Issue 149: july 2011

ra tive tread mill’ and go straight to the

heart of the mat ter rather than join the

oth ers  in  al le vi at ing  symp toms  and  re solv -

ing prob lems?  Can we still claim

pro fes sional  sta tus  if  we  un abash edly  ac -

cept the role of sur ro gate par ents

ad dress ing the needs of in fancy?  And, if

we prove our point, will any body listen to

what we have to say?  Well …..

Ref er ence

Stern, D. (1985). The In ter per sonal World of the

In fant. New York: Basic Books

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M

y first ex pe ri ence with a CYC

Week was in Oc to ber of 1996.  

In April of that year, I landed my

dream job, Pro gram Man ager of the De -

vel op men tal  Neu ro psy chi at ric  Pro gram

(DNP) at a state hos pi tal.  It was a spe cial -

ized pro gram for the long term treat ment

of  ad o les cents  who  had  con cur rent  di ag -

no ses  of  be hav ioural  dis or ders  and

learn ing dis abil i ties.  It had a ca pac ity of 22 

pa tients on three units, one for boys, an -

other for girls, and a third coed unit for

pa tients  pre par ing  for  dis charge.   

It had con sid er able re sources for these

22  chil dren–three  psy chi a trists,  five  psy -

chol o gists, three teach ers, two so cial

work ers, a music ther a pist, a rec re ational

ther a pist, lots of nurses, and lots and lots

of Child and Youth Care work ers called

“Be hav iour  Shap ing  Spe cial ists,”    BSS’s  for

short.  (Where do we come up with these 

names?)  Qual i fi ca tions for BSS’s were

high for our re gion–a col lege de gree or

sev eral years of prior ex pe ri ence in the

field.  Pay was like wise rel a tively high. 

Med i ca tion  was  de-em pha sized.  Be hav -

ioural treat ment was the order of the day.  

All of that at tracted me to the job–I con -

sid ered  my  ori en ta tion  to  be  pri mar ily

be hav ioural and I looked for ward to

work ing with a team of psychologists with 

more than ample staff and resources.

And so in Oc to ber, we came to ‘CYC

week,’ a week the hos pi tal set aside for

rec og ni tion of its di rect care staff–the Psy -

chi at ric Aides on other units and our

BSS’s.  The hos pi tal made note of the

week on the sign at the en trance to the

hos pi tal where they posted var i ous an -

nounce ments.  After that it was up to the

in di vid ual  pro grams  to  rec og nize  their

direct care staff.

The RN Man ager who hired and su per -

vised the BSS’s or dered color-co or di nated 

T-shirts for each of her staff, a dif fer ent

color for each unit.  The rest of us put on

a spe cial cov ered dish lun cheon for the

BSS’s on Fri day, with enough left over for

the eve ning and over night shifts.  Trib utes

were paid.  The RN Man ager told them

they were all spe cial, the back bone of the

pro gram.  “You all do such a great job. 

We could n’t get along with out you,”  and

so on.  One of the psy chol o gists gushed,

“You are all ter rific.  We could not do our

jobs with out the data you people

provide.”  

But it all fell flat.  Ex tremely flat.

The prob lem was that the hos pi tal

treated their em ploy ees as dis pos able

com mod i ties.  Com men da tions  were  ac -

tively  dis cour aged  be cause

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CYC Week – 1996

John Stein

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com men da tions could make it more dif fi -

cult to dis miss em ploy ees if they ap pealed

their dis missal to civil ser vice.  Dis ci plin ary 

memos for any in frac tions were the

rule–dis ci plin ary memos helped to jus tify

dis miss als.    Con se quently,  em ploy ees

were readily ‘writ ten up’ for any in frac -

tions of the pol icy and pro ce dures man ual, 

which was over seven cen ti me ters (three

inches) thick.  It seemed as if the hos pi tal

was more con cerned with dis miss ing em -

ploy ees that with re tain ing them.  The RN 

Man ager on DNP had a reputation for

being especially strict with her staff.

Mo rale among the BSS’s was abys mal. 

In the twelve months pre ced ing my ar -

rival, the turn over rate for our BSS’s was a 

stag ger ing 95%.  It’s not that we lost 95% 

of our BSS’s that year.  There were many

who had years of ser vice.  But we had so

many more who left in their first few

months.

In time, I con cluded that we had three

types of BSS’s.  There were those new

em ploy ees who had no in vest ment in the

job at all and who left quickly, after dis cov -

er ing that the job was not for them.  Then 

there were those who had been there for

a few years.  When they left, they could

with draw their con tri bu tions to the pen -

sion plan in which par tic i pa tion was

man da tory.  It could be sev eral thou sand

dol lars.  They also got paid for ac cu mu -

lated leave, which was often sub stan tial

be cause they ac crued leave in lieu of pay

for any over time they worked.  They

worked a lot of over time be cause of staff

short ages due to turn over, and rarely

were ap proved to take ei ther their com -

pen sa tory leave or their va ca tion, again

be cause of staff short ages due to turn over.  

More thou sands of dol lars.  They ac tu ally

could count on a sub stan tial cash ‘bo nus’

for re sign ing, per haps enough for a new

car.  Fi nally, we had the em ploy ees who

had been with the hos pi tal for many years.  

They could not af ford to leave be cause

they had so much in vested in the re tire -

ment plan.  So we had lots of dis grun tled

em ploy ees who left, and lots of

disgruntled employees who could not

leave.

So when the RN Man ager gushed

about how “ter rific you all are,” it did not

ring true. Many of her BSS’s had been on

the re ceiv ing end of her dis ci plin ary

memos.  More, there was at least one

whom she was ac tively try ing to ter mi nate 

and ev ery one knew it.

And when the psy chol o gist gushed

about the data the BSS’s pro vided...  Their 

most  im por tant  con tri bu tion,  pro vid ing

be hav ioural  data  for  the  psy chol o gists  so

they could re vise their be hav iour plans? 

Re ally.  I could just tell how im por tant a

part of the treat ment team that made

them feel.

In re al ity, BSS’s were dis cour aged from

form ing re la tion ships with the kids out of

fear that they would un der mine treat -

ment.  Psy chol o gists did the treat ment.  

They de vel oped the treat ment plans and

re vised them weekly on each child.  And

they met in di vid u ally with each child on

their case load (of four or five) weekly to

dis cuss their prog ress–pro vided the child

was not on restriction. 

The treat ment was be hav ioural, based

on the strict est of token econ o mies.  Chil -

dren earned points for each ac tiv ity

pe riod, one for being on time, an other for 

‘par tic i pa tion,’ and a third for show ing no

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