What is therapeutic residential care?

21 November 2017

In June 2017, 550 of the 3,484 children and young people in out of home care in South Australia lived in either residential or emergency care rather than home-based care such as foster, relative or kinship care.

We know that residential care should do more than just warehouse vulnerable children and young people, that what they experience there will have a profound effect on their future health, emotional and social adjustment, identity and life prospects. The children and young people who find themselves in residential care have experienced the same or more of the trauma and dislocation in their lives as others coming into care and need the same or more care and nurture to be able to heal.  Commissioner Nyland made the call that all residential care in our state should be ‘therapeutic’.

But what is therapeutic residential care?

This is a question for all child protection jurisdictions across Australia. The Guardian’s Office is leading a national policy development process to articulate what constitutes therapeutic residential care for the Australian Children’s Commissioners and Guardians (ACCG) group.  The statement will identify the essential elements that a service will need to provide to warrant the designation as ‘therapeutic residential care’.

These are some of the themes that emerged during its development.

Children and young people in therapeutic residential care are at the centre of the care model and live in an environment that emphasises their wellbeing and safety.  They are informed about and can influence decisions that affect their lives, are empowered to know and enjoy their rights. They have access to formal and informal mechanisms for resolving concerns, including through access to independent monitoring and grievance mechanisms.

Those from diverse cultural backgrounds have access to culturally appropriate care, in particular those from Aboriginal and Torres Strait Islander and other culturally and linguistically diverse communities.

Children and young people who have disabilities or are experiencing psychosocial issues have an environment that responds to their needs, as do those in regional areas. Wrapped around the children and young people in therapeutic residential care are comprehensive and coordinated services to meet the full range of their needs, including access to appropriate external or mainstream services.

Restabilising a sense of stability is important to traumatised children and young people so when changes of care placement are made, they are done with particular care and sensitivity to the needs and wishes of the one being moved and also the peers who share their space and their lives.  Where it is safe to do so, priority will be given to maintaining links with the child or young person’s family and significant others.

These are all necessary conditions for therapeutic residential care but could equally be what we aspire to in all residential care.

What is unique and critical to therapeutic care is that the residential care house is staffed with appropriately trained people who develop therapeutic relationships that respond to attachment-related and developmental needs.  Staff will be trauma-informed and, in turn, build the capacity of children and young people to form positive relationships with others.  Each child or young person will have an individual therapeutic care plan which is regularly reviewed.  Staff will have the training, supervision and support to understand and respond to the challenging behaviours that sometimes accompany trauma.  Personal relationships are key and staff need to be retained for a long time to provide a secure, stable and consistent base for recovery.

Guardian Penny Wright will present a draft proposal defining therapeutic residential care to the national ACCG meeting in mid-November.  The Australian Human Rights Commission and Commissioners/Guardians from the Northern Territory, Victoria, Tasmania and Western Australia have provided feedback on earlier drafts.

We will provide you with updates as the national conversation continues.

For an introduction to the practice of therapeutic care, see our article Healing Developmental Trauma from February 2015.

This item first appeared in the November 2017 Guardian’s Newsletter which you can download now.

2 Responses

  1. Thank you for addressing this very important issue. My comment relates to the under-recognition of children’s need for permanency (their sense that they belong to a family and a community and that they are loved) that still pervades our jurisdiction. Children are in residential care because they cannot remain with their families, and because there are insufficient foster placements to offer them alternative/complementary permanency. We know the profound harm that is caused to children who don’t have a secure connection to family. The statement in the paper “Where it is safe to do so, priority will be given to maintaining links with the child/YP’s family and significant others” needs to be expanded and articulated. Children have a critical need to belong somewhere. If they have no alternative permanent caregivers they only have their family to rely on for their sense of identity and belonging. Even if aspects of family connection are unsafe, children need this connection if they have no alternative. When we just say links will only be maintained where it is safe, and don’t break down the ways in which degrees of safety can be provided to meet this critical need, we deny children the many nuanced opportunities to maintain at least some meaningful connection with their families. We cannot be resigned to young people exiting residential care who belong nowhere, or who seek to reconnect with their families post-care in unsupported and possibly unsafe ways. The core problem with residential care is the lack of a loving (ie unpaid) and consistent caregiver for life. It must therefore be a primary focus to ensure these children and young people have family and significant others who love them and who they will stay connected with for life. This is the future focus that is too often missing in the way we talk about residential care.

  2. As young people living in community residential care units are unable to live with family for safety reasons it is very important they have some meaningful family contact for their sense of identity and belonging particularly when they residential care they will need their family connections. Despite the positive role carers have with young people they don,t have the same emotional attachment as family.

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