The Healing Embrace Blog: December 2007

What is the value of the non-clinical direct care staff in a residential treatment facility?

Think of a child whose trauma from abuse is so severe, she requires treatment in a residential facility for many months—if not years. Instead of life allowing her to just be a carefree child, she has to spend a significant amount of her childhood living in a facility that's not too far removed from a prison halfway house.

What kind of assistance would this child need to help her heal from her past and acquire the tools to enable her to have a happy, productive life going forward? Would merely a couple of hours per week or less individually with a therapist make much of a difference in her healing process? Doesn't she really need intensive, one-on-one therapy every single day?

Perhaps it is impractical to expect that a competent therapist can provide daily individual time to each of his clients in a residential treatment center. (Perhaps it's not—but that's an inquiry for another day.) In any case, if the consensus is that it is impractical for clients to receive daily individual therapy, then that's where non-clinical direct care staff (DCS) pick up the slack.

DCS interface with their clients for 40 hours per week—and often more (out of necessity, to supplement their meager wages). With so much face time with the clients, one could conclude that DCS are the most important members of a residential treatment organization, as they have the greatest direct impact on the clients.

So why, in our experience, is the training for DCS so woefully inadequate? One would think that their training regimen should focus ample time on all of the hats they have to wear in their daily duties: parent, counselor, therapist, friend, role model, psychoanalyst, and so on.

Yet, in our experience, DCS are simply thrown into the job to learn the system from, and (often bad) habits of, their coworkers. It then takes significant time—from six months to a couple of years—for a DCS to acquire the skills to be truly effective at their job. Until that point, DCS are capable of providing only a limited amount of help. And way too often they're even a detriment to the effective healing of clients as they try to employ ineffective and improper techniques.

To compound the problem, the turnover rate for DCS is extremely high. So by the time—or before—one has learned the skills to become an effective DCS, he or she will move on to another job or line of work.

Employers will throw up their hands and say there's nothing they can do about this problem. They cite the fact that many of the DCS they hire are using the job as a stepping stone to other careers.

BS! we say. In our experience, yes, this stepping-stone phenomenon is real. But only because there are other problems creating that vacuum for stepping-stoners to fill.

The number one problem is pay. The meager wages that DCS receive is not enough to attract and retain quality people. Sure, there's a paucity of funds in nonprofit business, but in our experience there can be an excess of nonessential managerial positions in a nonprofit organization eating up those scarce funds.

We've seen layers upon layers of managerial and other staff that appear to be utterly redundant—as if the nonprofit existed primarily to provide jobs rather than provide quality service to the end clients. So why not take the salaries of redundant and nonessential employees and channel this money to the DCS, who arguably provide the greatest direct value to the clients? Or spend it on capital improvements for the direct benefit of the clients themselves.

We've also seen expenditures that make little sense. It seems as if pet projects get precedence over actual, chronic needs, which consequently get neglected for years on end. We say, cut the fat and focus on the core of your organization! Feed the DCS a little better, and they will in turn better feed the clients. Or spend directly on the clients themselves. But don't get new flooring in the executive offices and vestibules when the carpeting in the clients' own milieu is filthy and worn out, as was the case at one of our former places of employment.

Another problem is the aforementioned training. This is something we've seen to be woefully inadequate among residential treatment facilities with which we've been associated. It's a shame that a 20-something kid still in or just out of school gets thrown into the arena with the "lions" and has not been properly trained on how to "tame" those lions.

The primary training we received at our DCS jobs focused on how to physically restrain an aggressive child. But we were never effectively taught how to best help that child get through emotional and behavioral crises and heal from his or her trauma. All our training did, at best, was prepare us for a worst-case, "firefighting" scenario; at worst, however, the training taught us to use a restraint as a method of disciplining a child or to enforce compliance—for we were never formally taught the verbal skills to effectively manage clients' behaviors.

Aside from how to implement a restraint, the rest of the skills were pretty much left up to the DCS to pick up on their own—on the job, with the children as the guinea pigs as the DCS struggled to figure out, over a long, chaotic, and arduous time, what works and what doesn't. (What would the APA say if therapists—which in large part DCS are—worked this way, figuring out their techniques by trial and error instead of through education and sound training?)

These children's lives are at stake. What we do for them now could make the difference between a productive life and a tragic fate down the road, such as prison, prostitution, drug abuse, or abuse of their own children. How can we take the training of DCS so lightly? In our opinion, it should be the mission of every residential treatment facility to provide world-class training to its direct care staff. If we love children, we'll do everything in our power to enable proper training of those that care for them.

Yet another problem is regard—or, a lack of it. Our experience has shown us that DCS staff are undervalued by the organizations that employ them. We already know that their wages reflect this attitude. Moreover, the concerns and ideas of DCS are chronically disregarded.

We've seen others and have personally experienced ourselves encounter this problem repeatedly. It's made us disillusioned and cynical about our jobs and employers.

Many of us enter the DCS line of work with high hopes and expectations to make a difference in the world. So, as good citizens, we point out the problems we see in the organization and make suggestions for improvement. But our concerns and good ideas go unheeded—and very, very often even unacknowledged. This is probably a problem in most organizations, but for ones in which children's lives are at stake, we think they need to hold themselves to a higher standard and genuinely listen to the "grunts" on the front lines.

Here's a real-life example of this problem. A former coworker, when she started on the job, was full of energy, enthusiasm, and brilliant ideas for things to directly benefit the clients. One of those ideas was to paint the grayish, drab, cold, institutional walls of her unit with positive sayings to immerse the kids in uplifting and encouraging thoughts throughout each day. So she submitted a written proposal to do this. But after months of "we're looking into it" and "we're just waiting for final approval" of this idea and numerous others she put forth—and at the same time while an outside financial contributor was allowed to have its employees volunteer to come in and repaint the walls of the unit—my coworker finally said to heck with it and quit her job.

This person went from being one of the best assets the organization could have ever had to becoming yet another in a long line of cynical and disgruntled employees. It's truly a tragic shame that the organization does not value its DCS more—which is ultimately to the detriment of the children.

So what's the value of the direct care staff? In our opinion, DCS are everything to an organization that serves children. No other employee spends more individual time with the clients, so no other employee is as critical to their healing.

So why do the administrators of some residential treatment facilities invest so little in their direct care staff? It's a mystery. It makes one wonder if they're so far removed from the "front lines" of child advocacy that they're satisfied with merely going through the motions of helping children—and if they actually help them, it's more by chance than design.

If we love children, we should do everything in our power to take care of them in the best manner possible. Here at Healing Embrace, we think it's everyone's moral obligation to do so.

© 2007 David Lee Cummings / Healing Embrace

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