Care-work practices with children in residential care in Malta : a mixed-methods survey

Abstract

Studies on residential care-work practices are scarse, especially those focusing on how care workers intervene with children in care and their families (Harder, Knorth & Kalverboer, 2013). Considering these gaps and given that family-centered practice has been associated with improved behaviour in children (Geurts, Boddy, Noom & Knorth, 2012), this thesis explores the extent to which care work in Malta is family-centered. The study builds a profile of care-work practices in Malta that was so far missing. Focusing on the perceptions and practices of care workers, as described by them, the study addresses multiple factors and themes that can affect the extent to which care workers and heads of care in Malta keep the children’s families in mind, when making sense of the children’s family experiences and the extent to which they include them in their work. The conceptual frameworks that inform the study draw on Attachment Theory, Systems Theory, Social Constructionism, and Resilience Theory. Inspired by a contextualist epistemological framework, this study employs a mixed methods survey. A mixed-method questionnaire was constructed and gathered demographic, occupational and skills information from 100 care workers and all the 12 heads of care in Malta. The high response rate turned the survey into a census. The numerical data were subjected to descriptive and inferential statistical analysis, while the responses to open-ended questions were analysed through thematic analysis - eliciting 15 themes which were organized into six care-work scenarios. Content analysis of themes generated pertinent patterns of prevalence. The majority of care workers were female, single, or belonged to a religious order. The integrated and triangulated findings reveal that while the level of training and reflexive aptitude varied, care workers were predominantly child-focused. Personal and family experiences, ways of being and working, learning within the work environment overtime, training, and supervision were amongst the main identified factors which the care workers claimed to influence their ability to make sense of the experiences of children in care and their families. Facing numerous challenging work conditions, care workers and heads of care seemed to excel more in their capacity to be there for the children. They were frequently driven by a strong vocational and at times also a spiritual disposition. While care workers who belonged to a religious order and heads of care were more in favour of including families in their work, contact with the family when children exhibited challenging behaviour created ambivalence in many care workers. The higher the care workers’ level of attendance to group supervision, the less the care workers were in favour of working with the families. The higher the level of education and degree of individual supervision, the less likely personal experiences were experienced as helpful in understanding the children’s experiences. The findings highlight various implications for policy, training, supervision, and practice. These include the need to support the professionalization of care work through adequate work resources, training, regular supervision, and a strong emphasis on reflexive practice. Enhancing multi-disciplinary teamwork and making the leap towards a clearly outlined, shared, family-minded conceptual framework is considered key in enriching the care workers’ contexts, enabling them to support children make sense of their family experiences.