn b
give up the fiont b someore
with a rpw way of seeirg.
A friend calls parcrtrng a
"humUirB" probsbn. I
rrould add to thd decriptbn
"edLndional." Flertly on a
guidedrntne wdK ttp
ldr
bld r.sthd slr.rgstave
a rntural aethetic qulrty.
Halli€and I olbn lnt€ de
batedthe teHiw valm of
slugs- r.suallydteraslug attrck on rnyvcgebbl€s. StF
tends to win the bdles and
cani€s the ofbndirg shtgs
bad( b the uumdswfpte, she
says , they willstay."My rnom
vrodd liketo killthem,"she
telb the leederand all the gen
th peopleutrp have@mpanied c on thb walk.
"HunblirB?" ltlct ertainly.
"Educatiornl?"Wittpttt a
doirbt.
Mdlse lldcndd writirg in
TheClvbttarnScbncp Hloritor-
r994
The Unitcd Nations
Interrnctional bcr
of thc knily
In thb, the secondof tvroexbactsreprintedwith permissbnfromthe Jounal of Ernotionaland
Elehavioural
Pnoblens,Proloror Jlormrn Alcrl asks:Howslpuld cHldfpod or adolescent depressionbe tteated?ls therea curc?WfEt is the rnosteffectivetreatrnent?b tlere a
rnostefbdive tr€atrnen?For bothstudentsand prrtitbrets, a helpfuldiscussbnon tpatrnent:
rnedbationsin conjunction
with'tlbmilytherapy."\if€ ha\re
found individual"psychottcrapy" to be insffectiveif tte
child b unableto corpenfide
or bels extrcrnelyself-ab
sorbed,g uilty,or asharned.
Thce studiesthat have
lookedat thb quetbn in
adultstanrcshownthat reither medkntionsnor "psyche
therapy"arc superior.The
best rspons€ appeas to re
sultfrcm a ombinatbn of
treatnent interuentbrs.While
thb fns rpt been prcvenwith
childrcnand adolescents,it b
usefulto beginwiththe as"
sumptionthat a muftimodal
approrchwill be mostefiective.
floptf*thelltlp^
Cbildw,
ofDeptassed
fr?rd'4dnlescents
Unfortunately
therearc rp
studiesthat dealwithtle "to'
tal" treatrnentof deprssed
children and adolescents.
Thereare drugstudies,and
tfpre are anecdotalreportsof
effectivepsychotherapeuticin
terventiorsfor both individtr
als and families.Br.rtthereare
nc studiestlnt clearlydemon
stratethe efficacyof ore ther+
peuticrnodalityoverarptler
for childrenand adolescents
withdeprcssi\redbordes. Further thereare rp studiesthat
haveevenattemptedto look
at a multimodalapproach.
Wfry?
Thereare a lot of reasons.
Oneof the forernostb tradition.Untilrecently,
childand
adolescentpsychia$ and frcr
tfnt rnatterpsychiatryin gen
eral,hasmt reliedon "studies"as a way to determirethe
efikxy of its inbrventions.tt
b only the adrcnt of psycfro
phannacologytfnt h6
charged theseexpectatbrs,
and mw "studies"arc sen
as tte way to approrch and
assesstherapedb irierrren
tiors.
Otherreasonsirpludethe
lowerfreqwrry of mapr de
pressivedbordersin children
andadolesents, as corF
paredto adults;tle hk of
funds;the hd( of personrelto
carryout sr,tchstudies;and
the bk of coherenttreatment
modebfor childrenand adolcents.
All of th€s€f*:tors elicitvarious esporxres;brJtthe rnost
destructir/€r€sporse b "therapeutb nihilism"- or aban
LlrleJ;E
Vol.l1 No.10 Oclobcr 1998 Pagc 13
dort'ngfaith in orrc'stherapeu
tic eilfectiverpss.OrE's effectivenes dependsa greatdeal
on om's dtitudes, beliets,
and the sustairedabilityto
car€. One canmt treat de
pressedchildrenor adolescents,or for tlat rnater
adults,withorJtbeirg dfucted
adverselyby their depression.
Thesearc mt dborders of
cognitbn or behavioucbut of
ernotbral sbts. Tteir dbturbare b ore that canmt alwaysbe undestoodfullyon
an intelleciuallevel.Corse
qrcnt[, to treatdepression
rneansthat one will be affected.
Pdndples of treatment
Despitethb "lackof infonnation",tfere are gernral principlesthat can be followedin
rnanagirBtlnse chiHrenan
dadolescents.THeseprirrcF
plesare mt to be thongtrtof
as specifictherapeuticinterverilions,but nather6 gen.
eralguidelineb obsenrc
durirB the oouse of beatrnent,regardlessof tln specif'rctherapedicnndality
chosen.
hinciple #I: Attend to
cmcrtcltcics
frrst
Obvidr.rsly,tfE-re are a broad
rarge of drcunstarps that
require imrnediate interu€ntbn. Clirticians rspond rnore
freqmntly in ttee circurn
stanoes when erpurtered in
acbfcoents, br.l th€e circumstarpes ale either urrpticed
or Srnred in yourper chil-
dren.Thernostfreqrcntly(7rpred symptomin ctildren b
the exprssion of se\rer€aggressiones a manilestation
of
depresioft. too often,this is
mblabelledas a ondtd disorderor,if the childb
yourger,an oppcitional defiant dborder.
Arrychild or adoleent with a
chonic aggrcsive disturbare ctarderized by ursb
ble rnod,'\bmper tantrums,"
or oveft impublverygrcssion
shor.ddbe evdtrbd br a
nrooddisorder.The identification of a deprssive dborder
in thb groupould haveerprmousimpacton trcatrnent
and, if the patientb tnspitalized,oouldshortenthe tnspitalizationsubstantially .
Suidde ideationand thmats
are tulativelycommonin adolesents. lt b too easyto dbmisstfese 6 "ps€udocide"
if
or mt ral, sp*id[
chpnic or in an adolescent
with severcdurrbr paftology.A dinicianmustdend
seriocly to any suicktalideation or thrcat a patiert rnay
he\rs,ufiether in a cfiild or
adoleert, and whetherit
lns beenverbalizedbeforc.
hinciplc #2: Don't msrnncthat n inglc trcnt%ontmcthodvill safwc
CItenow patiertsorp-to
the dinic tavirg hadeithera
prclorgedcouse of "psychothorapy",or havirBbeenon
severalrnedkntions- or
both.Ourclinicrnostoftenwill
begina therapeutbtrialof
bi"tqh #3. ht't msu.mcthat n inglc thernp cutie inten cntion rill
not saffi[c.
Therei-le circunstarpes
whereonly orc therapeutic
modalrtyb rncessary.Sometirn6 thb b the useof a medicationalone,withverylittle
parental,hmily,or individual
rvork.A childor adolesent
rnayrcturnnrcnthlyfor rnedicationcheck-ups,with little
moreneeded.Thisabo can
apply to a psychotherapeutic
interventionbeiry indicated
and suflicient.
Currently,a sirguhr vesus
multirnodalapprorch b most
oftendeterminedby the comfort and experienceof the clinician, lrct any r€searchdata.
Pri"tqh #4. Rcngnizc
frrrduEc onantcflrnnsfYrctrcc.
Counterfiarsblerpe is the
belirg stateelicitedwithinthe
therapistin rcsporse to a p*
tient Ernotbrnl disordes are
contagbus,and thce diniciars who say thattheyare
rnt rcspondirg to ttnse p*
tients are either mt rehtirg to
them or ar€ derryirgtheirown
feelirgs of ountertrarsferelpe.
Thereare a numberof re
sponsesthatcliniciarsrnay
havein reponse to ountertnnsferene. The rnostprcvalent b to dbtane orpself
from the pdbnt Cliniciars
may see certainpatientsless
fiequentlyin an attemptto
guardagairsttheirownfeelirBs of irndequcy or other
narcissisticstates, or the
amount of time clinicians
spend with these patients
may bec-omenegligible,perfnps restrictedto jtst the administrationof a medication
withor.rtany attempt to deal
personaltywith the patient.
The clinbians may even label
the patient as 'resistant to
help', personalitydbordered;
or condrrctdisordered- any
labelto rationalizethe need
for distance and to maintain
self-protective boundaries.
RecognizirE the @untertransferencewill help tfe clinician
to understand the full impact
of the depressive dborder on
the child or adolescentand
the world around them. lf the
child's feeling states create a
serse of hopelessrrcssor
numbnesswithin the clinician,
assurnethat the same will
fnppen to others with whom
the child @rnes into contact.
It will help to dlscrss this with
family and, if possible,the
yor.rth,to gain a sense of the
illness and its impact. Furthef
recognizing the countertrarsference may help the clinician
to have a sustained empathy
with the child, thereby providing an avenue of relatedness
that may not be avaihble otherwise.
Principle#5: Itunt'ifypnrontalfuprestvediswdcn
and.seeh
trontmcnt.
When a cfiild or adolecent b
seen forthe assessment, assurne until prcven otherwbe
that ore of the parents b or
has been depressed, as well.
Nunprous studies have demorstrated that the frequency
of depression amorg the offsprirg of depressed mothers
is quite high. Further the age
of orset br the child or adolescent b dependent on the
age atwhich their parcnt had
the orset of their depression.
Ask the parents about the age
at which they began becomirq depressed. A lot of parents have never been asked
tfpse questiors, and there
fore have rpver thotrgftt about
them. lt is helptulto explain
why you are talking with them
about their depression.lf a
parent had an early orset durirg their own childhood or
adoleserpe, the nature of
the child's depressionm(;ht
be better understood. And,
the potential of it becomirg a
fusterlJtg
Vol.11No.10 Oclobcr 1993 Page 14
lifelong illnessmight be mirrorgd in the parcnt's own expenenoe.
Parentscan be rebned for a
clinical evaluation and assessment. This can be done within
your own clinic or in a clinic
or.rtsideof your care. Depending on your own expertise
and comfort, you could do the
evaluation yourself. The advantage of evaluatirg and
treatirg a parent's depreasion
in your own clinic b that you
have direct experience of the
depression and you can ob
serve the interplay with the
child's depression.Thb also
helps in integration of care in
the family treatment.
Principh #6: Mafu certnin thnt you knowthe
f*ily hbry f* thcpresenceof deprasionnnd its
,nflltyftnns ondfw succes{al t hcrapeutic int ereentilms.
Oftenthee b an extersirrehbtory lor depressionin these
families.Thercrnayhave
beensuicideattemptsorsrrccessfulsuicides.Therealso
may be hbtoriesof alcoholbm, socbpatlry,and low-level
depressbrsexpressed
through aggressbn,initabilig,
etc. lt is impoftantto get a full
historyof whatthe literaturere
fersto 6 "depresive spectrum disorders."Th6€
disordes, identifiedby
Geoqe Wirpkur at the Universrtyof lowa, havebeen dernorstratedto be higtrerin
familieswith deprcssircdbordes. ln familieswith tfese
kindsof dbturbanoes,it b extrennly importantto understandif therapeutic
interuentiorshad been
sor.rgl'rt.
Often,medicatiorsworkirg
with onefamilyrnembercan
predid that rnedicatbn'susefulressin a rchtedchildor
adolescent.
Thb h6 beendernorstrated
withthe useof lithiumcarborr
ate in familieswith rnanbdepressiveillresses;and we
havefoundthb to be tne in
familieswith hbtoriesof depressionwhee rnt only fps a
child beentreated,br.ila
rnother,a siblirg, an urrcle,or
a cousinof the primarypatient has receivedtreatrnent
as well.
Principle.#7. Don't assnmcthat you con cure
the child w adolescent.
There is a significant differerr between healirg and
curirg. Fbalirg b the attempt
to help redurcethe severi$ of
symptomatobgy and assist a
peson to corne to grips with
their illrss.
[ny purpce as a clinbian is to
healthese children,their parents, and families. I do rpt
hold out the idea that a cure
will be forthcomirg. By rpt
havirg a curc 6 rny goal, I
am muph morc realistic in my
expectatiors; and ultirnately,
this leduces the likelil'pod of
my being overly frrctrated.
Posing thb as a lifelorg prob
lem, wherc there will be implications throughout an
individual'slife in marrydevelopnnntalstage, has made it
mrrh easier for rne to lelp
parentsand children dealwith
thb illress. Ultirnately,it has
also helped them.
nciplc#8: Not woryoru rill behched.
communicationor interpersonal skills that will be lost for
life. Treatment may irvolve
helpirg tfpse people only to
develop adeq uate copirg
skills and an understardirg of
tfrese limitatiors.
Principle.#9. Theprurposeof trcntrncnt iEto
helpthepaticnt, not
frrwe fr bunt.
1 ."y thbtecatrse,unfortu
nate|, therehavebeenlires
drawnbetweenpeoplewith
difierentprcfessionalorientatiors. Thereare the psycho
pharmacologists.Thee are
There
the psychotherapbts.
are the familytherapists.In
the midstof all of thb, therc b
a patientwhohasneedsthat
alwaysshouldbe regardedas
primary.Fatientsshouldrpt
be labelledor madeto feel
the bruntof their illress becausethey aresick and do
rnt rcspondto a particuhr
treatnrent.Thb would be like
labellirgsorneornwith cancer and sayingif ore particu
lar therapeuticintervention
did rpt work,we nould let
them die. lt is that levelof se
veditythat I am speakirgto.
Thereare a numiberof childrenand adolesents who
will rpt be helpedif treated.In
the adultliterature,thereb a
phemrnernn referrcdto as re- hinciple #10: Nwer
fractorydepressivedisorders,
nive ap hnpc.
meanirg depressivedisorders -lnese
ire &tienc who are exwhbtr do rpt respondto medi- trennly difficult
to treat. In a&
cations,psychotherapy,or
dition b keepirg an open
any tnrapetlic interuentbrs.
mind regardirg the multittde
Todde, there hs beenonly
of therapedic inbnrentbns,
ore peperwriten abotlt thb
you harteb maintain a sense
topic s it appliesto cftildrcn
of hopefulress. Among these
and adolecents. Thb paper
patients, dher careg ivers,
highlithtsthe therapeuticreand family rtembets, it b easy
spors€ of cfrildrento a fairly
to get swept away in a serse
broadnumberofphannaof lnpehssrss. \,tJemust
cologknl irtertentbrs. lt abo
maintain a sense of hope if
clearfystatesthat we do rpt
we at all want to help these in
knowat thb tirne how marry
dividtnb.
childrenwill or will not re
Tfrere is a way of rbirg above
spord to mdtirnodalrtytheratherapeutb nihilbm in treating
pie, or liorthat matter,e\ren
tfps€ patbnts.
extensivepfEnnmlog ical ir
To do so, Yr€must kep open
tenrentbrs.
minds. We stpuld bok to
Whena penionerters intoa
other professbrals who might
trcatrnentwith ore of these
be able to help us. Vileshould
childrcnandtheirfamilies,par- rpt orne b rapid corrclu
erts mustbe told that even
siors abod th6e individuals,
tlnugh we krpw tte rsture of
or about the fde d tfpse cl'tilthe problem,Yvernaymt be
dren or adolescerts and their
ableto helpthe child rcmedifamilies.
ateallof t*s or herprobbns.
It is only with fnpe and operr
Elementsof the deprssion
ress to a broad rarBe of
may r€spondb rnedirdion,
therapeuilb irterventbrs that
and otherf@ts rnay espond
tfse individuab can be
to parertalandfamilyirterven- helped.
tbnsJbr.rttherestill rnaybe
lr/breon depressbn:ll TtlorcNrrmn (1*11-18f) dtfn WalkerF*cnprer Elcton, uSA,was
an authorof the book TheOtlier23 Hanrc,ore of the bet-krpwn E)ttsbr child carcvrorkers.
Hb greatcontributionwasto harslatette daily lMrB erwitonnpntsof cfilldteninb ponerful
treatrnentconbxts - albwirg child careworkes b corlribub ntaterial} to dinical goab. Sorne
excerptsfrom hb writirgs ilh-sfamhis gift br combinirgsimplicitywiththerapeutbplevarpe ...
IlelpingChildtryrtoM
theirW
Children who fnte often are
childrenwho fpve sufbrcd so
rnany losses that they are
"cried out," umflillirg or un
able to dealwith arry more
sadress. The child's sadness
and sense of loss are easily
overlooked in our eagennss
"
to "get thirgs under @ntrol.
We are irplimd to help tfem
dealwith ange[ when perfnps we slpuld focr.s on de
velopingtheir competene to
dealwith loss.
t
t
*
ln ourwork with hyperaggr€ssive children at tfr6 Wal[e]
Scfrcol, we have been brced
to think about ways vre could
relp childen learn to deal
with loss and sadress, while
we wer€ coping with their acting out behaviour.We find op
portunitiesfor teaching about
sadness in the circumstarrces
of daity living. Hopefully,our
rptiors help the adults who
encounterthe child in the 23
hours outside therapy to be
corstrrctive agents of charge
in the child's life,
t
t
t
Some events have the clear
rirp of loss - the hornesickress of rew arrivab, the dbcrar.ge of a child's dG€
+n€rrd,tfE deah of a pet the
leavrrg of a brprile statl rnerrF
ber - tfese obvbrsly s(7nificant events are rarely
overlooked. Bu tfpre are tfE
'small' losses tlat present
worthwhile opportunities to
help children develop lcsbearirg, irrludirg broken or
missirg toys, rn rnail, losirg a
game, difficulty in rnasterirg a
skill. Terchirg loss-bearirg c*
pacities at such times rnt only
helps extend the ernotiornl
competenceof children, but
also helps keep befnviour
withinreasonablelimits.
t
t
t
To encouragea child to ventilate his feelirBs of sadress directly b a usefulteachirg
device. Ore migfrt say to a
fulcrrleurl'g
Vol.11 No.10 Odober 1993 Pagc 15
child, "ore of the thirBs you
can do fitstwhen you're feeling sad like thb b to cry. lt's
all rigfrt The tears won't hst
forcver: you'll be able to
stop." Orc mpht stggest a
private plae to an older child
too embanassed to cry
openly in the company of
Peers'
* . *
An eqmlly useful device is to
help a child develop the capacrty to repress or suppress
sadress, to 'Torgetabout it."
There are times that frcrthe
berefit of helpirg a child re
pair his lib and proceed to
grow, crying must stop. lf the
child b to learn skills and participate in scholastic affairs,
the task of "puttirB the sadness in the back of his mind"
fras to * n,r."l,o.the child.
The larguage of feelings can
be used to teach and remind
children of possible ways of
behavirg when "sad." One
can teach a child tfnt when
he names feelings and can
talk about them, he can know
them himsetfand then tell otlr
ers how he feels. To enlnnce
the awareness of feelirps, the
technQues of role-playirg, improvisatbn, and acting can be
used.
i
*
t
Amther teachirg device is tfp
tse that staff make of their
own feelirgs. When we hel dbappointnent, experierrcelcs,
ard tten npddand slate thb
enptbrnl experierne with ctildr€n, otr example mry be imF
tated.
When we ourselves can ventilate, keep workirB, use a little
hurnour,the cl'rildrencan use
the opportunity to be observantpupil".*
* ,
When we exploit small segments of reality to teach about
dealirg with sadress, we
make use of innumerable op
portuniliesthat occur daily
sr.rcfrs the end of a plecant
gameor the loss of a favourfu
staff rnemberuntiltornonow.
At thesetime, it is abo possible b rce the tchnhtr of en
cour4irg partial
replmnnnts for loss6, sttcft
s reattachmentsto a nerv
friend,or e\rentrarsitorywitF
drawal.Ttp childwho does
mt krpw howto tse solitude
frasa trernendoustemptation
Countertransference
Whena clienttansbr8 onb a
therapbtsome of |he belings
or attitudesproperlybelonging
b anoffrer(usuallya problemrw callthb
atic)relationship,
transference'.CttiH carc rcrkers ofbn find themselrcshandling matedalwttichbelongsto
e.g.hat
anotherrelationship,
betrreenchiH and parents.
But,when the ther*ist frnds
limsell ructing emdanlly to
sorned fie cliert's mdedd q
'countqlrllnvidlr, we cdl tls
tansferqpe'. A thenpbt may
deny u nd see lfiese lbelirBs but mwt be mde awqe d
trpltrr.
Prcf. Aerl ofterl cllnblrnr
len queetlonr tlry mrY mnt
to erlr thomlehp. to ddcrrilne ll tlrey erc erperlenclng
r couileilrrnrleruncc lowerd
e depreered petlcnt
1. Do you bel uncombrtable
with the patientufien you are
with him or her?
2.ll yut bel urrcornbrtable,
wtretbelings do you havt? Angpr,depresskrn,gornaticbeF
ings?Arc you beling sloupd
down,findingh difficultb ooncenfde, etc.
3. Do yor bel beter dter the
pati€nt leaveeyour office?
Sornetin€stheccunbrhar*rerne tesporte, lf il b rrcre $mdb h natJre,willrptbe
identifiabledttp lirnc you te
wihth€pahnt, clrnrydne
cr extremetydoity.T}nrebre, it
to ward off or denysadness
by beingcorstantlyin the
thick of thirBs.Thb yourBsbr
mrghtrped to leamto de
\rebp the caprcttyb be alore
and ltnd thd tferc b a "@rr
starrcyof peopb" urhostill rc-
cepthim." y:T.
It is importantb notethat we
havenotfoctssed on pathologicaldepresion or distortiors of the rnoumirg
prooess.Indeed,thse occur
- and with frequerry arnorg
distulted cftildren- butrve
empfnsizethat leamirgto
rnasbr loss b a hurnanrpessity,mt iust a "cul€" to rnental illrpss.OurtechnQuns
helpadultsrnakean alliarrce
with tfat patt of the child
strugglirg agairst hb difficulti€s.Thb b an alllancebr
terchirB emotionalcompe
terpe.
b imporffi b nfr vfiat ycrt
hel aftr he pdient leate the
dca.
4. Doyou arc*l seeingthe pe
tient?Do yon minimia the lime
een direcilyudtt the palient
spendirq time pimad[ wih fte
parents?Do yott speakbref
with thc cfrild q addecent or
do yor.rleaw them in thc rr€iting
roorn,neveraeing them?
5. Are you thinkingabouttansferring thb patient becanse
'!ou can't help them wry
much"? lg thb a rcalisticaasessment or one motivabd by countertransilerence?
0. Do you haw a tendency,with
this patent, b b€lthat "lhey
arc notfyhg In tedment"?
Haveyot starbd labelingthb
"not fy{ng" as beirB charcbr
pahdogy, 8rylng thal they
haw "an and rebntiw peraonality" or thcy an "passirrcaggrEosiw" or "paosivo
dependent"?
7. Do you havebelings of inadeqr.racywhen you are witt
thc patlent?Do you bel ttat lt b
yourhultthdyou an unableto
rerch or bond ufft them?
8. Do you bda 8en8eof anger? Do you bcl |hat thb p+
tient deeervneto get
inadcquateteatnent or no
treatncnt becaueeof their "atlitude"?
9. Havoyou bund that you
rculd rdrersee otter palients
than this paticnt? Do you bel
therc is absolubly rrc eeneeof
gratificaliondedwd lrom thb
patient?Do yon went more
gratificaton lrom this palient
than they can realiglicallyprovUc?
e?4
Xzr
ffi€il
-t+ \-
H;.e
SOL @RDON OFFERS
PRO'ECTCHANCE
CHILDRENAND YOUTHAT
R I S KB E C A U sO
EF H I V A N D
A I D SN E E D I N 6C A R EA N D
EDUCATION
lf you have mt received the leaflet which otdires this vital
programme targettirg the reeds of an estimated 5OO000
AIDS orphars by the year 200O,please telephore any of
the MCCWs offices or write to Elcx2&P3, ltlalvem 4055.
They will need everyore's help.
you and contributeto your
feelirgoptimbticaboutyourself.lf your loveb imrnatureit
will exfnustyou, and gernrate belirgs of deprssion, arr
ger and jealolsy,
NACgW
Eleven
lasf-rninule
'suwival'
ideas
by tellirg
1. Rbk intirnacy,
peopleabotrtyourself.You
thus becornevulnerableto being abtsed and rejected- or
beirp embracedand rccepted.
2. lf you can't be sonnbody
you wantto be, at leastdon't
be sornebodyyou don'twant
to be.
3. lf you havea bnderry to
be setf-depmcdirB,don't tell
arryone.lt's reallyborirg b be
with arryornwho b down on
himfteself.
4. lf you haveadvioeto give,
don'texpectanyorn to bllow
it easily(or at all).Whenwas
the bt tirnesorneorptold
you "rnt to wolry" and you
stoppedworryirg?
5. lf you do sornethirgwrorg
you shorJdfeelguilty.lVlature
guiltb oqanbirg, but not
long-lastirg.Youwill eitter
makearnendsor you will rpt
do it again.
6. lf youfeelguiltyabout
somethirgthat doesn'tmake
serrie - like havirB'evil'
thougfrts- yourguiltwill dborganiseyou and be the er>
ergyfrcrrepeatingthe
unreptable thongfrts(ob
sessbrs) or behaviour(compubiors)overand overagain.
7. lf your lovefor arnther person b rnature,it will erergise
furreurltg
Vol.l1 No.10 Odobcr 1993 Pagc 16
8. lf you wantto charBea be
haviourof yours (frcrexample,
talkirg too mrch or rpt
ernugh)your initialefbrtsto
charge mustbe bred or me
chanical.\bu mtst rnd<eyourself do sornethirg.\bu are
tryirg to changea behavbur
which fns becomea fnbit in asense it has becornea
spontarnous,'natutal'te'
sponseof yoursto tersion.
UponforcirB an a[enstive response(e.9.rnt talkirg so
mrch) you will be 'rcwarded'
by ernrmousrushs of aruiety. lf you are able to tohrde
the'rnechanical'
behavbur
charges and the relatedbn
sion,you will be ableto
charBe to a rnoreaaeptable
'habit'.
proferslonals
Ing plecc! ,,.
Atitlf;aednunbrd senior
peqle ln tE profasslcnoan
sfllget lntoilln 10ef cilassto
sbrt thb presdgianstv*e,yeer
speciCbed diplan c'txr te.
Thecouse ircludesthree
sernestersof couseuvorkon
a dbtanoeterchirB and bletuitbn basb (Oqanisational
Managernert,Legbhtion
and Policy,StaffAdminbtr*
t'ron,StaffDevekrpnnfi FinarpialAdminbtratbn,Child
Educationand Teatrnent,
Programrneltiarngement)
and ore prdiel sernster
to trckle an adminbtrdiveor
probssbrd problemin the
sh.rdent'sown worksitudion.
Prospect^rsandAppliati ut
FormE nu uallailetrcm
your neerc,t I{A@W olftce.
The Dfpfomt
In Chlld Care
A.lnlnlrtretlon
- rN lt
(Number8 is hesruy
again.)
9. lf you are intolerantof
someoneelse'sbehavburlikea personwho boastsa lot
but is rnt hurtirg you - you
are rerc{irBto something
aboutyourse/fthat you don't
like.
10.The processof not doing
whatyou'resupposedb do is
muchmoretirirg than doirg
and gettirg the rnostboring
tasksoverwith.The ultirnate
creative'btsy-rcss'b when
you havetimeforalmost
everythirgyou wantto do.
11. Beirg criticisedby some
oneyou don'trespectshould
haveno impacton you. Lib b
too preciolrsforyou to be offendedby or reactto arrytoo,
orp's ridicule.Remember
rnt everythingyou say or they
say is important.
For the fint Ume in South Africa, you can Balo a unlverrlty trdn'
ing in Chlld and Youth
The UMSA
Caro. A twolear oourle Certificatein
theorutlcal subfrts by dis'
tance teaching and pracdce
labs for hands-on and expe'
riential learning. br lnbrmaflon end mglrtrrUon
brmc, wrlta b Thc Ctrtlfi.
cate in Child and Youth
C;att, Schml of Soclal Worlq I-JMSA PO. Bor 302, hetorla Ofi)l
child &
Youth
Care