Reclaiming Residential CareA positive choice for children

and young people in care

Lisa Hillan

Programs Manager

Save the Children Queensland

Overview

• A study of residential care in:– Glasgow Scotland– England– Vancouver Canada– Chicago– New York

Vancouver Canada

Concerns re residential care• Costliness of the service

• Trauma associated with separation from family

• Victimisation by staff

• Learning of anti-social behaviour

• Poor outcomes Chapin Hall 2004 40% of up leaving res care between 1995-2004 had a negative outcome

Definitions of residential care

• Residential treatment program

• Therapeutic residential care

• Small group homes

Residential Treatment

• Strong mental health component

• Treatment plan

• Comprehensive and in depth assessment

• Strong diagnostic framework

• Directed change and fixed term intervention

Therapeutic Residential Care

• Therapeutic milieu

• Less focus on psychiatric provision

• Therapists are an integral part of the team

• Education component

• Therapy with residents and meeting with staff

• Longer time frames – still time ltd

Small Group Homes

• Small amount of children and young people

• Rostered staff

• Less intense requirements for young people

• Therapeutic design but therapists not playing major role

• Mostly older young people who will leave to go to independent living

Key Issues Across Countries

• Significant increase in use of drugs by parents – Scotland 2006 McKegney found 60 000 children living in drug dependant households

• Children and young people being left in situations of distress for much longer and returned repeatedly

Key Themes

• Place of residential care

• Evaluation

• Assessment

• Family Work

• Relationships/Attachment

• Staffing

• Training

Place of Residential Care

• Some form or residential care needed – extremes of environments don’t serve people well

• Quality of care environment important

• Low ambitions for residential care

• Children failing into res care

• Positive choice – should not be a last resort

Evaluation

• Lack of connection between providers and researchers

• Costs vs Outcomes• Assessment, evaluation and program design• Problems with evaluation• Place of young people• External evaluation – the Chicago

experience

Assessment

• The place of assessment

• Therapeutic teams in assessment

• Needs assessment vs risk assessment

• Value of assessment for young people

• Danger of assessment

Family Work

• 80% of young people returning to family on exiting care – rarely residentials working with family

• Place of family in residential care• Family work integrated into residential care eg of

practice in Scotland, England and Canada• The importance of family work within residential

care and a case for family therapists attached

Relationships/Attachment

• Importance of relationships as the basis for all work in residential care

• How do we teach res care staff the art of relationship?

• Key worker models and the place of attachment• Day to day building and repairing of relationships• Young people’s perception of the relationship• Relationships as learning and transitioning to new

relationships

Staffing

• The right staffing levels• Safety linked to staffing• Ratio’s of 1:2 and 1.5:2• The status of res carers and the need to upgrade

this• “Good care is not about tools – its provided by

people and investing in carers is investing in the heart and soul of children” Anglin

Training

• The need for specific training – Scottish Institute for Residential Care

• Including life span development, trauma, attachment and loss and grief

• Parrel process between training of staff and educational opportunities for young people

• Transference, counter transference and assisting staff to manage and intervene

What makes residential care successful?