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

The work contained in this blog is related to the thoughts and experience of senior frontline staff who work with residents who have developmental/intellectual differing abilities. The group consisted of program managers, clinical support leaders, youth care leaders, and personal support leaders who were divided in five groups.  They were asked to think about their personal experience and asked to reflect on their experience as new workers and the process they went through in the development of relationships with their clients. 

Six stages were identified to help new staff working in Ranch Ehrlo’s programs for people with developmental and intellectual differing abilities.

Stage 1   - Pre-contact anticipation/feeling out

Staff at this stage of relationship development experience fear, tension, anxiety, uncertainty, intimidation, and feelings of being overwhelmed. They also experience excitement, enthusiasm, motivation, and empathy.  Staff are gaining in self awareness, taking in information, looking for role definition, and starting to develop attachments. They want residents to share in the relationship, see the need for a “master plan”, and experience testing with other staff and the residents.

Stage 2 - Testing

Staff begin to develop relationships, understand boundaries, develop strategies, consider work/life balance, develop an awareness of safety issues, and start to learn how to deal with someone in crisis. At this stage curiosity increases, staff are wanting more information, are more accepting of the role, and learning to set boundaries. They also have motivation, a willingness to grow, and a more concrete understanding of the job. An awareness of safety issues is starting to develop as are communication skills, an understanding of the program’s philosophy, mission and mandate. , Although there may be some denial, feelings of manipulation, questioning of behaviour support techniques, a lack a complete empathy or understanding of residents,  and unnecessary conflict cycles (win-lose situations),  they are getting to know the rules, feeling things out and getting to know the procedures, policy , systems and routines.

Stage 3 - Crisis attachment

Staff are reliving their own trauma, being tested by the residents, start dealing with disclosures, and are experiencing anxiety prior to work based on knowing the residents better. At this stage the worker is more prepared to implement behavioural support,  solidifies commitment to job/profession, accepts and understands role definition Their comfort level increases, they start making decisions, establishing boundaries, they understand the safety related issues, start to develop memories with residents, and build professional and personal relationships with staff.   Although they can experience relapses, have burn out feelings and an “I can’t do this” state they are getting better at  establishing boundaries, have better awareness, are willing to take initiative, and are developing a personal style and approach.

Stage 4 - Settling stage

At this stage staff become more comfortable in relationships and the role, the rapid daily relationship cycles slows down, long-term planning begins, and there is interest in long-term employment. Reciprocal care from clients about the workers own life circumstances evolves as does , self-awareness, confidence, realistic expectations, and their ability to regulate emotions.  Staff are becoming valued by the residents and respected developing a higher level of empathy and understanding, learning to be in the moment, and have an increased understanding of being a team member.  They begin to understand the environmental setting/personal setting conditions, understand predictability and the importance of routines/structure, learn to not take things personally, and have an increased understanding of the clients feeling, needs, wants and thoughts. Further they have an increased level of emotional competence, are establishing positive memories with the residents, developing a tool box/ strategies to work with residents, becoming more individualized to residents personalities, are more proactive and  starting to see the bigger picture.

Stage 5 - Plateau stage

Staff have an increase in confidence, abilities, and level of comfort.  The testing continues but its severity lessens. The challenges and major obstacles lessen, work setting becomes solidified and a family type relationship develops. At this stage staff  become teachers and role models, , understand personal/professional growth, and are better able to gauge responsibilities. They start to have a sense of enlightenment, more consistent positive energy, understand the rhythm of the team, have a willingness to deal with confrontational behaviour and interventions, and help residents address thoughts, feelings, needs, wants and behaviours that are out of their comfort zone.

Stage 6 - Growth

Staff experience reciprocal relationships, become aware of their own personal triggers, continue to build confidence in skills, and develop strong relationships with individuals and the group. They integrate training into skills and have an increased understanding of resident needs, have a work/life balance, and are thinking ahead about events on shift with accuracy and confidence.  Further, they continue to develop leadership skills, have an increased understanding of residents needs, have increased ability to use a variety of communication strategies and relating skills, and have a competent understanding of safety issues.

The work of front-line staff in residential treatment programs is some of the most important work that gets done.  Many of the staff coming to the profession of youth /personal support care have no previous preparation. As a result, organizations are required to do a lot of front-end training while engaging in their day-to-day responsibilities. The most important of those responsibilities is the task of engaging the residents in therapeutic relationships.  Hopefully this blog will provide some assistance to new staff in the process of moving an encounter into a meaningful relationship that results in reciprocal growth. 

In my next blog I will discuss other factors new staff face when dealing with our clients.