Guest blogger Dr. Karl Mack, Senior director of programs for residents with developmental disabilities

This blog is a collection of thoughts based on my experience and perceptions. It also includes valuable insight from various other groups who have taken the time to contribute their perceptions about working with residents with developmental disabilities and to why turnover rates are so high at the front-line of most residential treatment programs.

The young people and adults in our programs, have life experiences that have negatively affected their lives in many different ways. Yet they are survivors, and come to our program with strengths and attributes that define their individuality. 

The people with developmental disabilities who are referred to Ranch Ehrlo Society for residential treatment have a variety of mental health, developmental and intellectual differing abilities. The one thing they share is that they all have behavioural problems, many since infancy. Based on over 30 years of observation and study, it has become increasingly evident that the behavioural problems began prior to the conception of the child. Theories such as multigenerational transmission of trauma, environmental hazards, and wide spread attempts at acculturation and social assimilation have contributed to an understanding of the problem. 

There is also extensive evidence that points to in utero trauma that is experienced by so many of our residents who have mental health challenges with co-occurring severe behavioural problems. People with a history of in utero trauma have brain development anomalies that result in a lack of coping skills. Personal, environmental, and social stressors, have a tendency to push the individual past his/her coping ability.

An individual’s ability to effectively cope with stressors is linked to what we know about autonomic arousal. People who experience life in this manner have been associated with a feeling state - before people see, smell, taste, hear, perceive, or develop a sense of touch, people feel. A sense of attachment, security, belonging, safety, and connectivity begins with a positive in utero experience. 

But for most of the people that our frontline staff work with, the in utero experience has not been positive and results in severe behavioural disturbances, that are very challenging to addresses.  In residential treatment programs, the staff members who spend the most amount of time with the residents are also staff members who have the least amount of training. 

Active listening is one of the skills taught to frontline staff to help reduce incidents of crisis behaviour.  Active listening is a skill that a worker uses to convey an understanding of the person’s feelings, needs, wants and thoughts, and is intended to reduce negative arousal through enhanced security. 

Active listening is a complex skill and in order to be effective, a worker also requires empathy. The ability to understand how someone else is feelings, thinking, or what they need or want, is based on a sincere desire to know or perceive what the other person’s life has been like. 

If a staff member is going to connect with a resident in a way that will achieve an insightful understanding of the individual’s needs, feels, wants or thoughts, then the worker must learn how to feel what the resident is feeling.  The feelings are not pleasant.  They are feelings of distress, anxiety, fear, anger, frustration, aloneness, agitation and uncertainty. 

Frontline staff can enhance the therapeutic effectiveness of their relationship by conveying to the resident that they understand. This level of understanding brings about a relationship that starts the process of healing broken bonds. But to feel this way, and going through the process of learning to feel what someone else feels, is a process that takes a lot of guidance and support. There is the risk of staff becoming traumatized if they do not have boundary preparation.  

There are several factors that contribute to the high turnover of frontline staff, and all the variables need addressing.  One variable is the premise that staff are not prepared to feel the way they need to feel in order to understand the residents.  These highly charged negative emotional states are very stressful, and rather than gain the insight needed, they choose to look for other types of employment. 

One way to address this challenge is to better define the stages of relationship development so new staff can understand what to expect. In my next blog I will better define the model created.