Abuse, the uncomfortable questions we have to face

“Mistreatment of people with serious disabilities, eight arrests in Piedmont”. This is how the note from the Carabinieri Command for the protection of health in Turin begins, which has shocked an entire community and, more broadly, anyone involved in social work. A brief sentence that outlines a complex scenario, the outcome of an articulated activity that led to eight custody orders and six house searches against seven social health workers and a psychotherapist, held responsible for “serious humiliation and physical and verbal violence” against people with intellectual and cognitive disabilities guests of the Comunità Mauriziana in Luserna San Giovanni, managed by the social cooperative Interactive.

There is nothing else to add on the matter, investigations are underway. In the face of collective indignation and bewilderment, once again, the reflection opens, increasingly urgent and increasingly profound, on the caring professions. Difficult and essential, extremely delicate yet invisible, requiring responsibility, sensitivity and constant maintenance made up of training and supervision. Do we really know what skills are needed when interacting with disability? Do we know the days of those who take up service in a RSA or a RAF? And above all, are we aware of the needs of the people who live there?

Rashmi Costanza is a Piedmontese social health worker who has also taken on coordination roles for about ten years. In Sagliano Micca in the province of Biella, she is the coordinator of two residential units managed by the Domus Letitiae cooperative, a RSA and a Type A RAF. We asked her to help us answer.

Starting with words is always a useful exercise. What is the difference between a rsa and a raf?

Rsa is the acronym for residential health care facility. It means that a care component of an assistance type is required inside it: in the RSA where I work, people with a physical and cognitive disability live, the youngest is 16 years old and the oldest is 81. There is no division based on age group, we think about the insertion in one nucleus rather than another always starting from the needs of the person : for example, in an area where we welcome people who are more compromised from a physical and cognitive point of view, we have inserted one who has many skills and autonomy because the environment is quieter and meets his need for a context of this type.

Raf, on the other hand, stands for flexible assisted living, where people with cognitive disabilities (some also physical) who have greater autonomy are hosted . Type A homes host people for whom it is possible to enhance their abilities and autonomy, while type B homes host people with more serious cognitive disabilities.

Faced with news like this, how do you feel?

My thoughts immediately went to my daily life, to what happens in the nuclei where I spend my days, to the responsibility of always being present within the services and to the ability to detect any ailments immediately. It is a call to responsibility , especially when taking care of people who are totally dependent on the operator.

We are dealing with people who react to situations of frustration through physical and verbal aggression, this aspect can put operators in difficulty. You need to have balance to manage certain situations

Rashmi Costanza, health care worker and coordinator of two residential units

Who works in the nuclei where complex needs are encountered?

On the front lines there are social health workers and professional educators . They are a constant presence, supported by figures such as physiotherapists, nurses, psychologists and doctors. We work six days a week, including weekends and holidays: even though we knew it from the beginning, over time the reconciliation between work and family and personal life can become difficult.

What skills are needed?

Caregiving skills for care work and relational skills, listening skills and empathy that allows you to grasp discomfort and find effective interaction strategies. We deal with people who react to situations of frustration through physical and verbal aggression, this aspect can put operators in difficulty. You need to have balance to manage certain situations, know how to contain anxieties, expectations and disappointments and on the other hand have the ability to put the person in a position to express themselves and reach the maximum possible autonomy. It is a job that challenges you a lot and in which the relationship extends to the entire reference network of the person. It is a game of balance, not only with respect to the needs and desires of the users, but also with respect to those of the operators. We coordinators must try to make these two things fit together, keeping firm the awareness that the starting point and the point of arrival are always the people we work for.

Is the risk of burnout high?

Of course, burnout is a real risk, this job is a magnifying glass on fragilities, even personal ones . But I think we need to take a step back, start thinking about the choice of the caring profession. Motivation is not enough. We need a push towards the other, the desire to make the person in front of us feel good. Skills can be built over time, what is difficult to build or transmit is a set of shared values: we need to be aligned on the meaning we give to the concepts of attention to the person and listening.

Training and supervision are an important tool

It is necessary to invest in very specific training on disability, to work on individual cases and complexities . Our teams meet once a month with a psychologist external to the system, to address dysfunctional group dynamics and strategies to be able to work well together and be effective. It is important to take care of the operating methods and build a common working method on the guests. But even this is not enough: what really matters is being there . I coordinate the services but I am also present during the shifts: experiencing them firsthand allows us to better understand what the efforts and tools to be put in place for users and operators may be. This makes the difference.

In the opening photo, a pet therapy activity

Tags:
• Disability
• social work