Therapeutic care – everywhere

10 October, 2016

Themes from Nyland  #6

The team from the Guardian’s office have analysed the 850 pages and 260 recommendations from The life they deserve: Child Protection Systems Royal Commission Report[1].  We have extracted some themes and priorities to allow us to critique the government’s response, judge the improvements over time and to shape our own work.  Following is a description of the issues and a short list of things to watch for in the reform process.  The first five in the series are available.[2] We will post the rest over the next few weeks. [3] 

Commissioner Nyland’s description of the need for a therapeutic approach to child protection rests on three understandings.

  1. Most, if not all, children taken into care will be experiencing trauma. It will have been  caused, if not by prior abuse and neglect, by the dislocation of their lives caused by the experience of coming into care.
  2. Treatment of developmental trauma is not rapid and cannot be delivered by professional intervention alone. Therapy requires consistent long-term work, with consideration of the child’s care environments, home and school, specialist therapy and support from others in the child’s life.
  3. Supporting a child affected by trauma, especially one with high and complex needs, requires adults to collaborate closely and share an understanding of what causes behaviours and how to respond appropriately.

In residential care and emergency care, all staff need to be trained in the effects of developmental trauma, how to support a trauma–affected child and how to respond appropriately to challenging behaviour.  Commissioner Nyland recommends a ‘streamed’ model of residential care where the specific needs of each child can be met in an appropriate setting.[4] 

Home-based care, which will continue to provide the bulk of out-of-home-care, presents some particular issues.

Home-based carers are not experts in trauma. They rely on the professionals to support them by identifying and addressing issues which emerge as the child grows. Two principal barriers to therapeutic support for placements were identified: one, that foster parents fail to communicate with support workers about the nature and severity of the problems with which they are grappling; and two, that professionals charged with supporting the placement do not refer the foster parents to appropriate support at an early stage. 

There also remain serious barriers for children requiring specialist therapeutic services.

… the therapeutic needs of many children in care are still being neglected. While there are some examples of very good service from the Agency, not all children with a demonstrated need are receiving assessment and support.

… [therapeutic] services for children in care are scattered across a number of agencies, each of which apply their own criteria for eligibility.

… greater investment in therapeutic services is needed for children entering and living in care. The assessment of their needs, and the processes for referring them to the appropriate service, should be better coordinated. 

As reform progresses we look forward to seeing:

  • The application of a therapeutic framework across all residential care environments giving a theoretical basis for care decisions.
  • Training, ongoing professional development and support for residential care workers in working with children affected by developmental trauma.
  • The initial and ongoing training for all foster carers to include the effects of and suitable responses to developmental trauma and the availability of therapeutic assistance.
  • Improved systems for the timely assessment and provision of therapeutic services to children who need them, especially in rural and remote areas.
  • The provision of therapeutic support to home-based placements that are identified as being at risk of breakdown.
  • The inclusion of Strategies for Managing Abuse Related Trauma (SMART) training in the professional development of all educators who work with children in care. 

Please join the discussion via the reply box leaving a name and an email address in the spaces provided.  We will remove them from the published post if you request in your reply.

1 Unless otherwise noted all quotes are from The life they deserve: Child Protection Systems Royal Commission Report,

2 See also previous ‘Themes from Nyland’ posts on Coordination and Collaboration, The voice of the child , Emergency care, Residential care and Home-based care.

3 This is not intended to be a précis of Commissioner Nyland’s report which provides a very clear and readable summary.  Because of the Guardian’s mandate, this analysis will tend to focus on issues for children in out-of-home-care.

4 Commissioner Nyland also recommended the establishment of secure therapeutic care facilities where young people in care can be detained for a period of time during which they will receive therapy.  Although the Commissioner sets out a number of safeguards and conditions, the Guardian believes that this model will not produce significant long-term benefit for the young people so detained and that the detention of young people who have committed no offence raises important human rights concerns. 

2 Responses

  1. Foster carers already receive training in therapeutic parenting but lack professional support to cope with the demands of a traumatised child. FSA are overly reliant on CAMHS as it is a free service, but in my experience quite inadequate to the task of providing long term therapeutic intervention for a foster family. Funding needs to ve easily available so families can access appropriate on going psychological support.
    More work needs to be done with schools around appropriate support of foster families, the adequacy of SMART training needs to be looked at. Many foster carers would tell you that their school is not helpful in the way they manage traumatised children, despite SMART training. Consideration should be given to establishing smaller more child focused and inclusive high schools where all kids, even those with trauma can receive an education in a caring receptive environment.

  2. As I read this I am in Donegal, Ireland, where TUSLA (the Irish Government’s Child and Family Agency) is supporting a three-year implementation programme for the Triple-A Model of Therapeutic Care. The implementation programme will see all foster carers and the professionals who support them in Donegal trained in the model, so that it is embedded across the alternate care system. This means that all adults involved in the home-based care of children recovering from abuse and neglect will speak a common language and implement care from a common ‘play-book’. The result is anticipated to be consistency in each child’s experience of care, within their own placement, in their respite placements and when they move placement. Consistency is vital, as inconsistency is the pervasive characteristic of a traumatising care environment and the primary trigger for trauma-related behaviour and affective displays. I am the author of the Triple-A Model of Therapeutic Care, as well as A Short Introduction to Attachment and Attachment Disorder (Revised and Updated Second Edition available December 2016). My home is Adelaide, South Australia.

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