Got Hugs?

Section 28 clients have developmental delays and Section 65 clients have a behavioral diagnosis. But professionals working in Section 28 can hug their clients. I can’t because I work in Section 65.  When my 9-year-old client gives me a hug goodbye at the end of the day, I have to teach Charlotte to give me a fist bump, high five, or side hug instead. When she asks why she can’t hug me, I struggle to answer.  I follow company policy, but I don’t understand or agree with it.  It’s uncomfortable to withhold appropriate affection towards a child.

“But behavior kids are dangerous!”   If you, or someone you know works with children with developmental delays, you might be chuckling. Kids with developmental delays can be just as unsafe and unpredictable as kids with behavioral concerns! The actual risk depends on the individual, not whether they are in Section 28 or 65. The perceived risk of working with behavioral challenges is deceptive.

Working in Section 28, there was a decent chance my client Michael, who was nonverbal and did not use sign language, would try to bite me on a daily basis. I am trained to avoid physical harm, but Michael’s aggression was often quicker than my training. His wants and needs were extremely difficult to understand. Charlotte is my current client in Section 65. She is physically aggressive, but her aggression is more manageable. If Charlotte threatens to stab me with a fork, I remove my body from harm’s way and call for backup. Charlotte never exhibits dangerous behavior without a physical or verbal warning. If you give her space, she leaves you alone.

Charlotte has never made a true attempt to follow through on her threats. Michael, however, sank his teeth into me on more than one occasion. The actual risk of injury is significantly less working with Charlotte than Michael because her physical aggression is predictable and avoidable.  Now, consider the risk management involved from a client’s perspective.

Michael can’t tell someone to stop touching him if it makes him uncomfortable. But healthcare professionals may hug him without specific guidelines. Conversely, Charlotte is fully capable of telling people to leave her alone. Yet Charlotte is the client I have specific directions regarding physical contact. It makes no sense that the client who cannot speak for himself can have his personal space violated more easily.

But hugging isn’t the focal point. The question is, what kind of physical contact is most beneficial to the client? Physical interventions should not blanketed statements applied to each department.  Instead, we should look at the role of physical contact in the client’s life.  We should assess what kind of boundaries would best support the child, and then decide what kind of physical contact is appropriate.

Michael lives in a loving home; positive attention and human interaction are a common occurrence. Charlotte’s life is full of trauma. She needs healthy affection far more than Michael, but she is the client I have to push away or redirect to a side hug.   The bottom line: we should avoid a one-size-fits-all mentality and do our best to meet the individual needs of clients.