Independence July 4, 2008

It’s the Fourth of July, and I am thinking about independence, and what a strange, fierce American value it is.  More than once now, I’ve had CPS workers tell me that their goal for a parent is simply that they become “independent,” without any explanation as to why that’s necessary.  I believe this is because there is a fundamental assumption that being a success in this country means not having to rely on anyone else for anything.  Self-sufficiency, by itself, is a good thing.  Period.

The value of independence runs deep, too, deeper and than I had ever realized until a minor incident led to a major revelation.  At age 19, I got a definition wrong on a quiz on French culture.  It wasn’t just a half a point off; my definition was 100% incorrect.  This was shocking and upsetting to someone accustomed to, and perhaps even feeling somewhat entitled to, near perfect grades. 

What on earth happened?  The word in question was solidarité.  Shoot.  I had not studied that one.  Well, most French words have English counterparts that are pretty close, and this was a quiz about politics and social policy.  Let’s see, solidarité sounds like solid.  I bet this word is about being solid in oneself, being independent.  And that’s how I got to the most wrong answer I have ever submitted in my academic history.  The most telling thing of all, of course, is that solidarité does in fact have an English counterpart–solidarity.  Astonishingly, in my nineteen years in this country, I had never learned that word.  In America we don’t have a lot of conversations about standing together to support one another; nobody I knew used that vocabulary.

As mind blowing as it was to be 100% wrong about something, it was even more astounding to learn that there are civilized societies out there that value solidarity more than independence.  The idea that an intelligent citizenry out there actually believes “we’re in this together” was stupefying.  I felt strangely safer just thinking about it.

Of course, on later trips to France I discovered that the “we’re” in “we’re in this together” doesn’t always include the immigrants in the banlieues, along with plenty of other disappointments.  Additionally, as a pragmatist and believer in several key elements of the American-style economy, cognitive dissonance caused many aspects of this original socialist vision of mine to fade.  Yet to this day I remain captivated by the basic idea that perhaps people are better off supporting–and depending–on one another rather than going at it alone. 

On this Independence Day, fate would have it that the single case I’m carrying involves an immigrant family from Guatemala.  The mother is not a citizen; her children are.  The mother speaks Spanish as a second language and another regional language primarily.  She cannot read or write in any language.  The family has no transportation.  Yet they are the model for what this country has always envisioned in immigrants.  The mother has found a job at a nursery and she works hard.  Her children are in school and the oldest already has more education than her mother.  They are quiet and law-abiding; the children are well-behaved and respectful.  For all intents and purposes, it would appear as though this family is pulling themselves up by their bootstraps–the all-American way.

At second glance, however, one sees that the success that is being achieved is the result of interdependence, not independence, which is probably the case for all bootstrap stories, whether it is admitted or not.  The mother relies on her sister, who lives with her, for child care.  In exchange the mother provides income for everyone.  The mother’s sister speaks Spanish; the eldest daughter speaks English.  Together they get enough translated to get by.  The job is possible only because the mother has a group of coworkers who carpool.  The family is supported by a church, which also provides transportation for the family to services.  Extended family members live around town and the whole family provides reciprocal social and financial support to one another.  It’s not the story of the solitary immigrant making her way, it’s a story of solidarity.  It’s complex and beautiful, and in some ways, so much more impressive than the simple success of a single individual.

I got into this case because as mentioned a while ago, I have to shadow a coworker who is experiencing some difficulty with deadlines and organization.  We didn’t actually get a case together for a long while, because there were a couple of false starts.  For two weeks, we chased around a family that really didn’t want services and never responded to any of our notes or calls. 

Ultimately, we wound up on this case together, and I am once again thinking about independence.  The original idea with me shadowing my coworker was for me to show her how it’s done so that she can be fully independent as a social worker.  This case has allowed the process to take a turn for the better, evolving into much more of an interdependent team effort.  Because I do not speak Spanish and have limited knowledge of Latino cultures, my coworker now has the opportunity to teach me as much as I’m teaching her.  With coaching, she’s doing better with deadlines, though she continues to struggle.  I’ve been hounding her about report deadlines all week, for the sake of both of us.  Even with this weakness, she brings so much to the team, especially with her expertise in Latino immigrants.  Is it really so bad that she needs lots of extra reminders in one area, if she can offer so much in another?  What is the place of solidarity vis-à-vis independence in a team of social workers?  My supervisor hinted that my coworker could lose her job if she didn’t get the deadlines down.  I see my supervisor’s point; our reports have to be in on time.  But I wonder if we have a better shot at meeting our clients’ needs if we stand together as team to meet our own members’ needs, and draw on our diverse strengths, instead of focusing on molding each member into an independent, comprehensively equipped worker-bot?

Burnout June 30, 2008

My coworker is looking for a new job.  It’s a let down for me, especially since he joined our ranks more recently than I did.  He’s a great worker, too.  He’s fun and has a natural connection with kids.  When he does manage to get hired out, I’ll miss having him around.  I’ll dread the hiring process.

I’ve mentioned before that our team struggles with a plague of turnover.  Sometimes I think it’s the pay, or the fact that we’re on call 24/7, even though we rarely get calls.  Mostly, though, I think people quit this job because of the work itself.

My coworker, the one who is leaving, had a 45-minute long meltdown at our last team meeting.  He said all the things social workers are not supposed to say–he was cynical, taking pot shots at the system and even his clients.  Apparently, his client had told him on the day before he was scheduled to close out his case that she could not complete a drug screen–because, incidentally, she smokes crack recreationally, though she had not ever mentioned that before.  My coworker was fed up with poor decisions, and I think poverty in general.  When he started going off on the clothing, dietary, and religious choices of people in a certain neighborhood, I finally admitted to myself that his time had come.

At that moment, he was not a safe social worker.  The work had gotten to him, all those kids growing up in sub par conditions.  If he went out and served a family, he could do real damage.  He had lost his patience, lost his cool.  He was desperate to spend time with clean, well-dressed, functional people.  He needed to be reminded that a large number of people in this world can keep it together, or at least put on a darn good show.

I wonder if all social workers reach that point, or if some are just wired for sustainability.  I have not reached it yet myself, and even find it surprising that after such a brief tenure, I’ve already outlasted others.  I have had my days where it all starts to wear on me.  It’s on those days when the mandatory strengths-based language of my agency can feel like a real chore.  There’s a deep desire to call a spade a spade, and allow oneself to feel hopeless.  It’s not so much that we fail to make progress in individual cases.  Rather, it’s the general disappointment that sets in when one realizes how many children grow up in conditions that are barely safe and very far from positive.  Kids receiving less out of life than they should is a source of true sadness.  Sometimes it seems the only way to honor the kids themselves is to cut through all the hope crap and speak honestly about the devastation they experience.  I have been there:  describing a family’s strengths, and at the same time realizing the gulf between strengths and risks is so profound as to render my hopeful recitation some sort of mockery of what the children really deserve.  

Even with a few of those moments, I still believe I am far from burnout.  I’ve been hesitant to write about why I believe this is, for fear that I might be perceived as, or actually be, cold hearted.  But here it is:  my secret to success in this profession is a deeply held belief that human beings are not that great.  Indeed, I think we’re quite a wretched lot.  When I consider myself and my own numerous and most often failed efforts to change, even with my privileged background, I cannot believe it is fair to project much in the way of expectations onto others.  I don’t mean to condescend, but I absolutely believe it’s a miracle any time any human being makes any sort of progress.  And, no, in case it was not obvious, I have never believed in saving the world. 

I like to focus on realistic options, which leads me back to being strengths-based. My world view is pessimistic for a social worker, I suppose, but quite accurate in terms of how human beings actually behave.  And it is this realism that allows me to be genuinely strengths-based, not just because I believe that’s the most effective approach, but because I am thoroughly blown away and ecstatic every time clients make the smallest steps in the right direction. 

It has taken me some time to come to terms with the lives that some children have to live.  There is nothing like experiencing that in living color–all those dirty faces and tangled heads of hair.  Still, I know that those crummy lives will become outright disasters if the children are removed from everything they know.  Sometimes it’s clear the kids have to be removed, but it’s still almost always a disaster.  I’ll never save the kids I work with or for that matter give them anything close to the quality life to which I believe they’re entitled.  Yet I still see it as a success, and even something of a supernatural accomplishment, when we can make enough positive change to keep kids sleeping in their own beds at night.

 

Privilege June 26, 2008

“Well, he put his pants on one leg at a time just like the rest of us, and I thought he should know that,” my client reasoned a few days ago while explaining how she managed to lose her last job for telling off an uppity co-worker.  Our focus is finding her employment, but her comment about recognizing privilege and entitlement was what stuck with me after our visit was over.

As you know, I recently enjoyed a brief vacation.  My mother generously paid for a little get away for herself and her three daughters.  I felt very indulged the whole time during this estrogen fest, complete with delightful restaurants and recreational activities that I cannot readily afford on my salary.  I had to tell my current client I was going–I was obviously not going to be available for a couple of days–but I almost regretted having to do so.  She wanted to know about where I was going and I didn’t want to have to share about a trip that highlighted the privilege differential between us.  She couldn’t afford to go anywhere this past weekend.  Unlike many of my clients, she actually has her own vehicle, but she cannot afford gas. 

A couple of weeks ago, I had an even more astounding encounter with privilege.  My old law firm invited former attorneys back for a reception.  I like most of the attorneys I used to work with.  This was the perfect opportunity to enjoy them as individuals without the large law firm employment environment, which I loath, for reasons having to do more with me than with the firm. 

I had forgotten how lavish those events could be, and how exclusive.  The reception was held on a roped-off, security-guarded deck that overlooked a public pavilion where a community music festival was underway.  I walked through the crowd, the security guards let me past the ropes, and I breezed onto the deck, complete with a free open bar, gourmet buffet, the best view of the concert, and access to some of the most powerful people in town. 

My husband and I proceeded to get into up to our ears in a discussion about purchasing the proper dingy for a sailboat.  My rapidly dwindling attention for this ”problem” reminded me, powerfully, why I am a social worker. 

It’s true that I have experienced privilege.  There was not excessive wealth in my immediate family, being the daughter of a social worker and all.  But when I asked my mother at about age five if we were rich, she said that indeed we were very rich.  And she was right.  Even if our family’s income was low, our access to education, travel, physical and emotional security, and opportunities made me privileged, especially compared with the global population.

The fact that I am a privileged middle-class American is, in itself, unremarkable.  What matters at the end of the day is not that fact but how I conduct myself given my background. 

Right off the bat, it strikes me that there is a threshold level of self-awareness that is usually either helpful or paralyzing.  I think it is beneficial to have an accurate perception of the privilege one experiences in society.  Amazingly, there is a strong contingent of our society that lacks a basic appreciation for the elements of privilege.  Some of the lawyers with whom I visited fell into this group.  Mind you, it was not because they are all insensitive and egotistical (though some are).  Actually, I believe some privileged people shy away from a full appreciation of their status because they would rather be humble than haughty.  Also, I believe there is a human tendency to look at who has more than you rather than who has less, regardless of the relative sizes of those two groups.  Anyway, while shying away from acknowledging privilege is quite polite, it leaves one ill equipped to truly engage the issues of privilege and social class.  As exercises like the famous Privilege Walk increase in popularity, hopefully attitudes toward privilege including ignorance, avoidance, and entitlement will gradually be stamped out.

Once a person has an accurate sense of what their world has bestowed on them, one very typical and tragic effect for lucky people is to feel just rotten about all the unearned privileges they have received.  White guilt is one incredibly common version of this incredibly useless way of responding.  And I admit I’ve wasted plenty of time spinning my own wheels, wringing my hands, wondering how I could ever get past my sheltered, favored existence.

Wonder no longer my friends in privilege: just get over it.  Privilege is money in the bank.  To lack awareness of it is like having an account you never realized was there.  To be stifled by it is to have the lump sum stuck in a checking account instead of an investment vehicle.  Have I tripped up based on my privileged background?  Of course.  But more often than not, taking the plunge and drawing on my privilege has improved a situation.  Did I feel like a snob just for attending that reception?  Just a bit.  But I’m convinced it also allowed me to be a better social worker.

Privilege in my life consists of an outstanding education, a caring family committed to enrichment, connections to wealthy and powerful people, and much more.  I am not ashamed of these things.  I am aware of them and I use them (finally).  My upbringing taught me innumerable life skills that I can model to clients, and most of the time I can do so without an air of superiority.  My community connections help to raise awareness.  My education provided me with language and advocacy skills that help clients every day.  The client I wrote about a couple of weeks ago, the one with the two year old wandering the neighborhood, wound up benefiting profoundly because of my privilege.  Based on my advocacy, at the last minute the CPS worker and the court agreed to let that mother re-do my program with a specific focus on parenting skills.  Her kids were not taken away.  She has another shot based on my skills, which were developed and refined because I had a very good life.

Privilege is not something to ignore, to hide, or to feel guilty about.  It is to be invested and used, which is, unsurprisingly, also about the best cure for that lingering guilt that plagues so many of us fortunate ones. 

 

Confrontation June 21, 2008

Even after my late night crisis management finally ended, I knew I had clean up work to do.  My client, who had made a safety plan to avoid alcohol, did not succeed in following that plan.  It was no coincidence that the conflict and the runaway it caused occurred on the same evening that the mother decided to have a few celebratory beers.

When I arrived at the family home it was obvious my client had been drinking, even before she decided to throw that beer can from her porch all the way across the front lawn.  As blatant as it was, it didn’t make much sense to confront an escalated, somewhat intoxicated, very worried mother.  I let it ride, focusing instead on just getting everyone tucked into bed.

But we still needed to have the Come to Jesus talk, and this time it resulted not in a teary confessional, but yet another runaway. 

The daughter had enough of the runaway shelter after one night.  Apparently she didn’t like sleeping in a room by herself.  Also, she had plans with her boyfriend.  And suddenly (sobriety does provide new perspective) the mother was also open to accepting her back home.  But I wasn’t about to encourage the reunification without a renewed commitment and safety plan around alcohol use.

I asked the mom why the last safety plan didn’t work.  She shrugged.  She said she wanted to have a few beers.  My sneaking suspicion that she never bought in to the initial sobriety pledge was being confirmed.  She explained that the problems the night before happened because of her daughter’s behavior.  She didn’t have a drinking problem.

I asked the mom what she would do differently now to prevent the whole cycle from repeating itself.  She said, “I just won’t drink.”  I said, “We tried that plan.  It didn’t work.”  When I asked her what she wanted to do, she sat there and did not say anything.  I watched as she started bouncing her knee in agitation.

I threw a couple of options out there:  how about daily AA meetings?  Well, if not, what about bi-weekly AA meetings?  She continued to shrug.  She could not promise to do anything more than she originally agreed to do (1 AA meeting per week), even though that clearly was insufficient to prevent a crisis.  I had no choice but to confront her.  I did so by banking on the goodwill we had already established with each other.

I told her I put my neck on the line by recommending her for her job, especially when the job coordinator called me back and asked if I was sure this mother could handle daily work.  I had said yes, and I told my client that I did so.  I now told my client, using language that fully matched her own typically uncouth presentation, that deep in my heart I believed she would lose that job if she did not do something about her drinking.

She grabbed her purse and stormed out.

This left me and her daughter, who was not permitted to be at the runaway shelter if she didn’t voluntarily agree to be there.  The resolution (and transportation) had not yet been hammered out.  Yet the mother, like her daughter, took to running when confronted with honest, though harsh, words from someone she had grown to trust.

I personally am not accustomed to saying things that cause other people to storm out of the room, much less out of the zip code.  I tend to take things personally.  I was one of those sweet, concerned girls that goes into social work in order to help.  I wanted to a friend, supporter, perhaps an advocate.  I did not envision myself as a Dutch uncle.  It is a professional skill I have had to work hard to develop.   

I’ve said it before, I’ll say it again:  real, professional social work is not for sissies.  I’ll be forever grateful to an intern who sent this point home about a year ago.  A large group from our agency was cleaning up one of the filthiest homes I’ve ever seen.  I was one of several workers in the bunch who was choosing jobs carefully, hoping to avoid the ones involving animal droppings and mold.  After recognizing this nonsense for what it was, the intern came up to a group of us, nonchalantly holding a dead mouse by its tail.  “We’ve got a job to do girls,” she said.  “Grow some balls.”

Being a professional means I have to care more about a client’s potential to make progress than my own personal desire to be diplomatic and to be liked.  It takes getting over my own distaste for conflict and building the self assurance to know that I am doing the right thing even if the client responds with explosive negativity.  It takes self control and practice to not take highly personal attacks personally, but to understand instead that they are to be expected given the client’s perspective.  As a professional social worker, sometimes you really are an emotional punching bag.  Somebody’s got to absorb that hurt and aggression without spewing it back if progress is going to be made.  That’s why we’re professionals.

Granted, I avoid direct confrontations if there is any other way the client can be encouraged to make the necessary move.  This is because direct confrontations usually do not work.  As tempting (and cathartic for the worker) as it can be to just lay it on the line for a client, usually, as in this case, confrontations just cause disengagement.  But sometimes, in substance abuse cases especially, addressing the issue directly is the only option. 

Despite my increasing ability to confront people and absorb their reactions, it stresses me out.  Even if I manage to hide this from the client, I usually need a serious workout or nap.  I’m getting better.  I usually don’t lose my composure during the intervention.  But I’m a mess by the time I’m back home.

It strikes me that communication in social work is a dance.  It’s not just about encouragement, nor is it just about telling people the hard truths clients seem to need to hear.  It’s about telling the client what will make it most likely for the client to take a step in the right direction.  Sometimes I’m amazed at how forced it feels for me to say the clinically effective thing.  Often I don’t really feel like my praise of clients is 100% genuine, but I offer it as authentically as I can because it’s a dynamite tactic.  I never feel like confronting clients directly, but to ignore certain issues would leave them destined for disaster.

In other words, clinically effective communication often fails to reflect my personal feelings; it can even feel a tinge dishonest.  That’s how it felt when I apologized to my client in a voice mail, and then in a written note, after our conversation.  I was not actually sorry I said what I said.  But I needed to provide a way for her to re-engage with me that allowed her to save face.  I felt like such a politician.  

The whole process reminded me of a tactic lawyers frequently use for inflammatory, inappropriate evidence.  Even when it’s clear a piece of scandalous evidence will be objected to and ultimately disallowed by the judge, many lawyers will try to slip it in anyway.  They will get a witness to mention the salacious bit or something like that.  Once a jury hears or sees something, there’s no taking it away, even if the judge tells the jury later that they cannot consider it.  That was the dynamic of this confrontation.  My client now knows what I truly believe about the risks of her drinking.  I’ve apologized for coming across harshly, but I cannot take back my core message.  And I don’t want to.  Still, my client called me back after a day and set up another visit.  And therefore I guess I’m treating the whole thing a success, notwithstanding the fact that I had to lick my own wounds back at home for a good long while.

The Limits of Family Preservation June 18, 2008

It’s 12:14 a.m., and I’ve just arrived back from a client visit.  I was blogging comfortably at home around 9:00 p.m. this evening when I received a client call and I had to put my post on hold.  I’m on call 24 hours a day, 7 days a week, but it’s actually fairly rare to get a nighttime call like this.  Clients are decent people; they hate to bother me.  Still, if clients fit the requirements of my program, they are in crisis by definition.  That means sometimes they call; sometimes I’m up late.

Earlier today my client was on cloud nine.  She was accepted into a transitional job program and for the first time in two years, she will be a member of the workforce.  She called me right away, all excited.  And I just fueled her excitement, reminding her of all the assets she would bring to the workplace.  Being the cheerleader is one of my favorite roles.

Apparently, however, she decided that drinking was the best way to continue the celebration.  Then she shared her good news with her daughter, who was considerably less excited about it, especially when the mother reminded the daughter that it was the daughter who made her lose her last job.  I guess the daughter would not stay put at home during work shifts, forcing the mother to leave work and track her down.  The mother is just terrified it will happen again.  Emboldened by the alcohol, she expressed these worries to her daughter using expletives and some other highly unfortunate language.  So, the daughter relieved her stress and hurt by going to buy cigarettes (quite a feat at age 13), and running away.

It was then (not before that first drink) that the mother called me.   It’s taken me over a year in this job to properly recognize that a “crisis” happens right away, the minute that first bad decision takes place.  If we identify that first drink as a crisis, we have a lot better shot of preventing the full on disaster that will often follow.  My client just was not ready to call her all-American beer celebration a crisis.  She kept saying she just wanted me to take her daughter away to the runaway shelter, to juvi, to foster care–anywhere.  I made no promises, except to come over. 

It is amazing to me the number of parents who believe that I can make their children disappear, safely of course, and have someone else straighten them out and return them.  My clients get quite frustrated that I cannot actually do this, especially if the child does not want to go to the juvenile crisis centers.  My main goal was to keep the mother out of trouble with CPS, which meant trying to find a safe place for the daughter to stay that night, or at the very least notifying police she had run away. 

At the same time, we did not want to encourage the daughter’s attention seeking manipulation by chasing her around the neighborhood.  I found the daughter early on, walking down the sidewalk, and asked if she wanted to talk with me.  I observed a huge grin on her face as I approached in my car.  She didn’t want to get in.  No problem.  I just turned around and drove off.  I was not playing that game.

In the end, my client abruptly decided she could not have her daughter in her house right now.  If I couldn’t solve the situation, she needed to go to her friend’s to decompress.  My client up and left (never mind the residual alcohol in her system), locked her daughter out, and there I was, sitting in my car with a mess on my hands. 

I didn’t know where the daughter was, and whether she was in a safe place for the night.  I didn’t even know where the mom was, exactly.  I didn’t have permission to call any local friends or family to intervene.  I didn’t know how drunk mom was, though she didn’t appear to be intoxicated to the point of being a lethal risk on the roads. 

I did know that the mom could get in a world of trouble with CPS if she didn’t resolve this soon.  Just imagine–her daughter gets assaulted by some stranger because she winds up spending the night outside after her absent mother locks her out.  Yet even if her mother did return, it wasn’t safe for them to be together.  Mom had already speculated that she would “pound” daughter if she had to have her in the house.

Enter my supervisor, who is conveniently also on call 24/7.  She said we needed to secure some safe place for this girl, and that place could not be home (not safe).  If this could not be done quickly, I would once again be forced to report my own client to CPS.  Now that we were sure the daughter could not safely return home, I did need to chase her around to locate her and make sure she ended up somewhere decent.  But first I needed to track down her mother.

Upon the threat of a CPS report, the mother returned after I called her.  On a wish and a prayer, I found the daughter hanging around about two blocks away.  I shuttled back and forth, and luckily each agreed the daughter could go to a voluntary runaway program.  It wasn’t exactly smooth.  The mother refused to give the daughter anything more than a tee shirt and some too small jeans for her overnight stay.  The mother was still relatively belligerent, swearing her daughter would have to go live with relatives for the summer until the mother’s job was secure.  The daughter was equally bold in expressing her distaste for her mother.  But I made the transport run, leaving this girl at the runaway program at least for the night.

For my family preservation program to continue, the daughter needs to remain in the home.  I’m not so sure I disagree with mom about keeping them separate in this instance, though.  The mother has legitimate worries about the neighborhood and her home (in foreclosure), about her own employment situation, drinking, and mental health.  I wish I could assure her that she can sort all of this out while her daughter stays with her, even though her daughter smokes (weed and cigarettes), she keeps running away, and at age 13 has yet to pass sixth grade.  Sometimes the best answer is a self-made foster care situation.  The kid stays with granny for a summer in the country.  Mom gets her act together.  After a summer of separation and hard work, the family is finally in a position to continue the family preservation process.  I’m not sure how this one will end up.  Realistically, there may be too much going on to preserve this family using traditional techniques.  There’s no shame in a few months at granny’s if that’s what will keep relationships safe in the long run.

On Vacation June 12, 2008

I’ll be on vacation and away from my computer (and my source material) for the next little while.  Look for another post after 6/16. 

Outcomes June 9, 2008

We are now in the midst of an era where professionalism in social work is growing by leaps and bounds, which means the old “black box” social work is behind us.  That is to say, we no longer go about interventions just hoping they work.  We check to make sure.

I’m fortunate to work in a program that has proven its exceptionally high outcomes for over a dozen years.  80% of families served by our program are intact 12 months after our cases close.  The program model is a strong one, and usually the process of evaluating our outcomes is a delightful one.  It involves me stopping in at old clients’ homes 3, 6, and 12 months after the close of my intervention with them.  If they still have their children, we count our efforts as a success.  Heck, even if another responsible adult in the family has the children, it still counts as a good outcome.  So long as state placement into foster care is avoided, the expense of foster care is prevented and the children remain in an environment without undergoing the trauma of separation. 

This past week, I’ve wrestled with three separate follow-ups, none of which brought much sunshine into my life.  The first case was truly tragic.  Three months ago, I worked with a mother who was well on the way to closing the door on her cocaine addition.  In fact, for the final three weeks of our intervention, she not only stayed clean, but she attended intensive outpatient counseling, riding the bus back and forth three nights a week for three hour sessions.  About a month after I closed my case, I heard from her outpatient counselor that she completed the treatment successfully.  I was so proud.  My first failed case ever was a cocaine case.  This client gave me hope and inspiration that cocaine dependent clients can keep their kids.

Then I got a call a few days ago from the CPS worker.  She relapsed, badly apparently.  She started no-showing for her less intensive home-based preservation worker, the one who followed me.  She got squirrely about her explanations for things.  She dropped dirty.  And now the CPS worker will take her infant away from her.  In spite of this disappointment, however, it will not be marked as a failure in our book.  Daddy is taking the baby.  For as long as he can keep the baby safe, and this is the kicker–away from the baby’s mother–he will have custody and our intervention will still be considered a success.  I worked with the dad a little.  He was living with the mom and actively involved with his child.  Still, it feels strange to have the bulk of our work wind up as a failure, while still being able to technically call the case a success.

The second case is even more strange.  Again, it’s a technical success.  The children are now staying with their respective paternal grandmothers.  The mother got picked up on an outstanding warrant, and CPS ordered the children be placed out of the home while the mother went to jail.  In fact, CPS ordered the children be placed out of the home for a year, based on the arrest plus a whole bunch of other instability.  In fact, this was the only case I’ve had so far where I had hoped CPS would remove the children from their mother.  Every single day of that intervention a crisis arose, whether it was a utility shut off, a threatened Section 8 disqualification, lack of supervision, lack of transportation, or lack of memory about crucial appointments.  Every single day I worried for the safety of the children involved.  Yet it is my job to advocate for parents to keep their children.  In this case, the intervention did not result in the goal we aim for:  parents keeping their children.  But the result was exactly what I hoped would happen.  In the end, it was not only a technical success, but also relief from my personal perspective, regardless of the guilt I feel for abandoning my hope in the mom.  The grandmas were far and away the best bet for the kids’ long term safety and success.

The third follow-up occurred today, and it will be a source of sadness for a while in my life.  I visited a family for their 6-month follow up.  During the actual intervention, we focused almost exclusively on getting this domestic violence victim mom into safe shelter and away from the perpetrator.  There were some parenting concerns, including a shelter staff member alleging that my client left her son in the bathtub unattended.  With a little advocacy with CPS, we managed to keep the family together, even if we didn’t really get to some of the more mundane parenting needs, like keeping an eye on the kids.  At least we got a roof over their heads.  Less intensive home-based services would follow up with the rest.

Somehow, though, it didn’t work.  I couldn’t get a hold of my client last week because she didn’t have a current phone number.  I called the CPS worker and learned her new address.  According to the CPS worker, things had unravelled a bit.  She had to move from the place we found for her because she kept her furnace on 82 all winter and couldn’t pay rent once she paid the gas.  There had also been new reports to CPS of lack of supervision.  I promised I’d do a thorough follow-up visit and some safety planning.

This afternoon, as I rounded the corner of her new street, I observed two very young children, about age 2, walking hand in hand down the sidewalk by themselves.  Please, Lord, let these not be my client’s children, I thought.  But they were.  Worse yet, my client, who was lying on her couch, realized it a good five minutes later when a neighbor hollered at her.  The kids were several houses down–her two-year-old daughter and a three-year-old neighbor boy.  Why oh why did I, as a mandatory reporter, have to be the one to witness this?  To top it all off, all the neighbors were out on the porches.  It was clear I was a social worker coming to visit based on my car, my clothes, my bag, my language, my gait, the color of my skin.  I didn’t want to make a scene.  I wasn’t there to humiliate my client.

Leaning on the most benevolent interpretation of the situation I could muster, I gave her a gentle reminder to supervise her children.  I figured I would informally update the CPS worker and hope for the best, especially because there were services in place already to address things like supervision. 

My optimistic plan did not pan out.  My supervisor thought I was obligated to do a formal report.  The CPS worker did too.  So instead of celebrating six months of keeping her children, in a few short hours my client will get yet another visit from her CPS worker.  She’ll be informed that CPS is taking her to court to remove her children.  She’ll have to face me, the worker she trusted and leaned on, in the witness box, testifying about the stroll her two-year-old went on today.  And most likely, she’ll lose her children to foster care–the worst outcome possible for her and for my statistics, even if it’s the safest result for her kids.

Touchy Subject June 5, 2008

I have yet to meet a parent who wants his or her child to engage in sexual activity.  In fact, I have yet to find a parent who enjoys thinking about the possibility of his or her child being sexually active.  It’s an uncomfortable subject, and one that creates triangulation for me as a worker.  Under my program contract, I’m required to serve the whole family and address the safety of each member of the household.  When it comes to sexual activity, parents and teens commonly have vastly different approaches to staying safe.  This subject, more than any other, draws on mediation skills.  Sometimes, as was the case with my experience this past week, there is no reconciliation.  I just provide resources and support to each family member and leave it up to each of them to figure it out.

The teen in my Bosnian family was sexually active.  That is, she had sex once with her boyfriend.  She told her mother, which despite the daughter’s protests, says quite a bit about the strength of her bond with her mother.  A firestorm ensued.

When I first brought up the idea of reproductive health and safety with the mom, she appeared open to birth control for her daughter.  She said she was worried about weight gain from pills, and thought maybe a shot would be better.  I was impressed that she was even willing to consider contraception.

It appeared that other issues were more important to her, however.  She asked me more than once if we could run a simulation where her daughter would have to care for an egg baby.  This was hard for me to understand because the daughter had already done this experiment at school.  It was equally difficult for me to grasp what the mother wanted out of such a simulation, especially given that her daughter used a condom the one time she did have sex.  If the goal was avoiding pregnancy, the daughter seemed to be on top of it. 

The mother was very concerned about pregnancy, and she said from the outset that she wanted to get her daughter looked at by a doctor.  The mother, apparently subscribing to some folk wisdom, told her daughter that it was possible that she could have her period during pregnancy.  I could not fathom why this mother of four believed this any more than I could disabuse her of the notion.  I began to suspect that the mother preferred scaring her daughter out of having sex more than conventional, scientifically-supported birth control methods.  But who could blame her?  She’s a mother.

I had separate conversations with the daughter throughout the intervention.  She was floored when I told her initially that her mother said she was open to birth control.  Regardless, we all agreed that it would not be a bad idea to get the daughter checked for sexually transmitted diseases and come up with a safe sex plan.  Given the family’s insurance situation, Planned Parenthood was the financially feasible choice.  The mother said she wanted to go along, and the daughter and I both agreed that this would not be a bad way to provide the mother with some sex education that she apparently missed back in Bosnia.

Thankfully, taxi driver was my only role for the actual appointment.  I waited for about forty-five minutes in the lobby with mom, who was clearly frustrated that she was only allowed into the appointment when the daughter wanted her there.  At the end, she did go in.  Five minutes later she came out, shaking her head and visibly agitated.  Exasperated, she got on her cell phone and began talking rapidly in Bosnian.  I had no idea what had just transpired and was sort of grateful for that.

A few minutes later the daughter appeared, carrying a discrete brown paper bag/safety plan.  Getting into my car, the mother demanded the bag immediately and was clearly infuriated to see packets of birth control pills.  She and the daughter had an escalated exchange in Bosnian.  After a bit, the mother started to explain in English about how pills were very risky.  They made people gain weight.  American doctors don’t explain health risks to clients.  American doctors are terrible.  The American health system was terrible–she went through two horrible pregnancies here to prove it.  I listened and empathized, hoping to bring her down a couple of levels on the escalation scale.  I finally looked each of them in the eye and said:  “you need to do what works best for you.”

Back at the family’s home, I engaged in some of the most disingenuous behavior I’ve ever committed as a social worker.  First I went up to the daughter’s room with her for a minute.  The daughter verified what I had come to suspect all along:  the mother did not really care about health complications surrounding contraception.  She was upset that her daughter was sexually active, and that unassuming brown paper bag brought it all home in an undeniable way.  The folks at Planned Parenthood, God bless ‘em, told the daughter that someone else could pick up another batch of pills if the mother threw them away.  I encouraged the daughter to follow up with them, to do what she needed to do to be safe.

I then talked with the mom.  I explained that Planned Parenthood always provides some sort of contraception for patients.  The parents could talk about it and decide how they wanted to handle the situation.  I empowered each family member to do what they believed was best, knowing full well that it was impossible for each party to get her way.

I have no idea what happened.  I think the parents probably took the pills away, and I hope the daughter arranged to get more.  I think I escaped with my relationship with all parties intact, though only by sending different messages to the various family members.  That felt sort of rotten.  But I think I provided the resources needed to keep the daughter safe, though it meant recognizing an area where the family could not reasonably be expected to communicate well enough to keep everyone safe. 

I have no problem with parents advocating for abstinence.  It is the safest possible route, and it can work well if the teen is on board.  From birth, parents are told they must protect their children from harm, sexual and otherwise.  Mothers who fail to protect their children from sexual predators wind up with CPS cases.  Sometimes they lose their children.  It’s an unnatural jolt for parents to recognize the very real risk of teen sexual activity and suddenly be expected to allow a teen to protect him/herself.  Most of the time, I think a rigid parental expectation of teen abstinence is the only way parents can go to bed at night believing their children will be safe.  A policy of abstinence can become something parents cling to emotionally or spiritually, something they enforce angrily, something that inspires threats of shame, guilt, and punishments.  It can become woefully divorced from reality and completely ineffective in terms of curbing risks such as pregnancy and disease.

Reproductive health is one of a few areas where non-communication is sometimes the reality, though this does not have to prevent safety.  It’s definitely not the best way to handle things if parents and teens have a good relationship, and parents accept that they must cede the responsibility for sexual protection to their teens.  Some families have open, if uncomfortable, dialogue.  That’s a true accomplishment.  For the rest of families, sexuality will involve a considerable lack of transparency.  As inferior as it is to have parents in the dark about their children’s sexual activity, this is usually what happens.  If the communication cannot or will not happen well enough to keep kids safe, my job remains to find other methods to reduce sex-related risks.  Like most parents, as a social worker, I routinely tell teens that having sex is not a good idea.  If the activity is already under way, I do help teens protect themselves, which can involve leaving parents right where they have decided to put themselves:  in the dark.

Adolescents June 1, 2008

Last summer, after starting this job, I attended my high school reunion.  It was a mostly positive experience to interact with old friends and acquaintances.  It was an even better experience to be reminded of what a relief it is that high school is so far in the past.  At some point between my graduation and the present time, I embraced being an adult.  Overall this has been a very positive development.  It does, however, make it difficult at times to empathize with my teen clients.  Having comfortably removed myself from the world of teen anxiety, insecurities, and various social pressures some time ago, I just don’t have much patience for the drama and attention-seeking behavior that often consumes the youths in my client families.  Even though at one time I was just as dramatic, insecure, emotional, and firmly lodged at the center of the universe as the teenagers I now encounter.

I’m wrapping up this case with the Bosnian family and their renegade/American daughter.  As mentioned earlier, it’s been one of my most ineffective interventions to date.  One significant reason is Bosnian/American cultural barriers.  Another perhaps more significant reason is the cultural barrier between American teenagers and the rest of the universe. 

At the end of the day, on some level I have to agree with the parents in this family who are simply astounded by the life American teenagers live.  They observe this extended adolescence–now going deep into the twenties for many young Americans–with extraordinary freedoms granted.  I agree that we raise American teens to expect to be able to come and go as they please, to use the computer and phone as they please, to post what they want on MySpace, to watch and listen to whatever they want, to eat what they want when they want it, to be sexually active if they choose, to participate or not participate in jobs or extracurricular activities as they please, to dress however they want.  At the same time, relatively few responsibilities are imposed before age eighteen:  most teens do not have to contribute to household income or pay for their own clothes, food, gas, insurance, entertainment, etc.  Most have limited household chores, and most are no longer expected to participate meaningfully in family activities.  They basically have to get themselves through school.  So long as they do that, many parents that I’ve observed sort of stand back and hold their breath, and hope to God their kids turn out alright.  I can see how parents from a culture that gives less freedom to teens are astounded and even enraged by these dynamics.  It is a little bit crazy to allow so much freedom and independence, especially when these privileges can hamper instead of help teens to become more responsible, better functioning people.  I admitted to this Bosnian mother that American teen culture is not the greatest.  But it is what it is, and certainly the freedoms and independence in this country allow some young people to develop themselves into supremely high functioning individuals.

This Bosnian mother wants me to force her daughter to remove the daughter’s pictures from MySpace.  The pictures are border line–she’s kissing her boyfriend in them.  There’s nothing overtly sexual.  The mother is horrified for her daughter’s and the family’s reputation.  Her request is typical of two things parents usually want from me:  1) address specific behaviors that the parent thinks are inappropriate (regardless of whether they involve safety risks) and 2) just act like a bigger, badder parent–make the teens do the things that the parent cannot.  Parents are sorely disappointed to find that neither of these agenda items float too well with me. 

Regarding parental desire # 2, I refuse to lecture teenagers about their behavior because I refuse to assume that my values and my agenda are the same as the parents’.  Plus, I will not be around forever, so it’s pretty ineffective to have me be the heavy.  In this case, I don’t agree with the mother that the MySpace photos are that big of a deal, and I’m not going to pretend that I do.  I also refuse to be used by parents to push a specific agenda.  At the end of the day, my job is to build parents’ skills in dealing with their kids, not to hammer their ideas home. 

Most parents assume that they are eminently reasonable in how they deal with their teens, and their behavioral expectations.  They just need someone to get that through to their subborn, irrational, cocky, spoiled, disrespectful teens.  (Hmmm.  If they are so reasonable, why is their approach failing so miserably?)  This is why they start asking me if someone, even if it’s not me, could please send their child to a boot camp or some place that will straighten their kid out.  Teens are not known for the innate ability to show respect, but most parents I’ve met are irrationally rigid in their belief that they are entitled to it.  This brings us to parental desire #1:  changing specific behaviors, often because the parent finds them “disrespectful.”  In my experience, this is the epitome of a cart before the horse reaction.  Parents try to zero in on specific manifestations of disrespect without considering their relationship with their teen, which is usually problematic in a way that is much deeper than disrespect.  By the time a kid is a teenager, it’s a little late to work on specific behaviors.  That’s what sticker charts are for, best implemented starting at age two.  Teens, with their abundant freedoms in this culture, have no good reason to change just because an ornery parent, with whom they have no bond, is trying to assert authority.  But it’s a whole different story if the person asking for a change is someone who has been their stable supporter and champion their whole life. 

I once worked with a young mom who identified the happiest period in her life as her time at boot camp when she was a teen.  It wasn’t because she was such a bad kid and she was so grateful that she learned to respect authority.  It was because it was the first time in her life when anyone provided her with any type of structure, security, and support.  Her parents, drug addicts, had severely neglected her and left her to be raised by the system.  She told me that at age 3, she ingested a whole dime bag of marijuana, baggie and all.  Her parents didn’t take her to the emergency room for fear their lifestyle would be exposed.  It goes without saying that she had no relationship with her parents.  She behaved badly, especially as a teen.  Boot camp cured it, for none of the reasons anybody expects it would.

I try to teach parents of teens how to develop a positive relationship with their teens because I believe it’s the only way to keep kids safe and protect them from the astounding freedoms they receive in this culture.  Sometimes the parents just aren’t ready to hear tips about relationship building when what they really want is someone to yell at their kids.  I don’t deny that their kids are doing some pretty stupid and annoying things.  I just don’t expect the kids to turn off the outlandish behaviors any time soon unless someone they really care about connects with them.  Even then, there will be plenty of teenage stupidity to go around.

With my Bosnian family, the cultural barrier makes the relationship building emphasis all the more difficult to convey.  I have not given up, just stopped preaching, as I so often instruct parents to do.  Instead of teaching communication skills, we just started communicating.  Last week, I forced the mother and daughter to look each other in the eye, acknowledge their relationship, and say they loved each other.  They both started bawling, as did the translator.  We’re not going to build too many skills before this intervention draws to a close, but at least we all know there’s a relationship, and that’s a start.

Strength in Numbers May 29, 2008

About four months ago, we hired a new member for our team, which is designed to consist of five workers, a supervisor, and a secretary.  For much of the time I’ve worked for this agency, our team has included only four workers.  Turnover is high.  Regardless, the team is important.  We meet weekly as a group to exchange ideas and support one another, and sometimes to interview the fifth team member that we just cannot keep.

I like it that we function so well as a group, and that we’re capable of group decision making.  Earlier this year we experienced some conflict, which made me even more proud of the group.  The conflict was about how we wanted to run our weekly meetings–it was mundane, yet we all had a stake in how it came out.  We worked through issues–such as how structured we wanted to be and how long we wanted to talk–with remarkable openness and maturity.  There was no pettiness, no cheap shots, no egomania, no power struggles, no name-calling, no pretending not to be offended when we really were or pretending to be anything we really weren’t.  There was just blessed honesty and a collective desire to work out differences.

This team culture is sort of a sacred thing to me, especially after experiencing large law firm culture.  The latter was shockingly disfunctional in my opinion.  After leaving the law, there was a brief period when I worried for the future of the American workplace.  If so many undeniably brilliant lawyers struggled to maintain a workplace culture that could only be described as tolerable by a kind soul on a great day, what hope was there for the rest of working America?  Quite a bit, as it turns out.  A lawyer myself, I was blind to my own arrogance, which is, I believe, the toxicity that claims the culture of the legal profession.

This is not to say that social work agencies have a monopoly on all aspects of the professional workplace.  Though I embrace my blue jeans and the casual, come one, come all acceptance of social work, I am concerned that social workers are perceived as sloppy.  In fact, I’m concerned that we are sloppy.  Objectively, there is no comparison between the average written product of my old law firm and the reports my agency puts out.  Social workers lose on spelling.  Social workers lose on verbal clarity and logical presentation.  Comparatively, social workers are loosey goosey on getting all the paperwork signed on time, in the right place, by the right people.  The forgiving approach of social workers to  paperwork is troubling when I consider that the consequences that flow from my written reports (e.g., the status of children) are ever so much more significant than those connected with my past legal work (e.g., tax efficient transmittal of private property).  I’ve also been disappointed in social workers’ ability to identify and handle ethics issues responsibly, even though it’s absolutely imperative that we do.  At first glance, social workers even look a little sloppy with our jeans and/or comfortable footwear and/or tee shirts and/or ethnic pride wear and/or long hair growing in various places.  (Though I would argue that as human service workers we dress for our clients, not for professionals in other fields, making our casual clothing most appropriate and even beneficial.)

The truth is that quality control just does not look the same when resources in the profession are so limited.  And most of the time I think my agency does a darn good job of providing high caliber services.  But where is the limit when it comes to compromises in professionalism?  I think I’m about to find out.

As I mentioned at the outset of this post, our agency hired a new worker a few months ago.  She is a wonderfully warm person.  Someone in my agency met her because she is the wife of a pastor, and apparently our agency used their church to hold some community programs.  From the agency’s perspective, the best part of all is that she speaks Spanish.  We have a lot of Spanish speaking clients.  We don’t have money for translators, but we’re obligated to provide services in the language our clients speak.  I believe the agency made a hastier than usual decision to hire her based on the value of her language abilities.

This past week, my supervisor called me into her office.  She said a team is only as strong as its weakest link.  Then she told me that our new hire was really struggling, and she was hoping I would mentor her.  (Details and paperwork are my specialties, which says a little about how low I rate on the social work glamour scale.)  My supervisor isn’t sure if it is because English is her second language, because she’s just now picking up computer skills, or whether there is something else going on, but deadlines keep getting missed.  Keeping track of detailed program requirements is a problem.  Only one cubicle away, she keeps asking me the same questions again and again.  Creative and relatively ineffective organizational styles abound at our agency.  Her chaos beats all. 

I don’t yet know how exactly this is going to play out.  I like my new coworker.  I’m nervous about the responsibility of mentoring.  I feel rotten that our agency sought her out and apparently did not get a proper read on her skills in the first place.  It seems very unfair.  Still, I’m worried about the significant lapses that my supervisor and the rest of the team have observed.  How far will she come, and how far is far enough?  I’ll keep you posted.