Working with Children and Youth with Complex Needs

20 Skills to Build Resilience

Michael Ungar

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000082616
• Edition: 2
• Topic: Psicología
• Subtopic: Psicoterapia

This new edition of Working with Children and Youth with Complex Needs provides detailed descriptions of techniques, ample case studies, fascinating and easy to understand explanations of research, and rich stories of how social workers, psychologists, counselors, child and youth care workers, and other mental health professionalscan help young people become more resilient.

Fully updated and including new discussions of trauma, adverse childhood experiences (ACEs), resilience, genetic susceptibility to stress, the impact of migration and natural disasters on families, and much more, Dr. Ungar shows why we need to work just as hard changing the environments that surround children as we do changing children themselves. Building on lessons learned from clinical, community and residential settings, Dr. Ungar discusses a shortlist of 20 essential skills that can enhance the effectiveness of frontline mental health services without relying on expensive, resource heavy programs. Along with descriptions of the skills necessary to talk with clients about the factors that put their mental health at risk, Working with Children and Youth with Complex Needs presents systemic practices clinicians can use in their everyday work to help their clients transform their worlds and improve their access to the resources they need to succeed.

Chapters present a variety of practical strategies that clinicians can use to enhance and sustain the therapeutic value of their work, including engaging with children's extended family; addressing issues of community violence, racism and homophobia; and helping parents and teachers understand (and change) children's maladaptive coping strategies. A series of videos accompanies the text to help readers see the skills that are discussed being applied to real-life situations mental health professionals and their community allies encounter.

Chapter 1

A Social Ecological Approach to Clinical Work With Children, Youth, and Families

Monday Morning, 9:20 a.m. (Part 1)

Michelle arrived 20 minutes late for her weekly appointment at the mental health and addictions treatment center where I worked. For months I’d been seeing this 17-year-old, impulsive, white adolescent, whose purple hair and pierced bottom lip made her look far tougher than she really was. Though Michelle eventually eased herself into her seat, a paper cup of coffee clasped in both hands, I knew these scheduled counseling sessions had done little except make Michelle much smarter about the consequences of her heroin use. It was remarkable, and a stroke of luck, that Michelle’s group home staff hadn’t kicked her out even though she continued to abuse drugs. Every time her 22-year-old boyfriend relapsed, she did too. Michelle insisted that he was the only person who really cared about her. He may also have been the only person she could rely on to be there when she turned 19 years old. When that happened, she would be forced to leave permanent foster care.

“I’ve had another fight with staff,” Michelle told me. She had been late for curfew and high when she did return. The group home staff had threatened to revoke phone privileges and Michelle had slammed her door so hard the handle broke. I’d spoken with the staff many times before. They knew Michelle was at risk of ending up homeless or dead immediately after her 19th birthday. But what more could they do to help? She refused to engage in any work to create a smooth transition into adult independent living. In truth, they were just as stuck as everyone else who was trying to work with Michelle to convince her to transform her life into something better.

“What are you going to do after you age out of foster care?” I asked, realizing that any talk of drugs and drinking was going to go nowhere that day.

I’ve got my boyfriend and his grandmother. He’ll be out of jail before my next birthday and I can live with them. I would let the group home staff set me up in my own apartment, but my transition worker said my boyfriend couldn’t live with me. Michelle rolled her eyes and stared into her coffee cup. “F—them. They’ve got no right to tell me who I can live with once I’m on my own,” she said, and then slumped down in her chair.

While most people saw Michelle as an angry young woman with serious problems, I came to know her as a lonely child with unmet psychological and material needs, living in a world that had badly neglected her for years. After a horrible start in a home where she witnessed frequent domestic violence, Michelle’s mother eventually threw Michelle out when she was 14 years old because of Michelle’s increasing drug use, violence in the home, and sexualized behavior toward her mother’s boyfriends. None of these behaviors surprised her caseworkers.

To make matters worse, Michelle had had an awful relationship with the police for the last four years. They’d been investigating her experience of sexual abuse by an online pedophile who had made contact with her and a dozen of her classmates through Instagram. Michelle’s case still hadn’t reached trial and might never. Not surprising, Michelle had refused trauma counseling. “I’ve been through worse,” is all she’d say about the incident.

I believed her. When she was 16 years old and had suffered through four foster placements in two years, Michelle asked to return to her mother’s home. She was told that if she did her younger sister would have to be removed and placed in care. Her mother did what Michelle expected and refused to take her back or advocate for her right to come home.

Unsure what I could do to help that Monday morning, I paused a long time, giving Michelle space to decide what comes next. Michelle raised her eyes and for a moment I thought I could see the wet shine of tears. “I just want them to listen to me,” she said, her bottom lip trembling. “Can you do that for me? Get them to stop talking at me and just listen to what I want?”

I nodded and reassured Michelle that I would try, though secretly I wasn’t sure I had the power to get anyone to do anything that Michelle wanted them to do. Mustering my courage, and with a deep breath that seemed to bring with it the faintest promise of hope, I looked straight at Michelle and asked her, “So, what exactly would you tell everyone if you could get them to listen?”

Changing Social and Physical Ecologies: Three Potential Problems

Meeting Michelle, I was entranced by her persistence, as well as the efforts of her professional caregivers to provide her with as much security as they could within the limits of their agency’s resources and mandates. Later in this chapter, I’ll revisit the work I did with Michelle to show the skills I used to help her. My work with Michelle is just one of many examples in this book of a social ecological approach to treatment designed for use by counselors, therapists, and other mental health care providers from diverse professional backgrounds.

I use the phrase “social ecology” to make clear that I mean interventions that address all the different systems that affect how an individual like Michelle interacts with her social environment. These include: biological systems that shape how we respond to stress and our patterns of self-regulation following trauma; psychological systems like our cognitions and our emotional responses to external triggers; our immediate and extended family systems and the supports or challenges each brings; our peers and online social networks; the educational institutions we rely upon for training; our workplaces and the wider economy that shape our employment opportunities; healthcare systems that provide access to care; cultural systems that shape our values, beliefs, and the everyday practices that express who we are; legal systems that sanction our behavior; and the political systems that set and administer the many social policies that decide for children like Michelle where they live and for how long. Figure 1.1 illustrates the way these different systems are nested. Changing one system is expected to change another, much as we know that providing housing to people with serious addictions can improve their mental health and make it more likely they will engage in therapy and sustain opportunities for work or training. Though I refer mostly to social ecologies throughout this book, our “physical ecologies” also influence how well we survive and thrive when stressors pile up. Our physical ecology is the natural and built environment that surrounds us (Brown, 2016), and includes everything from the availability of green spaces to play in to the location of child welfare offices, the positioning of wheelchair ramps, the availability of public transportation, and the physical layout of subsidized housing units (e.g., Do they have balconies to encourage people to feel less isolated from nature? Are there common rooms for people to socialize? Are there enough bedrooms in each unit for larger families?). Earlier models of ecological clinical practice (Belsky, 1980; Germain & Gitterman, 1980; Kemp, Whittaker, & Tracy, 1997) have certainly shaped my thinking, but a social ecological approach relies on a somewhat different and more up-to-date understanding of ecology (where our description of ecological relationships has dramatically changed over the last 30 years, becoming less causal and hierarchical, and with greater emphasis on the equal contribution made by all elements of an ecosystem from the smallest microbe to the largest multicellular organism), epigenetics (with its less fatalistic emphasis on how environments trigger gene expression), resilience, postmodernism, and integrated models of service delivery.

Figure 1.1 A social ecological model explaining the many systems that influence young people’s biopsychosocial development

Source: Adapted from Ungar & Theron, 2020

In practice, the emerging science that explains people’s interactions with their environments is reminding us that whatever services Michelle was being offered reflect a set of beliefs about what young people like her need and the social and political systems that decide who gets which services delivered in what ways. Policies, practices, and funding are always provided in a manner that reflects what society as a whole says is important. Thinking about social and physical ecologies will become much easier, and much more concrete, as I describe the work Michelle and I did together that helped her cope individually while also dramatically changing her access to the resources that she needed to stay safe and heal.

Ironically, while a systems-based, ecological approach to clinical work is not new, there has been very little research that shows it is effective. This book is meant to change that. Other notable efforts to describe an ecological practice that builds on our understanding of resilience include Resilient Therapy, a community-oriented model of social intervention popular in the United Kingdom (Hart, Blincow, & Thomas, 2007; Hill & Hart, 2016). It is a model that acknowledges the need to pay attention to social justice factors and is intended to take “resilience and turn it into a set of actions and working practices, mechanisms designed to generate better outcomes than would be expected” (Hart et al., 2007, p. 15). Likewise, the model of community psychology promoted by Isaac Prilleltensky (2014) also focuses on aspects of inequality and the broader social determinants of health that shape well-being. These models and others have influenced the ecological practices, principles, and skills that are described in the following chapters. This approach also builds on...