1. National Centre for Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007. ISSN 1751/9705Policy and Practice Meeting Needs: Moving us on to where young people need us to be. In this issue Proceedings of the National Centre for Five challenges for residential Excellence in Residential Childcare Annual child care 1Keynote address: Conference, 8 November 2006, Leofric Parmjit Dhanda, Parliamentary Conference Centre, CoventryUnder-Secretary of State forChildren, Young People The Annual Conference served both to launch new NCERCC policyand Families 3 and practice documents and to showcase positive developments across the residential child care sector. As in previous conferences itDeveloping the workforce5 also provided a forum for discussion of the key issues and challengesStakeholder perceptions of facing the sector. The contents of the proceedings include piecesMulberry Bush Therapeutic developed from the presentations for the conferenceSchool 6Pillars of parenting: newthinking on residentialchild care 8Bearing the unbearable:talking about things wewould rather forget 10Health in residentialchild care11Supervision in residentialchild care two newNCERCC practice papers12Setting up and sustainingtherapeutic care Lioncareand Childhood First 13Secure settings achieving Five challenges for residential care good outcomes 16Care planning seminar 17 An editorial by Ian SinclairBehaviour and educational This talk does what it says on the tin: it is The five challenges are: achievement 18 about five challenges for residential care. I the problem of defining and The latter term covers a wide range of maintaining a specific role for eachTaking care of education provision. There are, for example, units homeimproving outcomes19 dealing with the attachment needs ofI the need to gain agreement within the young children, homes that also providehome on what it is about and howRecruitment, selection and education, secure accommodation, things are done professional development20 assessment units for families, and provisionI instability: the great differences there for disabled children. The following coversare between homes and over time the most common form of residential care within the same home in the in social services: childrens homes for behaviour and morale of the residents challenging adolescents.I carry over: the problem of ensuringthat gains made by the residents

2. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 while in the home last after they havehome in the near future a long way fromdramatically between different homes in left it their homes. ways that cannot be explained by their I the high cost of homes and the impactintake. The level of disorder and misery can of this on other features, such as length The challenge to a home and its management be high. In one study 60 per cent of those of stay.is not only to define its purpose and function with a previous offence committed a but also to maintain these. Staff need to askfurther one if they stayed six months, as The talk is based on a review of thethemselves how they would describe the roledid 40 per cent of those who had no literature in English, on my own research of their home, and whether the characteristics previous record of offending. Four out of and on work by my colleagues in York. fit together to provide a feasible role, and if10 adolescents said they had thought of not, what needs to change. killing themselves in the previous month Defining and maintaining a rolean experience strongly associated with Homes do better when the managers feelGaining agreementaccounts of bullying and harassment. that they have a clear, feasible role. This isHomes seem to work better if the staff and explicitly or implicitly defined in terms of: the head of the home agree. This means Stability in this sense does not vary with I the residents that they share a common ethos, approach the staffing ratio, the proportion of I the homes function (for example, toproblems from a similar point of view, and trained staff, or whether the head of theprovide remand or assessment)are agreed on how to translate thishome has a qualification. External I its purpose and rationale (what it seekscommon ethos and approach into action. inspection seems unable to produce ato achieve for the residents and how)Such agreement is probably easier if the uniform level of stability. The key seems to I the length of stayhome has not recently had a change oflie with home managers, on whether they I the catchment area. role, if the head of the home agrees withare in agreement with the staff and on external managers and if the way the their approach to ensuring that the young These characteristics interact. There are home works is in keeping with what people go to school and do not disrupt the now many fewer homes. So the wish tooutside professionals feel is good practice. home. Home managers have to have an place young people close to their own Staff need to ask themselves how far theyeffective and appropriate approach. They homes makes it difficult for homes to beare signed up to the ethos and approachmust also be in a position to get this very specialist in the care they offer. of the home, and how can they implementacross to their staff. They are likely to find Homes may be asked to take young people this consistently, but in a way that usesthis easier if they have clear authority and with very different characteristics ortheir own strengths. a clear, feasible remit. needing very different lengths of stay simply because they are local and there isAchieving stabilitySo, the challenge is to ensure that the no other home in the neighbourhood. Morale, the incidence of running away andhead of the home has a clear and effective Equally, it may be a mistake to place breaking the law, school attendance, approach to managing behaviour and young people who are expected to return bullying and sexual harassment all varyeducation, and that this is implemented by 2 3. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 staff and supported by management.So homes need to ask themselves what them. Possibly, there is a need for new Homes have to ask if this is the case.assumptions they make about long-termmodels (for example, low support effects, how realistic they are, whether accommodation where a small group of Ensuring carry over they occur and how better success couldyoung people live without a member of It is very difficult to ensure that the be achieved. staff on duty at all times). Certainly, the benefits of residential care survive models need to be consistent with costs discharge. Homes can undoubtedly benefitIssues in controlling cost (for example, a home that sets out to young people while they are there. TheseResidential care is very expensive. In one provide a long-term home is unlikely to effects, however, may not last. For recent study, daily costs varied from 121 succeed if it is so heavily staffed that example, young people who have left to 837 with an average weekly cost of young people are continually moved on to unhappy homes may become happier; and around 1600. These costs lead to pressure less expensive placements). By contrast, a those who have left happy ones mayto close homes and move individuals forhome that keeps its young people for a become unhappier. The final outcome may reasons of cost rather than need. There areshort period of time can afford to have be much the same. The impact of the also issues of equity and timing. Is it fair high weekly costs. homes shows the power of the immediateto spend so much on a small group of environment. The environment to which young people? And if it is, would a parent So staff need to ask themselves: What are the young person moves is also powerful.with 160 000 to spend on their son or the sources of costs in this home? Is it true daughter spend it on two years of theirthat they cannot be reduced without Rather little is known about how to adolescence and leave little for whatdamaging effects on either the young overcome this problem. It seems likelyhappens next?people or the staff? Are they consistent that very long periods of stay (forwith what we are trying to do? example, four years or so) may make the These costs are largely driven by staffing but homes influence persist. It is also likely also vary with the role of the home, its Conclusion that homes should emphasise the skillsgeographical position and type of resident.Residential care is often on the defensive. that are needed at the next stage. In the Expensive homes have as much or as littleWhat is suggested above is that it has former approved schools, those that disorder as others. However, in homes with a questions to answer and that these can be emphasised trade training were more high level of disorder, the staff group tend toasked at the level of the individual home. successful in reducing delinquency, and feel that more staff is needed. A possible If a staff group has considered these this approach was seen as relevant by the explanation for this anomaly is that while questions and feels confident in its young people. There is some evidencehigh costs do not prevent disorder, a high answers, it certainly has nothing to be that work with a young persons familylevel of disorder creates the need for moreashamed of, and may well have much to before they go home may be useful.staff (for example, so that the home is notbe proud of. Given that much will depend on theleft unattended if a staff member has to take new environment, it is logical to set a young person to hospital). Professor Ian Sinclair, Research Professor, Social criteria for discharge (for example, thatWork Research and Development Unit, a young person should have a job andAlthough costs do not appear to determineUniversity of York. Tel: 01904 321294, accommodation to go to).outcomes, it is not clear how to reduceEmail: acs5@york.ac.uk Policy and practice meeting needs: moving us on to where young people need us to be Keynote address by Parmjit Dhanda, Parliamentary Under-Secretary of State for Children, Young People and FamiliesIts great to be here to address the firstSecure Accommodation Network are conference on residential child care sincerunning a seminar later this afternoon. the establishment of the National CentreSecure childrens homes are an essential for Excellence in Residential Child Care last resource and we want to ensure that there autumn. will continue to be enough places in these homes to meet demand. The Centre is funded by us, and hosted by the National Childrens Bureau. Id like to Children and young people living in thank them for all their hard work over the residential special schools and childrens last year, in particular their work to help homes should have exactly the same the government to improve the quality ofopportunities as all other children. If this is care in childrens homes and residentialnot achieved, then the state will have failededucation, employment or training at age special schools.in its corporate parenting role. 19 compared to 13 per cent of all youngpeople; and only 6 per cent of young We recognise that residential care can be a By now weve all heard the statistics: people whove been in care go to university. positive placement option for somechildren in care are five times less likely to children and young people it is their achieve five good GCSEs and nine times Since 1997 weve invested close to a billion placement of choice and can help them findmore likely to get excluded from school. pounds into the Quality Protects initiative. stability and achieve better outcomes.A quarter of people in prison today have Weve taken steps to encourage adoption spent some time in our care system. Over 30instead of long-term care. And weve put Im pleased to see that people from the per cent of care leavers are not inlocal authorities under a duty to improve3 4. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007And, overall, the cost of residential carecontinues to rise, although the number ofchildren and young people placed in thesector remains roughly static. Localauthority expenditure on childrens homesalone rose by a total of 33 per cent overthe four-year period from 2000/01 to2004/05. It is, of course, essential that thecost of residential care is justifiable, interms of the quality of services providedand the outcomes achieved by childrenand young people. Each local authority must ensure that theyhave timely access to a range of placementoptions, including residential care. Childrenwith multiple, complex and challengingneeds must have access to the therapeuticand rehabilitative services that areprovided by specialist childrens homes andresidential special schools. It is, therefore, crucial that localauthorities have commissioning strategiesbased on a thorough analysis of thecurrent and future anticipated needs oftheir local population of children andyoung people, strong partnerships withproviders, and a multi-agency approach toensure that health and education servicesare closely linked to placements. We wantto support local authorities who areexperiencing difficulties withcommissioning: to improve the value formoney they secure; to ensure that achoice of suitable placements is offeredfor each child or young person; and toreduce their dependence on out-of- the educational outcomes for children and Our proposals create a presumption thatauthority placements. young people in care. But this has notchildren and young people in care should been enough. The care system can andnot move schools in years 10 or 11, unless Were planning to pilot new regional units must do more to tackle the earlyit is clearly in their best interests. And theyto undertake commissioning functions on disadvantages experienced by children and make clear our intention to abandonbehalf of groups of local authorities. These young people before entering care and forever any practice that encourages or, units will bring together procurement help them to overcome them. worse, forces young people to leave care asexpertise and sector knowledge, and work early as 16. Instead, we intend to support more effectively with providers in planning Care Mattersyoung people to make a smooth transition local services. They will offer a choice of Care Matters, the Green Paper weinto adult life. suitable placements for each child or young published for consultation on 9 Octoberperson, leaving final decisions about 2006, sets out what now needs to happen The care system must act more like a individual placements in the hands of social to transform the care system. At present, traditional loving family, with all theworkers in discussion with children and despite the efforts of many committed responsibilities that implies foryoung people themselves. people, including residential care staff, corporate parents. their managers and social workers, manyDespite some excellent provision, children and young people in care are not What Care Matters means forcompliance with the National Minimum given the opportunity to achieve theresidential care Standards remains a major concern. Only aspirations we have for them. We want Some of our proposals will, I think, be of one-quarter of childrens homes meet 90 their childhood to be secure, healthy and particular interest to you: those whichper cent or more of the Standards. To enjoyable. Far too many children andseek to improve local authoritytackle this, Care Matters proposes a tiered young people experience care as a time of commissioning and placement practice,national framework of qualifications and great instability, with frequent placementand those which seek to improve thecompetencies for childrens homes staff and moves.quality of residential care. While there isfoster carers, with opportunities to progress good commissioning and placement towards degree level for qualified staff. Whilst developing our proposals, we talkedpractice in individual local authorities, to children and young people in care; someoverall this continues to be variable. Im We also intend to look in more detail at said they see as many as 30 different socialparticularly concerned to hear that some what constitutes excellent practice in child workers. We found that over one-third had local authorities are moving children andplacement, including in residential care. been placed outside their local authority young people on from residential We need to know how the best providers area, away from friends and relatives.placements where they have settled and are able to make care in childrens homes Others go through as many as 10 different are progressing well.and residential special schools such a placements in a couple of years. 4 5. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 positive experience for children and youngchildrens homes staff constructivelyCare Matters challenges us to recognise our people. And we plan to reinstate the duty manage childrens and young peoples responsibility for giving children in care an requiring social workers to visit childrenbehaviour. experience that enables them to flourish and young people placed in childrensand grow into fulfilled adults. It sets out homes at a specified minimum frequency, As you may already know, we are currentlywhat we think needs to be done to make with a greater frequency of visits for thosereviewing the existing National Minimumthis happen. But its only the beginning of placed outside their local area.Standards for Childrens Services, and the debate. My ministerial colleagues and I underpinning regulations. The review willwant to know what everyone, including At a meeting I had with the Magistrates rationalise, clarify and focus the Nationalchildren and young people, think of the Association earlier this year, I was shockedMinimum Standards on achieving positiveapproach weve set out. Will our proposals to hear that children and young people in outcomes for children. It will put in place amake a real difference to the lives of care are being brought before the courtsprocess that targets inspection wherechildren and young people in care enough for incidents that children and young improvement is needed or concerns have to achieve the transformation we want to people not in care have resolved in the been raised and avoids placing see? If not, what more should we do? family home, without the involvement of unnecessary burdens on service providers the police. To help address this, we will who provide good quality services. (The Parliamentary Under-Secretary of build approaches to managementFollowing the introduction of the revisedState for Children, Young People and behaviour, such as restorative justice, intoStandards, we propose to introduce a new Families then urged delegates to the tiered national framework ofspecial measures regime to ensure swiftcontribute their views through the qualifications and competencies. And we action where standards are not met inconsultation process, which ran until 15 will build into the revised Nationalchildrens homes. This will build on the January 2007 and wished them well with Minimum Standards, which we aim toexisting enforcement powers of the the rest of the Conference. He looked introduce in 2008, an expectation thatinspectorate.forward to hearing feedback from it.)Developing the workforce Ann Harrison, National Development Manager Social Care, Childrens Workforce Development Council (CWDC) gave the following account of CWDCs work over the previous year and the current policy context in relation to workforce development As part of this article I hope to update youTo realise the Options for Excellence vision on some of CWDCs activities over the lastfor 2020 of a qualified, motivated and year and will also refer briefly to the flexible workforce work needs to start findings from Options for Excellence, which now to develop and change working sets out key elements of good workforce practice. development. The main prerequisites to achieve this are: The Green Paper on looked after children, I strong leadership Care Matters, also proposes changes toI a comprehensive workforce plan and social care workforce development for thestrategy that reflects local need and future and we look forward to workingaddresses diversity with the DfES on taking this forward. Its aI effective human resource processes that good start although the Paper needs to outline recruitment, retention andLearning organisations be clearer about the role of the residential development opportunities The first phase of the development of an workforce and the value of residential care I a clear commissioning framework that Integrated Qualification Framework is for some children and young people.addresses quality in outcomes for nearing completion. The CWDC publicationchildren and for the workforce. Clear Progression, which is on our website, The residential workforce needs a higher sets out a unit-based framework with profile if we are to see better outcomes forRecruitment and retentiongeneric units based around the common children. Both the Green Paper and theAlthough the comprehensive spendingcore, providing clear pathways for General Social Care Councils (GSCC)review will not report until Autumnprogression, credits and value for previous proposed next stage of registration should2007, CWDC has published the secondexperience, with clear routes into higher help this through further professionalisation report into rewards and incentives, andeducation and qualifications. From the of the residential workforce. recommends the development ofresidential workers viewpoint, it should mechanisms that can supportenhance their role by supporting access to Options for Excellence describes a processmodernisation of skills, job roles,higher-level awards and progression across in which social care is at the heart of responsibilities and pay and rewards.integrated settings. healthy communities; and where the most This should include strategies to vulnerable are supported a social model encourage greater mobility, reducing CWDC has also been working jointly with in which users and carers play a key role atbarriers to entry and exit. CWDC will also Skills for Care on the development of the the heart of the process including youngbe working with the DfES on localContinuing Professional Development people and children. While we know that solutions to using temporary/agency staff. strategy, which was launched in October the spending review is not likely to be CWDC work with local employers to2006. There will shortly be a web-based tool generous, CWDC is already working onsupport local workforce strategies to advise on careers, training and some of the areas outlined in Options continues and there will be furtherqualifications on both the CWDC and Skills for Excellence. consultant support in 2007/08. for Care websites.5 6. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 The joint CWDC/Skills for Care LeadershipIn summary and Management Strategy, part of the The key to good workforce development Options for Excellence work, is nowpractice is, as I said at the beginning, complete. The supervision module and draft robust leadership, clear workforce planning, management induction standards was comprehensive training and development piloted early in 2007 in a number of sociallinked to career progression, and care areas; these will also be used within a commissioning for services that address number of integrated settings linked toquality outcomes for the workforce and Championing Children work. service users. A comprehensive workforceplan and development strategy needs to Commissioninghave these in place or be working CWDCs joint work with Skills for Care towards this and needs to be involving continues around developing National workers and service users in the process. Occupational Standards in Commissioning. The strategy also needs to be resourced This sets out key skills, building on the DfES appropriately. framework to ensure an integrated approach.Ann Harrison, National Development ManagerSocial Care The revision of the National Minimum Childrens Workforce Development Council Standards (NMS) also needs to reflect key3rd Floor Friends Provident House and core requirements for developing the 1314 South Parade Leadershipworkforce, and CWDC would hope toLeeds LS1 5QS Strong leadership is key to ensuring that influence this. For example, there should be Tel: 0113 244 6311 the workforce is developed and supportedconsistency in approach between the NMS appropriately. As you will probably know, for childrens social care services and some The CWDC website is at: www.cwdcouncil.org.uk the residential managers Nationaladult services, and they should also beSkills for Care is at: www.skillsforcare.org.uk Occupational Standards (NOS) are beingapplicable in the early years sector. There reviewed, and that includes the NOS for are many providers that operate across childrens managers. This is a UK-widesectors and some services such as mother approach and it is about to go out forand baby homes, childrens centres, home consultation, so you will need to add yourcare that provide to both adults, young views initially online through our websitepeople and children. and Skills for Care. The proposal is to reduce the number of NOS and have Part of commissioning for services and specific elements for all managers in socialunderstanding the local environment is also care, and some that are for those working knowing about the workforce out there. It is in childrens services. This could raise theimportant to encourage use of the Skills for profile of residential services byCare National Minimum Data Set perhaps underpinning pedagogic skill andthere is a role for CWDC in supporting some knowledge requirements. providers to use the data set.Stakeholder perceptions about the Mulberry Bush School Providers of relatively expensive programmes of therapeutic care increasingly need convincing evidence to demonstrate to purchasers the specific and added value of such placements. John Diamond, Director, Mulberry Bush School, and Jane Barlow, Reader in Public Health, University of Warwick, gave an account of research which they undertook to this endThe Mulberry Bush is a therapeutic school The provisionplacements, external evaluation is providing care and education for boys and The schools 38-week per annum provision,increasingly important to provide girls aged 512. For 58 years it hasundertaken in partnership with parents,convincing evidence of the added value of provided high-quality and integratedcarers and referrers, aims to reintegrate thethe service. To this end, Mulberry Bush therapeutic care, treatment and education child into a home and school environment.commissioned independent researchers at to severely emotionally troubled children The 38-week limit is important, as the the University of Warwick to undertake a who are clinically defined as school believes that 52-week provision can series of case studies (qualitative) of unintegrated, multiply traumatised or lead to warehoused and institutionalised stakeholder perspectives of the benefits of have disorganised attachment patterns.children.the school. There is little evaluation of this Their early childhoods typically include type currently available, which is an area highly adverse early life experiences,The work of concern for policy makers, education including abuse and neglect. Many willAs already indicated, the school works withand social care providers alike. have been cared for by local authoritiesseverely emotionally troubled children and had several disrupted fosterfrom all over the UK. After three-year Aim and methods placements. Without specialist intervention placements many children return to their The aim of the research was to explore the their futures are bleak, with a likelihoodhome and mainstream schools. Asperspectives of a range of stakeholders of relationship difficulties, criminalsuggested in the introduction to thisregarding the benefits and disadvantages activity and a continued cycle of abuse article, because fees from referring local of attendance at a residential school for and neglect.authorities with hard-pressed budgets fund children with severe emotional and 6 7. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 behavioural problems. Once ethical She enjoys reading, she likes to sit The research did also note less positive, approval had been secured, interviewsthere and write. Its something Iveunintended consequences of placement at were conducted with pupils, parents/carers never seen or had from her before the school. Children might learn new and and staff. The children involved were threeShe makes us her own cards and sendsundesirable language and behaviour from boys and three girls, whose ages rangedthem to us. Shes come a long, long peers. They might miss out on family and from nine years and six months to 11 years way. (Carer) home life and their choice of local friends. and eight months, with a mean age of 10Parents might feel a loss of control and years and nine months. Basic reading skills I Behaviour and adjustment improved. uncertainty as to what was going on. ranged from 0.2 to 3.4 years behind theSome were disappointed with the degree level expected for each pupilsBefore he went to the school he wasof academic progress, while conceding that chronological age (average 1.7 years below out of control. He would run away. He simply attending and participating in class expected). Mathematical reasoning ranged would wreck things in shops I never,represented a huge advance, bearing in from 0.5 to two years below expected ever took him anywhere on my ownmind the emotional state of the child levels (average 1.4 years).without another adult, because youwhen placed at the school.couldnt, say, pay and watch him Research findings observed [Now] I go all over the place, anywhere The research has its limitations, such changes in the pupilsI want to Hes an absolute joy to beas the relatively small numbers of I Children learnt to trust adults again. with He is a very different child. stakeholders involved and the limited(Carer) time frame on which it focused, butHe wouldnt trust anybody, and now nonetheless it did yield some valuablehe will. (Carer)I Parents/carers were helped by theinsights into the ways in which placement respite given during the childs at a residential school of this nature can I Children learnt to be a child.placement. As a result they felt betterbe effective for children with severe able to cope with a previously fraught emotional and behavioural difficulties.Hes actually coming to the conclusionrelationship and no longer felt thereThere is consistency across stakeholdersthat being a childs not such a bad thingwas no happy future for the child. about the problems experienced by theseafter all, that he doesnt have to be a children and the ways in which agrown up. (Carer)I no longer see [Xs] future in terms of residential school can help them. Furtherreform school, borstal, lock-down units,research is needed into longer-termHe is more able to accept that he is a prison. I see his future as probablyoutcomes and comparisons.child and that adults look after children,tumultuous. But I actually see himthat he is not an adult so he doesnt having a future all the things that John Diamond, Director, Mulberry Bush School,have to look after everyone else. (Staff were totally impossible two years ago and Jane Barlow, Reader in Public Health,member) are now possible for him.University of Warwick.(Carer) I Self-esteem improved. His self-esteem is something I didnthonestly believe I would ever see.(Carer)I Ability to deal with, and articulate, feelings improved. He can express himself properly, he cantell you, he can come and say to youIm angry, or Im sad. He knows hecan tell you, which is excellent. (Carer) I used to smash things, used to climbtrees. I used to punch adults [now] Ijust swear, and just calm down Meand [another pupil], we just talk aboutit and we tell the adults they try andmake us learn how to [talk about it] If you just mess around you dont getwhat you actually want. (Pupil)I Children were enabled to stay in class and do their work and there was academic progress. He stays in class now without runningout, which is a big, big change helistens and participates A year ago ifhe couldnt cope with certain situations,he just ran out, and fought, and hit out,and would be violent and rowdy, sothats been a major change. (Carer) 7 8. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 Pillars of parenting: new thinking and approach to residential child care. Authentically warm child care: understanding and supporting children in care Sean Cameron, Child and Educational Psychologist and Colin Maginn, Residential Care Consultant, described the essential elements for successful parenting and caring in residential child care Assuming parental responsibility for children other activities essential for successful and young people who have sufferedparenting and caring which we have begun In the case of children and young people in negative life experiences is not only to refer to as the pillars of parenting. Incare who have lost their parents or challenging but requires levels ofTable 1 we have listed the (currently) seven families and who face the transition to an understanding, compassion and patiencepillars, together with some examples of theunknown care setting, Cairns (2002) has beyond those of your average saint. The adult actions which support each pillar. A outlined a particularly useful model that good news is that positive changes in the full account of this approach and itsilluminates the nature of support and emotional, social and behavioural underpinnings from psychological researchmanagement likely to be required. These development of children and young peopleand theory will appear in a future issue ofphases of support are: will take place when their needs areThe British Journal of Social Work (seeI Stabilisation: providing a safe, valuing understood and addressed. It is meeting Cameron and Maginn 2007).and predictable physical and these needs with the combination ofpsychological environment. responsiveness, clear expectations and high While the pillars of parenting have been I Integration: aiding a child or young aspirations, which over time enables thedeliberately written in a positive style, it isperson in the processing of the trauma, child or young person to build trust andalso recognised that some carer behaviours i.e. helping them to make sense of the move on. Parenting is one of those(often unintentional) can have a negativetraumatic event(s) that occurred in their activities which most people take for impact on vulnerable children. Such pitfalls,lives and beginning to put the past in its granted and most parents learn their skills which are threats to an effective and warm place. through bringing up their own children. parenting style, can include the use of put-I Adaptation: enabling the child or young However, for professional carers who aredowns or comparing a child unfavourably person to re-establish social often looking after vulnerable children and with another child.connectedness, develop personal young people, the skills and knowledge ofefficacy and rediscover feelings of parenting need to be unpacked, analysed,Support for post-trauma stress well-being. understood and then put into action, oftenThere are a number of psychological theories in difficult circumstances. (notably Spall and Callis 1997, and Kubler-As well as providing authentically warm Ross and Kessler 2005) that attempt to chart parenting which shows children that they The pillars of parentingthe emotional impact of major life are cared about, residential and foster Meeting a childs physical needs is only thetransitions, including those that involvecarers also need to develop a deeper beginning of good parenting and there are considerable trauma and loss.understanding of the emotional andcognitive processes that are taking placewhile children work through and adapt totheir earlier negative experiences. Even forthe most skilled carers, the task ofproviding authentically warm emotionalsupport can present a huge challenge,especially when faced with a child oryoung person whose behaviour could beperceived as deliberately vindictive andhurtful, and who may frequentlyreject/spurn or exploit acts of carer or peerkindness, affection and good intent. Atsuch times, knowledge of the process ofpost-traumatic stress and loss becomes anessential aid both to ascertaining a childsor young persons emotional needs and toguiding sensitive support. In Table 2 weprovided some examples of the adultactions that can support a child or youngperson through each of the stages towardsadaptation following parental rejection,abuse and neglect. Final commentOf course, children and young people willrespond to and attempt to cope withadversity in idiosyncratic ways. However,the authentically warm child careapproach is designed to help residentialand foster care staff to establish a safeand stable environment where the child oryoung person is able to talk, and learn 8 9. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 Table 1: An outline of the Pillars of Parenting, with some suggested support activities by carers. Cameron and Maginn (2007) Primary care andSecurePositive self-EmotionalSelf-management Resilience A sense of protectionattachmentperceptioncompetence skills belonging Sensitivity to a Secure attachment This allows the This ability Self-management Resilient individuals Research and childs basic needs appears to act as a child to develop aunderpins the is the insulation,seem to be able totheory in shows the child buffer againstpositive self-successfulwhich preventsunderstand what relationships have that we care andrisks and toimage.development ofinappropriate has happened to established human that they are operate as a Positive andrelationships behaviour whenthem in lifebeings as important.protectivenegativeoutside the familyenticing or (insight), developfundamentally, Education ismechanism.statements have a and may moderatecompelling outsideunderstanding ofextensively social included here powerful impact susceptibility to factors try toothers (empathy)and highlighted because in ourWhy? Seeon self-and propensity forintrude.and experience athe need to complex world Ziegenhain (2004) perceptions.later mental health quality of life thatbelong. knowledge and for a summary ofproblems. Why? See Lewis andis often denied to skills are essentialthe considerableWhy? For more Frydenberg (2002) others who have Why? For details of to survival.volume of the details, see theWhy? A useful on the topic of suffered negative the link between research on research paper by overview of thispersonal problem- life experiencesrejection and Why? See Maslow attachment. Burnett (1999) or important, high-level solving methods (achievement).aggression, anti- (1971) for histhe book by Emler skill area has been used by children andsocial behaviour and universally known (2001). provided by Saarniyoung people andWhy? See Cameron poor self-regulation, pyramid of human(1999). Zimmerman (1998)and Maginn (2006) see the review article needs.for a description ofor Newman and by Baumeister the link betweenBlackburn (2002), for (2005). self-management summary of the and academicresearch on attainment. resilience and its implications for parenting of looked after children. Some examples ofSome examples ofSome examples ofSome examples of Some examples of Some examples ofSome examples of good practice good practice good practice good practicegood practicegood practice good practice suggested by carers suggested by carers suggested by carers suggested by carerssuggested by carerssuggested by carers suggested by carers tuning into a childs encouraging the celebrating the maintaining your guiding and ensuring stability individualising fears and offeringchild to explorechilds adult role duringsetting limits for and continuity in bedroom a reassuring word tuning into the developmental any conflicts with behaviour as the careaccommodation or hugchilds perspective advancesthe childchild grows up promoting developing attending to aof the world recognising and teaching the mentoring basicfriendships withfunctional childs appearance being consistent in rewarding goodlanguage ofskills and helping pupils doing well friendship groups so that they look your ownbehaviour;emotionchild to achieve at school encouraging and feel good behaviour and protecting the teaching empathy,difficult skills locating one adultfriendships in the (and do not attract your expectations child frome.g. How do you teaching self- who can act as aneighbourhood. hostile or hurtfulfor the childs disapproval,think that Chris reflection.mentor. comments from behaviour teasing or violence feels now? adults and peers) listening and setting high but seeking communicating reasonable opportunities toresponsively. standards for help the child to learning and succeed at school.behaviour. Table 2: The Cairns model of trauma and loss, together with some good practice suggestions by carers. Cameron & Maginn (2007)StabilisationIntegration Adaptation (providing a safe and predictable physical and (aiding a child or young person in the processing (enabling the re-establishment of social psychological environment) of the trauma, i.e. putting the past in its place)connectedness, personal efficacy and rediscoveringof the joy of living)Some examples of good practice suggested bySome examples of good practice suggested by Some examples of good practice suggested by carers carerscarers protecting the child from teasing, bullying and stressing the normality of feelings associated helping the child to recognise and accept the intimidation with previous traumatic eventschanges, that have occurred establishing a clear and predictable pattern of helping the child to manage post-trauma supporting the childs own efforts to adapt to daily events for the child.feelings of shame, guilt and anger. the changed circumstances. more, about the circumstances Contact details: Dr Sean Cameron, Child and Cameron, RJ and Maginn, C (2007) Parenting and surrounding their trauma; to begin to dealEducational Psychologist (r.cameron@ucl.ac.uk)professional childcare: The authentic warmth with the feelings that accompany such and Colin Maginn, Residential Care Consultant dimension, British Journal of Social Work. information; to process, control and(colinmaginn@hotmail.com).Kubler-Ross, E and Kessler, D (2005) On Grief and manage any resulting psychological or Grieving: Finding the Meaning of Grief through physiological reactions; and finally, toReferencesthe Five Steps of Loss. NY: Scribner. receive the type of support that re-Cairns, K (2003) Attachment, Trauma and Sprall, B and Callis, S (1997) Loss, Bereavement establishes social connectedness andResilience. London: British Association for and Grief: A guide to effective caring. develops personal efficacy. Adoption and Fostering. Cheltenham, Glos: Stanley Thornes. 9 10. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007Bearing the unbearable: the need to talk about the things youwould rather forgetChristine Bradley, independent consultantRecent government thinking, for example, in However, before I had a chance to finish, sheWell, that is important, I said, because thatthe Care Matters and Every Child Mattershad run off down a corridor crying, Oh no,way it may be possible for you to feel asprogrammes, has addressed factors important oh no. I dont want you to come. That meanscomfortable in thinking about yourself, asin changing thinking and skills. However, something horrible will happen to me. I you feel about putting together a tent.there are also some gaps, which needfollowed her and told her I was sorry thataddressing urgently if we are to bring aboutthe possibility of my coming to join themThis has made me reflect on how important ittrue emotional recovery in the world of had troubled her so much.is that we are able to think about theemotionally distressed and troubled children unbearable aspects of life for children andand young people. It seems to me that sometimes adults whoyoung people. In my view, it is very importantare trying to help and respond to you canwe have a strong and deep understandingIn particular, we need to develop a bettermake you feel and believe that something about dealing with the concept of how tounderstanding of how we, as professionals awful is going to happen. Now, thisbear the unbearable in our work.working with children and young people in suggests to me that you have somecare, bear the unbearable when living horrible feelings deep inside you that How can we develop our understanding soalongside children and young people belong to an earlier stage of your lifethat children and young peoples anxietiesprofoundly traumatised by events in their when you experienced some hurtful andcan be heard and thought about?lives. Through developing this understandingvery painful times. How easy and quick it iswe are better placed to help them cope with for you to feel that those who are Too often, those working with children andtheir own unbearable pain. I would like toresponsible for taking care of and young people confuse their own anxietiesgive an example from my own work. protecting you might hurt or attack you. with those of the children and young people.That fills you with some unbearableIt is crucial that organisations feel able toI regularly visit a childrens unit to providefeelings, which consist of more than anger talk about what is unbearable to them, as aconsultation and specialist training that and sadness a kind of panic and despairway of understanding the childrens andsupports and helps staff to develop the level that makes it difficult for you to think young peoples unbearable anxieties.of insight and understanding necessary to about what is actually happening. All ofachieve and deliver important and crucial this feels too much for you to deal with. Also, we must help workers to think abouttreatment methods, knowledge and practices and manage their own tensions and anxietieswith children and young people. I went on to say that because of this it was so that they can help the children and youngimportant that I try to help the grown-ups people with theirs. It is crucial that workersOne particular visit coincided with the around her to understand and recognise how understand the difference betweenchildren and young peoples annual summer they could help her with her feelings. At that responding and reacting to childrens andholiday with their workers. While there, apoint there were tears in her eyes. She putyoung peoples difficulties. The result will beyoung adolescent girl approached me and her arm around me and said that she wouldthat they are able to live alongside thespoke about how she was looking forward totry to have a good holiday.childrens or young peoples pain andthe holiday. She had experienced a numbervulnerability and support them.of painful experiences and relationship I saw her again a few weeks later. Ibreakdowns in her early life, which were at a recognised that because of our previousIn every piece of work undertaken with avery deep level and included missing out on encounter it was important for us to attempt child or young person there must be ameaningful attachments and failing to haveto do something practical together. We put a beginning, a middle and an end. It must beher dependency needs met. tent up. I told her she was much better than assessed, planned, delivered and monitoredme at this task and I had learned somethingto ensure the outcome is that the child orShe asked me if I was coming on the holiday from her. She replied, Yes, but you are veryyoung person is able to make a healthytoo. I began to explain that I was not, and good at helping people to understand about transition to the next phase of their life,gave my reasons, wishing her a good time. their feelings. whether they remain within their current placement or are in the process of moving to another. If this is not explicit in the work, it will overwhelm the child or young person with fears of abandonment and separation, which does not lead to a successful outcome.As argued above, children in care often have profoundly traumatic personal histories. The unbearable feelings associated with those histories, the anger and sadness, panic and despair, can overwhelm them and make relating to others, including those who are trying to help them, very difficult. As professionals working alongside such pain we need to develop an understanding of both its sources and also how best to help the child understand and resolve their feelings. In this way we can help them to bear the unbearable and move on in their lives. 10 11. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 Health in residential child care Care workshop Zarine Katrak and Sharon White, NCERCC AssociatesThe NCERCC project licensed by the Department of Health toto consult with LAC/YP regarding their NCERCC took on the job of finding, sharing provide care, education and treatment to issues. and developing tools for good practice ineight children or young people who display I Develop active participation of LAC/YP. promoting health for children and youngsignificant behavioural problems, areI Set up a health forum within the home. people in residential child care. We elected awaiting trial or are sentenced by the Involve everyone with responsibility for to work in partnership with the Healthycourts for criminal offences.corporate parenting of LAC/YP. Care programme at the National Childrens I Develop wider partnership working Bureau as it is a well-developed and Alloefield View, Halifax, is a local authority between agencies to share experience, researched multi-agency framework to childrens home operated by Calderdale knowledge and access to other services promote a healthy environment of care. MBC. It provides a home for six youngrelevant to LAC/YP.people, currently aged from 12 to 14. TheI Look on the Healthy Care, NCERCC and The NCERCC project wanted to find outaim of the home is to prepare youngother websites for free downloadable how the Healthy Care resources could bepeople for a return to family, or a move toresources. used in individual care establishments.a substitute family. It is one of threeI Liaise with partners about funding From this it wanted to produce a toolkit for residential homes in Halifax that work as aopportunities. practitioners that would raise awareness cluster and offer each other mutual and develop positive practice on issues of support. health and well-being.A key piece of learningHollybank Trust, Mirfield, West Yorkshire, The close working between the looked The project worked with three pilotcaters for children and young people withafter childrens nurse and head of partners in Yorkshire and Humberside, to profound multiple disabilities. It providesresidential services was vital to success. support them in carrying out a Healthy 38- and 52-week residential placements Care audit. This produced practical ideaswith 24-hour individual programmes that that have informed the toolkit.are incorporated through on-site Final thoughts from a pilot partnereducation, physiotherapy, occupational Format of the toolkittherapy, speech and language therapy,The Healthy Care audit tool gave me The toolkit summarises National Policy nursing and social care. the opportunity to identify the gaps and Guidance, explores the Healthy Care and the areas of development required evidence base, highlights the challenges The findings to enhance the services we provide. and successes experienced by colleaguesI When deciding to carry out a Healthy The overall outcome from completing in the field and includes case examples, Care audit ensure that you talk to staff,the audit has been very positive as it a practice checklist, resources lists andchildren and young people about whynot only identified the areas we are ideas for training.you are doing this and what it may delivering successfully but alsoinvolve. highlighted the need to not become It builds on the Healthy Care Standard.I Allocate designated time to prepare andcomplacent. Alison Howard, Hollybank Children and young people in a healthy carry out the audit. Trust. care environment will: I If there is resistance to certain actions, I experience a genuinely caring, bring in an external expert mediator toBoth the NCERCC and Healthy Care websites can consistent, stable and securechallenge institutional behaviours ofbe accessed via www.ncb.org.uk relationship with at least one some staff and to reach common committed, trained, experienced andground. supported carerI If resistance persists, consider training. I live in an environment that promotes I Recognise that you may be instituting health and well-being within the wider the beginnings of a wider cultural communitychange. I have opportunities to develop theI Find out if you have a local Healthy personal and social skills to care for Care or Multi-agency Partnership who their health and well-being now and in could provide networking opportunities, the future; and receive effectiveexamples of good practice, guidance, healthcare, assessment, treatment andtraining information and support. support. I Read through the audit tool and dontget overwhelmed. It covers specific issues on health andI Reduce it to bite-sized chunks under emotional well-being:the four headings of policy, partnership, I emotional health and well-beingparticipation and practice. I mental healthI Prioritise action points relevant to you. I healthy eating I Use the audit tool to identify and I play and creativitycelebrate existing good practice. I sexual healthI Think holistically about health. I drugs/substance misuse.I Seek out your local LAC nurse and findout how your home could utilise them The pilot partners fully in carrying out the audit. Aldine House Secure Childrens Centre, I Identify other partners, specifically Sheffield, is a secure childrens centre Childrens Rights participation workers11 12. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007Introduction to two practice papers on supervision inthe residential care of children and young peopleRichard Rollinson, Independent Child Care Consultant and NCERCC Associate, and Sarah Leitch, NCHManager and NCERCC Associate, introduced two practice development papers on supervision thatwill shortly be made available on the NCERCC website Supervision: guiding practice support living and learning/changing/Finally, we believe that in the largest part it isThese two papers are intended to be growing not simply in groups but asa prior good experience of being supervisedcomplementary to one another andgroups. Therefore, no system ofthat most often seems to be the greatestconstitute together a basis for managers andsupervision in residential group living canfactor in determining that a person thenpractitioners in residential settings to thinkbe complete and fully effective if it does becomes a good supervisor in turn. Certainly,widely, and wisely, about how best to utilise not utilise the very medium throughthis is often the testimony of supervisorssupervision to improve staff practice and the which practice is enacted. Of course, thethemselves who have been commended aslife experiences and outcomes of those foropportunity for individual supervision good by those whom they supervise.whom they care. One paper (by Sarah Leitch) must remain available if only so that each Therefore, it is of the utmost importance thatattends mainly to issues for individual person is located clearly within the we identify a way of supervising in/forsupervision, while the other (by Richarddiscipline of a programme of individualresidential care that will most reliably ensureRollinson) focuses on group supervision. Of oversight and accountability. Nevertheless,the transmission of good supervisors and,course, as readers will see when they readit is our view that group supervision canhence, good supervision across the professionthe full papers, there are large areas of well prove to be the key element that will and its generations.overlap between the two papers, given the assist us most in carrying out ourcommon subject of supervision.residential purpose and task, and in our For the full documents, see the NCERCC websiteprofessional development.at www.ncb.org.uk/ncercc and follow the linksIndeed, our own position is clear in relationunder Practice Documents.to this subject, and we summarise keypoints here. First, there are countless, and stillproliferating, frameworks to ensuresupervision happens. Most of them addressthe instrumental activity that isunquestionably a part of our professionaltask and for which any worker must beaccountable. These sorts of supervision arewell known, clearly needed and usually wellcovered in organisations, being amenable tosatisfying external audit/scrutiny. Even here,the effective use of any such framework willrequire a clear understanding of thepurposes of supervision beyond simplycomplying with regulation. At the same time, in residential work ithas long been recognised that one of themost professional aspects of our work isour ever-more conscious use of ourselvesas the most valuable resource available tohelp residents, particularly when young, tochange and grow. In effect, the feeling ofwhat happens does not simply lie at theheart of the matter; it is the heart of thematter. That being so, we contend that inresidential work our experiences, and theimpact upon us of those experiences, mustbe at the centre of supervision. Only thenshall we be able to capture what will mosthelp us to recognise and understand theexpressive dimension of living together ina manner that we can utilise to informour continuing interventions withresidents, with colleagues and withourselves. Second, the model of supervision mustmatch the major mode of practice in anyorganisational setting. Thus, groups andgroupings are key here; our task is to 12 13. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 Setting up and sustaining therapeutic care Lioncare Matt Vince, Director of the Lioncare Group, a private sector organisation based in Brighton and HoveWe offer specialist residential care andOur practice was based on common sense demands of the newly appointed inspection education to children and young peopleand basic parenting skills, following theunits, and difficulties in adapting their who have experienced abuse, neglect and guidance set out in the 1989 Children Act, practice to meet the needs of the more traumatic situations in their early life, and with a view to trying to accommodate challenging children now referred to them. who subsequently face difficulties in whoever we were asked to. coping with the emotional and practicalSeafields faced a choice continue as we pressures and demands of day-to-day So, why did we introduce a therapeutic were, hoping the change in the care system living. This article will seek to answer twomodel of care into Seafields?was a passing phase, or recognise that questions.Around 1993, the full effects of the 1989something quite fundamental had changed, I Why do we follow a therapeuticChildren Act began to be felt by Seafields.embrace this change, and begin a process of approach? The trend towards placing more children in transforming the services we provided, from I How do we do it?foster care, meant fewer referrals for sibling being a regular and basic childrens home, to groups who simply needed a nice place to becoming more specialised. The Lioncare Group began with the opening live. Instead, we seemed to be increasingly of Seafields Childrens Home in 1991. At that asked to look after children who displayed After several months of heated debate, time, there was no mention of therapeutic more severe challenging behaviour with discussion with our consultants, and having care, transferential relationships, or anyhistories of severe emotional neglect andseen more homes disappear, we decided to other complicated words to describe whattrauma.begin transforming our service. we did. We didnt call our practice therapeutic we simply described ourselves At the same time, we watched as many The need to survive in the face of an as a home that provided care andchildrens homes around the country closed increasingly hostile and selective business accommodation for children. after failing to keep pace with the changing environment gave us the motivation andenergy we required to accept the need tochange, review our tried-and-testedapproach to caring for children, move out ofour comfort zone and step into somethingaltogether unfamiliar and new. Acknowledging the need to change wasrelatively simple. Agreeing on the directionwe should take was harder. Our consultant provided us with a possibledirection. He suggested consideringadopting a psychodynamic approach to ourpractice, arguing that we already workedalong similar principles but lacked theconfidence and authority to call ourselvestherapeutic. He felt it would not take muchto introduce a fully functioning andworkable model of psychodynamic care toSeafields. Since I already held a degree in psychology Iwas nominated to undertake trainingtowards gaining a qualification intherapeutic child care. I registered for the Diploma in TheraputicChild Care at Reading University. This led tolively discussions amongst staff at Seafieldsas the information I was gaining was leadingto suggestions for changes to long-established practices. My manager supported me and once sheand my director gained an understanding ofthe benefits of working therapeutically, bothattended therapeutic training themselves.The level of understanding of therapeuticpractice improved within the home. However, the wider staff team was dividedon the need for change. It was recognisedthat, in face of such resistance, if we were13 14. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007ever going to achieve a true therapeuticRegularly reminding ourselves of this helpshopelessness and despair unless we takecommunity approach, it would need to be us to remain clear and focused on the work measures to prevent this.initially established in a differentneeding to be done with the children andenvironment to Seafields. young people, both individually and as a We have measures in place that attemptgroup, providing a guide rope we can use toto maintain the balance needed within theIn 1998, I was given the opportunity to set keep us moving forwards when the chaotic adult team between working with theup a new home, to be called Springfields. Asand muddling feelings and emotions all reality of the childrens situations, andmanager, I was given authority by the around us (from the children and from theremaining energised and enthused.director to establish Springfields from scratch,adults) threaten to overwhelm us.following psychodynamic principles and a These include effective systems for learningtherapeutic community approach. Number 4 and self-development for all adults in theClosely linked to this is my strong belief incommunity; regular meetings for individualsWhich brings me to the question:the need, within any therapeutic careand for groups to encourage the sharing ofhow did we do it? practice, for a clear, agreed vision of the wayinformation and ideas; discussion groups toThrough my experience, I believe there arewe see the home and the organisation encourage open and honest reflection onfive important ingredients needed to set up growing and developing. There should bethe work and the impact of this on theand sustain good enough therapeutic care: recognition that therapeutic care is organic worker; and gaining contributions fromand evolving. Like a person, it needs to beexternal experts and professionals to reduceNumber 1nurtured and looked after, to have its needs the risk of us becoming too inward lookingDeveloping a clear understanding of the met and be encouraged to explore and learn and isolated.theory and principles of therapeutic care, andfrom new experiences. A therapeuticadopting a model that underpins the way wecommunity is so much more than simply aIt is important to encourage colleagues tothink about the task of caring for children building, or a service. More than the sum of commit to remaining with us for aand meeting their needs.its parts, it is fed by the shared experiences reasonable length of time, to form theof all those currently living and working in attachments, gain real experiences,Number 2the community and those who have gonedevelop an understanding and consistencyTaking time to consider, and paying close before.of approach, and develop the trustingattention to, the details of the physical spacerelationships needed for the therapeuticin which the therapeutic task takes place.Number 5 work to be effective.Maintaining the energy and enthusiasm, andIt is essential that the qualities and feel ofkeeping it real. I have learnt that it is equally importantthe building and surrounding area, often to encourage a culture of openness andcalled the facilitating environment, allowWorking so closely over a relatively longhonesty that also allows us to recognisethe work to happen. It needs to be able toperiod of time, with children and youngwhen it is time for us to move on andcontain the often-chaotic emotions andpeople who have experienced severe and leave the community. There is a clearbehaviour arising when working with extreme deprivation and loss can, and does,message given to all those who join uschildren and young people who havehave a profound effect on us as individualsthat they will one day leave us and thatexperienced emotionally damaging andand as a community. Facing, on a daily basis,this is all right. By doing this, we allowtraumatic experiences. At the same time, it sustained hostility, negativity, resistance, the children and young people, ourselves,needs to have a homely feel about it to helpdespair and conflict from the children, andand the community as a whole tothe children and young people gain or often from others in the outside world, cancontinue to grow, change and develop indevelop an experience of normal daily living. lead to a sense of demoralisation, short, we remain true to our primary task.There needs to be sufficient physical space toallow different work and interactions to takeplace, without this overly affecting thenormal routines of the home. For example, we recognised the intense fearexperienced by many children and youngpeople around bedtimes, and so created asafe and comfortable reading area by thebedrooms, where an adult can sit and read tothe children and young people whilst they aresettling at night the reassuring sound of anadults voice reading a bedtime story helps toreduce the sense of isolation andabandonment keenly felt by our children andyoung people at the end of every day. Number 3Constantly revisiting and remindingourselves of the primary task of the home. For us, our primary task is to closely workalongside and with the children and youngpeople, sharing their experiences and usingour skills and abilities to help them try tomake sense of these, so they may graduallydevelop their own ability to do this and thusfunction better on a day-to-day basis.14 15. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 Setting up and sustaining therapeutic child care Childhood First Jenny Carter of Childhood First outlined the essential elements of therapeutic residential child care What is therapeutic child care? task with children who have not learnt thatTherapeutic community principles are such caring is a good thing. Often it needsbased upon a collaborative, democratic Child careinsistency, consistency and persistency for it and deinstitutionalised approach. We start The first step is to clearly identify whatto be taken as meaningful by, and for, a child.with the childs needs, think about what it parents, family networks and communities do Often it will need protecting from attack. is they need from a parental role and from in nurturing the young. Through providing Good experiences need symbolising, to be the community. reliable primary care and stimulation, children shown rather than told to the child, as then have a context in which they learn to think they can be remembered in order to help theHow does it work in practice? and understand, and develop the capacity to child keep good experiences inside themselves. We organise our communities to provide participate as a social and moral being. a network of interlinking groups. These Children who have not had this still have Second layer groups need orchestration. Our theoretical these developmental needs and have notGroup, community experience. The secondmodel demands an acknowledgement of been able to develop the ability to relate, layer needed to provide a really therapeutic pairings and partnerships, and dictates the which depends on these fundamental steps. experience is the experience of a group, of away teams are structured, the rota, every community, a place to belong, to be known. decision. It is often remarked that to Every Child Matters to whom?Our experience is that this is transferableappreciate the level of this thinking one For children to develop, they need thebeyond the residential setting and helps a must experience it or at least witness it. experience of mattering to someone and achild interconnect and establish their place Our treatment methodology includes a community. We all need the experience ofin the home/community they have been socomplex structure of group supervisions; being valued, understood, cared about, everytroubled in. The difficulties many childreninternal and external consultancy nuance noticed. We all want to belong.have are in relating and belonging. Moving addressing the group dynamics and task. on from including one other to including We have whole community meetings, It is important that the whole of us mattersothers needs attending to intensively forsmall groups, work discussion groups, not just in bits, like teeth to the dentist,those children for whom the intimacy of acase discussion groups. We provide a and heads to the shrink; mattering as a family is overwhelmingly painful, toothorough training programme for whole being is what enables us to develop familiar, and too vulnerable. Individual all staff. and grow. packages of care, medication and therapy do not necessarily attend to this critical The forums that are just for the adults are Childhood First, formerly Peper Harow need and something more is required. The directed towards meaningful action for the Since the 1970s, our communities have therapeutic in a therapeutic community children. It is through their experience of understood that physical and mental healthincludes good care as described above androbust real relationships between adults cannot be separated: educational andthe experience of a place to belong, a group that children will recover. It is often emotional development are interdependent. to belong to. This requires a clear way of difficult experiences between adults that Care is not caring unless it recognises the doing things, mealtimes, meetings and dailyhas deprived them of opportunities to whole person, so that we matter as a whole, structure: the way we do things in this develop. good bits, bad bits, bodily bits, spiritual bits. house. This way of doing things will also We shouldnt divide children up.need protecting by the group.Conclusion Psychosocial care integrates care, treatment For us, what is important in sustaining and education; body, mind, heart and soul.Third layertherapeutic child care is sustaining the It doesnt send children somewhere else toA theoretical framework. For the first two experience of parenting that the child have mind and thoughts examined.layers to work, they need integrating with a experiences. This means their experiences theory. It will not just happen, and a group of our relationships with each other, as well Therapeutic child care three layers setting can easily turn into a bunch ofas with them. individuals who are not connected. The Foundation layerconnection between people must be worked Like parenting it requires the following: Good child care is about good primary care. at. It costs time and money to provide and I There should be attunement to the The need for individual therapy will be sustain a real framework for moral, socialchilds needs as expressed and yet to be assessed and might be added on as belonging and meaning. For Childhood First, expressed. necessary for an individual child to make this shared understanding, meaning, or theoryI Relationships between workers matter. their care match their needs. Not all childrenis a psychoanalytic-systemic one. We attend We think about how we are together as need direct therapy and the therapeutic into the feelings and the ways these are shared part of what the child experiences. therapeutic child care is to be found inconsciously and unconsciously within the I The people providing the parenting repeatedly providing good experiences and community. We start from the here and now.experience should have time to think sustaining good primary care. This is a big We ask the question, What is happening now together and to relate in a real way, and and how does it affect us all? From this to the moral and theoretical framework starting point we can look at origins and of the work for each child and the futures. We look at the feelings we community. communicate to each other and use aI We consider that the structure provided psychoanalytic framework to understandoffers an opportunity for everyone to what communications mean. grow and learn, and that this culture for a child and community has meaning for A therapeutic community operates accordingus all. to an inclusive assumption that children are I We should be clear about meaning and not the only ones who function emotionally. the moral and theoretical framework of It is not a model which holds that they are the work for each child and the mad/bad, and we adults are sane/good. community. 15 16. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007Residential child care and secure settings achieving good outcomesThe workshop was led on behalf of the Secure Accommodation Network (SAN) by Michael Nerini,Service Manager, Clare Lodge, Peterborough, and Jeannette Winson, Team Manager, Clare Lodge,PeterboroughThe session examined some myths and facts contracted to the Youth Justice Board (YJB), evening she was brutally raped. Clare came toabout secure care, and approaches from thesome homes exclusively so, some on a mixed the secure home in a highly traumatisedpoint of view of commissioners and providersYJB/Section 25 (Children Act 1989) basis.state, having made a serious attempt to killthat are most likely to achieve goodSimilarly some homes are single sex, while herself. She was violent, destructive, andoutcomes for young people. Although others are mixed gender. Six of the 24 securewould prolifically self-harm by cutting therepresentative of secure homes nationally,facilities in England and Wales are exclusivelyname of her abusers into her flesh.the material presented drew heavily on work for Welfare (Children Act 1989, S25) youngundertaken at Clare Lodge, Peterborough.people. To achieve best results, placing Through the multi-agency approachauthorities must be aware of these available, Clare made steady progress overThe discussion highlighted secure care as partdifferences, match young people to homes the nine months of her stay at Clare Lodge.of the continuum of residential child carethat can deliver what is needed, and support A combination of short-term strategies wasprovision. It is not in competition with otherplacements involving young people andadopted to enable her to manage thetypes of provision, and nor do other services,families in all key decisions. immediacy of her trauma, while longer-termdespite the marketing claims of some,programmes were put in place. Twelveprovide a real alternative. The dog eat dog Secure homes also need to acknowledge that specialist agencies seamlessly worked withattitude of some, which is so damaging to even the best of teams are unlikely to beClare during this difficult period assisting herresidential child care as a whole, has arisen able to meet the complexity of needs to make sense of her life and take control ofas a consequence of over-provision resultingpresented without the existence of a range her future.from government choosing a market forces, of cross-agency relationships, workingrather than a strategic, approach to thetogether as a united entity. Systems must be Clare was reintroduced to school anddevelopment of services nationally. integrated, and planning multi-dimensional achieved considerable success. There waswith clear processes for identifying key areas greatly reduced incidence of self-harm, aPlacing authorities should not regard securefor work and distinguishing these from reported reduction by Clare in suicidalplacements as the option of last resort, andsecondary behavioural issues.feelings. She was also able to internaliseshould give detailed consideration to whichstrategies for avoiding and managing risk,young people require such care, and when aThe history of Clare, a young woman whoand greatly improved her self-image andsecure place should be used. Secure until recently was placed at Clare Lodge, waspresentation. Clare continues to build onplacements are only ever going to be helpfulpresented as an example of how, throughthese successes in her present placement infor a small minority, need time to achieveproviding a wide portfolio of integrated the community, which she helped to choose.results, and are best used not only for services, good outcomes could be achieved. One could be forgiven for imagining Clare iscontainment, but when there is clarity an older adolescent in fact she has justregarding fit with the overall plan for the Clare had experienced many moves withinenjoyed her thirteenth birthday.young person, and the outcomes beingher family, the extended family, and caresought. placements. She had been physically abused To gain a copy of the presentation and Claresat the hands of her carers, sexually exploited story visit www.clarelodge.co.ukNot all secure homes are the same.in the community, misused alcohol and drugs, Michael Nerini:Approximately 60 per cent of the estate isand was excluded from school. Late one Michael.Nerini@peterborough.gov.uk 16 17. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 Care planning seminar Sheree Kane, Principal Officer, Children in Public Care, Social Inclusion Department, National Childrens Bureau, led this seminar I challenging negative ideas anddeveloping positive ideas about childrenand young peopleI seeing children and young people asexperts, competentI seeing the world through their eyesI working with them to promote theirwell-being. The ideas around involving children andyoung people in the care planning processprovoked much debate and difference ofopinion. Involving children and youngpeople presents challenges. However, thishas to be given serious consideration if weare to overcome the barriers tomeaningful participation. To end the seminar, participants weregiven a tool that can be used as part ofthe preparation for assessment and careplanning. This model can be used todevelop a more analytical approach tocare planning and, as Dalzell and Sawyer,(NCB 2007) suggest, it provides the When you look at this picture, what do youparticular groups of children may influenceopportunity to explore the unconscious see? Is it a picture of a man drowning, or of the extent to which children and young processes and hidden influences on a man wearing a hat, pulling himself up people are involved in the assessment andworkers ability to engage with children, from the water? Could it be a man playing a the decision-making process. young people and their families. This tool piano? We all have different ways of looking can be used in supervision or individually. at things. The same applies to our work with Experience tells us that plans have aIt can be used in preparation for an children and young people. better chance of succeeding where the admission as well as care planning.children themselves have been involved An important part of the assessment andin their preparation. (Timms and Thoburn Adapted from Holland, S (2004) Child and planning process is the worker themselves2003, p.18) Family Assessment in Social Work Practice. and the organisational context in which theLondon: Sage Publications (p. 130). work takes place. Recognising what part thisResearch suggests that listening and reallyUse of questions for social work assessments might play on objectivity and our involving children and young people is the based on the Cultural review, a tool for social engagement with the care planning process key to effective care planning. Exploring this researchers in McCracken, DG (1998) The Long was the focus of the seminar. theme further, participants were presented Interview. Beverley Hills CA: Sage Publications. with ideas that came out of the Blueprint An important issue to recognise is how theproject Start with the Child, Stay with theSheree Kane practitioners own identity and attitude, Child (Blueprint Project 2004):Principal Officer, Children in Public Care professional knowledge and skills might I within social care children are often seen NCERCC Associate on Care Planning impact on the assessment and planningas either at risk or posing risks process. It is equally important to I perceptions forming the basis of servicesCare Planning practice materials relevant to understand the internal and external we provideresidential child care can be found on the environment in which residential care I child focused are we child centred?NCERCC website at: www.ncb.org.uk operates. This internal world includes an awareness of the implications of the purposeCultural review of a particular establishment and the methodology used in meeting the needs of I What do I know about children, young people and families with this particular their client group. The external world isbackground or life experience? represented by those that commission I Where does my knowledge come from? placements, the corporate parent and other I What prejudices may I hold (positive or negative)? agencies outside of the home, school orI What do I know/expect about children or young people of this age, their lives and needs? establishment that can assert influence over I What might surprise me about this child/young person/family and why would it be a how work is carried out. surprise?I How might the child/young person/family/community perceive me? All these factors may influence howI How might the assessment and my agency be perceived? assessments are carried out; the way inI What impact might the assessment have on the child or young persons familys life which the information is gathered, analysedand on their perception of their lives? and interpreted to formulate a plan. How anI What agency norms and practices do I take with me on an assessment? (for example, organisation or individuals view children or awareness of risk, resource restrictions, theories used within the work?)17 18. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007Behaviour and the educational achievement of looked after andother vulnerable children seminar presentation by HeatherGeddes and Gerda HankoThis workshop reflected the content of the document Behaviour and the educational achievementof looked after and other vulnerable children (for full text see NCB/NCERCC website atwww.ncb.org.uk)In Part 1 of the seminar, the challenging setting helped to identify interventions which I For the children, the benefit ofbehaviour often associated with the can effect more positive educational and developing a capacity to reflect on thechildren in question, was discussed in termsbehaviour outcomes, at the heart of whichmeaning of behavioural difficulties,of being a communication about earlyare strategies for meeting the most primitiverather than merely reacting to theirsocial and emotional experiences andunmet needs of a frightened infant anexperiences of forced separations andreflecting developmental immaturity withexperience of being understood and anxiety institutional care, helped them to moveimplications for learning. Examples werecontained. Summarised and discussed in the along a pathway to resilience and self-given of pupil behaviour that led toseminar group, the participants respondedworth into their later years.exclusions from school and referral to off- well to the examples offered from practice I For the professionals who at timessite services. Analysis of this behaviour and associated interventions.may well be left at the mercy ofrevealed the adverse nature of their early feelings of perceived ineffectiveness emotional experiences, discussed within the It was acknowledged that the ability todeveloping a collaborative staff supportframework of Attachment Theory and howprovide such a response depends heavily on strategy, showing how professionalsthis impacted on their capacities to learn. the consistent and reliable understandingthus supported can have theirIn particular, it was seen how pupils withand response of those working with suchendeavours recognised, can help themsuch adverse early experience can develop children, and that this required a support to feel cared about, as they care forlimited capacity to articulate experience,system which also recognises the workerschildren and colleagues in oftenand impaired capacity to cope withneeds to make sense of adversity and to feel overwhelmingly difficult work settings.challenge and uncertainty; and how, safe enough to explore their own This makes it possible to stimulate ainstead, they can become highly defendedunderstanding and responses to the new sense of professional worth andand lacking in self-awareness and trust indistressed children they work with the worthwhileness on behalf of so manyothers. This makes them particularlymain focus of Part 2.children.vulnerable in education where therelationship with the teacher/adults is a key This part showed how a collaborative staff Highlighting the significance of suchfactor in learning and where the ability to support strategy can address the needs understanding within any setting on atolerate uncertainty and challenge are theboth of the children and of all thosechilds whole pathway, the seminar, like thecore attributes of interest in and response engaged with them in the educational recently published Green Paper Careto the learning task. Underachievement is process. Examples from the presenters own Matters, thus endeavoured to putrelated to difficulties tolerating not professional experience and from education at the centre of care planningknowing and fear of the unknown, but pioneering research, like Quinton andwhere it belongs.with little capacity to turn to the teacher Rutters, showed the significance of usingfor support and guidance. such insights as Bowlbys attachmenttheory or Bettelheims findings on creating ReferencesFurther exploration of interventions with empathy and respect, and of how these can Bettelheim, B (1990) Recollections andchallenging behaviour in an educational be made accessible to all involved: Reflections. London: Thames & Hudson. Bettelheim, B and Rosenfeld, AA (1993) The Art of the Obvious. London: Thames & Hudson. Quinton, D (1987) The consequences of care. Maladjustment and Therapeutic Education, 5, 2, 8-29. Quinton, D and Rutter, M (1987) Parenting Breakdown. Aldershot: Avebury. Rutter, M (1991) Pathways from Childhood to Adult Life: the role of schooling. Pastoral Care and Education, 9(3), 3-10. Rutter, M (2006) Critical Review. Journal of Child Psychology and Psychiatry, 47(3).Full bibliographical references to the presenters publications, developing the issues here summarised, will be found at the end of the papers published on the website at www.ncb.org.uk/ncerccThe NCERCC website contains several other examples of practice materials regarding the education of looked after children such as Understanding Why and Young Peoples PEPs an evaluation. 18 19. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 Spring 2007 Notes of the Taking Care of Education (TCOE) seminar Dr Isabelle Brodie, NCB and Senior Researcher for TCOE, and Pauline Inwood, Derby City Council, Principal Officer TCOE Isabelle began the workshop bymonthly meetings I use of part-time timetables and summarising available research on the I multi-agency training and many other alternative pro