I completed a 700-hour clinical practicum from April 8 to August 13, 2019 as a child care counsellor at Maples Adolescent Treatment Centre, Crossroads Program/Unit, which is an eight-bed forensic unit for adolescents who have been found “Unfit to Stand Trial” or “Not Criminally Responsible by Reason of a Mental Disorder” (NCRMD) and are in custody as determined by the BC Review Board. During my practicum, I have encountered such a diverse array of experiences, participated in interdisciplinary meetings, and attended workshops and activities that have contributed towards achieving the objectives I laid out for myself in my learning contract. In addition to describing my learning progress to-date, this paper examines mental health work, as well as the field of social work, through an intersectional lens. Moreover, the essay writer paper concludes with my personal ideology, practice strategies, benefits and critiques for working from an intersectional standpoint.
The first objective of my learning contract was to apply social work ethical principles to guide my professional practice in interactions with clients as well as other clinicians. In every interaction, it is important to reflect on whether my actions, words, and manners align with social work’s values of service and social justice, as well as providing self-worth and dignity to the youth/clients, emphasizing relationships, integrity, confidentiality, and competence of my ability (CASW, 2005, p.5). At the beginning of my practicum, my supervisor told me to read the Maples policy binder, which provided an in-depth description of maintaining confidentiality and establishing professional boundaries, and also noted the values of dignity and worth of the person, which reflects the Social Work Code of Ethics. One of the greatest ethical challenges I encountered was setting professional boundaries; for example, when a youth asks for a hug. Per the policy, Maples staff are not allowed to provide a full hug. It was a dilemma between setting boundaries, and worrying that the youth may get hurt and feel they are not worthy. Oftentimes, when a youth asks for a hug, I provide a side hug with one open arm. As I got to know youth better, I let them know that I will give them a side hug because it is the “Maples hug” to make them feel special.
Another social work ethics-related challenge I encountered work on the frontline as a child care counsellor was providing a safety net to make the youth feel safe, trusted, and secure. I utilized active listening skills and empathy in interactions with youth, understanding that their social history has a profound impact on building relationships and feeling safe again. However, in retrospect, I believe that my bias led me to passively listen more than engage in further conversation as I had my own preconceived notion of “forensic youth” as being aggressive and violent. At the Crossroads unit, youth with a history of aggression/violence are marked with a purple sticker on their room number. Although this is done for safety reasons, I found that labelling youth unconsciously influenced my mind and caused me to be hyper-aware and cautious. Now that I have learned to build rapport with youth on the Crossroads unit, I am comfortable starting conversations and even making jokes with them and just sharing space with them, letting them know that I am available if needed. It was important for me to reflect on my personal biases and trace back in my mind whether I may have impacted the relationship with youth because preconceived biases were unintentionally reflected in my behaviour or actions. Discussing with my supervisor and identifying how biased beliefs can impact power differentials or dynamics has been an important learning throughout my practicum placement.
My second learning objective was to further develop my communication skills with youth. Through active listening and short conversations (for example, about likes and dislikes), I have been able to get to know the youth more and help them feel “seen” and valued. In order for them to feel safe around me and build rapport and trust, the youth also need to know more about me. I have been shadowing my supervisors and staff members to learn how they practice communication skills with youth. Oftentimes, they are providing active listening skills, engaging and paraphrasing as needed to validate their voice and expression. Learning from their examples, I use verbal and non-verbal cues to guide my interpretation and also ask my supervisors for advice when I am stuck. Overall, my communication skills with youth has progressed well during my four months of practicum because I try to interact with youths by establishing rapport and advocating for them when they ask to speak with social worker or have requests. I first paraphrase their request, not only to confirm that I am understanding their request, but also to assure them that I will deliver the message for them; doing so promptly and accurately effectively allowed them to trust me.
Another way to challenge myself to develop my verbal communication skills was through presenting at the clinical meetings with interdisciplinary health professionals present, such as child care counsellors, nurses, program coordinator, psychiatrist, psychologist, the Manager, and the Director. I presented one of the youth’s weekly progress report, noting about their vocational, health, safety, relationships, and any request they have put forward. At the beginning, I was nervous to present in front of many professionals; however, it helped me understand how important it is for social workers to be involved in interdisciplinary meetings, because oftentimes, social workers work with multiple players, including other health professionals as well as the community team. My supervisor also guided me step-by-step, providing good advice such as how to word it concisely due limited time, what is important to mention, and what could be summarised together. I felt this process helped me grow my awareness of how to present the case in a strength-based approach, while also delivering some of the challenges the youth struggles with. Nonetheless, it was a good learning process for me, as I have been attending the clinical meeting for months. For me to actually present the case allowed me to experience firsthand the procedures of writing up the weekly clinical form, presenting in front of other health professionals, and learning different perspectives of their beliefs, values and awareness.
My third objective was to learn more about the assessment process. After two months of shadowing other staff members, my supervisor asked me to start writing progress notes following my interactions with youth. My supervisor kindly explained the procedure to first review and read past progress notes/ SOAP notes written by other staff members and then describing what each abbreviation stands for and providing examples for each box. S stands for Subjective Data, O stands for Objective Data, A stands for Assessment and P stands for Plan. First, Subjective Data refers to clinically-important statements made by youth during the interaction with the child care counsellor that are important to note. According to my supervisors, these statements may refer to feelings, thoughts, actions, and concerns; therefore, the statement has to be clinically-relevant and important to be noted. I am not allowed to assess or interpret statement in this box. The next step, Objective, is where I enter my observations in factual and observable terms without interpretation; for example, writing about their behaviours, facial expressions, physical appearance, hygiene, whether they were tired alert, and actions or activities they were involved. After this, Assessment part is where child care counsellors document their interpretation or understanding of the S and O data. For example, if a youth is smiling and talking a lot about the activity they are soon going to partake in, I would write about my insights to their behaviour and feelings, noting that the youth appeared excited and happy to participate in outings with staff members and other youth and elaborate on any additional information that would help the team understand their progress. Plan is where the progress is being evaluated, where counsellors document the next step of the treatment or progress. I often enter “continue to monitor and support the youth” under Plan if there are no specific goals or treatment to be noted. Overall, my assessment planning has improved compared to the beginning as I practice more and get more familiar with terms and definition. I now feel competent in assessment skills, and the process has also helped me to better understand the youth’s needs and wants, their likes and dislikes, and to get to know them better.
My fourth objective was to learn skills to de-escalate agitated clients by reading the client’s safety plan assessment and observing how my supervisor interacts with youth. I have learned the importance of giving youth some space or alone time to de-escalate situations. I have also had the opportunity to shadow and work closely with a social worker at Crossroads who has taught me an important lesson, that the success of social worker is building strong relationships with the youth, the family, and the community to help the youth reintegrate back into the community with all the necessary support, tools, and resources. I have seen firsthand the social worker’s role of bringing interdisciplinary professionals together, and wearing multiple hats as a moderator, liaison, and advocator to reduce communication gaps. Like the social worker, personally and professionally, it is important for me to always preserve the dignity of any individual I work with; therefore, the de-escalation tactics of stepping back, providing enough space, and being attentive to their needs acquired from my supervisors and other staff members have been useful and relevant. I have learned to use verbal methods to let youth know that it is okay to take space rather than physical interventions, which I believe should only be used when there is imminent danger to self or to other people. Additionally, I completed a mandatory training prior to the start of my practicum placement that taught skills and strategies to prevent and effectively reduce escalation and negative situations that may pose a threat of harm to self or to others. For example, an incident occurred where a youth reacted aggressively towards a male staff due to a misunderstanding. At that moment, two staff members were using MANDT hold to de-escalate, and as soon as the youth calmed down, the staff disengaged and stepped back to give her space asked her to go to her room and take some space. In spite of what happened, the youth was stable to come out to the common room after 30 minutes. This indicates that oftentimes youth need a break from stimulation and the environment that they are surrounded by. I have learned that it is okay to even disengage in conversation to provide youth with space and silence to de-stimulate.
My fifth objective was building confidence in setting boundaries. This has been the hardest practice thus far. As a child care counsellor, oftentimes, youth request my assistance with getting food, snacks, playing, letting them in and out from the unit, watching TV, and asking questions that may seem transactional in requesting to meet their needs. One good example in which I was challenged occurred when a male youth asked me if he was allowed to go to school. Due to low staffing and since I am not an employed staff member, I do not have the authority to take the youth to school (despite the school being in the same building); therefore, I informed the youth that I would check with the shift head to see if another staff could take him to school. The youth was seeking to hear a clear “yes or no” answer; instead, I said, “I’m not sure… maybe not at the moment,” which is ambiguous for an individual who prefers black and white answers. Therefore, the youth got irritated at me. Luckily, another staff member was at present when I had this conversation with the same youth. After I returned to the office, she provided a really good recommendation that for next time, I should be more concrete on my answers by saying “sorry, we don’t have enough staff at the moment, so we have to hold off your outings to school until we sort out the staffing.” This helped me a lot in terms of understanding how to approach youth as a child care counsellor and how it is necessary to be firm and assertive at times. After debriefing with the staff member and encouraging me to try it next time, I learned to re-direct the conversation to another topic as appropriate, tell youth that they would need to wait until I am available to help, and send out a clear message to set boundaries around what is appropriate in terms of the policy and rules, and to convey these messages in a pleasant tone and calming demeanor so as not to intimidate youth but to let them know firmly the boundaries.
Have someone “Write My Essay,” here.
My sixth objective was to practice self-care to reduce burnout from work throughout my placement. This also has been a very challenging aspect. At the beginning of my placement, I found myself exhausted from my shift and would go home, intending to take an hour or two nap, which would turn into an eight or longer sleep. Eventually, I realized it was not helping with my mental health or the way I felt at work since I would get tired due to over-napping and not getting enough sleep at night time. So, instead I started coming home and working on weekly journal entries to enter my learning progress in different activities I have partaken at Maples, reflecting on my own behaviour and assessing my work as a child care counsellor. After beginning to write journal entries, I felt better about my practicum placement and got more motivated to engage in self-care to reduce burnout. I also learned from the SLWK 4022 Practicum placement that self-care is a neoliberal notion imposed on the population in order to be effectively profitable in market by going out for a spa day or treating ourselves with food, items, materials, and goods. Therefore, I realized instead of being the consumer, I decided to partake in self-care where I am contributing my knowledge back into the community and assisting people and influencing in a greater space (mezzo, macro) by working on a non-profit organization grant proposal that my friend and I compiled together. The proposal is to provide mental health awareness to youth in high school through fine arts, psychoeducation, writing and creative ways, since there has been a great link between creativity and mood disorders (e.g. bipolar and major depression). This has not only created passion for myself and my friend to be active and served as a self-care tool to heal from our burnout, but also could bring a potential project to fruition that could bring out the inner creativity of people with lived experience of mental health and education.
My last objective of my learning contract was to use critical thinking to help guide my practice and reflect on the agency’s values and beliefs. The Maples values, goals, and objectives, are to “[improve] outcomes for children, youth and families through accessible, safe and appropriate services” (citation from Maples); in addition, “youth who are in conflict with the law or who have significant psychiatric and behavioural difficulties will be supported through an integrated, multidisciplinary trauma informed approach” (citation from Maples). From reading the policy book, I noted that Maples uses attachment theory, strength-based approach, and trauma-informed approach to combat many destructive factors (such as the behaviours of adolescents), to intervene with adolescents who have experienced intergenerational trauma, neglect, sexual and physical abuse, and abandonment with a safety net by maintaining secure attachment relationships with staff at Maples, as well as ensuring a balance of empowerment through decision-making, activities, autonomy, and setting boundaries (Morton, et al., 1999). The important aspect for intervention, which is also a goal at Maples, is to, first and foremost, provide and demonstrate supportive, healthy, and positive relationships with staff, peers and family. As a student, I was consistently reminded to demonstrate pro-social relationships because of the youth’s traumatic history of abuse and lack of primary caregivers in their lives in the case at Crossroads Unit.
After reading the values, goals, and interventions that Maples strives to deliver, I was able to identity how social work values and ethics align with Maples. For example, oftentimes, the social work emphasis is on a psychosocial approach instead of medical approach. Although we have psychiatrists and doctors at Maples who make medical decisions via the medical model, they also simultaneously vocalise the importance of incorporating a cultural agility model into assessment and the youth’s care plan. This is especially important because Indigenous people account for 100% of youth at Crossroads Unit, which is indicative of their overrepresentation in the legal system, social services system, and health care system (Statistics Canada, 2010). Maples employs a holistic approach, such as having Indigenous awareness workers at Maples partaking in round table meetings or sitting in circles when participating in meetings to make it more interactive and connect with one another to learn about Indigenous practice, knowledge and art. This is an important step of empowering youth with their heritage. Maples also provides cultural training to staff members to further help all members and multi-disciplinary health professionals, with the local First Nations community Elders and other individuals coming together to enhance the youth’s life by sharing about different cultures and having an open discussion instead of resistance. Overall, shadowing the social worker, and child care counsellors I have learned that our values, goals, and ethics align for one reason: to provide a safety net to youth. Maples has come a long way to implement changes and to incorporate more cultural awareness activities—including smudging, drumming, medicine picking, Aboriginal dance performance and more—to incorporate Indigenous cultural aspects into the care plans. Culture is an essential part of youth’s identity; so, in order to empower them, we also need to appreciate and acknowledge their cultural and engage with them in ways that make them feel heard and valued.
Definition of the Framework and Theoretical Exploration
Intersectionality is a framework that seeks to provide an understanding of people and their experiences in the world as a way to provide a framework for analyzing the complexities of human life (Collins & Bilge, 2016). Under this framework, social identity is understood as being made up of a wide range of different factors, which include the individual’s gender, race, ethnicity, socioeconomic class, ability and sexuality (Wilson, 2013). These factors are interconnected with one another and operate in the individual’s life simultaneous to one another, which, in turn, leads to the development of experiences that can lead to privilege or oppression for the individual (Wilson, 2013). The framework was first introduced by Kimberle Crenshaw in 1989 before the theoretical framework was expanded in her work in 1991 to explore the vulnerabilities that existed for women of color in disadvantaged communities (Carbado, Crenshaw, Mays, & Tomlinson, 2013). Today the framework is used as a way to explore oppression within social systems and to highlight how the factors associated with social identity impact the individual (Wilson, 2013). The framework is also used as a way to identify the oppressive social systems in place in society that organize social hierarchies and allow power to be maintained by privileged groups (Wilson, 2013).
Influence of the Framework on the Field of Social Work
Intersectionality is highly relevant to the field of social work as it provides a deeper understanding of how the individual’s social identity is impacted by a wide range of external factors. Social workers must be able to recognize power imbalances that exist in society that lead to the oppression of minority groups. Approaching this work through an intersectional lens allows social workers to more accurately address “the impact of racism, other forms of oppression, social injustice, and other human rights violations” (NASW Press, 2015). Through the use of intersectionality, social workers are able to gain a better understanding of the total human experience and better meet the needs of minorities and minority communities (NASW Press, 2015).
Rationale for Selecting the Framework
The framework was selected as a way to better understand the complex needs of forensic youth and minority communities. Youths at Maples Adolescent and Treatment Centre (MATC) are directly affected by social structures and hierarchies of power within society, and none of the factors that impact youth are independent in nature. Social identity for the individual is based on a wide range of factors, all of which contribute to the individual’s personal lived experiences. To be able to understand those experiences, it is important to be able to accurately identify where oppression stems from and how it interacts with other social factors. Intersectionality also allows the practitioner to address external issues facing clients and provides a strong framework for addressing oppression by focusing on systemic issues in society that impact the individual.
How the Framework Relates to What the Learner Has Learned in Placement
Throughout my placement, intersectionality has provided a method of guidance when working with individuals of all backgrounds. Prior to my work at MATC, what I knew about custody came from what I had seen on TV. The framework has been especially helpful in guiding my practicum work as a child care counsellor with disadvantaged minority populations, forensic youth in particular, by learning to recognize social discrepancies and how to pay attention to the impact they have on the individual. The majority of my work during my practicum placement thus far has been focused on working with Indigenous forensic youths in custody who not only have histories of criminal conduct, but also suffer from larger systemic problems associated with intergeneration trauma, lower socioeconomic status, and have faced racial/ethnic bias within society that has contributed to their overall social identity. Not only are the traumas experienced by these youths highly complex and stemming from a number of different factors, but they often suffer from mental health issues, use self-medication as a coping mechanism, hold onto internalized biases about the world and others they encounter, and face developmental issues as they explore their own social identities and seek to find their place in the world. Additionally, the majority of the youths come from remote geographical locations, which creates further issues for them as they struggle to adapt to their new surroundings. Through the intersectionality framework, I am able to better understand the unique experiences of the individual, their positionality within Maples and how social factors have impacted them. I am also able to delve deeper into the personal experiences of the youths I work with to really understand how oppression leads to increased disadvantages for the individual and why it is so important to address oppression on larger social levels within communities. For example, even within Maples, crossroads youth are stereotyped as aggressive, violent and unstable and often we see Crossroads youth needing one-to-one ratio of staffing, whereas other unit youth are free to go for outings and are less supervised. When treating these youth, positive outcomes are linked to multiple social factors, including the family dynamic, personal traumas, finding ways to stabilize their mental illnesses, and raising cultural awareness and cultural incorporation into their treatment plans. To do this successfully, multiple intersecting factors must be addressed in depth and unfold any preconceived notions practitioners/staff may hold.
How the Framework Shapes the Learner’s Understanding
One of the great benefits of intersectionality is that it forces the practitioner and staff to address their own understandings of social systems and the impacts these systems have on the individual. By applying the intersectionality framework, it becomes clear that everyone has different sets of experiences that are informed and impacted by the individual’s social identity. It is only through the intersectionality lens that the practitioner begins to assess how different factors intersect with one another to give privilege to some while oppressing others. Through the intersectionality framework I have learned to identify systems of oppression that affect the individual, especially as they relate to individuals who are living with mental illness. Understanding the larger institutionalized systems of oppression within society and how they are maintained over generations assists me in recognizing that everyone has a different set of experiences that informs their actions and behaviours.
On a personal level, the intersectionality framework has made me more acutely aware of my own privilege. While I am a female Asian (Korean) immigrant, I didn’t realize how many more factors of my social identity formed together to give me a larger degree of privilege in society. Simply growing up in the city, for example, gives me far more advantages than some of the youths I have encountered who grew up in relatively sheltered, remote, and rural areas. I also come from a family of individuals who have never been in custody, which creates even more disadvantages for the youths I have worked with over the long-term. Seeing the oppressive social factors and how they intersect with one another firsthand has made me more aware of the privilege that I have often taken for granted, especially when I am confronted with the youth at MATC who have gone through so much at such a young age, struggle with mental illness, come from dysfunctional families, and who have troubling histories with drugs and alcohol, often from prenatal exposure. This has allowed me to identify my own positionality in the world and become highly aware of the areas of my life that I have often taken for granted or overlooked, and how these privileges have colored my own worldview.
In addition, learning from intersectionality framework has not only allowed to me unfold my preconceived notions, values, and attitudes I had in my head regarding my privilege, but also critically examine how working in a multidisciplinary health facility, interdisciplinary professionals bring their own unique backgrounds, such as privilege, race, education, SES, sexuality, and more into their own practice. Also, the overrepresentation of Indigenous youth in the correctional system is evidence of macro level of oppression and, instead of addressing where this discrepancy initiates between different cultures/ethnicity, our society tries to seal and hide the truth by blaming it on to the individuals, families and communities to take responsibility.
Evaluation of the Framework in Relation to the Learner’s Practice and Relationship to Agency and Community
Throughout my practicum, I have witnessed how the youth I work with are affected by privilege and oppression. Due to the shared backgrounds of the youths at MATC, it is clear how important the intersectionality framework is to positive treatment outcomes. The work at MATC is focused on multi-dimensional treatment programs in order to tackle as many factors as possible to improve the individual’s chances at successful treatment. The program focuses on treating specific traumas via attachment, creating safety nets for the youths to fall back on in times of need, to develop trust, care and support for the youths, and to try—whenever possible—to stabilize the youth’s family structure through empowerment. Cultural awareness is also used as a method for connecting the Indigenous youth to their cultural heritage as a way to help heal past traumas and address issues related to mental illness.
Working closely with the social worker at MATC has shown me the benefits of addressing the youth’s individual agency through treatment and the importance of working closely with the community when it comes to preparing the youth for discharge from the centre.
At the Maples Crossroads unit, there are clinical sessions every Tuesday and Thursday, where the primary care team—including nurses, social workers, psychologists, and psychiatrists—as well as the director of Maples Treatment Centre attend a meeting to discuss and provide updates on the status of youth. This is an opportunity to modify treatment plans and discuss privileges they can earn as they get better, as well as an opportunity to have an open dialogue among multi-disciplinary professionals regarding the youth’s progress.
I have observed how clinical sessions are essential to fostering good communication among the different professions working as part of the care team. Further, it also enables all staff to recognize each other’s value and engage with the difference arising from the range of health professional knowledge and their practice in the field. For example, I noticed how Crossroad’s social worker spoke heavily on the discharge planning, which is the social aspect; she is the mediator between Maples and the community, building relationships with the care team, youth’s family, and the community through bringing all interdisciplinary professionals together cohesively and communicating to achieve a shared goal. The psychiatrist adds their own unique value — to help the youth stabilize their symptoms in a timely fashion using a medical model. On the other hand, the psychologist is flexible in their approach, focusing more on the behavioural aspect; in other words, how to support the youth to reinforce positive behavioural outcomes. The work of the childcare counsellors took more of a holistic perspective, looking from the youth’s point of view and projecting both behaviours, medical as well as psychosocial views. As a student, it has been very interesting to sit in the clinical sessions and observe the dynamics, norms, attitudes, and respect from inter-professional collaboration. From my perspective, having meetings where interdisciplinary professionals come together reduces barriers and enhances learning from each other, while also helping to promote open conversation and facilitate collaboration in order to achieve the desired outcome for all the youths at Crossroads unit.
By understanding the youth’s personal experiences and how social factors impact their social identity, it is possible to determine what resources the youth will continue to need post-discharge and how those resources can be made available within the community to assist in their rehabilitation and treatment. In many cases, this includes creating strong community support and arranging for housing post-discharge if the youth is unable to stay with family. Another community impact that intersectionality has is on MATC itself, which forces the staff members to become aware of their own social positioning and how it impacts their practice. By being aware of our own social positions and the factors that influence our own experiences, we become more tolerant and understanding of the experiences and needs of others, which strengthens the community of practitioners and creates a stronger team environment that benefits everyone involved.
Benefits and Critiques for Working with the Framework
The benefits of working with the intersectionality framework are an enhanced understanding of social factors that impact the individual, a larger understanding of how oppression affects all groups, not just minority groups, and a firmer grasp on how social hierarchies trickle down to disproportionately affect minorities and individuals in lower socioeconomic groups. By being able to determine how social factors work together to impact individual social identities, it is possible to create a supportive treatment plan for the individual to address specific concerns that contribute to the individual’s mental health status, criminal backgrounds, and social identity.
One of the primary critiques that I have for the intersectionality framework, however, is that it can often lead to overgeneralizations of the individual’s personal lived experiences. With so many intersecting factors to consider when working with an individual, it can be difficult to assess which factors are more prominent and which may be in the background. At Crossroads, for example, the population of forensic youths that I work with all share similar backgrounds and similar social factors. While intersectionality is a method for understanding the complexities of the youths’ individual experiences, it can be difficult to remember that the reason for using the intersectionality framework is to focus on the differences between individuals, rather than the similarities that they share. It is important to avoid overgeneralizations when working with individuals based on the practitioner’s own professional experience, and to instead approach each individual as being different from everyone else, even though situations, experiences, and backgrounds may appear similar on the surface.
Conclusion
Despite the critiques of the framework, intersectionality provides a strong framework for working with individuals and addressing a wider range of concerns. Overall, intersectionality allows for the identification of influencing external factors on the individual and how it impacts their overall social identity. By recognizing that everyone is different, no matter how similar their situations may appear, the practitioner can target a wider range of issues in the individual’s treatment plan so that the underlying symptoms of specific behaviours or concerns can be addressed more fully. Intersectionality provides ongoing learning experiences for even seasoned professionals, let alone during my own practicum, which is why the framework will continue to be a strong tool for practice throughout the course of my career.
References
Collins, P. H. & Bilge, S. (2016). Intersectionality (key concepts). Cambridge: Polity Press.
Carbado, D. W., Crenshaw, K. W., Mays, V. M., & Tomlinson, B. (2013). Intersectionality: Mapping the Movements of a Theory. Du Bois Review,10(2), 303-312.
NASW Press (2015, June 18). Incorporating intersectionality in social work practice, research, policy, and education. National Association of Social Workers Press. Retrieved from
Wilson, A. R. (2013). Situating Intersectionality: Politics, Policy, and Power. Palgrave Macmillan.
