PETE HARRIS 4 YOUTH: OPINIONS

Youth work and operator dependency

changing the outcome

I visited my GP the other day for a routine blood pressure test. As he was pumping up the machine’s sleeve around my upper arm, he and I got chatting about the whole business of medical ‘measurement’ and taking ‘readings’. He explained that the problem with taking blood pressure readings was that the results were difficult to trust because of ‘white coat syndrome’ (people get more anxious when they see a doctor and their blood pressure readings shoot up). He casually added that in fact, the whole process of using a blood pressure machine was very “operator dependent”. The phrase jumped out at me. “What do you mean”? I said. “Well,” he explained, “the readings are really very dependent on how the person operates the machine; for example, have they been trained in how to operate it properly?” 

When I got home, I googled the phrase “operator dependent”. When you do that, a lot of references to ultrasound machines show up and lots of medical-type people can be read chatting about the concept on open forums. One contribution from Dawn, a radiologist of 45 years, made the point very succinctly, I felt.

Sure, just like getting blood drawn, or having any imaging study, or seeing a Physical Therapist, or having surgery. All medicine that involves humans is “operator dependent” to some degree. As is getting your car worked on, or having work done around your house. And too many other things to name. Think this through. If the person doing “whatever” is subpar, your results may be subpar also. And if the person doing “whatever” is excellent at their job and cares about doing a good job, that can also be reflected in the outcome.

Common sense, right? If it is so blindingly obvious, why has there been such little common sense in public policy and government circles about the people we need to do the really crucial jobs that our country needs? In my professional and academic areas of interest (young people, youth work, education, youth crime and youth justice) there has been, for many, many, years a cyclical debate about “what works”? The essence of this debate revolves around the constant vacillation of opinions and endless research that seeks to objectively establish what ‘interventions’ are most effective in reducing youth crime. Many of these interventions, often acronym-ised such as CBT, Cognitive Behavioural Therapy, MST, Multi-Systemic Therapy or RJ, Restorative Justice, are studied ad nauseum via meta-analyses, systematic reviews and randomised controlled trials (RCT’s) to produce ‘accurate’ ‘readings’ of their effectiveness. Famously, CBT came out on top in one renowned study and ever since has been championed as the most effective (and evidence-based) intervention when it comes to preventing the ‘problem’ of youth crime. 

All this has always appeared to me to be missing the point. 

As Dawn so pithily notes above, in the context of the medical profession, the quality of outcome is wholly dependent on the “operator”: a bad surgeon = a bad outcome; a bad radiographer = false reading; a bad CBT therapist = bad therapy. More to the point, even the process of trying to establish which intervention is bad or good (conducting research on ‘what works’) is very much “operator dependent” too. 

A colleague of mine, Luke Billingham, recently produced a great paper where he lambasted the concept of “intervention-itis” in public policy, especially when it comes to youth work. He defines this as “the tendency of policymakers to treat enduring, systemically generated problems with limited interventions that are insufficient or inappropriate for the intended improvement”. Another old friend and colleague Graeme Tiffany has coined the medical term “iatrogenic youth work” to describe oxymoronic interventions that end up generating harms in the pursuit of reducing them. Both Luke and Graeme are trying to desperately point to a folly that they, as do I, see all around us. We are all asking, when are we going to realise that when we send humans into work with other humans to try to educate, transform and heal, the chances of a good outcome are, like my blood pressure readings, dependant on the operator.

When it comes to youth work (and I would argue this is especially true in my old profession street-based youth work) the ‘machine’ being ‘operated’ is not so much a particular intervention (or at least it shouldn’t be). When working on the streets with young people I learnt very quickly that the worker (me) was the resource – I was literally ‘operating’ with myself only. So, it goes without saying (but maybe we have to say it again) in that context, if the machine is the worker, a ‘bad’ worker is even more likely to lead to a bad outcome. I want to suggest that ‘bad’ workers in this context means incompetent, inexperienced, inadequately trained workers who are not reflective, and not able to provide a rationale for their practise. Conversely, ‘good’ means well-trained, expert, experienced, reflective and value-driven.

I am interested in good outcomes; very interested. So why is it that when we are faced with some of the most intractable, complex problems when it comes to young people, such as educational underachievement, knife crime, gender-based violence in schools, gang violence, we think that putting under-qualified, inexperienced folk to work at the chalkface of the problem will somehow produce a good outcome? As I found out reviewing a local authority’s youth violence response recently, or when I visited a school to deliver a gender based violence project, or in the past when I’ve visited prisons to meet with young people and staff,  or when I’ve been into Pupil Referral Units, I am often confronted with the same sorry scene: inexperienced, poorly trained, poorly paid, often part-time and for all intents and purposes, amateur workers struggling with the most challenging young people in some of the most difficult and brutalising environments. 

All of this can, in my view, be traced to the decimation of youth work training routes, closure of university courses, and the undermining of professional qualifications that began post austerity.  The new Labour government seems serious about turning a corner – nurses and doctors have had their pay claims settled. OFSTED’s one-word judgements are being called into question. Youth workers’ services, decimated by cuts are now being seen as a potentially important part of a meaningful response to the problems faced by young people in Britain today. So please, can we have a little less “iatrogenic intervention-itis” and instead. a serious, sustained effort to invest in the training and professional development of youth workers and teachers. Maybe then we can attract and retain good workers with reserves of practice wisdom and keep them engaged in doing work at the chalk face that actually does more good than harm.