Sunday, December 05, 2010

Working with Regulatory Agencies

Providing treatment for children in a congregate care setting is a complex job. There are so many parts to what we do, and we are constantly on the edge of disaster. Thank heavens most of the things that could go wrong don’t. But the behaviors are so dramatic and life threatening, the staffing so stretched, the tasks so many, and the stakes are so high. Every day includes many many interactions with the children, designed to help them get through the day, change and improve, have fun and relax, or just manage life. In addition we have all the physical care of our living spaces. We provide everything necessary to raise the children, from food, clothes, supplies and living space to medical care and education. We must document everything we do following regulations of various agencies and accreditation bodies. There is so much to do on a given shift!
Sometimes things do go wrong. These can range from egregious, deliberate wrong doing, to mistakes of omission by a harried staff, to errors in judgment, to just plain accidents. When something goes wrong, we are often visited by representatives of regulatory agencies. It is their job to investigate what happened, make sure that the care being provided meets acceptable standards, and make suggestions for improvement. It is essential that such agencies exist and that we maintain oversight of the care that is being provided to children.

However, I wonder if it would ever be possible to apply what we know about how people change to the relationship between regulators and service providers. I believe that care would be improved by maintaining a RICH© relationship between the regulators and the agency staff. RICH means treating each other with respect, sharing information, establishing and maintaining connection, and creating hope.

In the situation in which a basically sound agency did something wrong such as inadequate documentation or imperfect handling of an incident, and therefore needs to improve in some way, what actions on the part of the regulators would make improvement most likely to happen? I think that if the agency felt understood and respected, had information about better ways to do things, had a relationship with the regulators and felt hopeful about the possibility of change they would be most motivated to strive for excellence.

Both the treatment agency and the regulating agency have a common goal: providing excellent treatment and care for children. One essential component of the agency’s ability to do this is retaining committed, enthusiastic, hopeful staff. The work itself makes this difficult, as staff working with these children and families experience significant vicarious traumatization from the pain they share with the clients. If the staff feels constantly criticized; if they feel that nothing they do is ever good enough; if their good work is not noticed or appreciated; if they have to spend large parts of their time in meetings explaining what they have done; and if they feel that there is no way to win this vicarious traumatization is compounded.

In our training we stress that there are two sides to a relationship. If we feel that the relationship is our main tool of healing, we must pay attention to both sides. The staff cannot offer a caring relationship to the children if they themselves do not feel cared about and well treated. Just as it is crucial how agencies treat their staff, it is equally important how the staff is treated by the surrounding community. If the staff begin to feel that there is no way they can succeed within the child welfare system; if they experience constant criticism and no recognition, they will feel hopeless. And hope is a crucial component of our work with the children, who are often hopeless themselves.

So how could this be different? First, it would help if outside agencies instituted a method of praising and recognizing the hard work of treatment staff, and called meetings to convey positive impressions at the least often as those for negative issues. Another important factor is the attitude of inspectors when they are in the agency. They, too can mention good things they see and want to encourages, as well as acknowledging the hard work of individuals. They can express appreciation for extraordinary efforts, and display understanding of the complexity of the work.

Agency staff expects correction and suggestion, and is usually eager to improve. This can be offered in a spirit of respect and mutual desire to improve the lives of the children. And when changes are made, they can be acknowledged and celebrated by both agency and regulatory staff.

In short, it would be great if we adults treated each other in the way that we are advocating treating the clients.

What are your experiences with regulatory agencies? Has anyone had good, mutually respectful relationships you can share? Click “comment”.

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