What are your thoughts on the term 'Front-Line Workers'?

Hey Stephanie, I'm a 3rd Year CYW from Fanshawe College and so far just about all of my instructors/teachers have used that term and nobody really gave it a second thought. It wasn't until this year while on placement that my boss mentioned the controversy of the term "Front Line" and how it may apply some form of opposition.

Personally, I don't use the term (not anymore haha) because I believe it implies that there is some kind of war or battle going on between the workers and clients.  It also puts up yet another barrier and don't we already have enough of those already?

I agree with the previous post, much like the "War on Drugs" for example, we militarize, or add aggression into situation to imply a fight/battle vs. finding positive solutions, typically in a collaborative way.  "Cancer" is re-thinking its use of the aggressive language, moving from the fight against, to learning to live with.  its a goodlesson for MH as we know it will be a life long journey.

We struggle with terminology regularly, moving from direct care staff, front line worker, direct care clinician, residential counsellor, etc.  still haven't landed on anything, I'm interested if anyone else has!

We're so quick to retreat (!) toward war imagery, aren't we? (Even in art, the avant-garde -- thought to be progressive -- alludes to 'advance guard,' a militaristic concept.)

In terms of other, more general terminology, "Aboriginal Peoples" is a term we're starting to move away from here at CAMH. We're now trying to move toward using FNIM Peoples (First Nations, Inuit, and Métis).

Agreed Ian! I think that what we need is a paradigm shift from that rigid authoritarian way of thinking you previously mentioned (fighting against) to a much more fluid/authoritative one. A mindset that says "We are here to help you, help yourselves, to teach us how to help others and in doing so; help the system itself".

As for a different term: Hmmm...how about something intuitive like "Agents of Change" or "Community Engineers"?

But seriously, if there is anyone out there that has their own definition for child/youth/client engagement I would be very interest in hearing it.

So true Jason! There have been huge changes in terminology lately, especially for the LGBTQ+ community and individuals with Mental Health needs. There also seems to be a push for "Mental Wellness" (instead of "Illness") which I'm so glad to see.

I think that if changes in language and terminology like these can happen then we can definitely come up with a better name for those engaging clients than "Front Line Workers". This is 2013, we can change things; right here, right now!

I've struggled with all the military terminology too. How is service provider instead of front-line worker?

"Service provider" is definitely something we strive to use at EENet.

Thanks for your comments, FarrellWeir and Julia!

Oh, and thanks to Ian and Steph, as well!

'Service provider' and 'direct care staff' seem like good alternatives to me. 

I wonder, though, why these terms weren't used instead of front-line workers? What was meant to be conveyed by 'front-line' that 'service provider' or 'direct care staff' misses? Perhaps the idea that these professionals are working tirelessly on behalf of our clients?

Those sound like some good ones! Another term I just discussed with a few of my colleagues today is "Primary Caregiver". I just wonder if this terms and others like it could be taken out of context, especially by those not in Human Services. For example: "Primary Caregiver" could mean "Guardian" or "Parent". Would it be too presumptuous to ask for a universal term?

I think the aggressive nature of teh language used is a throwback to the times when we were fightign with everyone.  I see it much like harm reduction in addictions, a more recently accepted shift from fighting to eradicate, to learning how cope/manage/live with etc. 

it can get mind boggling when you stop to think and familiarize yourself with all the nuances of teh language we use for different contexts/issues.  If we can each focus on one word a week (month? day?) to replace in our vocabulary, we become agents for change.

Absolutely, it might not be easy but I think we can do it gradually, after all: slow and steady wins the race!

On a side note, I just googled "Another term for front line worker" (among other variations) and all I got were links to pages essentially embracing or using the term as their focal point. *Shudder* that's just bad. Are we (CAMH and mindyourmind) some of the only people talking about this?

Ian, I love the "one-word-a-week" call to action. Really interesting. Thanks for it.

The label I really dislike is "case manager."

Along the lines of "case manager" i'm starting to hear some clients labeled "complex cases". First time I heard it, it reminded me of calling someone "a head case".

Fun and good discussion to make a Front line worker reflect, as I had provided that description of myself to EEnet. I guess it is about context and how used and I might as well toss in power and authority and legitimacy. A few points of context etc. or what goes through my mind why I use the term sometimes in some contexts and call myself a social worker in others.

• Frontline worker to me is used in talking within organizations and where you are in the pecking order of things; useful to distinguish between knowledge broker types, program consultants, docs etc. Few would be using the term with clients unless at formal organizational meetings.
• I have seen "workers" call themselves "housing workers" and while they are trying to be non-threatening I believe they are hiding that they are actually mental health workers with knowledge and potential coercive power to intervene on individuals they are serving. Better to be clear about what you are about, your focus etc.
• There are some First Nations people who use the term Indian, with total purpose in order to reveal the big sleep of racism and ignorance of "the Indian act" and its impacts, in their lives every day.
• Service Providers and service users terms are interesting, just as we talk of clients, but are we suggesting the kind of work we do in mental health support has the generic role title as my internet provider sales person?

On the militarization front, I have to confess that I am a former army brat and found Arnold's First - Predator movie a fascinating deconstruction of masculinity.

Yeah, I personally prefer the term "Complex Needs" (more specific than "case" I guess). It could just be a matter of turning a negative into a positive. For example: "Martha doesn't take care of her hygiene" becomes "Martha would benefit from a motivational environment and occasional reminders around self care". Just a thought.

Yes! Saying that a client has complex needs is a language that describes something (one thing) about the client that will hopefully be helpful. On the other hand calling someone a "complex case" is labeling them, which creates an identity. Big difference indeed! I prefer using language that never labels, either positively or negatively, because people are always more than one thing and no one likes to be labeled.

So essentially what we're trying to do here is create a label that isn't a label? Ahahaha! Actually, better yet; we're trying to come up with neutral, universal, matter-of-fact/layman's terms to describe workers, clients and their interactions with one other without using a "cookie cutter". Does that sound about right or would someone put it another way?

Good point. I guess job titles are labels too but it's hard to get around that. To some extent all words are labels, but for clients I think the more descriptive and less labeling the better.

Thanks for the great comments, everyone! I especially appreciated Bill's point, which seemed to be about how an objectionable term can potentially work in different contexts -- something to keep in mind, for sure. And as a recovering graduate student in English, I'm all for hearing more about Predator as a deconstruction of masculinity!

is there a way to create a shared document?  people could post their pet peeve words/labels/titles and we can all weigh in on potential substitutes?

I like it, a huge collaborative roster of accepted terminology!

Maybe we can start a wiki?

Actually, whenever you post a new topic to EENet Connect, you have the choice of adding a custom poll. Maybe we should do that for "front-line worker"? (With some of the suggestions already provided as answers?)

We can also just upload a spreadsheet to this thread with various options, too.....

Fabulous idea. I'd be extremely interested in people's suggestions for an alternative term to the much-despised "case management", for example.

Boy, go away for a few days, and look what happens--exciting discussion! So, a couple of things:

Jason says: In terms of other, more general terminology, "Aboriginal Peoples" is a term we're starting to move away from here at CAMH. We're now trying to move toward using FNIM Peoples (First Nations, Inuit, and Métis).

Just to note that the legislation includes all these people in the term "Aboriginal". Don't know if that helps or not. I do get concerned about shifting terms without a sense of historical progress.

Farrell said: So essentially what we're trying to do here is create a label that isn't a label?

and Julia replied:To some extent all words are labels, but for clients I think the more descriptive and less labeling the better.

Just a comment in support of the idea of describing the person, where that's appropriate, rather than the specific aspect (e.g., person with schizophrenia, rather than schizophrenic; person with substance use problems, rather than addict or substance abuser; etc.)

Hear hear. I would be very interested in hearing from others about alternative terms. I've been working on this issue for years now, and have yet to find an acceptable alternative, despite fairly widespread consultation with service providers and users.

"System navigation" was looking good for a while, but seems to have been co-opted by the segment of the field concerned strictly about access, transportation, etc. "Care coordination" is another option, but it's strictly clinical.

I've been looking for something that conveys the value that "case managers" are, ideally, partners/guides in the process--providers who offer their expert knowledge of the system and its components to help the patient/client find the most appropriate, helpful, and timely service.

So I'd like to draw on the wisdom of the group.

Good points all, and thanks for your comments. I'm going to start a spreadsheet with a list of all of these terms, and upload it when I have a moment. 

When I was a "case manager" I never considered the "case" to be a person. I thought in terms of the file I was managing, but each person was managing their own life. If I was fortunate, the individuals I was engaged with allowed me to be part of their process. Now, as I talk about "case management", I often think in terms of situation=case...so from a system perspective, it is our role to support the overall system support for a complex situation.However, this too can sound pejorative which often makes me wrangle for a new term that will still convey some shared meaning. I love language and would welcome terminology that better fits the experience of a person accessing services. Some words have less collaborative meaning because of how we have actually employed them, not because of an inherent value in them, I think. The word "management" implies a sense of being "done to", rather than "done with". Please forgive the quotes...I am "air quoting" in my mind. This is an interesting dialogue. Good that we do not become complacent our terminology and important that we don't get lost in it either.

best regards.

Here's my two cents. If we start from a place of caring, then all of our work flows from there. Direct care and Care manager are a couple of thoughts on changing terminology.

I also agree about using the word worker. Many years ago I was talking about my colleagues to a friend. She was so impressed that I used that word and what it meant about collegiality. She had never worked in an organization where people called each other colleagues and where that feeling of commraderie was fostered.

Language is culture. What kind of culture do we want our work to reflect? Relationship? Connection? Caring? Other? Heirarchy?

Hi Farrell,

I would even suggest that we should think carefully about the term 'helping' as wel. I have attached a piece that I got from a co-worker's physician sister a few years back, and I think it says it all.

Wow, that's quite the interesting Holistic view. Thanks Rheanon!

I do have to add one more term that is my personal bane of service provision in partnership with a hospital: My ARGGHHH! term... is "Outpatient" when it is used to refer to anyone who receives service from the hospitals' "community programs", even if the person has never been in the hospital!

Rheanon, is it that you think 'outpatient' over-medicalizes someone's situation?

That is exactly it, Stephanie. I think patients is an appropriate term within the hospital or any clinical setting. In fact, the fact that people who are being treated for physical or mental illnesses are called the same thing can actually be seen to cut the stigma a bit.

My rant is about individuals who are accessing services that have nothing to do with clinical treatment, perse, but are funded through hospital programs. In this district, we have recreational and vocational events and services that are opened to people in the community who are living with mental illness or addictions. Often, these are people who are not affiliated with any formal services and the the events can help connect them and bring them in from the fringes, so to speak. These same people may never have been in the hospital for their mental illness or addiction issues, but they are labled as "Outpatients" anyway. I would not have as much issue with this if the same people could access the formal, clinical services when they needed them because they were so labeled, but I have not ever seen any such advantage for the service recipients over the years.

I agree Rheanon! Not just outpatients. Sometimes people with mental health issues are called patients or even clients even if they have never been a patient or received a service for their mental health.

Rheanon, I like the expression "ARGGHHH! term." I think we should title our next post on terminology: "ARGGHHH terms."

Speaking of which, as already noted, we're going to gather up all of these great terms and suggestions, and create a spreadsheet, hopefully by end of week.