Professional Dangerousness

Transcript:

Cassie Gillespie (00:02):

Hi, I’m your host, Cassie Gillespie. And you’re listening to welcome to the field. A podcast of targeted trainings for child welfare professionals, caregivers, and community partners. Today, we’re going to be talking with Kate Cunningham around professional dangerousness, but before we get into that, I should let you know that because of COVID-19 like everybody else who’s recording a podcast we’re currently recording this from our homes. And you might hear a little bit of a difference in the sound quality. All right, Kate, thank you so much for joining us today. Would you start off by telling us a little bit about yourself?

Kate Cunningham (00:37):

Sure. Thank you for having me. My name is Kate Cunningham, as you said. I have worked for the Child Welfare Training Partnerships since 2012. And prior to that, I was a front end worker in the Burlington DCF office and an Easterseals Engagement Specialist and supervisor in the Burlington office as well. I’m also a Licensed School Counselor in the state of Vermont and I consider myself a surviving single parent of three amazing young 20 year-olds. And we’ve really enjoyed getting close again during these last few months in 2020.

Cassie Gillespie (01:17):

Great. That’s awesome. And towards full disclosure, I should share that Kate and I have had the privilege of working together in the child welfare world for probably going on 10 years now, does that sound right Kate?

Kate Cunningham (01:29):

It does. And in different areas, between different offices and roles, it’s been great.

Cassie Gillespie (01:35):

Absolutely. And for you out there listening, you should know that throughout all that time that I’ve had the opportunity to work with Kate. This has been an area of interest and expertise for her. So we’re really lucky to have her here today to talk to us about it. So let’s start right at the beginning. Kate, can you tell us a little bit about what the term professional dangerousness means? Like what it encompasses and what the definition is?

Kate Cunningham (02:00):

Sure and actually, if I could just take us back a little and provide a little background to how the dynamics that create professional dangerousness come about. I wanted to start by doing that by reading a part of a blog from a child welfare social worker, who this was written for years ago. And she resigned from her position, but just to give a little background of what it is like to be a child welfare family service worker, a social worker. “I woke up flooded with dread. I was going to be sick, but try desperately to prolong the inevitable. For me this was one of the regular symptoms of anxiety caused by working in frontline child protection. For two years, the overriding trigger was a feeling that I would never be able to finish all my work. This was intolerable for me, despite staying late most evenings and working some weekends, I could not be on top of the work. I was advised to accept that this is the reality of child protection, but it was a constant battle. I discussed some of these issues with my manager, but I did not feel I could be honest about my anxiety. I think there is still a stigma about anxiety. So I did not tell them about my panic attacks palpitations or that I was being sick in the mornings. I did not want anyone to think I couldn’t cope, that I wasn’t good enough or resilient enough. I didn’t want to be judged incompetent by management. Consequently, I never took a day off and just kept pushing my body. Workload management and prioritizing were regular topics for supervision, which I thought would help with my anxiety. But clearly, if there was too much work to do, firefighting will only get you so far. I gained a ton of weight and regularly binged and comfort ate finding there was no time to exercise as I used to. Many members of the team had similar experiences, knowing others were in the same boat was reassuring, but did not diminish my symptoms. Something had to give.” And I read that because that rings true. It rings true to me from doing the work and to other people.

Cassie Gillespie (04:26):

Yeah, it rings true to me too. I think it’ll probably speak to a lot of folks out there listening.

Kate Cunningham (04:31):

Yeah, yeah. And so what it, what it speaks to also it encompasses right. That we lose that ability to function when we get to that place in our work where we are feeling burned out and we’re feeling incapable of getting up and going to work without being sick. There’s also a quote. Can I read this, that speaks to that. And I know I’ve, I’ve put it in my presentations and people have seen it, but it also encompasses where we’re going with this. And that is that the expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet. Everyone gets affected by the work in child protection and not identifying and acknowledging when you’re wet, right. When you’re affected by it. When you’ve gone through the water, doesn’t make it go away. It just means that you’re not functioning at a hundred percent. And so subsequently, oftentimes we’re working dangerously.

Cassie Gillespie (05:36):

So I think that a lot of times when people talk about these same topics, they’re using the word burnout, but we are using the word or the term professional dangerousness on purpose. Tell me about the difference there, where there’s overlap or how they’re different.

Kate Cunningham (05:52):

Absolutely. Because there is some parallel, right? There’s a connection. And when we’re talking about professional dangerousness, the term comes from Tony Morrison who did a lot of research and work on supervision in social services. And he’s written a lot about how to support workers and get through this. He developed this term professional dangerousness to mean when professionals inadvertently collude with maintain or increase the dangerous dynamics of the abusing family within which they’re trying to be helpful. And so what that means is when workers get caught up in these dangerous dynamics, we make it less safe for children. And we do that often because we’re burned out. So there’s a connection, right? The work itself is so complex, stressful, and it’s full of anxiety all around. It’s even been likened to working on the frontline you know, being on the frontline in war that we often get triggered by difficulties and issues, which then affect how we do our work.

Cassie Gillespie (07:09):

Wow. That’s super powerful. So I heard you say there that in particular it’s like the collusion or participation in some of the dynamics. What are those dynamics you’re talking about? Can you give some examples there?

Kate Cunningham (07:23):

Sure. I’m gonna give you a picture in your mind right. There’s so many relationship dynamics that happen within child welfare and the child protection work. So if you consider a triangle and in the middle of the triangle is the family. And the family itself has so many dynamics going on within it, right? Like they may be dealing with substance abuse or substance use issues. Like we know like with opioids, right. We know that caretakers spend their days or their waking hours usually using withdrawing from, and, or seeking opioids that the children get left on the fringe and not part of the dynamic of the family. And that’s really unsafe. There’s also mental health challenges. That create dissonance and, and unsafe situations. There’s domestic violence behavior and families, sexual harm, families keep secrets. And collude with each other to keep secrets.

Kate Cunningham (08:31):

They live in poverty. And there oftentimes is denial that they’re doing anything dangerous in their parenting style or the lifestyle that they’ve created. So that too is part of the dynamics, and all of those make it less safe for the children inside of that triangle there. So other dynamics are the outside corners of the triangle. Let’s say the outside corners are the actual professionals who work with the families. And so there’s dynamics that happen coming from the inner triangle to each of the corners, right. There’s dynamics between family members and professionals, whether they’re Family Service Workers or community partners that also occur that make it less safe for kids. And some of those just there’s a lot, but some for a few, and it’s exacerbated right by this pandemic. And physical distancing, we have definitely seen a difference. Right. And families think about that right there in that inner dynamic they’re isolated. They are all shut in together. So any kind of issues and frustration that was happening before, has been escalated.

Cassie Gillespie (09:54):

I bet. I bet everyone can relate to that. Even in terms of spending a lot of time with their own family during this quarantine.

Kate Cunningham (10:01):

Absolutely. Like I said, boy, my 20 year olds and I have gotten really close mostly positive, mostly positive. So yeah, and then as well in the pandemic, right, that exasperated issues between the families and the professionals families have used splitting right between workers either in an agency or in other agencies, or between agencies. And that’s easier to do when there’s no communication, no face to face communication between professionals, families, and professionals, both may not always be honest about situations. And that’s a form of protection, right? Family members lie about the situation that they’re in to protect themselves. It’s self protection professionals on the same hand also will collude with families to avoid real issues. And to avoid raising concerns either out of fear or just out of their own, feeling of incompetence, right. As a way of protecting themselves,

Cassie Gillespie (11:11):

Can you give an example of what that collusion might look like? Just so folks can connect the dots as they’re listening.

Kate Cunningham (11:16):

So if I go into a family and I ask about a situation, maybe I’m an investigator. And I say we’ve had this concern that there have been needles lying around that there’s been substances left out on surfaces that your two year old can get into. And the family says, absolutely not. We don’t use needles. And we don’t use substances one that’s protection. Of course, they’re not going to come right out and say that that’s admitting something they don’t want to. And then where we start to collude is we say, you know, just kind of take that easy way out. Oh, okay. Well, maybe somebody was confused, or, you know, tell me what else might have gone on. And we just take their story and kind of run with that.

Cassie Gillespie (12:10):

Instead of digging deeper.

Kate Cunningham (12:12):

Instead of questioning or confronting, you know in a respectful way, but just take that story firsthand.

Cassie Gillespie (12:21):

Got it. Okay. That’s helpful.

Kate Cunningham (12:23):

And taking a story firsthand, I will also share is you know, something I’ve been reading books on thinking like Blink and Thinking Fast and Slow. And I am just amazed at our brains. And one of the things I’ve really picked up and run with, in this is just that we do like to take initial thoughts. Somebody tells us something and we can associate it to something else we know, or it makes sense. We’ll stick with it because our brains don’t like to work too.

Cassie Gillespie (12:54):

Right.

Kate Cunningham (12:55):

That’s true. We just try to take the easy way out and go to paths that we know. And if I hear something that makes sense that I can just accept and run with it, instead of delving deeper. And if I’m feeling burnt out at all, boy is that going to be easier to do, then really sticking with the story and asking questions.

Cassie Gillespie (13:16):

Right. To just disengage a little bit there and not fully walk forward. So what other dynamics might be happening between professionals and families?

Kate Cunningham (13:29):

Sure. we know, and this is a little bit of the fight flight or freeze, right. Families sometimes flee. And that doesn’t mean just leaving a community or a state though. We know that that happens. But they may not be there when we have an appointment. They may not be answering the door. Right. Although they actually may be there. They may not answer their phone. And likewise professionals do the same thing. We sometimes may go and show flight behavior by maybe we knocked really softly on the door, hoping that they won’t hear right. Or we call and let it ring once and then hang up and assume, okay, I’ve called or we don’t answer phone calls. And it’s really telling if, as a worker, you’re not going to door and nobody’s there that you kind of turn and skip away and say like, phew. Right. That’s a good thing. And it’s also telling if, if the family was there, right. Sometimes that happens too, where they’ll just not answer the door and just hope that you go away. Yeah. And those mutual dynamics, there are very dangerous for the kids because it keeps us away from them.

Cassie Gillespie (14:43):

And I can only imagine for folks who have a full caseload and too much work to do right. And they’re feeling overwhelmed and you have an unannounced that you’re really dreading and you’d get there and you knock and no one answers, you’re like, yes, I needed this today. So powerful to think about how those little breaks or those ways to like disengage and protect yourself as the worker are actually increasing the dangerousness for the child or just the danger for the child.

Kate Cunningham (15:12):

Oh, yes. That’s exactly what it is and what is notable here is it increases the danger for the child. And it is such a red flag, right. For you as a worker to say, Whoa, something’s going on here. I, yeah. That either with his family and I’ve got to work this through in supervision or maybe even my own stuff. Right. Because I think we all have those families that get under our skin. That are the tough families for us. Whether it be the families that slammed the door in our face and yell at us, or whether it be the family that every time you go, they cry. Like things are just, nothing is their fault and nothing is going right. And so they are breaking down constantly, for some of us, they take so much energy. And so it is easier if they’re not there, but those kids are living in that experience. Just some other thoughts is, you know, sometimes we over identify and, and in talking about those dynamics or the family dynamics that can come up we do over identify sometimes with the needs of the adults and we tend to those and don’t fully regard the needs of the children.

Cassie Gillespie (16:33):

Can you give an example of what that might look like?

Kate Cunningham (16:36):

I will give an example of when I was doing the work, I was talking to this mom about the issue that, her young child was roaming around constantly unsupervised, but all she could focus on was that her neighbors were putting up threatening notes and their windows. And they were the ones who called DCF. And so her focus was continually all she could talk about with the neighbors and what they were doing. And so my support ended up being how she was and how she was managing with the neighbors versus the fact that her young son was running around the property unsupervised. And so it was about her need and not his.

Cassie Gillespie (17:19):

Yeah. I bet lots of folks can identify with that push and pull. Especially when you’re in the home, trying to build rapport, it’s an easy place to go to, to really dig into that need that the caregiver raises.

Kate Cunningham (17:30):

Yes and it’s natural. Right. We’re humans, we want to help. And so we get caught up in the stories of help. And that makes sense. And one other when I talked about the threatening kind of families that is used also as a dynamic to avoid, well, it’s used as a dynamic where families may use it to keep us away. Because then we want to avoid them. And so when we find ourself again, going to knock on the door and having it slammed in our face and just turning around and leaving it is effective, like you said, and then again, we’ve left that child. And all of that said, it increases the danger for the child, but all those different dynamics where on workers, in this, again, it’s this complex, anxious, stressful situation.

Kate Cunningham (18:30):

And if we’re not getting held and we’re not getting the support and supervision to help us work through these dynamics then it’s dangerous for us and continues to be dangerous for the families and the children. Another definition of professional dangerousness, which was developed in 1978 by another researcher and in Fletcher is the risk of being caught in a system where the professional is psychologically and emotionally battered by the client, by colleagues, by the system, and may defensively make inappropriate and sometimes destructive responses. So really it can be the system wide thing. Of the clients like we were just talking about clearly can have an effect on the worker just by those dynamics between them colleagues are sometimes either have higher expectations or have their own stuff going on. So they also may not be there. And then the system just may not support. And so this is where professionals get burned out, especially if they don’t have support and safety within their own office, their own agency and with their colleagues.

Cassie Gillespie (19:52):

Yeah. You’re going to laugh cause we’ve all been talking about it so much, but as Vermont is really rolling out a mindful approach to safety culture, you know, one of the pieces we talk about over and over is, is there a secure base, does that work or have a secure connection to their team? So at the supervisory level and at the team level, but it also has to be thinking about the way agencies can support professional dangerousness or actively work against it. One of the examples that Mike Cull gives in some of the safety culture work is the idea that when they were looking at error rates in hospitals, there was an example, or at least a hypothesis that the hospitals that had the lowest reported error rates would have the best outcomes. And it turned out when they dug into the research, you know, that actually it was the hospitals that had the highest reported rates of errors that had the best outcomes, because those places had created safety. You were able to talk about your mistakes and work forward. And I feel like I might have mis-said that in the beginning. I want to be clear. It wasn’t Mike’s research. It was research that gets rolled into the safety culture discussion. But I guess that has me wondering Kate, do thoughts about how agencies and inter-agencies even can contribute to professional dangerous.

Kate Cunningham (21:13):

Yes, absolutely. I think it was Amy Edmondson who did that research. I listened to her podcast about it, and she was just shocked. She was like the data was going in the right direction, but it was the wrong way. If that makes sense. I mean, with interagency stuff, the biggest concern, the biggest issue with interagency work that has been discovered is a lack of communication or miscommunication between either workers within the same agency or between agency workers. That has been the one consistent finding in every inquiry into a child death when they’re involved with DCF or a child welfare organization is that there has been a lack or miscommunication between workers.

Kate Cunningham (22:15):

And so that’s a huge piece, right. Of just being able to stop and share the information and what happens sometimes in the interagency dynamics. That do create the danger is either they have a difference in mission, and agendas. So we may feel like we have very different agendas and we don’t then communicate, or we have a disagreement on how we’re seeing things. And then we just stop communicating. And again, there’s that communication piece and also role confusion. So if I’m in even a team meeting, and there’s a next step, but I assume somebody’s doing that next step. And they assume I am, and it doesn’t get done. That can be very dangerous when that role confusion and having expectations that are not realistic or even known can happen. And even, and I’ve seen this in, I’ve seen this within the agency, DCF is you can have a group of workers who connect around a single belief. Or opinion, and they’re not going to shift no matter what. And so they don’t want to hear anything else. And that is a big concern when we do start talking about child safety. Is there’s also findings again on our reasoning, the way that we reason, and the way humans respond is we typically take, if we have our first initial assessment of a situation or a family, that’s what we stick with, because it’s really hard to change gears. Once you’ve determined that you’re going a certain way, or that you have a certain belief about the way a family works or what’s happening in it, to be able to back up and say, wow, I may be wrong. Let me take this new information and really plug it in and see which way to go now. We find that can, create a lot of danger and people not wanting to admit they’re wrong.

Cassie Gillespie (24:27):

Yeah.

Kate Cunningham (24:28):

Which comes back to that safety culture stuff of I’m too scared to say I was wrong. So I’m going to hold so tight to this initial assessment and stick with it rather than say, you know what? I may have made a mistake.

Cassie Gillespie (24:42):

Well, and the liability is so high in the work. You know, it makes sense that folks really struggle to say, I might’ve messed up here. Is there research that shows that when people are willing to sort of be curious about their potential mistakes that, that decreases the professional dangerousness?

Kate Cunningham (25:03):

Absolutely. There’s so much research out there on looking at common errors and reasoning. And they’ve done a lot of different experiments. I shouldn’t say experiments. Research, data collection on when workers, and it’s not always just child welfare workers. But when people are willing to shift their thinking and say, wow, I am going to pull back and I am going to relook at that. That it actually does make it safe.

Cassie Gillespie (25:37):

Are there other ways that we can either on the worker level or the supervisor level or the leadership level prevent and respond to the dangerous dynamics and the burnout?

Kate Cunningham (25:49):

Yeah, absolutely. One of the things, and this comes from the safety culture. I would say right off the bat is use your oxygen mask first, make sure that you can breathe, make sure that you are taking care of yourself before you go out and take care of others. And just thinking of my initial reading from that blog, that wasn’t the case. It was about pushing through and continuing to do the work. So, so be aware, have some self awareness and use your supervision. To talk through anxiety, to talk through mistakes, to talk through the fact that you may not know what to do. And as a supervisor or a leader in child welfare ask. Ask workers how their anxiety level is, what they need to think through a case, right.

Kate Cunningham (26:43):

To make sure what might need to be done. So that’s just one thing workers can certainly do again, role clarity is going to be huge. Who’s doing what. Is going to help. Balancing your empathy and your relationship skills with being boundaried. And not being afraid to have hard conversations with families is certainly one way to support those children, keep the children’s needs in focus. One of the things we didn’t talk about was, there is something that happens between workers and families is that discount hierarchy. Where we discount the experience of the child. And so we start with this idea that you know what, there’s no, there’s no abuse here, right? There’s nothing going on in this family. This report was, you know, mistaken. It’s just a neighbor who doesn’t like them.

Kate Cunningham (27:43):

So we just discount that there’s any sort of abuse going on, or we can then discount the significance of it. And that happens, I think more often than not with workers who have numerous cases and some are pretty horrid situations so that if you get one that’s a little bit less horrid, it’s easy to just be like, they’re fine. That child is fine. We close cases too early. We don’t go and visit as much as we need to or do the collaterals, like we need to, because it seems better than some of the other cases.

Cassie Gillespie (28:14):

And I wonder, you know, if there’s workers out there listening, I’m just guessing it’s been a long time now. Right. But what my own experience would have been to hear that I would have been like, no way I totally dig into all of these cases, like get outta here lady, but there must be a piece here. Where there’s, I don’t know what you would say, a distortion where you can’t see your own discount hierarchy stuff. Am I understanding this correctly?

Kate Cunningham (28:43):

Absolutely. And I think with all the dangerous dynamics that can happen, unless we take the time to sit back and reflect. And unless we have like a supervisor and, or supportive colleagues or somebody to give us that time and help us work through and think about what we’re, what we’re working on. It’s really easy to just trudge through and you don’t think that you’re doing it. We don’t see it. And so again, just some awareness of these happening can help. When I was first introduced to professional dangerousness and the idea of it was back, we had Nicki Weld from New Zealand come and do work with us on this. And what got me interested in it was every single dynamic that she talked about. I got sick to my stomach because all I could think about was, Oh boy.

Cassie Gillespie (29:44):

This case and that case and all the ways it had played out in your own career a little bit.

Kate Cunningham (29:50):

Absolutely. And then the reason it’s a discussion and the reason there’s books on it, and there isn’t literature on it is because it’s common. We all do it.

Cassie Gillespie (30:03):

To link back to safety culture. You know, one of the things that safety culture really tries to raise up is although we all have a responsibility as individuals to participate in our self care. So too, does our agency, and our organization have a responsibility to protect us and provide us opportunities. To reflect and recognize. So I’m just thinking a little bit about how not only workers, but supervisors and district leadership and all the way kind of up and down can participate in getting curious, I guess, about those dynamics,

Kate Cunningham (30:37):

Right. I mean, it can help, the more we know and recognize, identify when they’re happening, acknowledge that they’re happening and then have conversations about them happening, the safer these children are. And then the result for us, or for workers is you feel heard, you feel safer. You’re not working in that silo of fear. You’re not getting up every morning and vomiting, right. Because you’re, you’re so anxious. You are much more able to take it out and do your critical thinking and feel supported and feel safe in doing the work when you have that opportunity for reflection and you feel supported to have these conversations about the whoops or the, I don’t knows.

Cassie Gillespie (31:24):

Yeah. To report the errors and then have the better outcomes.

Kate Cunningham (31:27):

I know, it’s a huge relief for people. And I think really as an organization, and I know we’re working towards this, so this is, it’s amazing and wonderful. And I know the safety culture work group is constantly talking through how to support people, but really we can use any crisis or any mistake, even as a learning point. A learning opportunity that it’s okay to make that mistake. And what did we learn from it? We can’t go back. But what can we do moving forward that we take away from that? And now we know.

Cassie Gillespie (32:05):

In closing, we could talk about this all day and sometimes we actually do, but since we have a time limited episode here, is there anything that you want to leave the listeners with as we close one last thought one last point?

Kate Cunningham (32:20):

What I do want to offer is something that Nicki Weld said years ago. And it just has stuck with me. And I like this idea that one of the things that we know helps people to change is hope. If they have hope they’re able to change more. And we in our system can offer families hope, but we can’t do that when we don’t have that sense of hope ourselves. So we need to just be filling our well, filling our bucket getting that support so that we don’t lose hope. And three things that we really need to be hopeful. But with a balance, like an eyes open, hopeful, optimistic, but using a rigorous assessment and engaging with families and being willing to ask hard questions and have hard conversations.

Cassie Gillespie (33:25):

That’s great. That’s the recipe huh?

New Speaker (33:28):

That’s from Nicki Weld, to you.

Cassie Gillespie (33:33):

Wonderful. Okay. Well, thank you so much for spending time with us today. This has been great. And I’m sure we’ll get to talk to you more about this some other time. So thank you so much, Kate.

Kate Cunningham (33:43):

Thank you. This was fun. This was great. Thanks.

Cassie Gillespie (33:46):

Thanks for listening. If you have any ideas about topics that you want us to cover or episodes that you’re interested in hearing, shoot us a message. You can reach me by email at Cassie.Gillespie@uvm.edu, or you can leave us a comment on the web page where you downloaded this podcast. Welcome to The Field is produced by the Vermont Child Welfare Training Partnership and the State of Vermont and a special thank you to Brickdrop for composing and recording our music. See you next time.