OUr therapeutic model of care
Therapeutic residential care moves beyond the basic provision of daily care and support of children and young people. Research informs that children with complex to extreme needs require intervention that delivers reparative therapeutic learning experiences within daily life. With this growth and healing is an ongoing experience where each moment of the day can provide opportunities of intervention. Particularly:
- While individual therapy may be one component of a therapeutic care program, therapeutic care is not about therapists seeing children individually
- It is about the skilled therapeutically intentional use of daily interaction as a vehicle for delivering healing interventions
- It is about opportunity led work where every moment can be used to make a difference
The National Definition of Therapeutic Residential Care: therapeutic residential care is intensive and time-limited care for a child or young person in statutory care that responds to the complex impacts of abuse, neglect and separation from family. This is achieved through the creation of positive, safe, healing relationships and experiences informed by sound understanding of trauma, damaged attachment, and developmental needs.(National Therapeutic Residential Care Working Group)
Key components of therapeutic residential care include:
- The use of the daily living milieu and direct care staff as primary agents for therapeutic change
- Highly skilled and trained staff, who have access to quality supervision and support
- The pivotal role of a psychologist in providing assessment and intervention services, as well as contributing to program development
- The involvement of multidisciplinary teams of professionals (mental health, education, direct care staff)
- Short to medium term interventions, where placements are usually 12 to 18 months in duration
Organisational Theoretical Influences
YLO (Residential Care Services) model of Therapeutic Residential Care is influenced by the overarching organisational values and culture. Two influential researchers in which YLO (Residential Care Services) draws information is that of Sandra Bloom’s creation of sanctuary and James Anglin’s struggle for congruence.
Theoretical Influences in the Provision of Therapeutic Residential Care
YLO (Residential Care Services) model of Therapeutic Residential Care draws upon five main theoretical references:
- Child & Adolescent Development
- Social Learning
YLO (Residential Care Services) holds the following key elements as central to its practice of Therapeutic Residential Care:
- Suitably experienced and qualified team of Residential Care Workers that are attuned and responsive to the needs of children and young people within the service and are able to work collaboratively as part of a multidisciplinary team in promoting a therapeutic milieu
- Therapeutic parenting approach as opposed to the youth work paradigm
- The creation of a safe, stable, consistent, predictable living environment. Within a predictable, safe and supportive environment the child or young person can learn to reflect upon their behaviour, and learn more socially adaptive ways of responding through their daily interactions with staff and others. The importance of developing a functional sense of self through interactions with others
- Comprehensive biopsychosocial assessment that informs therapeutic programs and care planning for each child and young person that guides implementation of individualised service delivery
- Seek to bring about directed and clinically significant change (based on evidence/research) in the child or young person through goal directed, planned and integrated therapeutic interventions involving documented records monitoring progress and feedback on the attainment of goals
- Using the combined elements of positive peer pressure, trust, safety and repetition, the therapeutic milieu provides all aspects of the environment that the young person’s experiences should contribute to their recovery
- The provision of reparative, learning experiences
- Day program and education program structure and activities
- An approach to care which is sensitive, respectful and actively explores to understand the child or young person’s experiences
- Provision of a safe organisational culture that emphasises both employees and children/young people have responsibility for their own choices and behaviour within appropriate limits and boundaries setting
- Translation of complex theory into understandable action
Therapeutic Intervention“Treatment is no longer confined to a specific hour or group, but becomes a continuous process in the context of an environment that lends itself to healing” (Bloom et al., 2003)
The aims of therapeutic care are to provide reparative experiences that promote healing and recovery. Individual therapy, although it may be helpful, cannot provide the intensity or the repetition that is required. In therapeutic care the provision of safe, nurturing relationships, stability and care enables integration of the child/young person’s experience and promotes healthy development. Rather than providing basic care and managing behavior, therapeutic care emphasises relationships and considers and responds to the child/young person’s underlying needs.
YLO (Residential Care Services) does not endorse or have total reliance on one therapeutic approach. YLO (Residential Care Services) utilises evidence based practice in the treatment of children and young people with a history of trauma and cumulative harm within the child protection system. Interventions used by YLO (Residential Care Services) include:
- Trauma Focussed Cognitive Behaviour Therapy
- Acceptance & Commitment Therapy
- Narrative Therapy
- Skill Development Programs: such as assertiveness training, relaxation skills, social skills, etc.
- Programs that assume and encourage a child/young person’s need for mastery, belonging, independence and expression of pro-social behaviour.
All chosen interventions are informed by a holistic and comprehensive assessment, developmental readiness and carer’s capacity to provide consistent and nurturing care.