Residential rehab support work supervisor, Paula, on how services can work together better

Innovative Resources’ managing editor, Sue King-Smith, recently sat down to chat with Paula, a support work supervisor at a residential rehab in Victoria. Paula talked about some of the challenges she experiences in the human services sector and also shared some great ideas and examples for using Innovative Resources cards to build rapport and connection in groups and teams.

Sue: Great to meet you, Paula. Thanks for agreeing to talk with us today. Could you start by telling us a bit about your program?

Paula: The program is a 12-week residential rehab for young people up to the age of 35. It’s a bit unusual to have an AOD (alcohol and other drugs) rehab program specifically for young people, but it works well.

Day to day, there are two sites, one for residential and one for day programs. At the units, we focus on life skills. People stay for up to 12 weeks. It used to be six weeks which meant we could really only stabilise people. This change has really increased our scope and what we can help people achieve.

Sue: You’ve worked in the sector for many years. What changes have you seen over that time?

Things have become really competitive. Services that used to work together are now battling for the same piece of funding, particularly with things becoming more technological … ‘oh we can just do that online now’. We’re losing our face-to-face presence with people and, because we worked face-to-face all through the pandemic, I’m really noticing it.

The sector is much more about ticking boxes, closing at the right time, opening at the right time and making sure you get your funding.

There also seems to be a really big push on outcomes and measuring outcomes in a bazillion different ways rather than just saying, ‘Well, this is where they were when they started and this is where they are at now’. We are measuring things constantly and we are always ‘at’ people to tell us more. It’s frustrating the participants and it’s frustrating staff.

If you talk to practitioners they’re saying, ‘Why do I have to do it that way?’ and we have to say, ‘Well, when we report, we need this piece of data’. They feel it’s getting in the way of them doing their jobs and building rapport with people. They’re sick of filling in forms and ticking boxes.

Now we constantly battle to keep people’s supports because as soon as they come into resi rehab, everyone closes—they have to because they want to get paid. And that’s big for the participants because they lose all their supports and you have to refer them back out into the community. There’s no continuity of care and that doesn’t seem fair.

Sue: If you had a magic wand, what would you change?

Paula: It would be nice if we could all cooperate with one another—collaborate and be resources for each other. It’s hard when we’re all battling for the same funding.

The service system needs to be changed from the inside out. I would put it back into the hands of the community—the people who could respond to what the needs are. I think when you empower people to build their own communities, they build them to work. To feed one another. To care for one another.

We forget to look at our clients sometimes. If I could change things, there would be a lot more focus on outcomes being created and driven by participants. Right now, we sit with these templates and say, ‘Well, these are the outcomes we are going to create’. It’s not always what people want.

Sue: It’s funny isn’t it, we talk a lot about ‘people-centred care’ or ‘client-centred practice’ but what you’re saying is that, in many ways, we’re actually moving further away from that?

Paula: Yeah, even though we’re saying the words, we’re not living the words. And we can’t live the words because we’ve still got boxes to tick. And yes, we need to regulate and make sure we’re doing good quality work and we’re not damaging people, but I don’t think building our towers higher and bigger and shinier is the way to do that.

Sue: You mentioned that you’ve used Innovative Resources cards before?

Paula: Yes. My two defaults are the Strength Cards and the Ups and Downs. They’re such a good way to get people to talk about things without necessarily talking about themselves.

I often take a pack of Ups and Downs into a community meeting [where a group of residential AOD participants come together], especially when the group seems to be feeling really flat.

You know that if you ask, ‘How are you travelling?’ you’re going to get, ‘Yep, good thanks.’ But if you spread the cards out and say, ‘Ok everyone, look at the cards and choose a picture that speaks to where you’re at in your recovery today’, they will be more open because they can talk about the little man on the card and it’s not necessarily about them anymore. They come out with the most awesome things and suddenly the room’s feeling better and everyone’s feeling more connected.

I use the Strength Cards a lot. Sometimes it will be, ‘Introduce yourself with a card’, or, ‘Pick a card that makes you think of someone else in the room’. They’re a good one to use when people are low, or if people aren’t feeling connected. You put the Strength Cards out and say, ‘Tell me something I didn’t know about you by picking a card and talking about it.’

We do what we call ‘warm fuzzies’, which is all about getting people to think positively. We encourage people by saying, ‘When you see something you like in someone else, write it down and put it in the warm fuzzies box’. When they get slack about doing that, we bring the Strength Cards out and say, ‘Ok, pick a card. Tell me about someone else in the room. Tell me what you see in them’.

It’s just so powerful because the ones who feel awkward—the ones that don’t want to talk about what’s inside them—can pick up a card and talk about that. It becomes easy for them to connect.

All my support staff use them. Twice a week we do a reflective focus group with the community and there are set questions to talk about. On a Tuesday night we talk about our personal journey and on a Friday night we talk about our educational journey. Because we do it week in, week out, participants get sick of the same old questions, so my staff will go and grab some cards. We use the Deep Speak cards a lot too.

I use them differently each time. I don’t think it’s ever fallen flat when I’ve introduced the cards. Even if it hasn’t had the desired impact, it’s had some impact that’s been positive.

Sue: Can you give an example of when you’ve used the cards with a group?

Paula: We had two people in the community who became a couple, then, after several things happened, they split and the community took sides. There was a real sense of resistance between the two sides. We came to a community meeting and I put the cards out and I said to the couple, ‘I want you to pick a card that makes you think of the other person’.

The things he said about her helped mend the divide. They built a whole new relationship based on much healthier things—there was respect and there were boundaries. It was really good for the rest of the community to see that too.

Sue: Have you got any advice for people who may be using the cards for the first time?

Paula: When there are new staff, I encourage them to watch me use the cards a few times, then I give them the cards and say, ‘I want you to have a look at those cards and think about what you might do with them today’.

If they come up blank, I say, ‘Think about what’s going on in the community and where the power sits at the moment. Think about who’s getting on and who’s not liking who. Think about all the stuff that’s going on—which cards do you think are going to be the most helpful and how do you think you might use them?’

They generally come up with something good. There’s no point in me saying, ‘I want you to do this’, because then it’s awkward and stilted. When the staff choose, they’re excited about what they’re doing and that makes a difference.

It’s good for us to have that kind of ‘shield’. In the same way the participants can use the cards to protect themselves, we can use them to protect ourselves as well.

For example, we do a session about personal hygiene or sexual health. That can be tricky to do. Using the cards allows people to be more open. They don’t feel like we’re talking about them, but they say, ‘Oh, I could use that’.

Sue: Is there anything else you’d like to add?

Paula: The cards make my job easier. I’ve even used them in staff meetings: ‘Pick up a card that reminds you of someone else. Say something positive about the people you work with’.

It really makes a difference, giving people the opportunity to look for something positive in others. We can forget to ask, ‘Where’s the value here?’.

I find Strength Cards are a great way to talk about value and Ups and Downs are just great to talk about life.

Sue: Thanks so much Paula for sharing your thoughts, ideas and reflections with us. I’m sure so many of the things you’ve described will resonate with our readers.