screamAt a recent training, one person shared a letter he had recently received from a client, expressing her gratitude for the program’s help and the changes she and her son had made. The letter ended, as such letters often do, with the phrase: “most of all, you didn’t give up on me.”

Perhaps the most important thing we do for clients is not to give up on them. Sticking with them- staying around- is something many of our kids and families have not experienced. Our kids have been in so many placements, so many families, and so many treatment facilities. In addition to undermining healing relationships, all these moves underscore the basic message- you are such a terrible person that no one is able to stay around you for any length of time.

In order for any of our techniques to work, we have to keep the kid with us. And many times I have experienced situations in which we had completely given up on a kid, and we were sure we could not help him. However, the child welfare system being what it is, the child did not leave. And guess what- time passed, and he got better.

So maybe we should pay more attention to exactly what makes it possible for us to keep a child. And when we are struggling with a particular child, maybe we should have a meeting specifically focused on enhancing our ability to keep her.

And what could we do to increase our stamina? Some ideas are:

  1. Increase staff stamina by dividing the responsibility for the child among several staff every night. If (as we do)you have a concept of a “primary” staff (we call them team mates) then maybe a certain child needs two or three team mates. Maybe we should plan that anyone who deals with this child for a long period gets a break off the unit.
  2. If there is a particular horrid task (such as cleaning the room of a child with hygiene issues) let’s do it in teams, not one staff alone.
  3. Let’s keep a note book of any signs of hope we see.
  4. We must articulate clearly that even if we do not (yet) see any change, our not kicking this child out is a victory in itself, and we should congratulate each other for that.
  5. Let’s regularly review what happened to this child, and how we understand her symptoms- what problems are they solving for her? How are they adaptive- helpful in the short term, even if they have negative long term consequences?
  6. Let’s make sure we have a treatment theme (such as: Jeff is learning to trust adults) that everyone on the team including the child and family knows, and that we use this theme to frame all events and interventions.
  7. Let’s plan some ideas for restorative tasks before the child is in crisis, during our treatment team. Each task should be an opportunity for the child to practice one small skill that he would need to develop to give up his current symptoms.
  8. We can make sure to complement each other lavishly whenever anyone is particularly caring, giving or helpful to this child.
  9. Administration can attend meetings and praise the treatment team for their stamina.
  10. Is there anything we can do to make the child feel more safe and connected?
  11. Can we deliberately do something fun together, to acknowledge the effort we are making- a pot luck lunch, little presents, chocolate?
  12. The most important thing that we can do is to acknowledge both how difficult and how valuable what we are doing is. If we can stick with the child, his or her entire life may be different.

This is not to say that children should never leave our programs, or that children never need a different form of care. That happens- but not as often as we think. More often, we are frustrated by the pain the child is feeling, and by his ways of making sure we feel the same pain. We think, if only she were gone, the unit would go so well. But if we do succeed in ejecting a child, another one always steps into the role.

Let’s talk actively about our feelings about the child, how hard working with her is, how much chaos she creates for us and others, and how tempted we are to get rid of her. Let’s talk about our feelings of sadness, of inadequacy, anger and frustration. Let’s remember how she got this way, how we understand her, and let’s make sure we have a strong team plan.

And then let’s re-engage with the child and hang in there. Then after he gradually starts to get better, and finally achieves that positive discharge, and does fairly well, we will get one of those letters:

Dear staff,

Heart DoodleI just wanted to let you know I am doing well at my new home. I really miss you guys! I want to thank you for not giving up on me…

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