Supporting the needs of caregivers improves staff capacity to deliver effective interventions.
By Dale H. Saul and Brenda Jones Harden
Dropping her keys and heavy toy bag on her desk, Alissa heads toward her supervisor’s open door. Sticking her head in, she asks, “Got a minute? I was just at Keisha’s—-”
“How’s she doing?”
“Never got off the couch, just like our last three visits. Jason came over with a book, and she pulled a pillow over her head!”
“And you’ve been trying so many things. Is the mental health specialist still here? Would you want to see if he can join us?”
Maria has worked in the Panda classroom only five months. As the staff meeting begins to wrap up, she hesitates, then raises her hand. “I know I talked about this last time, but it’s Julia’s bottles again—sour, twice this week. Her mom was so apologetic when I talked to her, but nothing’s changed. …”
“Maria,” another teacher says, “Why don’t you call me next time her mom comes in? Her son’s in my classroom. Maybe we could talk with mom together.”
Scenarios such as these underscore the challenges Head Start and Early Head Start (EHS) staff face, as well as ways they can receive informal and formal support in their work.
When staff reach out to families, they count on relationships to open the door to conversation. Ideally, families see staff as informed, helpful professionals. For staff to build and maintain these relationships, their own needs must also be met. This is especially true when addressing parents’ mental health needs and crises.
How do we nurture caregivers who support high-risk families with young children? The first step is to identify staff’s general and individual needs. The second step is building a strong organization, not only to ensure that program missions are achieved, but to provide a healthy environment for staff. The last step is implementing strategies that provide ongoing nurturing experiences for staff.
Needs of Caregivers
Stress management. Serving high-risk families can be hard work. In this high-stress
environment, some staff may experience stress-related health problems, such as bad backs, migraines, and high blood pressure. For some staff, securing time in a busy schedule to address work stress, time management, and accountability can improve their productivity and availability to families.
Setting Boundaries. Passionate about the well-being of children, staff often have years of experience in community child care agencies. Some EHS and Head Start staff had their children in the program; most are women. Head Start emphasizes having staff who are representative of the community. While this emphasis facilitates participant engagement, it may also contribute to the difficulty staff encounter in maintaining appropriate boundaries with the families they serve. Issues can arise when staff, who have strong feelings about what worked and what did not in their own lives, encounter families with similar issues.
Professional Development. Many caregivers have not had mental health or family studies training. They may require specialized training and consultation to understand how a child’s overall development and social and emotional health are impacted by a parent’s mental health.
One home educator said after a training on depression:
I appreciate the mental health stuff ‘cause I see so much of it with my families—it looks normal, but it’s not. Now I see it’s not just poverty, it’s what’s keeping them where they are—or what got them there in the first place (EHS focus group, University of Maryland 2004).
Healthy Relationships
A major goal of Head Start programs should be enhancing staff’s capacity to serve families and children in the healthiest manner possible. What does a caregiver in a healthy helping relationship look like? The caregiver—
- Recognizes when issues are too close to home; knows when to step back and take a neutral stance with a distressed parent
- Understands his or her role with families and prioritizes the goals of the parents regarding their children’s development
- Listens actively instead of jumping in to “fix”
- Offers information but not advice
- Collaboratively problem solves with relevant, open-ended questions
- Acknowledges that each parent—not staff—is potentially the ultimate expert with a child
Supportive Environment
How can organizations provide a supportive environment? In the relationship-based organization, relationships among staff and between staff and families are based on trust, empathy, and responsiveness.
Organizational Structure. Regular staff meetings and supervision enhance staff’s connection to the agency and their internalization of the organization’s service mission.
Clearly defined agency expectations (mission, goals, job description) are essential for staff to know their jobs and improve their skills. The pay-off for revising organizational structure, practices, and goals to support staff is in the parallel process. Experiencing support from peers and supervisors enables staff to support families more effectively. Parents, in turn, can then support their children through trust, empathy, and responsiveness.
Reflective Practice. A key element in parallel process is reflective practice, which can be achieved through reflective supervision at all levels of the organization. Reflective supervision moves beyond staff accountability and case management. It provides the opportunity to slow down and review events and dynamics in a non-crisis mode. It can be “a bubble of peace in a crazy work week” (EHS focus group, University of Maryland 2005).
Through reflective supervision, staff can become more attuned to child and parent psychological functioning, address their own boundary issues, and think about how they can best promote positive child and family development. Staff can explore the impact families and children have on them and the impact they, in turn, may have on families and children. Working reflectively helps to address the recurring challenges families present and “face the unthinkable,” such as suspected child abuse, neglect, and domestic violence. (For more information on reflective supervision see the Steps to Success Unit 3: Reflective Practice Mentor-Coach Manual available at the Early Childhood Learning and Knowledge Center at http://eclkc.ohs.acf.hhs.gov/)
Resources. Successful intervention with high-risk children and families requires the collaboration of many service providers. Head Start staff should always have an up-to-date referral list, screened by the supervisor, in order to feel confident in making referrals. Consultation from a variety of disciplines (e.g., disability, employment) is important to appropriately address family and child development. In particular, staff need ready access to a welcoming mental health professional who can provide guidance to staff on young children’s behavioral and emotional issues and on parental mental health.
Staff Training. Training should focus on specific competencies for a particular job as well as specialized areas, such as maternal depression. Training is enhanced if it is experiential and concrete, occurs in a small group, and utilizes multimedia formats (such as videotapes of staff working). Information and skills acquired through training can be sustained only through ongoing mentoring, supervision, and professional development. Importantly, opportunities should be created to enhance and share professional knowledge through informal and formal peer interaction.
Strategies for Nurturing
What are specific ways that management can nurture the nurturer?
- Incorporating workshops on stress management and self-care, physical exercise and psychological healing into staff development, promotes general well-being. Mental health consultants should be available for addressing staff concerns and experiences that could affect their work.
- Adhering to safety protocols shows acknowledgment of the risks staff face and their importance to the agency. For home visitors, there should be a system for knowing where staff are, accompanying home visitors to new families, and assigning teams, rather than individuals, to work in more dangerous communities and with more difficult families.
- Providing “mental health days” as part of leave acknowledges the difficulty of dealing with job stress and simultaneously encourages more appropriate use of sick leave.
- Acknowledging staff effort and sharing examples of expertise in supervision during staff meetings, in newsletters, and to funders, demonstrates to staff that what they do is valued. Having a journal or box where staff accomplishments are recorded and shared encourages managers, supervisors, and peers to document staff’s positive interactions and interventions with program participants.
- Conducting periodic “retreats” away from the agency provides an opportunity for staff to reflect on their work, get recharged, and reconnect with the overarching mission of the agency.
Summary
Enhancing Head Start’s capacity to address the mental health of participant children and families is rooted in the support of their caregivers, the front-line staff. Understanding and addressing their needs promote the parallel process that facilitates their responsive intervention with families and children. An emphasis on staff nurturing within ongoing professional development and organizational activities improves staff morale and staff capacity to deliver effective interventions. Applying these principles enables Head Start programs to move closer to their mission to enhance the overall development of children and families.
Dale H. Saul is an infant mental health specialist in the Family Based Recovery program at the Yale Child Study Center in New Haven, CT. T: 203-785-7822; E: dale.saul@yale.edu
Brenda Jones Harden is an Associate Professor at the Institute for Child Study at the University of Maryland in College Park, MD. T: 301-405-2580; E: bjharden@umd.edu
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