Pain, Normality, and the Struggle for Congruence

Reinterpreting Residential Care for Children and Youth

James P Anglin

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780789021403
• eBook ISBN: 9781317787457
• Topic: Psychology
• Subtopic: Social Work
• Index: Psychology

Learn what children living in group homes need most!

Pain, Normality, and the Struggle for Congruence: Reinterpreting Residential Care for Children and Youth presents the results of a 14-month study of 10 staffed group homes in British Columbia. The book uses grounded theory to construct a theoretical model that speaks to the primary challenge care workers face each dayresponding to pain and pain-based behavior in residents. It combines participant observations, transcribed interviews, and document analysis to develop a core theme of congruence, several major psychosocial processes, and 11 interactional dynamics identified as being fundamental to group home life. The study brings to light several neglected aspects of residential care and proposes new directions in policy development, education, practice, and research to create an integrated and accessible framework for understanding group home life for youths.

Pain, Normality, and the Struggle for Congruence: Reinterpreting Residential Care for Children and Youth is a full and rigorous examination of the theoretical and empirical underpinnings of residential group care. The studyconducted during a time of heightened sensitivity to the rights of children and increased emphasis on accountability and outcome measurementreveals a core theme of congruence, focusing on consistency, reciprocity, and coherence. The book examines the major elements of this theme, including:

• creating an extra-familial living environment
• developing a sense of normality
• listening and responding with respect
• establishing a structure, routine, and expectations
• offering emotional and developmental support
• respecting personal space and time
• discovering potential
• communicating a framework for understanding
• and much more!

Pain, Normality, and the Struggle for Congruence: Reinterpreting Residential Care for Children and Youth provides professionals concerned with the development and treatment of children and young people with a unique understanding of group home life and work.


From the Foreword, by Dr. Barney Glaser:
I am honored and delighted to be asked by Jim Anglin to write the foreword to this grounded theory text... The purpose of this grounded theory is to construct a theoretical framework that would explain and account for well-functioning staffed group homes for young people, that in turn could serve as a basis for improved practice, policy development, education and training, research, and evaluation. THE READER WILL SEE THAT ANGLIN HAS ACHIEVED HIS GOAL WITH ADMIRABLE SUCCESS. . . . HIS GROUNDED THEORY TRULY MAKES A SCHOLARLY CONTRIBUTION TO THE LITERATURE.

Chapter 1

Historical and Contemporary Issues in Residential Care for Children and Youth

No informed conclusion about the future of residential care can be reached without paying careful attention to the kinds of external changes that are likely to determine its scale and character. That, in turn, cannot be done satisfactorily without some understanding and appreciation of those forces that have shaped its history.

–Roy Parker (1988, p. 3)

The term “residential care” encompasses a wide and imprecise range of services. In some definitions it encompasses foster care, as young people are “in residence” in the foster homes for periods ranging from days to years. Other definitions use the term “residential” in direct opposition to “foster care.” In this volume, the term will be used to cover the spectrum of “24-hour care” resources, from staffed homes for small groups of children to large congregate institutions such as residential schools and orphanages, but excluding foster care provided in families’ own homes. Thus, in addition to group homes, the continuum of “residentiality” includes such services as detention facilities, mental health treatment centers, psychiatric wards, and boarding school residences.

This study was initiated to address the generally acknowledged need for a more in-depth understanding of residential life and residential work in children’s residences (see Bullock, Little & Millham, 1993; Whittaker, 2000). This chapter will consider some of the larger historical and contemporary issues pertaining to the domain of residential care in general in order to set the group home study in context.

It is important to clarify at this point that the following selective review was undertaken in order to determine if the current study was warranted and to situate this research within the historical evolution of the residential care research literature. Grounded theory, the method selected for this study, is primarily an inductive approach, and unlike more deductive approaches, one does not undertake a comprehensive review of the literature before initiating the study (Glaser, 1978, p. 31). At the same time, the researcher had an extensive work career in the field of child and youth care and was reasonably familiar with the residential care literatures in the United Kingdom and North America overall. It is important that the framework being sought in the grounded theory research process emerge from the actual research data to the greatest degree possible and not from prior formulations. As a result, after the study findings and emerging framework are explored, a more traditional review of selected relevant literature will be presented in relation to the emergent framework (see Chapter 8).

This chapter is organized around a number of the major themes found in the initial overview of relevant residential care literature from the United Kingdom and North America. One of the most fundamental questions raised pertains to whether the state should be involved in removing children from their homes at all and, if so, under what circumstances.

THE ROLE OF THE “STATE” IN RESIDENTIAL CARE

Social welfare policy and practice characteristic of the late 19th and first half of the 20th centuries has been under serious attack on both sides of the Atlantic during the latter part of the 20th century. This critique, sometimes referred to as “neo-conservative,” combined with serious efforts to reduce government deficit spending, has brought about a profound rethinking of the role of the state. At the beginning of the 21st century, this questioning now appears to transcend political parties and is characteristic of the trend toward globalization and transnational corporate thinking. Even the provision of residential care for young people is necessarily subject to and greatly influenced by the various ideological forces that compete for ascendancy in societies over time (Gottesman, 1994, pp. 2-9).

In the field of child and youth care, Fox Harding (1991) suggests that we have entered into “a situation where there can be no certainty as to what the state should do, when it should do it, or how” (p. 3). In a useful overview of the major competing perspectives in child and youth care policy, Fox Harding identifies four major value orientations that characterize ways of thinking about the role of the state in parenting and the provision of child and youth care services–both residential and non-residential–namely, laissez-faire, protectionist, supportive, and radical.

Laissez-Faire

In the laissez-faire approach, parents are considered to be the best carers for children except in extreme cases of abuse and neglect. The biological bonds between natural parents and their children are considered to be vitally important to the proper attachment and socialization of children, and the recent historical efforts at “child saving” are considered to have been overzealous and likely to have caused more harm to children than they have prevented. According to this perspective, as Fox Harding points out, the central right of children is to have care and nurture provided by their natural parents. In brief, this perspective views the state as a poor parent, and maintains that substitute services should be kept to a minimum. This approach, characteristic of many conservative thinkers, also has the benefit of keeping state costs for child welfare services relatively low.

Protectionist

The protectionist stance is somewhat less parent-focused and is rather more concerned with the need to protect the child from the inadequacies of parents. The state is seen as being able to act in the role of a good parent due to its ability to be unbiased and to provide professionally competent services. The psychoemotional bonds with significant carers are understood to be more significant for a child than the biological relationship with parents. Children have the right to care and nurture, and the best care may be provided by a parent substitute. Services need to be quite extensive, requiring a relatively high investment of state funding.

Supportive

The supportive approach shares the laissez-faire perspective’s emphasis on the importance of the biological bonds between the parent and child. However, more emphasis is placed upon the need for the provision of support services for the family. Social inequality is perceived as a major source of family problems, thus the need for some state support to families in order to care adequately for their children is recognized. The focus of service provision differs from the protectionist approach, with a much stronger emphasis on the need for family support services rather than substitute care arrangements. As with the laissez-faire approach, the basic right of the child is to live in the biological family. At the same time, whereas the laissez-faire orientation is minimalist in terms of cost, services, and intervention, the supportive approach has moderate to high expectations for expenditure and programs.

Radical

The fourth major perspective has a more radical view of the rights of the child and sees parents as being overly dominant in the lives of children generally. The state has an important role to play in ensuring sufficient autonomy for children and the focus is on their right to make choices. The autonomy and self-determination of children is more important than residing with biological or substitute parents, and independent living for youth is a favored option. The cost implications are low to moderate, as the focus is on the need for parent education services and independent living for young people unable to live at home.

THE SITUATION IN BRITISH COLUMBIA

In the early to mid-1990s in British Columbia, just prior to the inception of this study, the virtues of the laissez-faire, protectionist, and supportive orientations were actively debated, with the more right-wing political proponents championing the first (Magnusson, 1984), an independent judicial inquiry promoting the second (Gove, 1995a, 1995b, 1995c), and the Ministry of Social Services revising legislation and seeking to reorient the child welfare system more along the lines of the third (Ministry of Social Services, 1994). When the field research was undertaken for this study in late 1998 and throughout 1999, the protectionist philosophy was firmly in place as a result of the tabling of the report of the Commission of Enquiry into the Death of Mathew Vaudreuil (Gove, 1995a, 1995b, 1995c) and the strong groundswell of media, political, and professional support for its 118 recommendations. The general thrust of this major report was that no child should ever again die due to the abuse or neglect of a parent and that it was the responsibility of the state child welfare services to err on the side of protection rather than family support. For example, one recommendation stated:

A social worker who considers that a child is in need of protection should apprehend and remove the child from an abusive or neglectful environment, and should not try to “second guess” what a judge will do once the case comes to court. (Recommendation 22, Gove, 1995b, p. 88)

This orientation, emphasizing the primacy of judicial assessment and intervention over the direct use of child welfare expertise, and articulated in the context of a highly visible public inquiry process, likely contributed directly to an approximately sixty percent increase in the number of children taken into care over the subsequent five-year period (Anglin, 2000).

While most ideological positions will accept that, under some circumstances at least, the state must intervene to remove and protect children for whom in-home protection is not possible, the evolution of residential care has witnessed a wide range of actual and potential purposes and functions for its use in addition to physical protection.

THE PURPOSES AND FUNCTIONS OF RESIDENTIAL CARE

There are always multiple purposes and functions for residential care. Over the last two centuries, it would appear that the emphases placed on the way residential institutions and homes are used and understood have been more cyclical than linear in nature, apparently reflecting the swings in political ideologies and macro-economic realities. For example, one finds a progressive international child care movement emerging after the Second World War (Courtioux, Davies Jones, Kalcher, Steinhauser, Tuggener & Waaldijk, 1985), with a resurgence in the early 1970s (Papanek, 1972) and apparently rising yet again being led by a wave of studies in the 1990s in the United Kingdom (see Department of Health, 1998). Such a cyclical developmental pattern is also notable in allied service fields such as parent education and support (Anglin, 1985).

The origin of the present European and North American systems of residential care for dealing with deviance and dependency of young people can be traced to the revolution in social practices that occurred at the end of the 18th and the beginning of the 19th centuries (Colton, 1988; Parker, 1988; Ward, 1995). Until the 20th century, there was a primary emphasis on institutional care. Large numbers of young people were housed in orphanages, industrial or training schools, hospitals for the mentally or physically disabled, and boarding schools. While there developed a movement towards foster care (the care of young people in the homes of other families) in the 19th century, the group residential care sector in Canada remained largely one of big institutions until the 1960s. At this point, an ideological groundswell of “deinstitutionalization” (after Goffman, 1961), “radical non-intervention” (Schur, 1973), and “normalization” (Wolfensberger, 1972) caught the imagination of those in the social care field, and the move to smaller, community-based homes was underway. The work of Goffman (1961) on asylums and the concept of “the total institution” along with the research on infant attachment by Bowlby (1958, 1969) were particularly influential in this regard. The contemporaneous advent of a governmental emphasis on cost-benefit analysis only added to the momentum (Schur, 1973).

In Canada, the earliest residential institutions were the orphanages founded by the Ursiline nuns in Quebec in the early 1700s. The primary emphasis was the provision of housing and basic care for the homeless, orphaned, and impoverished. For the socially deviant, the goal was segregation from mainstream society and “correction.” In the 1800s, the emphasis on protection of children emerged, culminating in legislation in Canada such as the Act for the Prevention of Cruelty to and Better Protection of Children (Fewster & Garfat, 1993). Welfare organizations, usually of a religious nature, ushered in the “child saving” era which persisted until the Second World War. The 1930s and 1940s saw increased specialization in the nature of the institutions (e.g., physical and mental disabilities, delinquency, emotional disturbance, etc.) and a strong shift toward foster home care for those who needed a home and were without severe special needs (Turner, 1979).

An important and regrettable development, emerging from the initial encounters of early European colonists and the Aboriginal peoples living in the territory that became Canada, was the creation of residential schools for Aboriginal children in the 1880s (Chrisjohn & Young, 1997; Fournier & Crey, 1997; Miller, 1996). To this day, hundreds of court cases remain to be resolved concerning allegations of abuse and mistreatment of young Native children, and many horrific stories have been documented and validated in relation to residential schools across the country (Haig-Brown, 1988; Miller, 1996). While these schools were developed as the result of government policies of assimilation, most of them were run by religious orders of various denominations. The last of these institutions were not phased out until the 1960s (Miller, 1996). Since about 50% of young people in care in Canada are of Aboriginal descent, any detailed consideration of the future of residential care as a service will need to acknowledge this and take into account this history.

By the 1960s and 1970s, the specialized residential facilities in Canada and the United States were increasingly focusing on doing “treatment.” Medical doctors, psychiatrists, or psychologists were hired either as institutional directors or as “treatment directors.” With this movement emerged a redefinition of the role of the careworkers from custodians to “milieu therapists” (Treischman, Whittaker, & Brendtro, 1969). At the same time, most institutions were being built with a number of small cottages, generally with 12 to 20 “beds,” in an effort to emulate a more “family-style” environment. One of the aims of this study is to explore the degree to which a “family-style” environment can, and should, be created by community-based group home residences.

In the early 1970s a major Canadian report on children with learning disabilities addressed the topic of residential care, and it heavily condemned both the large institutions that were still in operation in many parts of the country and the notion of treatment that they espoused:

While residential programs are necessary they are also regrettable. It is regrettable that they are necessary.… Residential programs are cannibalistic of scarce professional staff and by giving greater amounts of time and attention to a very small number of individuals they magnify present and future shortages….

Residential treatment is prodigal rather than parsimonious of resources and therefore should be used for as few cases as possible for the briefest possible periods required to be effective…. Residential care and treatment are a drastic interruption of the normal pattern and environment of a child’s maturation and growth. Residential treatment always compounds difficulties or creates them, particularly if there are major differences and conflicts between the values and expectations of the family and the institution. Separation from the experiences needed for normal growth and development should be as short as possible with primary emphasis on flexible child rearing programs of group home care, and the most rapid return to normal rather than highly artificial living situations. (Rae-Grant & Moffat, 1971, pp. 98-101)

In summary, the major shifts in the purposes of residential programs for children and youth have been from custodial (“warehousing”) to protection and care (“greenhousing”) and then to treatment, which perhaps could be referred to as “hothousing,” in reference to the intensity of intervention (Barnes, 1991, pp. 123-155). Some studies undertaken during the period of evolution into the treatment era have indicated that while there may have been a rhetoric of treatment in a home, the day-to-day practice appeared to consist largely of routine care activities (e.g., Berridge, 1985). At the same time, whatever the particular purposes and functions being addressed by particular residential settings, there remains the question of determining for whom they are appropriate.

FOR WHOM IS RESIDENTIAL GROUP CARE APPROPRIATE?

Residential group care, as opposed to foster family care or adoption, has been recommended in the literature for a number of reasons. For example, Utting (Department of Health, 1991) suggests group care for children and adolescents who:

have decided that they do not wish to be fostered;

have had bad experiences in foster care;

have been so abused within the family that another family placement is inappropriate; or

are from the same family and cannot otherwise be kept together. (p. 8)

A growth in support for foster care and adoption followed the influential studies by Bowlby (1958, 1969) and Ainsworth (1972) on the importance of attachment and at...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• Introduction
• Chapter 1. Historical and Contemporary Issues in Residential Care for Children and Youth
• Chapter 2. The Staffed Group Home Study: Research Method and Implementation
• Chapter 3. A Theoretical Framework for Understanding Group Home Life and Work
• Chapter 4. Congruence in Service of the Children’s Best Interests: The Central Theme of Group Home Life and Work
• Chapter 5. Creating an Extrafamilial Living Environment: The Overall Task of a Group Home
• Chapter 6. Responding to Pain and Pain-Based Behavior: The Major Challenge for Staff
• Chapter 7. Developing a Sense of Normality: The Primary Goal for Residents
• Chapter 8. Through the Lens of the Theoretical Framework: A Review of Selected Residential Child and Youth Care Literature
• Chapter 9. Implications for New Directions in Child and Youth Care Policy Development, Education, Practice, and Research
• References
• Index