The Holiday Monster

Everyone who works in a congregate care program knows that there are more behavioral problems during the holidays. The escalation usually starts around Thanksgiving. We explain it to each other: “you know, it’s the holidays.” Yet have we taken the time to look at the components of the holiday experiences of our children, and from that understanding plan how to best support them during this time?

Memories are a central part of the holidays. For our children, both good and bad memories can hurt. If they have warm and caring memories, they feel sad and angry that they are no longer with their families. Many children also have painful holiday memories of fights, alcohol, abandonment and other types of pain. These become vivid as the holiday season approaches.

We are all surrounded with media images of what the holiday season is supposed to be. On Christmas or Hanukah you should be surrounded by loving family and friends, eating huge piles of delicious foods, and opening wonderful gifts that change your life forever. It’s not just that our children’s holidays do not fit this picture. It is the meaning they ascribe to that difference. What does it mean about me that I have no family, no feast, such a different holiday? There is an underlying message in the media that suggests that if you do not have these things you are a loser and it is somehow your own fault. Our kids are prone to thinking everything is their own fault anyway. So holidays are not just disappointing, they are one more source of shame: I must have done something terrible because I am the only child in America that is not having a happy day.

Then there are the gifts. Many places like ours are inundated with generous donations during the holiday season. We receive more presents than our children can possibly use, and we save some for distribution throughout the year. The kids get to ask for specific presents, and then get many more they do not choose. So they should be happy they are getting all this very nice stuff, right?

But what is this gift receiving experience like for our children? They know the gifts were not chosen by someone who knows and loves them. They know that people give gifts out of sorrow and caring about their plight. They may receive gifts from family; they may not. Often the donated gifts are more than their family could afford. What does all this feel like? It is wonderful that people donate gifts and it means a lot to the child that receives them. Yet, there is a hollowness, a disappointment, because the gifts are not the same as love.

A child may build up expectations around the holidays. Maybe my mother will finally come and visit. My father said he would send me a video game. Often, these are disappointed. Luckily, some children are able to spend time at home. In fact, we facilitate them going home if it is at all possible. Sometimes our wish that the child be at home for this one important day may even overcome our common sense. So a child who has not gone home in a long time does, and may or may not have a good visit. Either way, it evokes a lot of complex emotion.

Then there is the inevitable let-down. The holidays are over. Nothing has changed. My life is still the same and I still have no plans for my future.

So what can we do to help our kids with this holiday season? The most important thing is to validate, rather than try to cheer them up. It might be helpful to share that there are many people who do not have a picture perfect holiday. And to acknowledge that gifts from strangers feel different from gifts from families; and that it sucks to be stuck in a residential at Christmas or Hanukah. Give them an opportunity to talk about their memories of past holidays, good and bad. Talk about their feelings about their families, any contact they are going to have, anything they are going through. Don’t try to point out the good things- at least not at first.

Another thing to watch out for is over-stimulation. In our efforts to offer many treats to our kids we can ignore the fact that too much good stimulation can be overwhelming to them. Getting over tired reduces their already limited coping ability. Lots of noise and activity can wind them up and they do not know how to calm down. For some kids, a low key mellow celebration might be best. If there are parties, make sure to alternate them with down time, time to relax, talk about what you are feeling, and to engage in quiet activities with people you know. Remember that strangers are scary to some of our kids. It is easy to underestimate how stressful it may be for certain kids when members of the public attend agency events. Will my abuser be one of them?

Schedules and predicting what is going to happen, where it will be, who will be there, how long it will last is helpful. Also predict any stressors or issues that might come up. The child may dismiss what you say, but it can still be helpful when the event happens. Involve the child in planning for success. Is there a signal he can give you if he has had enough at a party? Will it help if he sits next to you, or brings his stuffed animal, or takes a nap before the party? Remember in doing this you are not only helping the child with this particular event, you are teaching him a method to anticipate and conquer stress which he can use throughout his life.

The adults caring for the children are also often stressed out by the special demands of the season and the pressure to do more, plan more, accomplish more. They may be experiencing their own holiday stress outside of work. And on the actual holidays themselves, the children may be cared for by part time staff they don’t know as well. Furthermore, we experience vicarious traumatization from participating in the childrens’ pain. It can feel especially sad to see children managing without their families through the holidays. Anything we can do to support each other and acknowledge the pain to each other will help us offer regulation to the kids.

Most importantly, watch and listen. Pick up early signs of stress. Give the child plenty of time close to regulated adults, when he can talk, be validated, and just be connected with someone who cares. After all, isn’t this really what we are all looking for during the holidays?

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”.