The process of developing, following and adapting policies at the frontline level has been examined in other public service workers. "Street Level Bureaucrats" are defined as public service workers who interact directly with citizens in the course of their job, and who have substantial discretion in the application of policies in the execution of their work [21] . This level of discretion and ability of the frontline worker to modify set government policies for the individual situation has also been described among police officers, social workers and others who work within the public sector [21] . Additionally, studies of nurses have demonstrated similar reliance on previous experience and visual cues such as touching, observing, listening, feeling or sensing, and "knowing" in decision-making [22, 23] . Conflict in care has also been reported in health care workers who demonstrated balancing the risks and demands of caring for patients [20] . The results of our study demonstrated that the decision making process and demands placed on CCC staff are similar to those experienced by other professionals, who work in high stress environments and care for others on a daily basis.