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Worker and Agency Quality Care Self-Assessment Tool
Introduction
Agencies striving to meet the needs and best interests of children and youth in
residential care can benefit from periodic assessments of how they are, in fact, performing. This
tool has been developed based upon research undertaken by Dr. James Anglin, School of Child
and Youth Care, University of Victoria, Canada. It is based on the findings of empirical research
related to the elements and processes characteristic of well-functioning residential care
agencies. It is not a standardized instrument, but is offered as an informal self-assessment tool
that can form the basis for self-reflection and team discussion within agencies seeking to
achieve congruence and provide quality residential care to young people. It has been prepared
for use by agencies and workers participating in workshops facilitated by Dr. Anglin, and should
only be used in this context.
The following items and questions address the “active ingredients” found in my research
(Anglin, 2002) to be characteristic of well-functioning agencies and workers at the various levels
of agency functioning. The questions are posed in a manner suitable for self-reflection and
agency dialogue. Both ongoing self-reflection and dialogue amongst agency staff have also been
found to sustain worker and program development towards the provision of ongoing quality
care.
Part I – The Child’s Best Interests Touchstone
Ever since the earliest days of “modern” residential child and youth care practice (i.e.
over the past 100 years), “the interests of the child” have been understood by leading figures in
the field to be the touchstone of good practice. In more recent times, the United Nations
Convention on the Rights of the Child (UNCRC), state legislation and child welfare policy has
focussed on “the best interests of the child” where guardianship decisions are concerned. This
test has broadened from a focus on who should have custody of the child to day-to-day
decisions regarding the child’s care and well-bring.
In theory, most child care practitioners and agencies would think this is an obvious
focus, and one to which they adhere on an ongoing basis. In practice, it is evident that some
agencies do not act in the best interests of young people in care, or at least not on a consistent
basis. And we are not always clear how to apply this test. Too often we find ourselves simply
imposing our will, or disagreeing with others and acting inconsistently in our decisions about
the best interests of the children in our care.
The following questions are suggested as one means of helping each of us, and all of us
as care teams, to focus on the best interests of young people in our care.
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Agency Model
1. Does you agency/program have a clearly articulated model of care (including principles,
values, theory of change) that includes a commitment to acting in the best interests of
the young people in care?
Leadership
2. Do agency leaders (Director, Program Head, Supervisors) make frequent reference to
“what is in her/his/their best interest” when discussing program decisions?
3. In discussions with government workers placing or case managing a child, do staff in
your agency keep the focus on the child’s needs and interests?
Direct Care
4. Do you take time to talk with each child about decisions you believe are in his/her best
interest? Do you acknowledge his/her feelings and desires respectfully, and explain your
rationale, even when you decide to take a different action than they want you to?
Comment: Managers and workers have found that by consistently asking questions such as
“what do you think Allie needs from us right now,” or “tell me how you think that is in in Sam’s
best interests” serves to diffuse arguments and power struggles between staff in the
organization. There is no better way to stay on track towards quality care than to keep the
focus on what WE together can do to help this child, or these children.
Part II – Principles and Values
The literature on therapeutic residential care for children and youth is still in the early
stages of development, however there is a growing consensus relating to some of the core
values and principles (Holden, 2009). Some of the key principles and values are presented
below for your consideration in the context of your own program and its development.
Programs that can be labelled therapeutic tend to be characterized by the following:
1. Developmentally focussed – Quality residential programs have a good appreciation for
the different areas of child and adolescent development, and recognize that a child can
be at very different stages of development in different developmental domains. For
example, a child whose chronological age is 14 years may be at about a 5 year old level
emotionally, a 10 year old level cognitively, and a 16 year old level physically. Often
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adults have expectations for behaviour based upon a child’s physical size, and thus may
be setting inappropriate expectations.
Well-functioning programs adjust their expectations to the levels of development
demonstrated by the young person, and gear their activities to what lies within her/his
“zone of proximal development”. This zone extends somewhat beyond the current
developmental abilities of the child, and includes activities which the child can attain
with some targeted support, or “scaffolding” by care workers or teachers.
Questions:
i)
What indicators can you identify in your program that demonstrate a sensitivity
to the developmental issues and dynamics of the young people in care?
ii)
Can you think of ways that the attention paid to the development of children
and/or adolescents in your program could be made more effective?
2. Relationship based – There is extensive research supporting the vital importance of
relationships in human development. Some programs refer to this aspect as
“attachment based”, recognizing the critical significance of the early bonding with a
primary caregiver, usually the child’s mother. Each young person will have some form of
“attachment system” comprised of those people with who s/he has developed close
personal ties. In most cases, this will be immediate and perhaps some extended family
members, and may also include close friends and significant others (e.g. teacher, coach
etc.). In some cases, a child may have been removed from the immediate family for
some time and may have an alternative attachment system consisting largely of
substitute caregivers and some friends or neighbours.
A paradox of residential care is that it is an artificial and non-normative setting in which
young people can develop a sense of belonging when the original attachment figures
are not available for whatever reasons. While no child “belongs” in a residential home, it
may be that they experience a sense of belonging through the attention and nurture of
skilled and caring adults, such as foster parents or child and youth care staff. While
residential workers are not permanent attachment figures, they can play a very
important role in helping the young person to develop a sense of normality (i.e. a sense
of connectedness, a sense of self-worth, a sense of being valued and respected, a sense
of competence, etc.).
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Questions:
i)
Is there clarity amongst the staff and managers in your agency/program about the
dynamics of attachment and the power and significance of relationships in
therapeutic work? What are the indicators of this?
ii)
Are staff encouraged and supported to develop strong positive relationships with
the children in care, even though these will be “transitional” relationships?
3. Competence centered - A central responsibility of an effective residential program is to
assist the residents to develop competencies appropriate to their levels of
development. Basic life skills (such as hygiene, eating habits, sleeping patterns, doing
school work and homework, socializing with peers, relating to adult authority figures
etc.) are vitally important for children in out-of-home care to master in order to be able
to re-integrate into their communities and, eventually for many, to return to their family
of origin. Closely related to this principle is a commitment to being “strengths based”,
and building on the positive attributes that young people bring with them to the
program.
Given the relatively short time periods young people will spend in residential care (in
many cases just a matter of months or perhaps a year, or year and a half), it is important
for programs a) to plant the seeds of new attitudes and behaviours through the creation
of positive interactive experiences and b) to shift the residents’ trajectories away from
travelling deeper into the care, justice or mental health systems. We will often not know
while the child or adolescent is in care which experiences will make a significant and
perhaps life-course changing difference for the future decisions of the child, but the
testimonies of young people who have benefitted from quality residential care
frequently identify powerful relationships and interactive moments when a new path or
new direction was opened to them.
Questions:
i)
Are all of the activities undertaken within your program purposive and designed
with the intention of enhancing competence?
ii)
Do you have a plan of care of some form that identifies the areas of development for
each child and the competency goals for each area? If so, is the plan reviewed and
updated on a regular basis (i.e. at least monthly?).
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4. Trauma informed - All children and adolescents in residential care will have suffered the
effects of trauma. At a minimum, this will involve the trauma of being removed from
their family and community. In most cases, the traumas will be multiple and involve
various forms and degrees of neglect and abuse over many years resulting in profound
and deep-seated psycho-emotional pain. Such pain is easily triggered, and often results
in pain-based behaviour. Too often we have glossed over and labelled such pain-based
behaviours with terms such as “troubled”, “acting out”, “delinquent”, “aggressive”,
“anti-social”, “oppositional defiant disorder” and “maladjusted”.
We also need to be aware of the vicarious trauma that is often experienced by staff
working with these young people, and support our colleagues to be aware of their own
pain and triggers that can result in reactive and non-therapeutic behaviours. Responding
appropriately and effectively to pain-based behaviours is a core challenge for agency
staff, and especially the direct care workers.
Questions:
i)
Are all staff in the agency trained in understanding the nature and origins of complex
childhood trauma, and in ways to contribute to creating a safe and responsive
therapeutic environment?
ii)
Is ongoing support provided to staff and regular debriefing offered for incidents and
struggles experienced by staff members?
5. Family involved - Research studies in many countries indicate that the majority of young
people in residential care return to their families at some point after they leave care;
according to some studies as many as 80%. As noted earlier, these families are their
original attachment systems and we need to do whatever we can to help the young
person to deal with both the negative impacts and the potential opportunities
embedded within their family systems.
It may well be that one or both birth parents may not be able to have contact, or have
very limited contact with the young person, but frequently there are siblings, cousins,
aunts, uncles and grandparents who may offer enduring and positive relationships well
into the future. Many programs that thought they were engaging families have come to
realize that there is much more they can be doing to support and even strengthen such
relationships.
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Questions:
i)
Does your program view parents as the problem, or at least a problem, rather than
as a potential resource?
ii)
Do you find ways to maintain contact between the child/adolescent and his family
members, to the maximum extent possible?
iii)
Are there barriers to such contact that could be removed with some dialogue and
creativity between the various professional systems involved?
6. Ecologically Oriented – The large majority of young people in residential care will be
returning to community settings either after their brief stay or when they “age-out” of
the system, therefore programs need to use every opportunity to support them in
learning to function within the community and its various settings and institutions (e.g.
school, workplace, recreation, banks, restaurants, public functions, etc.).
In addition, programs must also pay close attention to the design and use of its own
space and facilities. Programs that adopt a therapeutic orientation begin to re-design
their buildings, how they create spaces to be more welcoming and home-like, how they
prepare and serve food, and how they involve the residents in decorating and shaping
their own rooms and living spaces. There are only two ways we can influence the
behaviour of others – by changing our own behaviour, and by changing the
environment.
Questions:
i)
Is the residential environment/home a place where you would be comfortable
having your own child (or sibling, or cousin) living? If not, what needs to be
changed?
ii)
If a resident struggles with being successful in the community, do you understand
this as a need for increased community involvement or as a reason to reduce or cut
off such involvement?
7. Culturally responsive- Many of the young people in care come from Indigenous cultures,
or minority cultures with faiths, life experience and belief systems different from the so6
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called mainstream. In fact, all of us live in many cultures at once, and this is one of the
new global realities that has resulted from increased mobility and new modes of
communication. Staff members need to learn how to learn about different cultures,
understand their values, respect their traditions, honour their histories and join with all
the young people in their struggles for their rights, justice, a place in society and a
hopeful future. No longer can we accept simple “add ons”, or a “beads and feathers”
approach to culture within our programs. We need to find ways to more fully integrate
cultural realities into our programs, and to integrate ourselves and the residents more
fully into cultural realities outside our walls.
Questions:
i)
Do the young people in your program experience a sense of acceptance and
honouring of their cultural backgrounds? What are the indicators you can identify to
assess this dimension?
ii)
Are staff members being creative, and do they demonstrate a willingness to move
out of their own comfort zones to engage with people of difference, especially
members of the resident’s families and communities?
Part III – Agency Congruence
The daily functioning of a residential program can be challenging and sometimes
chaotic, and one can lose sight of the therapeutic aspects of decision making. Effective practice
means being responsive to the needs of the individual children and the group, rather than being
reactive based on your own feelings of anxiety, anger or fear. It also means being responsive
and respectful to each other as staff members, at whatever level of the organization we may
work.
Recent research has demonstrated the critical importance of congruence across all
levels of an agency’s functioning. Congruence means “always acting according to principles and
values that promote the health and well-being of individuals and groups.” A congruent agency
is one where there are clear principles and value expectations held in common to which
everyone is accountable. Having such explicit values and principles helps to shift the focus away
from arguments about “my position” and “your position” to a focus on “how does what you are
saying/suggest/did accord with our agency principles?”
But we need to remember that we are engaged in a neverending “struggle for
congruence,” and that as a result of many factors (lack of knowledge, miscommunication, new
staff, financial challenges, external pressures, etc.) we will inevitably, on occasion, fall short.
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Congruence has at least three major components.
a) Consistency – refers to the fact that staff members are striving to apply the values and
principles in everything they do. It does not mean always reacting in the same way to
behaviours or incidents. One needs to be aware of many factors (e.g. what lies behind
the other person’s behaviour, the goals of the activity, the situational context, your own
state of being, etc.) in order to respond in accordance with program’s values and
principles, and not act mechanically or by rigid adherence to rules. (See section below
on rules versus expectations.)
b) Reciprocity – refers to the need for two-way communication and responsiveness, where
both sides in an interaction are treated with respect and demonstrate mutual
accountability.
c) Coherence - refers to the overall integrity of the agency which is apparent across all
levels of the organization. There is a sense of unity, harmony and wholeness, rather
than discord or fragmentation, throughout the organization and its functioning. There is
not one set of principles or expectations about interactions at one level of the
organization and a totally different set at another level (e.g. management and direct
care).
Another way to think about congruence is to think about the culture and climate of the
organization.
Questions:
1. What is the atmosphere like when staff are together? Is it open and relaxed, or tense and
strained?
2. Is there a sense of mutuality and respect between staff members and residents, or is there a
sense of unease, anxiety, fear or mistrust evident in much of the behaviour and interactions?
Part IV – Rules versus Expectations
Many programs depend on a set of rules to control staff and residents’ behaviour. In
one extreme case, a program manager admitted to having over 500 rules, stating that
whenever something happened that was not governed by a rule, they created a new one. Most
programs have far too many rules, and rules can lead to “sanctions”, consequences or
punishments when they are not followed. Programs seeking to act therapeutically tend to limit
rules to safety issues (“You must wear a helmet when riding a bicycle”, “We require that you
ask permission to leave the premises” etc.). Everything else can be an expectation. “I expect
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you to tidy your room before you come to breakfast”; “we ask that you talk respectfully to the
staff and other residents”; “please don’t forget to do your chore right after dinner”.
The beautiful thing about expectations is that you don’t have to punish or
“consequence” (usually perceived as punishment anyway) a child if they don’t meet your
expectation. You may decide the expectation was unreasonable given the child’s emotional
state, or level of development, and you can modify the expectation. Or you may simply convey
disappointment that a reasonable expectation wasn’t met, thereby leaving the child space to
experience letting you down. If you have built a strong, reciprocal and respectful relationship
with a child, they don’t usually feel very good about disappointing you. How do you feel if you
know you have let a respected friend or colleague down? Therapeutic care is all about helping
the young people to develop inner motivations and direction (self-regulation).
Part V - Interactional Dynamics: Differences that MAKE a Difference
In a study of well-functioning residential programs (Anglin, 2002), 11 interactional
dynamics were identified which were consistently associated with positive change. On the basis
of analyzing every positive change that occurred across all levels of 10 organizations over a
period of 14 months, including for administrators, with placing agencies, amongst staff,
between supervisors and workers, with and between the residents and their family members,
these 11 interactional dynamics were found to be “the differences that make a difference.” In
some cases, one dynamic was evident, but often several of these dynamics were at play in the
situation where the change occurred.
This was a rather surprising discovery and one which can significantly assist workers and
agencies to focus on what really matters. Residential care programs are about helping children
to grow and develop in healthy directions, and in order to create health-enhancing conditions,
staff members need to be acting in ways that are congruent and health-promoting. This
relatively brief list of dynamics can act as a set of interactional compass points for workers and
agencies striving to act in a therapeutic manner.
The eleven interactional dynamics are set out below with some questions suggested for
self-reflection and agency discussion.
1. Listening and responding with respect

Do I genuinely “tune-in” when people are talking with me (i.e. make eye-contact,
stop the dialogue in my head (at least for a few moments), respond with empathy
acknowledging the feelings and key messages being conveyed to me before I take a
position?
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



If I cannot attend to people in the moment, do I make eye contact and indicate
when I will be able to attend?
Do I seek out the views of the children/youth when decisions concerning them need
to be made?
Do I communicate the reasons for my actions to others, and am I open to their
opinions and feedback?
Am I aware of my personal reactions when I have a strong emotional response to
something someone else has said or done, and respond in a respectful manner?
2. Communicating a Framework for Understanding





Does my program have a clear and articulated set of values and principles that are
communicated openly and widely to other agencies, professionals, staff members,
residents and their families?
Does my program have a philosophy and model of care for behaviour change that
reflects the values and principles characteristic of quality practice?
Do I keep at the front of my mind the values, principles and philosophy that guide
the agency and program, and do I articulate them to others in a succinct and
accurate manner?
Do I hold and refer to expectations for others (staff, residents, family members) that
are congruent with the values and principles of quality care?
Do the young residents understand why they are here and what the goals of their
placement are?
3. Building Rapport and Relationships





Do I believe in and demonstrate the central importance of healthy and respectful
relationships in my interactions at all levels of the organization?
Do I act in such a way that others trust and respect me?
Do I take advantage of “teachable/learning moments”, and understand the
opportunities offered by mistakes, crises and problems – my own and others?
Do I “relate to relationships”, where I can support the positive development of
relationships between others, whether clients or other staff? (It is not always about
MY relationship with others.)
If I do something thoughtless, hurtful or unintentionally harmful, do I reach out and
make a meaningful apology to those I may have offended.
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4. Establishing Structure, Routine and Expectations



Does my program have a clear structure and set of routines (e.g. predictable
activities for. meal times, resident life, involvement in programming within and
outside the residence, etc.)?
Do I communicate appropriate expectations in a positive manner (i.e. make requests
“with a positive expectation in my voice”?)
Does my program keep rules to a minimum, and mainly for safety issues, allowing
for the flexible use of expectations?
5. Inspiring Commitment




Do I model positive attitudes, demonstrate pride in my work and follow-through on
my commitments?
Do I acknowledge the contributions of others, “catch residents being good” and
convey a sense of hope and potential for the future, both individual and collective?
Do I place a concern for the well-being of others in the program ahead of my own,
and do I go “the extra mile” to support the residents, their families and my
colleagues?
Do I move out of my “comfort zone” into my “take-a-risk zone” when opportunities
for change and challenges needing attention occur?
6. Offering Emotional and Developmental Support



Do I “tune in” to the emotions of those around me (co-workers, supervisors,
residents etc.), and am I responsive when I sense someone is feeling down, anxious
or in pain (physical or psycho-emotional)?
Do I engage others in supportive conversations, demonstrating concern and respect
while allowing them the right to privacy and confidentiality as appropriate?
Do I create or advocate for developmental opportunities for residents and staff
based on demonstrated needs and in accordance with individual or agency goals?
7. Challenging Thinking and Action

Do I appropriately challenge and encourage others (coworkers, residents) when
there are opportunities for growth and development that they may be unaware of
or hesitant about?
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

Do I engage colleagues in constructive conversation about statements or actions
that appear to be incongruent with the values, principles or goals of the program?
(e.g. “I am not sure what you meant when you said X. Can you clarify that for me?”)
Do I participate actively in agency meetings and staff discussions about program
practices, procedures and goals?
8. Sharing Power and Decision-Making





Does my program actively encourage the involvement of residents in setting rules
and routines, and generally feeling some sense of ownership for the program?
Are staff members encouraged to be creative and to take initiative in alignment with
the program values and principles?
Do I encourage others (residents, staff members) to take personal responsibility
commensurate with their developing capacities?
Do I solicit the involvement and input of others (staff members, residents/families)
in decisions affecting them?
Are mistakes, problems and crises embraced as opportunities?
9. Respecting Personal Space and Time



Do I demonstrate sensitivity towards the processes and pace of staff and child
development, recognizing and respecting individual differences?
Do I respond sensitively to the inner and outer experiences and realities of the
residents, and seek to intervene in an appropriate manner and at an appropriate
time? (e.g. It may not be effective to attempt a therapeutic conversation in a
moment of turmoil or high agitation.)
Do I differentiate between issues requiring immediate attention and those better
deferred to a later time?
10. Discovering and Uncovering Potential



Do I recognize and acknowledge the strengths and demonstrated capacities of
fellow staff members and residents, especially when they may not be fully aware of
these qualities themselves?
Do I encourage others to take on appropriate challenges and pursue opportunities
for growth and development that they may think are beyond their abilities?
Do I approach others with positive expectations and supportive messages for the
successful achievement of their goals and ambitions?
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11. Providing Resources

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

Do I advocate for resources (money, time, equipment) that I think are necessary to
serve the best interests of the residents and their families?
Do I invest the time and material resources necessary for the achievement of team
and agency objectives?
Do I spend sufficient focussed time with individual youth and the resident group and
participate in and support activities designed to help the residents to achieve their
goals?
Do others perceive me as a generous and giving person?
Some Last Thoughts
“Children do well if they can. If they can’t, we need to figure out why so we can help them.”
Ross Greene
“When you plant lettuce and it doesn’t grow well, you don’t blame the lettuce.”
Thich Nhat Hahn
“We need to shift our thinking from “What is wrong with you” to “What happened to you?”
Sandra Bloom
“We need to feel like we matter, and we can tell this by how we are treated. Words alone are
not enough.”
Martin Brokenleg
“It is helpful to see attention-seeking behavior as attachment-seeking behavior.”
Martha Holden
“Residential care is NOT rocket science: It’s far more complex than that!”
James Anglin
References
Anglin, J. (2002) Pain, normality and the struggle for congruence: Re-interpreting residential care for
children and youth. New York, NY: Routledge.
Holden, M. (2009) Children and residential experiences: Creating conditions for change. Arlington, VA:
Child Welfare League of America.
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