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    Ncercc Conf Proceedings 2008 Ncercc Conf Proceedings 2008 Document Transcript

    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 National Centre for Excellence in Residential Child Care Annual conference proceedings Manchester Renaissance Hotel – 5 November 2008 Residential Child Care: Leadership, management, outcomes In this issue Jonathan Stanley, manager, National Child Matters outcomes that serve as a Residential Child Care 1 Centre for Excellence in Residential Child foundation; but what else does residential Care (NCERCC) child care need to add in order to Leadership 2 Positive leadership and management are adequately represent its unique task? essential for residential child care. Managing children’s homes 3 Maintaining the integrity of the child- The conference looked at how outcomes are Where are we going with centred, opportunity-led, residential viewed and used across the world; and group-living task requires leadership and heard of the in-depth methodology used by groups and groupwork in management that both meets the needs of one leading English provider to explore and residential child care young people and contributes to the develop their own outcomes framework. in England? 4 current development of children’s services. This year’s conference examined research Residential child care is a sector Restorative justice and residential and practice into leadership and characterised by its creativity, with settings child care 5 management; and developments in developing according to need. The seminars measuring outcomes for children and offered insights into the different ways in Continuing the development of young people. Keynote speakers which providers have sought to resolve the social pedagogy in English considered the nature of leadership and potential conflicts involved in the management in residential child care, standardisation, differentiation and residential child care 6 whilst the seminars offered opportunities individuation of outcomes. They also looked Making sense of Mental Health 7 to hear positive developments in some of at a diverse range of topics that are all the most challenging areas of residential highly relevant to residential child care, Learning from the Scottish child care. including social pedagogy, restorative experience 9 justice, leaving care, therapeutic It has long been understood that any interventions, decreasing physical Leaving care 10 residential child care evaluation should be interventions, mental health issues and related to outcomes. Defining outcomes workforce planning. Children’s Residential Networks 11 needs to be related to the task of caring for Introducing SCIE e-learning young people within the residential child These conference proceedings represent care context. Outcomes need to be edited summaries of the transcripts for materials for positive behaviour evaluated and communicated effectively most of the presentations – except where management and physical and efficiently. There are the five Every sessions were not recorded. interventions 12 Young people’s views 13 SACCS’ therapeutic residential care for traumatised children 15 Measuring what matters, the social return on investment and residential child care 17 Decreasing restrictive physical interventions 18 Resilience and residential child care 21 Developing meaningful outcomes for young people with disabilities 22 Therapeutic residential child care 23
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 Leadership: Remembering and reclaiming the task and role in residential child care You can’t make anybody do anything, you can persuade, encourage, cajole, inspire, or implore but you can’t actually make it happen; whether it’s a reluctant teenager curtailing their behaviour or a resistant staff member who doesn’t want to work in a particular way Adrian Ward, Tavistock Centre and Leadership as relational and leader understands, engages and works with University of East London, and co-author interactional the whole network of relationships, both of Working in Group Care (Policy Press Knowledge about leadership in the caring within and outside the unit. 2007) and NCERCC leadership professions is not very high and it is not a development materials (forthcoming), topic that has featured strongly on training Leadership as a process both of which consider essential aspects courses, even at post-qualifying and Integral to this relationship-based approach of residential child care leadership. advanced levels. Old labels, such as is an emphasis on leadership as an ongoing, charismatic, autocratic and laissez-faire, are evolving and involving process, rather than (Adrian’s paper was delivered by John commonly used – with a so-called as a static event represented by an Turberville, director of the Mulberry Bush democratic model ‘fitting in somewhere’ as organisational chart of the formal School, as Adrian was unable to be present a preferred approach. hierarchy. Leadership takes time, like any due to travel problems caused by weather.) relationship or set of relationships. One A distinction is currently made between grows into it through a transitional phase: The four aspects of the leadership role in transactional and transformational you become the role, relationships develop residential child care were considered. leadership. Transformational leadership and grow and eventually you move on. emphasises the moral element of The ‘moving on’ is especially important. Why leadership matters in residential leadership. Moving beyond simply getting The truism that ‘nobody is indispensable’ child care people to do what you want them to and applies to leadership in the same way as it Numerous research studies and overviews of in the way that you want them to do it, does to any other role. Too many inspection reports indicate that clear and the model transcends everyday needs and apparently good leaders seek to make effective leadership plays a critical role in expectations, aiming at higher or deeper themselves indispensable, by playing the producing good quality care for children and goals. It draws attention to what leaders charismatic or transformational role, as if young people. The corollary to this is that an have to do to inspire people to think and nobody could replace them. When they absence of leadership, negative or destructive plan beyond the immediate and everyday. leave, the place collapses or implodes leadership, disengaged or excessively because they have undermined everyone charismatic leadership all produce unhappy, Models and terms, including the else’s confidence in their own or the team’s confused and divided teams, poorer quality transformational one, can seem to reduce shared abilities. The other critical point to child care and probably poorer outcomes for leadership to one-way traffic. Almost as if be made about the leadership process is the young people. leadership primarily involves doing things that, rather than simply being appointed to to people in order to get them to do the the leadership position, the process involves There is a distinction to be drawn between things that you want them to do. negotiation and testing out. leadership and management. Management is about planning, organising and Insistence upon compliance misses the point – Leadership is therefore relational and a overseeing. Leadership is about having the the more you insist, the less compliance you process. The best leadership nurtures, vision that informs all that planning; the will evoke. Leadership is not one-way traffic, it facilitates and promotes good practice over sense of strategy to ensure it actually is interactional, involving a complex network the long term, enhances team capability works; and the personal qualities of of relationships that require continual and confidence and is self-effacing rather engagement, inspiration and attention to nurturing. It is unhelpful to see leadership than self-aggrandising. As Lao Tzu said in team issues, such as morale, which are so purely in terms of the leader’s characteristics Tao Te Ching over a thousand years ago: critical to getting the work done. or style. We need to think about how the ‘When the best leader’s work is done the people say “we did it ourselves”‘. The leader as a person Children’s homes can be described as small and intense human organisations focused on addressing the pain of separated children and supporting them towards some resolution of that pain. A children’s home is not a bureaucratic or industrial undertaking engaged in the processing of data or physical materials, nor primarily an educational or leisure-oriented organisation focused on providing emotionally-neutral learning or recreation. Its clients are, by definition, very distressed young people and this distress permeates the very fabric of the building and the human interactions within it. The task combines everyday care and support-giving with a longer-term focus on addressing each young person’s 2
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 life predicament and the distress it causes need the active support of leadership to help everyone’s strong feelings. Therefore, it is them. This distress has enormous them withstand the stress and remain critical that there is an equal emphasis on significance both for the nature of the responsive and positive. Therefore, the regular and reliable access to supervision child care team’s work and the space in leadership role can entail a high level of and consultation for leaders. which it operates 24 hours a day. It has demand and potentially a degree of isolation, important implications for the kind of supporting and directing staff who are The demands of the job require leaders to be support and leadership the team needs. themselves under great pressure. Leaders often able to stand back and to review and evaluate occupy the boundary between the their own experience and contribution. A child care team may have to absorb or organisation and the outside world; mediating External line managers must ensure that respond to extreme emotions in the average between different groups and groupings residential leaders have regular supervision on day’s work, often with very little notice. Some within and beyond the organisation. all aspects of their work, including the of the distress and disturbance they witness opportunity to reflect on its psychological and may deeply affect them, perhaps without Leaders may sometimes have to hold emotional demands. Residential leaders should them fully realising it at the time. This confidential information about change and also have access to independent consultation everyday reality means that child care staff often find themselves the focus of on their role and task. Managing children’s homes: Developing effective leadership in small organisations The approaches used and the ways of working that were established between teams and managers within the fluctuating nature of homes occupy an important position. Leslie Hicks, University of Lincoln and the individual manager’s approaches within Management includes the task of forming co-author of Managing Children’s Homes: the home and their relations with the staff a coherent staff team over time, where the Developing effective leadership in small group and young people; together with quality of relationships is a major organisations (Jessica Kingsley 2007) and managerial approaches in contextual component in establishing the potential for NCERCC leadership development arenas, such as the organisation, other good practice. This requires sensitive work, materials (forthcoming). agencies and the wider realm of policy and constantly revisited, as group composition, procedures. The effectiveness of managers both staff and resident, changes. Leslie Hicks gave a brief introduction to the relies on their being sufficiently well research published in Managing Children’s placed, within each of these arenas, to External levels of influence can come to Homes, and subsequent developmental bring about consistent and reflective bear on the role of manager. The role is work. This involved examining what practice for, and on behalf of, the young performed within the organisational managers do overall; what they do within people in the home itself. Accumulating context. Managers need to feel they have their organisations; the way they work with strengths in these different contexts acts as sufficient autonomy while concurrently young people and the key factors an overall enabler of good practice. having access to line-management influencing positive practice; and concluded support and supervision if needed. with a consideration of the implications for Crucially, to achieve a well-functioning Managers are reliant on establishing training arising from the findings. home, managers and staff must cooperate credibility within their own organisations; to establish a consistency in the they need sufficient development The research was funded by the collaborative culture, led and developed by opportunities and value a close Department for Children, Schools and the manager, within a hierarchical system relationship with, and access to, their Families, and focused on: of accountability. Managers have a key role organisational hierarchy. They value in communicating the home’s purpose and involvement in strategic management and I the role of managers and how they assisting staff to realise that purpose. A contributing to planning, particularly the manage functioning team requires the drawing planning process for their own homes, and I the kinds of leadership in operation in together of individuals into a cooperating in writing and developing procedures the homes group that shares the manager’s clarity on across the parent organisation. Managers I how leadership was achieved and goals and how to achieve them. Managers also need access to external professional sustained and the ways in which need to share roles and responsibilities development opportunities. Each of these resources are used. based on a solid understanding of the arenas contribute to a manager’s strengths of each member of staff. They perception of them being treated fairly Managing children’s homes to produce the must spend time, formally and informally, and feeling valued by their parent care and positive outcomes required maintaining the staff team. organisation. involves more than the use of bureaucratic administration or ‘managerialism’ to The degree of autonomy afforded to Successful managers use formal and establish working relationships between managers is important. Managers must informal means to establish a consistency staff teams and managers. How managers empower staff while retaining their across the group of staff and young people, create, maintain, influence and develop decision-making authority. In small while respecting and focusing on individual their staff teams is fundamental to success relationship-based organisations such as needs. This balance between individual and – it helps staff to meet the needs of young children’s homes, the role of manager group needs involves notions of parity and people. involves and is sustained by many factors fairness, negotiation, and the juggling of other than the manager’s position within resources. The research highlighted the importance of the hierarchical structure. The culture of the manager’s role in terms of the internal the organisation itself and the kinds of Relationship-building is a necessary and external context in which they operate. leadership deployed contribute towards the precondition for active work. Achieving a Interdependent factors in success include success of the managerial role. collaborative team dynamic, which works 3
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 The research examined the elements that distinguish between being able to perform the role of manager adequately and being able to perform it well. Overall, it showed that in homes where the manager had clear, well worked out strategies for dealing with behaviour and with education, staff had higher morale and they received clearer and better guidance. The staff felt that the resident young people behaved better and were less likely to be excluded from school, convicted or cautioned while in the home. They also expressed more favourable views about the social climate of the home; were happier on some of the areas we measured; and were seen as functioning better by their field social workers. The research may have implications for training, although many questions remain as to what would constitute appropriate training. There is still little research evidence about the forms, standards and merits of the training that exists for consistently over time and within the routines (using sanction-and-reward managers or staff who are working, or who manager’s preferred approach to practice, is processes where relevant and appropriate); are about to work, in children’s homes. of primary importance. It is a shifting, building relationships; establishing key However, given the importance of complex and dynamic challenge, requiring worker systems; and developing and teamwork and team dynamics in children’s an active understanding of the dynamics of maintaining relationships with others, such homes, training should be home and the home and of young people’s needs and as field social workers and schools, group-oriented and have a specific focus characteristics. It requires the manager to neighbourhood groups, parents and carers. on individual context and individual be involved in establishing boundaries and purpose. Where are we going with groups and groupwork in residential child care in England? Messages from the NCERCC research study on the importance attached to formal and informal groupwork by residential child care staff The key thing in shared responsibility, is reflection, not a means of managing the place but a means of thinking with each other about what’s happening in the place we share. Roger Clough, Eskrigge Social And I thought what’s going on? What’s developed a project, which is just reaching Research Centre happening in residential child care? I its conclusion, in two parts: an overview What I want to do is to raise some always understood groups and groupings to and a survey. questions about groups and groupings in be at the very core of residential practice. I residential child care. Working in a local thought the community and the people I The brief overview captures some of the authority and looking at children’s homes, I who lived and worked in the establishment key themes around what’s happening in discovered to my surprise that when staff were central. That core belief seemed to residential child care, including changes were talking about their work, the thing have been lost. in the size of homes. Working with a that they valued most highly and thought community of three, two or even one is most important was what they called ‘one- In reflecting on past days, when things and dramatically different from the sixty to to-ones’. If something went wrong in the ideas were different, what I want to do is eighty young people I worked with in an home, they would try to resolve it by one- to share with you ideas about groups and approved school. How has our to-ones. Staff would say: groupings and leave you with some understanding of groups and groupwork questions. The research that I’m going to been affected by size? How has our do you know if only we had one less resident, talk about here is a very small piece of understanding of groups been affected we’d be able to do a really good job here … research and all it’s doing is raising some by perceptions of residential child care, we’ve got this very difficult young man, he’s serious questions. the emphasis on fostering, and societal relating to the other kids, he gets carried changes such as the huge emphasis on along by them, feeds off their excitement, Jonathan Stanley and I tried to set up a individualisation and personalisation? they feed off him, they get him doing all survey about what’s happening in relation I The survey asked how people work in sorts of things and he gets out of control to groups and groupings in residential child groups. We asked managers to complete and if only he wasn’t here, we would be able care and apparent changes to ideas that I an online survey but received a low to really do a good job with the children. thought were at the core of our work. We response rate. Those who did respond 4
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 seemed to be more interested in group runs through everything we do, say to-ones; and this has significance for working with groups than may be the and think; group is the treatment and the groups of young people learning to share, norm today in residential child care. way of life not part of it. to take responsibility and be confronted by the group on their behaviour. So, whilst it was not a scientific survey, we Another says: got some pointers to developments in I want to finish on the word ‘reflection’. Craig practice. Asked about the sort of groups in Our community meetings are Fees, writing about therapeutic communities their homes, people mentioned things like psychodynamic, the agenda is set by what and shared responsibility, wrote: activity groups, and task or focus groups is going on in interior life of the community looking at a particular issue or problem. at the time, which we can be confident will shared responsibility has been used as the They talked about formal and informal manifest itself in the room if it hasn’t term to describe the involvement of children groups, such as child–family conferences, clearly done so yet outside it; the job of the in the running of the establishment. staff groups and external groups. They focal therapist is to ensure that it does. talked about school groups and several He goes on to write about shared mentioned young people’s meetings or What we’ve got there are some pointers to responsibility: community meetings. understanding or describing group living. I would like to pursue the question of how shared responsibility is in fact an orientation Some of the people responding talked we understand the ‘group’; and how that of individuals towards one another, towards about ‘group living’, using those two words. understanding varies in different settings. the groups in which they live. One person responded that: People talked about the skills needed, such as the ability to contain the group well; He goes on to write: If managed by staff who value children, who work well in a team; plan confidently; be want to consult the children, to provide a patient and understanding; set appropriate because there is a formal machinery to run space for children’s emotions, anger and individual and group targets; plan and through community meetings, it is easy to sadness, make children feel safe, contained juggle; provide ‘emotional containment’; miss the fact that the central characteristic and cared for, who want to work with social and be attuned to the children. If these are is reflection not self-government. workers, families and significant others, the skills necessary, my question is: What admire resilience in children and actively sort of training do we need and where My original question was something like: ‘Has build on strengths; who want to plan for the should the training take place? work with groups and groupings got lost?’ – future alongside the child, able to know the that is, have we lost something crucial about children and plan a great structure to the The ‘one-to-ones’ that people were talking group living, communities and shared child’s day, able to challenge the child and about don’t seem to have the aspect of responsibility? As I reflect on residential child others whilst being challenged, then group sharing that goes on in many group living care in the past, I wonder if that sense of the living can be amazing. situations in the best residential child care. group and shared responsibility is something The emphasis seems to be on that is still important, that should still be Somebody else spoke of how the: individualisation, personalisation, and one- central to all or most of residential child care. Restorative justice and residential child care: Messages from research It’s about reflecting on our behaviour … Talking about your behaviour, how it affects other people and what you can do to be better (12-year-old child) account the fact that residential care Steve Fallowfield, Hampshire County Offending rates for looked after children groups tend to have characteristics that do Council have generally come down in Hampshire. not make a sort of ‘clinical approach’ to Steve Fallowfield, who manages seven However, this cannot just be attributed to restorative justice easy to apply. children’s homes in Hampshire, gave an the young people in residential child care. account of Hampshire’s initiative to With regards to overall figures, the position Hampshire had just £5,000 for restorative introduce restorative justice approaches to now is not a vastly better position; justice work. This was quite a shortfall from reduce offending rates of children looked Hampshire’s proportion has come but one the £160,000 considered necessary to cover after in the county. He recorded that child or two children in a children’s court training, through an external provider, and Hampshire’s restorative justice initiative can have an enormous impact on the embedding the core training into their own began back in 2004, when offending rates headline figures. structures. Further funding came from a among children in their care peaked just variety of willing sources, for example, the short of four times the national average Hampshire spent a considerable amount of local Wessex Youth Offending Team joint- against the PAF target indicator. The other time talking to managers of a home in funded training and liaisons with private contentious thing was the number of police Hertfordshire who have implemented a agencies and other local authorities – call-outs to children’s homes. restorative approach, to find out what Portsmouth and Southampton – who worked and avoid making mistakes. They likewise could not afford to go it alone. Hampshire had to do something to reduce identified who and what was needed to put call-outs and reduce offending. Things this training in place, settling on Walker One of the key messages from the discussions could be done about reducing the number Research and Training with Hertfordshire was that there was no of incidents in the homes. Logs could be (researchandtraining.co.uk/) because their point in training half-a-dozen willing souls kept about incidents. But actually making model was ready to deliver and had been from the residential sector to be restorative residential care a better place to work shaped around some of the vagaries of practitioners then expected to champion the and live, measuring that, is very difficult. residential care. They had taken into 5
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 approach. It was not to be left to the The initiative has been evaluated by has been changed to promote reflection in residential sector to do alone – the decision Portsmouth University. The headline staff and young people. For the staff, there was taken to embed it across the system and conclusions are that it is being used regularly are questions like: What were you doing the whole of the child care culture. Training with some perceived success in resolving before it happened? What do you think you was made mandatory for residential staff; some of the conflicts within units. Most staff did? How do you feel about it now? What with briefing training provided for key preferred to use restorative approaches. A do you think you could do to make sure partners, YOT teams, probation officers, police majority of staff working in children’s homes this doesn’t happen again? A totally and the field work managers. understand restorative approaches with separate incident record for the children children and the principles and commitment includes questions like: How did you feel? By March 2006, the majority of staff were it takes to actually resolve conflicts. Were you angry? Were you upset? It trained and a core training period includes a series of facial expressions for established within the calendar for all staff. Two tensions have been observed. A staff the young people to use (angry, upset, It is now part of residential staff induction member who has been seriously assaulted happy, puzzled, and so on) to communicate training. Having started with a certain may feel pressure to opt for restorative how they feel. group of staff, these changes created the approaches when they would prefer to involve need for further training. In 2007, further the police. Police call-outs are still high as It is not a quick solution but it is about two-day refresher training was established they respond to missing person notifications. reflection and managing relationships to keep the impetus going. The training has between people. It is a real challenge for had to evolve and adapt, in the light of There have been developments in practice staff that requires a whole-system approach feedback from staff, to become less formal as a result of the implementation. For with everyone signed up to it – and that is and more intuitive. example, the format of the incident report the direction Hampshire are moving in. Continuing the development of social pedagogy in English residential child care Social pedagogy provides a theoretical and practical framework for understanding children’s upbringing. It has a particular focus on building relationships through practical engagement with children and young people using skills such as art and music or outdoor activities. In a residential care setting it provides a particular expertise in working with groups and using the group as a support. (Care Matters: Time to deliver for children in care. DCSF, 2008) Encompassing a sound theoretical context, residential child care workers in their you both like to do, that is potentially new alongside a very hands-on experiential application; and to discover possible ways for both of you, involves learning together. training experience has, I believe, given me of translating social pedagogic approaches It is helpful in building relationships and a greater insight into the benefits of a into meaningful practices in English participants said that they found this very pedagogic approach. As a senior manager, I residential child care settings. Staff from positive and were trying to incorporate this feel resourced with new tools and an six children’s homes were trained in social approach more into their practice. enthusiasm to see a positive change in how pedagogy and the holistic ideas residential service provision will be viewed underpinning it. Homes were revisited three Residential workers participating in the as a service of choice with trained and months and one year after the training to research reported that previous training respected staff. I will continue to give follow-up support and see how things had often been fragmented. Social disseminate this approach within my were developing. pedagogy gave them a more holistic organisation through training and understanding of how all the various ‘head, information-sharing and hope that on a It seems social pedagogy is very similar to heart and hands’ pieces fit together. They national level social pedagogy will remain best practice in residential child care, so also recognised that social pedagogy is high on the agenda. (Senior manager) some homes are in fact already using often about working with your elements of it. Staff, nonetheless, felt that commonsense, listening to what you feel, Gabriel Eichsteller and Sylvia Holthoff, they benefited as a result of the training not only to what you think. Social ThemPra Social Pedagogy Community and of being exposed to social pedagogy. pedagogy encouraged them to look not Interest Company As a result, they felt they were giving just at the guidelines and read ‘okay in this This presentation focused on what has children and young people more positive situation I’m supposed to do this’ but to happened in developing social pedagogy in experiences, a sense of achievement rather actually use commonsense and do what is residential child care settings in England, than the feeling that everything in their right in that situation for that particular one year after the first English social life is about failure and negative child or young person. pedagogy research pilot projects (2007) experiences. They were building on the were funded by the Social Education Trust positive experiences, showing them that Revisiting the research homes one year on, and commissioned by NCERCC. The they can actually do something, and that there was still enormous enthusiasm for evaluation report can be found at they have resources and skills within them. social pedagogy and much work going on www.ncb.org.uk/ncercc. trying to implement it, and promote it in Social pedagogy works from the other children’s homes. They felt that it gave The project aimed to develop understanding that everyday activities like them a better framework; better ways of understanding and knowledge of the sports, cooking, repairing punctures on a achieving the outcomes; and a way of theories behind social pedagogic tyre, can give you a situation to develop getting positive outcomes across and approaches; to build the confidence of relationships. Focusing on an activity that empowering children or, as one worker said, 6
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 ‘to walk alongside rather than lead the way’. homes, seems most beneficial. The training There was much talk about involving children provides positive learning experiences, and young people more in the decisions that giving participants ownership and are going on and empowering them. Many responsibility for making sense of social commented that it was a holistic way of pedagogy within participants’ unique looking at their practice. working contexts and enabling them to take on board enriching new concepts and Participants also had a greater sense of perspectives. This provides an ideal basis for community, of working within a group supporting them further in implementing living in one home with shared activities. changes within their homes, thus Participants felt that the social pedagogy maintaining the momentum and training had given them the opportunity enthusiasm they have developed during the and the tools to reflect on their own training. practice, and on their own personal influence in their practice, in working with Involvement others in their teams and with the children Social pedagogy requires the support of and young people. And it had focused on everyone, which is why a critical mass of the importance of the concept of ‘head, the workforce needs to gain a thorough heart and hands’ and using them in understanding of it if we want to create balance in order to work effectively. sustainability. This is true at every level, whether it be a team, an organisation, Social pedagogy is a continental approach residential child care in England, or even and every country – like Denmark, Germany the entire children’s workforce. It is and Belgium – has a different approach to it. important that all staff share a basic There is a core that is common to all, but understanding and are involved in any each country has then developed different changes. ways of interpreting it in light of their own society, history and culture. So it is essential Implementation Networking to tailor the model to the needs of the work Social Pedagogy is a holistic approach, and Networks are crucial for maintaining you are doing here for it become a genuinely this means that its implementation should momentum and generating a critical mass, and UK approach. ideally be a holistic one, with social these need to be nurtured both within pedagogy becoming part of every level of a organisations embracing social pedagogy and In order to successfully construct a social system. It is not enough that fieldworkers at a national level. A virtual network has been pedagogic approach within organisations, are making use of it – organisational set up on www.socialpedagogyuk.com the following points are recommended. policies, strategies, leadership, legislation, regulations, and so on, have to reflect Further information and contact details can Training social pedagogy too. Irrespective of our be found on our website www.thempra.org.uk The NCERCC Social Pedagogy research has position, we all can contribute to taking Up-to-date information concerning all Social shown that a mixture of intensive training, social pedagogy forward, starting with our Pedagogy developments can be tracked via followed by direct support within the own practice. www.socialpedagogyintheuk.org.uk Making sense of Mental Health: The emotional well-being of children and young people with complex needs in schools In any setting where there are lots of children with disabilities or complex needs it could be anything up to 40 per cent of your population that could have a diagnosable mental health problem. We are talking about an issue that affects most settings to some extent. Where policies and interventions are owned by everyone from the top down it feels like people understand what is going on and they are going to be safely contained. There is no area of that organisation’s life that isn’t impacted upon by the theory of why they’re doing what they’re doing. Claire Dorer, chief executive of the diagnosable mental health problem. Part of special educational needs as the estimates National Association of Independent the difficulty is in distinguishing between a reckon you are anything up to six times Schools and Non-Maintained Special mental health problem, an emotional more likely than your non-disabled peer to Schools (NASS) difficulty and a special educational need. have a mental health problem. So in any The estimates for the prevalence of mental setting where there are lots of children health problems in children and young A UNICEF report in 2007 claimed that the with disabilities or complex needs, there people range from one in five children with UK is one of the bleakest places to grow up could be anything up to 40 per cent with a a psychological problem (Bright Futures, if you are a child or a young person. The diagnosable mental health problem. We are 1999, Mental Health Foundation), to one in situation is even bleaker if you are a child talking about an issue that affects most ten children estimated to have a or a young person with a disability or settings to some extent. 7
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 I How do you define mental health problems and especially how do you distinguish between what is a function of a special educational need and what might be an additional mental health problem? I Even if an additional need for support is identified, how does the school get access to services? Access to CAMHS has been a major issue, especially for a child placed outside of their local authority. Compare the information for parents about signs of depression with information for parents about autism: there is a considerable overlap in terms of signs such as mood swings, irritability or apparent disinterest in learning. If you are working in a population of children with complex needs and disabilities you might accept a lot of such behaviour as being ‘normal behaviour’. If you are working in a school for children with autism a lot of those things you might reasonably expect to see and to interpret as being a function of that child’s autism. So how do you work out what it is that is actually causing concern? What are they doing with children who A lot of prevention work is around building Thinking about some of the common life they have identified as having mental resilience and particularly around experiences of disabled children gives an health problems? A questionnaire was promoting emotional well-being. To do this understanding of why the incidence of followed up with in-depth interviews in 28 schools are, for example: mental health problems might be so high. schools with a wide range of professionals. A child with a disability has a far higher I clarifying the lines of responsibility for chance of being in a family living in Schools identified a huge number of pupils mental health problems, that is, for poverty, of being in a family where one of who they felt had difficulties – far more identification and referral the parents has a mental health problem or than were actually getting some form of I implementing clear policies to help staff substance-use problem, or growing up in a intervention to help them. Interventions identify when they should be concerned family where fewer people than average included individual therapy, referral to and what action they should take work. A lot of life events impact on the counselling, and the use of medication. I providing staff training, both in child above and beyond having a disability. school/home and external services When asked who is actually responsible for I setting up effective partnerships with This situation has led to policy mental health issues, the schools came back local and placing CAMHS services developments such as Aiming High for with a huge range of responses. In some I changing the environment, for example Disabled Children (HM Treasury and DfES schools, it is someone from a health by providing access to a ‘chill-out’ space 2007); and work on short breaks and background or possibly a care background. I supporting formal therapy, for example individualised budgets, which is trying to In a significant number of schools, it is the by monitoring mood and behaviour tackle some of these inequalities. headteacher who takes responsibility for I using expertise in SEN to support mental health issues. It does make a CAMHS services. Risk factors outside of the individual child are difference who takes the lead and where factors more likely to happen in a family responsibility for mental health issues is The survey identified schools where where there is a child with a disability. In seen to lie within the school. everyone in the school was clear about families of disabled children, the divorce rate who was responsible for making a referral, is higher as is socioeconomic disadvantage. A gradual sea change was identified across if there was concern about a child, and The cost of raising a disabled child can be education in terms of people’s perceptions what should be done. Elsewhere people significantly more than the cost of raising a of their responsibility for a child’s were not sure who was responsible for child without a disability. And families still emotional well-being. Every maintained mental health, whether responsibility was face a lot of discrimination and harassment school is about to have a duty placed on shared across the whole organisation or if because there is a disabled child in the family. them to promote the well-being of children there was a split between care and and young people, and that includes education. In this context, NASS undertook this piece mental health. This is in Every Child Matters of work – Making Sense of Mental Health but people working in care settings Training was a huge issue identified by the – with the Centre for Special Needs alongside education will have seen the research: covering both difficulties in Education Research at the University of change in attitudes developing over time, accessing mental health training on Northampton, to look at schools’ with people thinking more about emotional children with disabilities, and how little it experiences of identifying and responding well-being and how that is promoted features in things like initial teacher or to the mental health needs and the across a whole organisation. social work training. emotional well-being of children and young people with complex needs. How are We found that the main issues schools the schools trying to make sense of that? were facing were: 8
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 Learning from the Scottish experience To make residential care the first and best placement of choice for those children whose needs it serves Maureen Anderson, Scottish Institute for With regard to these latter two, Anderson managers who are in some ways trailing Residential Child Care (SIRCC) recalled that when she had started in behind? SIRCC decided to look at what is outlined challenging and problematic work residential work in 1971 the notion of happening in the workplace and evaluate with managers in Scotland, and described charismatic leaders had rather doubtful the impact of the Higher National some of the policy drivers affecting what is connotations; yet now other areas of work Certificate (HNC) by asking people who happening. Finally, she mentioned some of with young people seem to be wanting have completed it, what difference it has the projects that SIRCC was currently leaders to be charismatic. Changing Lives made to their practice. working on to support managers in also says it wants managers to be brave knowledge transfer and promoting learning enough to challenge bad practice. It In 2007, SIRCC surveyed everybody who organisations. defines ‘credibility’ in terms of a person had graduated in 2006 and had 103 ‘with a firm base of knowledge and respondents. A significant number said The presentation began by considering experience’. She noted that these are very they had had a good experience, which what makes a good leader. similar to Harvard Business School changed their attitudes in positive ways, definitions, and she wondered if business made them think about how they saw the I What is a leader? definitions were being adopted by children, how they saw each other and the I What do you need to do? managers across children’s services work they were doing. They became I What are you doing? including residential work. confident and morale increased at work. They felt that they became more efficient; Anderson observed that it is not enough Other significant changes, or drivers, in asked young people more often to make just to have vision, or just to be creative, or Scotland are the We Can and Must Do their own choices; gave young people just to be charismatic, in her experience, Better report on children’s educational information so that they could make knowledge is one of the key attributes. achievement, or non-achievement, in informed choices; and felt happier at work. Scotland. The report focuses on leaders But despite this positive feedback from In residential work in Scotland, there are and managers and the roles that they some returnees, a majority of people variations and differences between who is need to play in promoting children’s said that: qualified and who is leading. A educational experiences. The Scottish qualifications audit in 2004 showed that Social Services Council has developed a most of what we’ve learnt on our course only 23.5 per cent of managers were sector skills agreement in five stages. The we can’t put into practice. We know now qualified or working towards a qualification first is assessing each sector to determine what we should be doing but we can’t do – significant when one considers the task in what their needs are in terms of skills. The it. The workload’s too heavy, there are residential work. The audit in 2007 showed second is to review all current training insufficient workers for us to try out new quite a significant improvement, with 65.5 levels across the whole of the care sector. things at work. per cent now qualified or working towards a The third seeks to identify gaps, qualification – good progress in three years. weaknesses and priorities in workforce Another concern was that almost 53 per But that still means that 34.5 per cent are development. The fourth is a review into cent of the respondents felt that the not qualified. the scope for a collaborative action. And information, or the learning, that they the final outcome is an agreement on brought back into the workplace was being She acknowledged that lots of these how social services, clinical staff, and blocked at supervisor level. They felt managers are people with lots of charisma, employers who work with key funded managers did not really understand their vision, creativity, but sometimes what is partners, can secure the training or HNC learning, as many of those managers missing for them is that essential element of development necessary. are not yet qualified themselves. In similar knowledge. The other factor in Scotland is consultations with the managers, they that managers are working against a In Scotland, a Residential Child Care readily accepted that they had limited background of massive change in terms of Children’s Manifesto has been produced. knowledge of what staff learnt on their government policy and drive. The Changing The government has asked SIRCC to look at HNC course and some felt they had too Lives review for Scotland makes little ways of making residential child care many other pressures to acquire that mention of residential child care but it does better, hosting the National Residential knowledge. talk in general terms about social work – Child Care Initiative to identify and advise presumably including residential child care on key issues impacting on provision of To try to help with these issues, last year managers when referring to ‘managers’ and residential child care and to agree a way SIRCC produced a workforce planning tool ‘leaders’. One of the five work streams is forward for a step change in quality kit for managers and training managers. about leading and managing. It talks about provision for better outcomes. The Initiative The Learning into Practice project what it expects from managers, for example: will make recommendations for change ‘to consulted with managers on the HNC make residential care the first and best evaluation findings; and SIRCC is meeting I dedication, seeing this as not just a job placement of choice for those children senior people in different organisations, I bravery whose needs it serves’. and also the ADSW, to take the learning I motivation forward. One of the projects that it will be I values SIRCC is looking at the challenges for working on is with the training manager on I equity managers in the context of all this change. Edinburgh City Council who has introduced I inclusion Its 2007 qualifications’ audit showed that if a mentoring scheme, giving managers I providing person-centred services all the main grade workers in Scotland support in their work. I integrity currently in training (over 2,560 workers) I charisma are successful, then 51.2 per cent will soon The Social Care Institute for Excellence has I credibility. be qualified. So what does that mean for said ‘The frontline manager is in a key 9
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 position to promote learning’. Yet the mentoring project will offer them some SIRCC has arranged with colleges to host manager is usually the person who is most kind of support, a kind of critical friend events at which managers can meet the isolated in the workplace. Other workers who is there to advise but not necessarily HNC teaching staff, hear what the usually have ready access to peers who to always agree. content of the course is, and discuss how they can discuss things with and learn managers might facilitate putting some from; and managers really are on their As a result of managers saying they did of that learning into practice in the own. It is hoped that the coaching and not know the content of the courses, workplace. Leaving care: What are the lessons? How do you overcome obstacles? We know that for many care leavers safety is a really big issue. So we put in a lot of support to make sure that they feel there is always someone to talk to. Outreach workers go out and do hobbies with them. We encourage them to join gyms or we’ll go and sort out local links for them. Emmie Spencer and Louise Jackson, Next When the young person is ready to move justice system, or poor health – they are Step Care Management into one of our flats we set up the support vulnerable young people. Next Step Care Management has been package for them, ensuring it is centred providing independence projects for young around what the young person wants Some young people just don’t know their people, care leavers, mothers and babies, rather than what social services might needs and wants. They’ve come out of and young offenders since 1994. Our want, although obviously we take that into child care at 16 or 17, they’re living on philosophy rests on the belief that young account. Before the move, we ensure all their own and they feel like everything’s people should be provided with the means the paperwork is complete, any risk just been turned upside down. They’ve to move forward through adolescence into assessment discussed, and the outreach been used to residential care where adulthood in a safe and supported way. The worker and young person have started there’s always staff there, meals cooked programmes and support offered to young building a relationship before the package for them, always somebody there to talk people seek to enable smooth transitions to actually starts. to. All of a sudden being alone – that’s living independently. Care and support is the biggest challenge that we find the discussed and planned with young people We know there are many pitfalls in leaving young people have. and centred around their needs. care but we also know what works. According to NCAS, in 2007/2008 there We know that for many care leavers safety At Next Step we aim to support the young were 60,000 children in care and 8,300 is a really big issue. So we put in a lot of person and tailor programmes to their young people over 16 left care. From our support to make sure that they feel there is needs. Whatever the young person’s issues experience at Next Step, a lot the young always someone to talk to. Outreach are, we try and support them. We offer people have had poor experiences and workers go out and do hobbies with them. practical and emotional support to fully outcomes. Perhaps due to instability when We encourage them to join gyms or we’ll prepare people for independence. Over the in care, an involvement in the criminal go and sort out local links for them. last 14 years we have worked with about 1,500 young care leavers. We find that at 16 a lot of young people are nervous about leaving care and feel that they are being pushed out to live independently, so our aim is to try and ensure they are ready and equipped to move on. When a young person begins at Next Step, we realise they are vulnerable and try and find out first what it is the young person wants: do they want education, training or employment? We normally get referrals from social services then meet with the young person to find out if what we offer can meet their needs. If they want to live in a certain area we try and locate it. We meet the young person and bring along one of the managers or an outreach worker like myself to start building up a relationship with them. When they are ready, the young person decides with social services whether they want to work with us. We try to build up a relationship with the young person while they are deciding. 10
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 We try and support them as much as night, if they need any support or if they just our young people to make sure that there is possible. We do regular visits, we literally feel lonely or a bit scared because it’s a new some sort of training programme in place. go in every day; we spend a maximum of area and they’ve never lived on their own Social services also play a big part in their three hours with a young person. Now that before. We want them to know they have not education. A key thing for some young could be to cook a meal, young people just been pushed out into accommodation on people is they feel that, although there are a sometimes say ‘I’ve been living off junk their own, to know there’s always somebody lot of services to help them, they can’t food, I don’t know how to cook a meal.’ So at the end of the phone. connect with them easily. So it is important part of our job is to make sure that the they have an outreach worker or PA they can young person can manage on their own – We consult the young person closely on relate well to who can help them. We try and and outreach workers are expected to sit where they want to live and involve them match every single outreach worker with the down and show them how to cook a basic in decorating and furnishing their flat. right young person because we think that’s meal. We help with things like making sure Initially we take the tenancy for them on really important. that the property is clean and tidy. A lot of the understanding with landlords that if young people that I’ve worked with say, the arrangement works well and the young We work in partnership, networking with ‘Well it was always cleaned up for me’ or person keeps the property in good order, at several agencies, and to make sure that ‘I’ve always lived like that.’ So at Next Step 18 it can be smoothly transferred to the things come together we arrange for we always make sure that we speak to the young person. Housing is the major regular updates, weekly meetings to discuss young person about this: ‘Well no, this is obstacle we found, so we build up good every single young person that we have the standard that we expect you to have.’ links with local landlords and estate agents. with us. We do regular updates for social services, providing reports for them, There’s always somebody out there at the end We also know that education is a major because they want to know how the young of the phone. We have the on-call system, obstacle. We work really closely with their person is doing. Every single young person which is a freephone number so a young Personal Advisors (PA) on arranging has a monthly report that is submitted to person can call us at any time of the day or education and training. They regularly visit the young person. Children’s Residential Network: Themes from practice informing policy I support, or the lack of it, for the Charlotte Levene, principal officer, What happens at a typical CRN event? transition from children’s services to NCERCC, Children’s Residential Network adult services; and about difficulties The Children’s Residential Network events I We start off with introductions. accessing psychological services for 16- are about exchanging good practice to Managers explain who they are and a 18-year-olds better support the children who live in our little bit about their homes. I referral processes and admissions – homes. They provide an opportunity for I Then we talk about burning issues, concerns about not meeting the child managers of residential child care and what’s pertinent to the people working before a placement has occurred others to meet and discuss practice issues. in the homes at the moment. I relationships with other professionals – Participants can be from the voluntary I We move on to theme-based poor relationships with the police, or sector, the local authority, the private discussions: last year we looked at problems getting a social worker sector or residential special schools. education, health and supervision; this allocated year we talked about access to mental I Ofsted, including perceived In terms of the events themselves, it’s an health services, including emotional inconsistencies with the way services are opportunity for participants to learn and health services. inspected. share best practice. NCERCC can then share I After lunch we have a guest speaker, the messages, from managers and somebody from the region, and at the All of these issues have been documented practitioners, with others, including policy- moment we’re discussing what we want and shared on our website and we share makers, Ofsted and anybody else who has education and social workers to them with policy-makers. an interest in residential child care. The aim understand about residential social is to improve the experiences and outcomes work. In discussion groups, we have been talking for children in residential child care in I Finally, we evaluate the event so that about partnership with other agencies. For England. we can use that feedback to inform example, we have thought about the future events. mental health and emotional health The events are organised by Farhana services currently available to young people Allyjaun, our administrator, and myself. So what have been the burning issues of and considered what was going well, not Anyone from the sector can join the Network 2007–8? They have been about: going so well, what the dream situation and attend. We have events twice a year would be, and what needs to change. taking place in the nine different regions I training – NVQ3 is insufficient training across the country, hosted by local members for residential child care Participants identified in-house therapies of the Children’s Residential Network. We ask I staffing and difficulties in recruitment as going well. When there’s a therapist members, ‘Does anyone want to host it for and retention within the organisation or within the us?’ and people always respond positively. I education, school exclusions, lack of children’s home advising the workers or The locations are diverse – sometimes in education information when children advising the children that was working children’s homes, sometimes residential are placed very well. Contact and relationships with special schools. We now have the Children’s I placement stability and cost GPs in some areas were quite good. Residential Network representatives from considerations dominating placements, Where there were specialist CAMHS teams each region coming together to form a truly worries that the current financial for looked after children, to which national group. situation might affect referrals 11
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 workers could directly refer, it was seen as child care? What do we want education the social worker will pay off and that a real positive. and schools to know? What do we want statutory visits and maintained contacts are social workers to know? vital and do make a difference. Support Things were not going so well where systems in place between visits also make a referrals had to go through others, such as Linking residential child care and difference: letters, phone calls – these all doctors, and there were delays. education help children feel cared for and thought Residential staff wanted education to about. The sector would like social workers Asked to imagine an ideal situation, realise that the sector cannot accept to understand the ethos of placement, to participants had many ideas. Therapists unofficial exclusions. The law around understand the reasons for gatekeeping would be coming into the residential exclusions is clear and workers didn’t and acknowledge that residential child care setting. There would be more family of want to feel ‘on call’ to pick up children is a difficult job. support. There would be linked-up training ‘having a bad day’. School exclusions were across disciplines, better accessibility to having a significant impact on the other What is needed from social workers? services for more children with a wider young people in the home and on the Residential workers are saying: ‘We want to range of needs, drop-in services for young individual young person. Key workers work with social workers. We want to talk people, more diversity in the workforce, wanted the time and invitations to attend to each other so that we can make joint and buildings fit for purpose. school meetings. Residential staff wanted decisions and discuss and share our value schools to have training on the needs of base.’ Two main things came through Asked what needs to change, people said looked after children and for Designated repeatedly, getting the paperwork from training and funding need re-examination. Teachers to have a senior position within social workers in order to keep children We need to look at processes of support: the school. We talked about what joint safe and understand their needs, and for What’s actually happening when we’re working should look like with joint risk social workers to be accountable. working with the children? We need more assessments around behaviour family work and the services needs to be management. Residential staff said they’d Our next step will be to work with more flexible. We need to look at the like to be able to better support young organisations, social workers and education, environment where therapeutic work is people with their homework. to feed back to residential child care what taking place, and early intervention. they, in turn, want us to know about them. Linking residential child care and After lunch and the guest speakers, social workers The CRN is about partnership. To join it, discussions have examined: What do we Residential workers want social workers to visit www.ncb.org.uk/ 020 7843 6017 want people to know about residential know that investment of time and effort by clevene@ncb.org.uk Introducing SCIE e-learning materials for positive behaviour management and physical interventions Jonathan Stanley, manager, National Centre for Excellence in Residential Child Care (NCERCC), introduced new e-learning materials Improving workforce quality is high on the spaces are given for including the views of I How will they behave? Care Matters agenda. These materials, equally children and young people. The materials I Where will they be placed? suited to new entrants to residential work lend themselves to work with a peer group and interested professionals from other and facilitator, but they can be worked A key message at induction and foundation disciplines, fill a gap and offer an overview through alone. level is, as Sir William Utting said: of what residential child care is for and some of the challenges in delivering it. They are These materials are free, web-based Homes which meet the personal, social, primarily meant for people at induction and resources. All residential child care settings health and educational needs of children foundation level. But the authors were also can readily incorporate the materials into are much more likely to be safe places for thinking about policy-makers because it is all their existing induction material. A lot of children than those who do not. too easy to assume that they will be experts ground is covered, so to get the full value in their field. In fact, with such materials of the content learners need to follow up There is both educational material and an they are sometimes given an understanding the suggestions for further reading. The audit tool. These materials offer ample of the complex needs of young people in materials are not solely about content but opportunities to reflect on experience and care for the very first time. also about method; and e-learning make plans, to reflect on what may help materials make underpinning knowledge the child through this experience. They are There are three modules: readily accessible. designed to develop the key skill of 1. An introduction to residential child care learning through observation. A lot can be 2. Meeting the needs of children in The focus is on positive behaviour coming understood about how a child is affected residential child care in a positive context, and what is essential by the things that have happened to them, 3. Managing challenging behaviour. for this to happen across the range of by observing their behaviour. All behaviour needs and provision that makes up is a communication, so questions need to The modules progress through a series of residential child care. It is important to posed in order to open out the discussion: reflective questions and case studies before know that there are three tiers of provision ending in a summary of key points so the materials take time to answer I Why is this child doing this? supported by exercises. questions for each tier: I What is it this child is communicating? Worksheets mean some of the learning can I Why are they a child in care and what The reasons for a child’s behaviour are the be put into practice straightaway, and do they need? culmination of many experiences and 12
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 influences. The materials propose a reframing of the term ‘challenging behaviour’ – often used to describe something the child is doing to those looking after the child. What is called ‘challenging behaviour’ is placing the child in a challenged situation. It is rethinking what that might mean, which might make it a difficulty, or an opportunity. The materials present another way of looking at it: that those looking after the child reacted in a way, or have presented a situation or an environment, that the child is finding challenging. The materials link behaviour management to physical intervention; and seek to promote a settled environment and the strengths of an individual. There is always a trigger to behaviour and the authors want key workers to understand what the triggers are for their particular children and group of children. They want them to be prompted to say: ‘When my key child feels safe and their needs are being met, I know this because I can see it. When they’re getting stressed, I can see these changes.’ Users are supported to plan for when these triggers are seen, and to divert or de- escalate behaviour. What is and is not acceptable in ‘physical intervention’ is comprehensively covered; as is the often underemphasised area of debriefing. For further information see www.scie.org.uk/publications/elearning/rcc/i ndex.asp Young people’s views – and expectations of outcomes It’s not the law or the policy that matters – it’s the outcome I personally get … road; the result of alcohol Roger Morgan, children’s rights director with children on these topics is charted to I 40% of them worry about safety. for England show trends and highlight improvements or The Children’s Rights Director is based in concerns. Further information can be found Bullying Ofsted and has statutory functions to at: When surveying children and young people consult children receiving social care or www.ofsted.gov.uk/Ofsted- about bullying: living away from home, advise on their home/Publications-and-research/Browse- rights, and raise issues of concern. all-by/Documents-by-type/Thematic- I 9% felt they are ‘sometimes’ or ‘often’ reports/Children-s-care-monitor-2008 bullied Monitoring children’s care in 2008 I 39% felt they are never bullied Roger Morgan went through some of the Roger went on to give a preview of I they felt that the most frequent type of key messages about outcomes from forthcoming changes in Regulations. bullying is verbal (78% of total) children and young people contained in the I they thought that the bully is most report he authored entitled Children’s Care Keeping safe likely to be in same age group as the Monitor 2008: Children’s views on how When surveying children and young people one being bullied care is doing. The report records the about keeping safe, they said that: I 15% worry ‘often’ or ‘always’ about experiences of children in six specific areas being bullied as part of an annual monitoring process. I they feel safest where they live, least I those in residential special schools worry These areas are: keeping safe; bullying; safe in a town or city most about bullying and feel that this is having a say in what happens to them; I children with disabilities are less safe where most bullying goes on making complaints and suggestions; I the biggest dangers to them are drugs, I those with a disability worry more and education; and care planning for people alcohol and strangers/kidnappers are bullied more. being looked after in care. Consultation I the most likely accidents are on the 13
    • Having a say in what happens but actually they thought it had worked security and felt safer in secure When surveying children and young people out right for them. accommodation than outside it. about having a say in what happens: Roger sees the fact that 81 per cent rate Activities and staff were given as the really I 45% say they usually or always have a their education as ‘good’ or ‘very good’ as key issues. Good staff make the place and say on things that matter encouraging; as is the three-quarters who bad ones can break the place but very, very I 14% say they never or don’t usually said they thought they were currently good staff – not necessarily staff who are have a say doing ‘well’ or ‘very well’ in their good and qualified generally but that you I 49% say their opinions make a education. It seems interesting that 58 per get on with and that get on with you – are difference cent of the children thought that any very important in secure accommodation. I 16% say their opinions never or rarely changes of school that had happened were This is probably more so than elsewhere as make a difference in their best interests. This seems to secure units tend to lack space and feel I those who are in foster care, children’s challenge assumptions that we should slightly claustrophobic. homes or are care leavers say their necessarily try and stop children changing opinions are more often asked but less schools. Discussions in focus groups Increasingly and problematically, a very often make a difference confirmed that it may be wrong to just strong split is seen by the children and I those in boarding schools, Further assume that a change of school is bad, you young people between those who arrive in Education colleges and living at home have to assess it educationally, assess it secure accommodation via welfare routes, say their opinions are less often asked socially and involve the child in that and those who are in places funded and but make more of a difference assessment. commissioned by the Youth Justice Board I 42% are always told about changes in (YJB); with some units tending now to their lives Preview of Regulations specialise in one rather than the other. I 9% are never or not usually told. Children and young people were asked Children are very, very aware of that ‘How frequently should a social worker be difference and are telling us that they feel Making complaints and suggestions required to visit a child in care?’ The most that they ought to be dealt with differently When surveying children and young people votes were cast for a frequency of once a depending on what their original about making complaints and suggestions: month. placement was for. I 43% had made a complaint Children and young people were also asked Final point I 65% of those who had made a ‘What kind of people should be regarded as The general issue or message from children complaint felt it was sorted out fairly suitable for Independent Visitors?’ The most and young people is, never mind the law I 41% had made a suggestion votes were cast for an Independent Visitor being right or bad, never mind the policy I 71% of those who had made a to be someone with experience of care being right or bad, what really matters is suggestion felt it was dealt with fairly themselves. the outcome I personally get. I 58% knew how to get an advocate. Interestingly, the government questions are Roger observed that getting an advocate far more to do with judging the meant going to staff, parents, etc. – not independence of the visitor, whereas the using statutory procedures. children and young people, unsurprisingly, were more interested in what kind of Education person they would be – with the top vote When surveying children and young people going for somebody with care experience, about education: somebody who is actually a care leader themselves. I 81% rated education good or very good I 75% felt they were doing well or very Preview of Life in Security well in education When surveying children and young people I 58% felt that a change of school or about living in secure accommodation: change of placement had been in their best interests. I they offer a strong positive view of a safe environment Care and care planning I say that activities are key When surveying children and young people I say that staff make or break the about care and care planning: experience I find that secure units tend to lack I 88% feel that care is good or very good space. I 84% feel themselves to be in the right placement The Life in Security report (forthcoming) I 69% consider their most recent involved interviews in just over half of the placement change to be in their best secure units in England. It produced very interests strong positive feedback from the children I 72% have a care plan and young people about the safety of the I 79% say their care plan is being kept to environment in the units. Indeed, a number I 66% agreed with their care plan said one of the negatives was that they I 52% had a say in their care plan. were going to feel insecure leaving secure accommodation. A lot of the young people Young people thought that they were in worry about threats to themselves and the right placement, that it was not always express this by referring to ‘going back to the placement that they had a say in my old ways’; some actually say they had choosing, or that there had been a choice, some experience of coming back into 14
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 SACCS’ therapeutic residential care for traumatised children Outcomes are synonymous with good practice and synonymous with our primary task … If we’re clear about our primary task then the outcomes will be self-evident … It can only be said that outcomes have been achieved if the child has internalised their developments and behavioural change. It is for us, as practitioners, to help the external world hold on to what we know about children and child development and how critical child development is to achieving outcomes. Billy Pughe, operations director for SACCS’ primary task is to achieve recovery environments – and that is the bit I am SACCS for children, defined as when the child has going to keep stressing. This is important SACCS is a specialist provider of integrated internalised their attachments and because it is not just about these children treatment services for severely traumatised consolidated their emotional development being able to whilst they are in a highly and abused children and, although a to the point where these can be structured, contained, and highly specialist provider, it has experience that is successfully transferred to other supervised environment; this is about when transferable to other residential settings. A environments and relationships. This child those supervisions, the structure and the current preoccupation in residential child has the potential to achieve their full input are reduced. This is about them being care is outcomes. We have had outcomes ability in all aspects of their life. So there able to maintain this level of functioning in defined for us through the Every Child are some key words in how we see a family setting, their future placement. Matters agenda. Maybe for some of us recovery: internalisation, consolidation, ‘outcomes’ is a new concept but I am transferring. At SACCS we have defined our destination suggesting that outcomes is an old concept – Level 4 – as the achievement of 24 to most of us and that outcomes are SACCS work with children that are outcomes, reaching recovery as we have synonymous with good practice and perceived to need specialist services, defined it. At that point our children can synonymous with our primary task. probably only one in 200 looked after carry on on the continuum of all children My focus then is to suggest that if we look children. This is a specialist service for to achieve the Every Child Matters at our primary task the outcomes will children with highly complex needs. These outcomes. define themselves. children cannot sleep, have normal eating habits or have healthy relationships. However, we begin with children who I remember the work a lot of us did in cannot. To reach the point of ‘can’ we need residential work a long time ago on the It is not that they could and they have to take them through a developmental primary task and acknowledging the decided not to. It is not that they are ‘just journey. We would not expect a child to be importance of it – that if children are to be being difficult’ to their carers. These able to run until they have been through helped in these settings, staff first need to be children do not have the capacity to; and the developmental stages of being able to absolutely clear about their primary task. our task, as we have defined recovery, is to sit up, crawl, and of being able to walk. Task must be related to outcome, which in help these children get to Level 4 Only then would they have the potential to therapeutic child care must include planning treatment where they can actually begin to be able to run. So, too, we suggest this for the child’s future. It was true then, as access more generic or general services and approach with a child’s emotional now, that the primary task is essential to our can access the support of families. development. They need to move through work and particularly to our residential work. critical stages of development. At SACCS It is not about our purpose and function, it is So we need to help children move from the we have defined these critical areas as about really being clear what we exist for – point where they are not able to, to the attachment, emotional development, our primary task. point where they can, and can within most learning, physical, social and communicative, and identity. Through our assessment process at SACCS, we are able to assess a child’s journey through the developmental areas to the achievement of 24 outcomes indicating that a child has reached the desired outcome of recovery. Although it is important to assess and report as we go along this journey, it is essential not to stop too soon or be confused about the primary task and what the desired outcome is. There is now a lot of pressure on providers to ‘reach a point’, ‘report the child is now ready’, say that the child has ‘achieved the outcomes’, time to ‘move them on’ or ‘go to a generic service’, ‘save money’ – those sorts of, in my words, fantasies. Earlier states of a child’s assessment may indicate a change in presenting behaviours but it may not be an indicator of an outcome being achieved. Unless things have been internalised when 15
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 the child’s placement ends, he or she will the point where, we are encouraged to stop probably revert to earlier defensive in terms of outcomes, behaviour has behaviours. It can only be said that changed – therefore we can move on with outcomes have been achieved if the child this child. But this point is critical for our has internalised their developments and children because they have only achieved behavioural change. The pressure on us, as this in the current placement with all the providers, is to stop at the point where resources of all the carers. The next bit of behavioural change is merely indicated. It is the triangle is where they are internalising. for us, as practitioners, to help the external We can withdraw some of the resources. world hold on to what we know about We can allow them to take some risks, to children and child development and how check it out and unless they can do that in critical child development is to achieving our context we know we are setting them outcomes. up to fail in the family context. During the many years, it could be eight Our primary task at SACCS defines our years it could be 15 years, before you meet outcomes, based on what it is we aim to the children you are working with, their achieve. It’s got to be based on children, on negative experiences have created their child development, on what we know about inner working model, their view on life, children and how they learn and how they and their view on themselves. What we change, and it has to go that extra bit. It has need to do is help them change that view, got to ensure that it is about their future to move away from feeling they are placement. It is not just about what outcome worthless, from absconding behaviours, to they have got when they are with us and change internally through the development that we can report, it is that outcome being process, to see themselves no longer sustainable for the child’s future into their needing those unhelpful defences and then adult life that will then allow them to access we will see a behavioural change. I have what every child should access. called this the Zone of Vulnerability. This is Simplified model of the constructing, deconstructing and restructuring treatment process of the SACCS Recovery Programme Phases of change The internalised process Treatment Level 4 Phase 1 Recovery influences restructuring healthy Level 3 internalised model Zone of vulnerability Level 2 Phase 2 Recovery influences deconstructing unhealthy internalised model Level 1 Phase 1 External influences creating an unhealthy internalised model Development of internalised model 16
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 Measuring what matters, the social return on investment and residential child care The notion that price somehow reflects value and the price of something reflects all of the underlying benefits and disbenefits that an intervention is creating is really not the case in residential care … We have got to look at value much more broadly. Eilis Lawlor, researcher/project leader, we know children in care need long-term residential care there was a return of four Valuing What Matters, New Economics stability and markets can’t guarantee that to six pounds worth of social value. Foundation because they’re biased towards short- The New Economics Foundation (nef) seeks term outputs. Markets are ‘value neutral’ Anecdotal evidence suggests providers that to look at alternative economic and this is problematic. We all know that do not fit a narrow definition of efficiency possibilities. Our economy and decision- prejudice plays a big role in decision – more outputs for fewer inputs – are making tends to be driven by economics making. The commissioners are actors in being squeezed and are closing down. and narrow financial considerations. At nef the market and they are influencing the Desirable wraparound therapeutic services we want to create an economy that puts market. So the idea that if you have got can’t be provided because they cost too people and the planet at the centre so we an efficient market then bad providers much, effectively a false economy when make broader, more holistic, better and will close down and good ones will stay there were long-term savings associated more sustainable decisions. New Economics open is not true. with providing those services if they were Foundation undertook a project looking at producing good outcomes. the economics of residential child care. So nef is working on a new methodology – Social Return on Investment – which seeks And we found that measurement largely Three particular things came out of the to address these problems. It is a reflects the priorities of government. All research. stakeholder-led process through which the information flows upwards to organisations can measure, understand and government and it’s aimed I First, there is a problem with measuring manage the social, environmental and disproportionately at managing and what matters. We were looking at what economic value that they’re creating and minimising risks. How we measure things we measured and what was problematic translate it into financial language. We use needs to be changed. Why does this with that; and a lot of that relates to financial proxy to put value on things that matter? Well it matters because it affects outcomes. The impact of markets on are not traded in the marketplace. So when children. residential child care very quickly came you get a return on investment ratio, that up as something problematic. The ratio reflects the broad social and economic A couple of solutions notion that price somehow reflects value – giving a true sense of the return on Sustainable commissioning for outcomes value and the price of something investment. It is not perfect but ‘value’ is a We need to measure what matters. We reflects all of the underlying benefits very subjective concept and the notion of a need to use approaches like Social Return and disbenefits that an intervention is true measure of value is incorrect. On Investment and we need to redefine creating is really not the case in failure, value and efficiency. residential child care. We have a culture Our research examined the benefits of now where unless something carries a investing in higher quality residential care Measuring outcomes price tag we don’t value it. In Valuing and the long-term societal returns. For We need to measure with people, asking What Matters we are working at every pound invested in support-focused them the things that are important to developing new ways of measuring and quantifying other kinds of social and environmental values that can sit alongside economic value. I The second problem is measurements. We tend to measure things we can count. What gets measured is what gets valued. What gets valued is what we resource, what we pursue. And things that matter most get left out and so we enter this vicious cycle of measurement. We do not think about value to other stakeholders. We have got to look at value much more broadly. We’ve got to stop commissioning people to do narrow evaluations that just report back to government; and instead think about having information flowing downwards to service users and having mechanisms to hold services to account, with stakeholders much more at the centre of policymaking. I A third problem is a blind ideological belief in markets that is misguided. One myth is that an efficient market will always produce the best outcomes. Yet 17
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 them and designing measures around that. not others, what stakeholders we include or solved. The government has an ideological We need to value the things that matter do not include. We need much more attachment to markets, which is most, not just the things that are easy to transparency in how policy making is done; problematic and needs to be tackled. It is count or that have a price attached to and to measure assets and strengths as well not that market solutions don’t have a role, them. Successes and failures should be as risks and liabilities. If we define it is just that blind faith in them is shared. measures only in terms of the reasons why certainly not working. Local authorities people fail, and of risks, then we crowd out have a very narrow interpretation of the Outcomes are difficult to measure as they other considerations and we do not leave Gershon efficiency savings, which they are are over a longer time period and usually it enough room to explore why people required to make, and of what is good is not just one person that contributes to overcome their problems and do quite well. value for money. This leads to cost cutting achieving an outcome. We need to find rather than to getting real value for money. better ways of sharing successes, risks and The Outcomes Star is a tool for tracking We have poor data management: a really failures. We need to avoid over-claiming. distance travelled for the much big challenge in this research. harder-to-measure outcomes relating to an In Social Return on Investment we have individual’s personal growth and What can providers do? built quite a robust methodology to make development. All of the points on the star I Influence your commissioners – there is sure that we are accounting for things like represent a different outcome and as a pressure on them to improve the kind of dead-weight and displacement, which child moves through their journey and they commissioning they are doing, so having happens an awful lot in public services. In a move along the prong on the star and a dialogue with them and sharing this lot of areas of public service the behind each prong there is a series of kind of work with them might be government spends money, good things indicators, subjective and objective helpful. happen, government says that is because indicators, so you can see how the child is I Think about how you can create they have spent money and actually it is doing. Details can be found at: accountability to your own people in for macro-economic reasons. Consequently, www.triangleconsulting.co.uk/ your own organisation; and try and they do not really know what they are shield them from some of the doing, right or wrong. We need more Challenges bureaucracy. transparency and accountability: Some of the problems we identified are I Think about how you can measure what transparent reasons and processes for why part of broader cultural problems in public matters to yourselves as well; and look we decide to measure certain things and services so they are not going to be easily at approaches like Outcomes Star. Decreasing restrictive physical interventions: How a focused method can decrease the use of RPI A culture of openness among staff and young people, openness without judgment. Sarah Leitch, Action for Children, of which were outlined in this session. them’. That awareness had a huge effect on Sunderland staff thinking and there are a number of Sarah Leitch, who is doing a research What do we know? What are the must- strategies that have actually made a project on reducing Restrictive Physical haves for reducing RPIs? We do know it is difference in reducing RPIs. Interventions (RPIs), gave an overview of not a quick fix. You cannot just go in and research on restraint reduction and change the service culture because it is Some of the literature on restraint claims changing cultures at organisation/service about changing the organisational level, therapeutic benefit, that some children seek level. ‘RPI’ was taken to mean holding a the service level and the tertiary level, restraint because they need containment. child rather than guiding them. which is what happens afterwards. Kevin Creeden of the Whitney Academy (www.whitneyacademy.org/whitney.html) has Research in the USA and elsewhere has We need more evidence about what does done a lot of work on the use of positive demonstrated that restraint can be or does not turn an incident into an RPI. touch. He considers that if you have got dangerous, both for staff and young We know that RPIs will have an effect on children you think are seeking touch because people, with long-term negative outcomes. the young person and on staff. We also they need it, then putting in proper Some American studies indicate that know staff of a service or organisation programmed touch sessions, making sure that restraint can re-traumatise children with sometimes ‘share assumptions’; and a way they are touched appropriately all the time, experience of abuse. Some evidence of thinking about children and their can their reduce their need to seek restraint. indicates that it damages the relationship behaviour or a particular client. between staff and children. Children tell us Nobody’s saying that you cannot restrain. how terrifying and claustrophobic some In Massachusetts they have managed to What we are saying is that if you do restraints can be, how panicky they feel; reduce their RPIs; and what was really restrain, just have a think about it and one child said if someone’s in care influential was teaching staff about afterwards. I have introduced a simple idea because of abuse, then getting restrained trauma-informed brain development, how for formally recording the meetings of feels the same. Other children talk about brains are affected by trauma and abuse services to look at alternatives when the distress of watching a restraint – the early on in life and how that subsequently they’ve had an RPI. It seems to be working loss of dignity and so on. affects behaviour. Staff started to think in most services. about the children’s behaviours differently. Full refs available from They actually started to view non- Robyn Kemp, service development Sarah.Leitch@actionforchildren.org.uk compliant children differently – ‘We’re not manager, residential, Action for Children, talking about a child being deliberately spoke next about culture change in a large RPIs do not really change behaviour; are disobedient, we’re talking about a child organisation and their attempt to review reactive; and there are alternatives, some that just can’t listen to what I’m telling and change behaviour policy. 18
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 A UK-wide review of organisational manage their behaviour. www.ojaifoundation.org/Content/ behaviour policy and practice, 6. Timely and responsive assessment and council_core.php commissioned in 2006, raised concerns. It treatment planning This means planning revealed that across England – but not is individualised and it involves the young Sharon Willis, children’s home manager in Scotland, Northern Ireland or Wales – the person and other stakeholders. Sunderland offered her experiences. organisation had many different types of 7. Processing after the event, debriefing What happened for us during the three- training packages. Training was not always We have very clear evidence to show year pilot project involved a massive linked to policy. Many service managers did that debriefing staff will reduce stress, change in culture in the house. A culture of not know about RPI or why particular sickness and will improve practice with openness amongst staff and young people, interventions were being used. children and young people. An openness without judgment. Things that opportunity to evaluate what you’ve sometimes went unsaid in a debriefing Scotland had introduced one behaviour been doing and how you might change after a critical incident, people could now support and training model – and your practice in the future is important. say without fear of being judged or restrictive physical intervention rates had 8. Communication and consumer reprimanded. People became much more dramatically reduced, staff morale had involvement We’d like to call that reflective in their practice. They kind of gone up, and children’s outcomes were ‘service-user involvement’. The emphasis weren’t just coming out of an incident showing improvements. The organisation here is on self-determination and the feeling tired or exhausted or stressed or set up a steering group, including young need for greater inclusion of service how difficult it was. They were thinking people, to clarify and communicate a clear users in both their own packages of about what they could do better or what vision of its behaviour support culture. The support and care, and the way in which they could do differently, and about the first thing was to change terminology from the home is run; and establishing impact on the young people. ‘behaviour management’ to ‘behaviour policies, procedures and systems for support’ to reflect what we do – support continuous evaluation based on action In terms of the staff team alone, children to manage their own behaviour. and analysis. professional relationships were better Policy was based on research evidence and 9. Systems evaluation and quality because we were giving ourselves time to best practice, and was rewritten. A project improvement. really listen to each other – the use of Way was set up to undertake data collection of Council had a massive impact on us as a and analysis at service and whole- Colton’s checklist has been a catalyst for group of adults and young people in terms organisation levels. Projects were often change in our organisation and we really of really establishing us as a community. quite good at monitoring their own data, recommend it to others. but were perhaps not analysing it because The programme is not about training they lacked the systems. We are piloting Simone Silverpath, Catherine Lennox residential workers to be therapists. It is the BILD (British Institute of Learning and Sharon Willis, The Kite Project trying to help them to think Disabilities) database for projects at the (Action for Children, Sunderland): psychologically, to have a different way of moment – a really good way of tracking Culture change at service level approaching things, to work with Council what happens in your residential home and The difficulty of engaging young children for better outcomes for young people. what those outcomes are attributed to. and young people from residential homes Then we wrote findings into policy and set in any consistent therapeutic programme The training is for two years and is to be up systems, which we will continuously was identified. The key role is that of the accredited at pre-diploma level. Students monitor, evaluate and review, with a view residential worker, since they have the do 42 days, split into 10 days each term. It to reducing the rate of RPIs. relationship with the children. It was requires commitment as they expect decided to train and enable staff to try and students to take the training back to their As part of this we used: think about changing the culture within workplaces where there may be resistance. Checklist for Assessing Your Organization’s their homes into more ‘therapeutic’ After the first year of training, trainees are Readiness for Reducing Seclusion and communities. This is called the ‘Holding the asked to set up council groups within their Restraint by David Colton, PhD. For a copy, Space’ pilot. home on a weekly basis and bring learning go to: www.signalsymposia.com/ from groups back into the second year of restraint%20reduction%20paper.pdf In the pilot training, Carl Roger’s Core training. This identifies nine key areas for action or Conditions and Listening Skills models are assessment. used alongside a model from America The Scottish Institute for Residential Child called the Way of Council, a group work Care is going to be evaluating the Holding 1. Leadership Actions to reduce seclusion method. This enables everybody in the the Space training, which Action for and restraint need to be the result of a council, young people and staff, to have an Children is starting in all its Scottish conscious decision on the part of both equal voice and is used as a way of homes. It will be evaluated over two years the administrative and the clinical processing things. The Way of Council is a with a report, taking Sunderland’s practice leaders. method rooted in native American Indian experience into account, at the end. 2. Orientation and training This involves culture, and also Quaker culture. using a comprehensive training curriculum that is delivered in a There is always a centrepiece set up, a consistent manner. ceremonial object, which can be different 3. Staffing Adequate numbers of trained each time. We use ‘talking pieces’, where and experienced staff are necessary. only a person holding the talking piece can 4. Environmental factors Things like speak. You cannot interrupt and there are square footage, heating, lighting, and guidelines to council, which are that you smells need to be addressed. speak from the heart, from your centre, 5. The programmatic structure We need listen from the heart, do not rehearse what to have routines, rituals and rules you are going to say in the circle, and what creating a supportive and therapeutic is said in council stays in council unless environment, which is based on there is danger to yourself or others. For empowering our people to be able to further information, visit 19
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 Assessing inappropriate, harmful or risky behaviour Close cooperation and as much information as possible is needed, from all partners in the work, to reach an informed understanding and decision as to what is going to meet the child’s needs. All the pieces of the jigsaw are needed. Richard Cross, service manager, Oracle Care Everybody, from the administrator to the I Socialisation – group processes. Oracle Care is a specialist residential care people on the board to the care staff, service designed to support young people needs a shared language, a shared Also needing inclusion is an understanding aged between 10 and 18 with complex understanding about how they are going to of the biological aspects of sexual needs, an aspect of which may relate to work with and help the children. This also development, arousal and automatic problematic psychosexual development or includes parents and children in sharing the physiological responses with the sexualised interpersonally inappropriate, risky or sense of understanding and language of and erotic part of sexual development, harmful behaviours. This presentation the staff. Whichever model of relapse what we as individuals see as pleasurable. looked at some of the systems that can prevention is used, the language and help contain and support young people, understanding about how to work with Cross proposed that we need to look at all not just in this area but in any challenging children should be accessible to children, these areas in relation to assessment and area of practice. staff and the management. We should not also in terms of treatment. respond to the information on the basis of Cross observed that, during the last twenty our own anxieties about the content but Adolescence is a major physical, cognitive years, the pathologising of young peoples’ on the basis of its real context. and psychological change in terms of behaviours from a very young age has sexual awareness and the development of increasingly concerned professionals. Our response needs to be multi-systemic self-awareness and self-esteem about who Sexual health is more than the absence of and multi-model across all the we are, about what is positive about us, sexual pathology. This seminar explored developmental domains. It needs to happen about what makes us attractive; and there how putting psychosexual development consistently in the school and in the home is potential for us to have consensual, back into context, in terms of what is – across the whole system. Someone should positive relationships. Most adolescents normal and healthy, could do much to be able to go into the school or home, and cope with developmental transition. avoid the labelling and misconceptions find that the staff have a shared However, some do not and some of the about working with such young people. understanding. Everybody has got to have adversities can be acute, chronic, This is an area of residential work that can multiple strategies and tools at their simultaneous and it can impact on the create a lot of anxiety and stress for disposal to help the children. Staff need to resilience factors. For a child that is not people; effective practice will support staff have a real, practical, useful understanding going through that developmental stage and change the trajectory of young of the ways of helping a child within their normally, there can be fixation and people’s lives. daily life. distortion. We need to provide the services to respond to these young people. Cross proposed a continuum that Freud in 1949 said, ‘The anatomy, gender and Therapeutic interventions can help the commences from an understanding of function of the human body is the child to make a difference. natural and healthy sexual development foundation of identity’. Right from the very based on the developmental age of the start, when the child is in the womb and the A child’s sexual behaviour may move child. Working from this basis, he proposed sucking reflex happens (pre-birth), the child beyond what is good, natural and healthy that if practitioners ask questions like, is starting to develop senses and responses due to many factors, such as if they ‘What is that child’s story?’ and ‘What has that it is going to need to survive. And experience any one or more of the happened to that child?’ they will bring through the course of development into following: forward more helpful material than by adulthood, these automatic reflexes become asking questions like, ‘What is wrong with part of the systems the child also needs to I exposure to pornography that child?’ Having answered such survive. Pleasure and sensations become part I inadequate levels of supervision questions we can go on to ask, for example, of ‘who we are’. I a home or neighbourhood where there ‘Are their sexual behaviours of concern or is is a sexualised environment it the system that is anxious about children What is meant by psychosexual I a home where there is little or no possibly displaying sexualised, normal development? The term psychosexual physical, sexual or emotional privacy behaviour?’ Or, ‘Is there a requirement to encompasses the psychological, what we I exposure to domestic violence and seek professional help to prevent someone think, and the emotional/behavioural aspects sexual aggression getting hurt?’ of sexual development. This development I a period of physical or emotional abuse process is lifelong, begins in infancy and runs or neglect. If there is only partial knowledge or through childhood. In adolescence this understanding of the child’s world, history development makes a template. So how can you tell if the sexual behaviour or context, then normal sexual behaviour is normal or abusive? Ask yourself if the may be misunderstood and pathologised by Associated with it is cognitive development: type of sexual activity might normally be anxious carers. In such ways carers may in this case, linking to what we think about expected for the child’s developmental (as inadvertently reframe natural, healthy relationships and how we relate to others; opposed to chronological) level? The sexual development and curiosity about life and in turn linking into relationships and developmental level may be affected by as fixation. In every system that is aiming what we perceive as important. abuse or trauma. In assessing whether to meet the needs of children within this behaviour is abusive or not consider many area or any other complex area within the I What are friendships? factors, such as: residential environment, everybody needs a I What are caring relationships? clear model within their heads of how they I What is the power differential in I Do the children involved have a are going to work with the child. relationships? relationship? 20
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 I Is the child able to influence the other decision as to what to do to meet the I Has anything been kept secret? child in the situation? child’s needs. All the pieces of the jigsaw I Is behaviour compulsive or obsessive? I Were force, threats or intimidation are needed. All too often people are I Is there fixation on the behaviour? used? working on just one little bit, leading to a I How often are these behaviours being lack of accuracy in constructing the exhibited? Cross reminded us that this is not one- behavioural definition of the problem. It I Is it normal or is it cause for concern? person work; close cooperation and as could be other professionals, it could be much information as possible is needed other people, that hold some part of the from all partners in the work to be able to jigsaw, especially when asking such reach an informed understanding and questions as: Resilience and residential child care: Continuum Group’s journey so far in measuring outcomes The hard fact now is that commissioners want to see outcomes … It is the little things that we do every day that make a difference, but we also need clinicians to help us when there are behaviours which are bewildering. Bob Hall, chief executive of Continuum, Continuum’s House of Resilience has as its We often hear about therapeutic Pam Burden, clinical director of foundation Every Child Matters. The young responses for young people with very Continuum and Dr Lloyd Humphries, people that we manage in residential care deep-rooted problems, anger, rage, Clinical Psychology Associates (CPA) now have very complex needs and we felt dysfunction. Continuum were interested in Over the last two years, Continuum has that we needed to move beyond the ‘good a framework that allowed psychoanalysis been developing a way of measuring parenting’ model to something more to work, cognitive behaviour and systemic outcomes concerning the concept of specialised and therapeutic and that staff therapy to work, but also gave staff a role resilience. Continuum’s outcomes need the skills and training to support this in providing and incorporating an eclectic monitoring system, entitled The House of complex work. Allied to this, the House of range of services to support engagement Resilience (Figure 2), enables commissioners Resilience benefits from a concept and and monitor effectiveness. Continuum to have detailed information relating to framework derived from a Japanese model of think it is important to have models that every young person’s progress. The total quality that was adapted for purpose. frontline staff, who actually have to apply information takes the form of reports completed by the group’s operations team Figure 2: The House of Resilience – Continuum’s outcome monitoring system and subjected to a rigorous review by independent external psychologists. THE HOUSE OF RESILIENCE© Continuum’s unique outcome monitoring system. Continuum Group offers care, with some specialities, in homes dispersed geographically as far as Tynemouth and Plymouth. It has 750 UNCONDITIONAL CARE POSITIVE REGARD or so staff, including about 80 teachers and nine specialist schools up and down the MEASURABLE OUTCOMES CONTINUUM INTERVENTION country. The homes include DCSF-registered PROGRAMME (CIP)© schools. Contributes to and participates in local activities The challenge for Continuum in measuring Access to education and lifelong learning outcomes has been to do so in a holistic Reduction of self harming behaviours Able to make and sustain friendships way, in line with the resilience philosophy Safety from abuse and exploitation Develops self-esteem and identity linked to productive employment that it has always worked from. The Emotional health and well-being Develops talents and interests concept of resilience appealed to the networks and social contacts Develops independence skills Healthy eating, exercise and Cultivates local community organisation as it is one that staff and and financial awareness Develops a set of values young people can readily understand. The (empathy, sympathy) system needed to show clinically sound and to be statistically robust. Scales and rating Mental health sexual health approaches have been devised; and an independent view of what is being done SINGLE CASE EVALUATION built in. The system needed to be demonstrable value for money. Work on the concepts and systems began in October 2006 and they were finalised in the spring of 2007. BE STAY ENJOY AND ECENOMIC MAKE A POSITIVE HEALTHY SAFE ACHIEVE WELLBEING CONTRIBUTION CPA are partners in this development as not EVERY CHILD MATTERS only do they have clinical expertise, they also supply clinical expertise via a nationwide The model above represents Continuum Care and Education Group’s House of Resilience. We believe unconditional care extends beyond the Every Child agenda which we adopt as our minimum standard. Once this foundation has service and ‘get on’ with young people. CPA been established we build a validated resilience model, pillar by pillar in the pursuit of un conditional care, positive work with both the Continuum internal team regard and opportunity for every young person in our homes and schools. and with the young people directly. © Continuum Group 2006–2009 21
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 these things in day-to-day practice, can model has an ethos and approach based on health and well-being and measure healthy understand and translate into everyday resolution, not simply management. The eating, exercise and sexual health. work. The model also needed to help those objective is not only to modify behaviour young people who often do not engage. but to effect a long-term change in the Every two months, there is a report compiled Resilience theory seemed to meet that young person’s personality. Every part of the on each young person that is then bound need by drawing on lots of tried and outcomes monitoring system works within a and circulated to social workers. tested information from Robbie Gilligan, a clinically governed, systematic, outcomes- leading author on resilience theory and based assessment framework, demonstrated The hard fact now is that commissioners practice. in the production of bi-monthly (or as want to see outcomes. But that was not required) reports. The system ensures that Continuum’s intention in the first place: it Each of the main principles of Every Child the pillars and domains of Resilience are was just good residential provision to equip Matters has been combined with elements incorporated into care planning. staff with skills, and help young people of resilience to create the Pillars of with complex needs to leave changed and Resilience (Figure 2). This draws out the For example, looking at the Be Healthy with the skills to manage the rest of their most relevant factors to address the outcome of Every Child Matters, with the lives to the best of their abilities. individual needs of each young person. The help of CPA, Continuum measure emotional Developing meaningful outcomes for young people with disabilities It is so much more important that a child comes out the other end of communities like Muntham House School happy, not just with loads of GCSEs but everything that they learn during their residential time measured, evaluated and recognised, including their activities and their social interaction. This is where the school makes the biggest difference, in terms of their confidence and self-esteem. Richard Boyle, principal and Tracey Wilton, residential side of what happens in a also adapted to fit with our care plans for partnership manager (pupil outcomes), residential non-maintained school is equally the residential side. Using ‘P scales’ to set Muntham House School as important and is not given enough focus targets helps, but it was recognised that Muntham House is a non-maintained in national curriculum standards. the school needed to bring in something residential special school for boys aged 8 to for care staff to record and evaluate too. 18 with needs relating to behavioural Many of our young people have gaps in There is a total of 251 skills on the difficulties, and in that group an increasing their education and may be behind their checklist: 68 are personal, 75 social, 49 number of children have Autistic Spectrum peers in attainment, which may or may not emotional and 59 behavioural. Disorders. There is generally an increasing be caught up. As they progress through the population of highly complex children with school and arrive at the end of their time The school sets targets not outcomes, by the several difficulties all wrapped up inside one with us it is important that they leave session and weekly. There is a termly sheet of little person. The only admissions criteria here feeling confident and worthwhile citizens evaluation, using all of the checklists. It is not is that the child wants to be at Muntham and that are able to achieve the same as just one person’s observation and recording, that everyone involved is happy to work anybody else. Deficits in their educational because obviously different people’s alongside the school. The mission statement achievement can be rectified in adulthood, perspectives do differ. The tutors’ evaluation of our school community is that the school is probably more easily than deficits in their will use a BESD checklist, and go deeper into a safe, caring, happy, positive community, self-esteem and social skills. understanding a child’s personal attitude to which challenges children and everybody learning, and their independence skills; whilst connected with them. The school has had a conversation about the care workers will focus on personal defining outcomes for the school and hygiene and care, first aid, independence, The work of the school has always been wanted to keep the focus on the growth and organisational skills and social skills. about managing difficult children, taking development of the young person; for local them away from difficult environments, authorities it seemed more to do with sets of The tutor group will then sit down and reorienting them, giving them some work to checks and balances. The school believes that discuss whether they think they have do that was effective, and then trying to get outcomes should have a purpose, be improved. At the Annual Review, the them back into employment or into further evaluated and communicated effectively. completed checklists and summaries written education. The school has always integrated by the tutors are then moderated by the well with all the agencies involved in SEN Organisationally principles, process, practice Heads of Education and Care. So it is the and that could be because the children each are taken into account. The school looks at whole picture, not just an educational point have several special educational needs. As a what has happened to the young person, and of view, that describes the child in context. non-maintained residential school dealing then the ‘what’ and the ‘how’ of change. If with 22 different local authorities and a wide something is not working, if it is of no use, This is presented in the format of an range of children’s care groups all with their or harms the principles of how we work, Outcomes Wheel (Figure 3), which indicates own ideas of key outcomes, the school has then the school stops doing it. The principles achievement in identified skills and had to become very sensitive to meeting the of the school are never changed, they are the progress in acquiring such skills. needs of a disparate group of people who only things that do not change, whereas have defined outcome measures they expect process and practice change constantly. The wheel is made up of annotations of us to meet. skills or skill sets. Children’s progress is recorded in terms of The school is aware of the external influences behavioural, emotional and social The skill annotation makes up a section of and internal influences on its work. There are difficulties (BESD). The school uses a the wheel sector and is shaded in when the educational pressures – but we think that the checklist that is educationally focused but young person attains the skill. 22
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 Therefore, in a clear way, Muntham staff value of the outcomes wheel is that it offers Note: This process has moved on very identify outcomes they seek for their group. a comprehensive assessment of progress as it quickly since the seminar and is now Initially, key staff fill in progress although this happens and the assessment is monitoring regularly updated with pupils as well. It has is then moderated by senior staff through the universal Every Child Matters outcomes, pace therefore become a self-assessment tool annual review process. However, a snapshot of improvement, strategies and value. Best of and pupils can also add their own of progress and skill acquisition is available at all, it has bright colours and can be easily strategies to the mix. any one time on the school’s intranet. The understood by all of our young people. Figure 3: Developing meaningful outcomes for young people with disabilities UNIT 1 6 12 UN T9 6 IT NI 12 5 11 Segment index U 2 11 4 10 5 kf6 Shows an awareness of the use 6 10 4 12 of illegal drugs, alcohol and smoking. 5 3 9 11 9 3 4 2 8 10 3 8 2 9 Section index 12 11 2 7 1 7 1 8 6 kf1 Shows an awareness of danger 4 5 UNIT 3 U NIT 8 10 9 1 7 3 during leisure activities. kp 8 7 ka kf 1 2 kf2 Shows an awareness of 6 5 4 3 2 1 ks ke 7 8 9 10 11 12 healthy eating. kc kr 1 kf3 Eats a healthy diet. 8 71 kd kv 2 3 9 7 4 kf4 Shows an awareness of the 11 10 2 7 1 7 1 8 5 6 12 importance of taking regular exercise 3 8 2 9 4 2 8 10 UN 4 9 3 5 11 IT 3 9 IT 7 UN 6 10 4 12 11 4 10 5 12 5 11 6 6 12 UN 5 IT 6 UNIT Therapeutic residential child care: Evaluation, outcomes and child-centred practice Integrity is doing it right when no one else is watching … Child-centred practice means staff keep the interests and well-being of the children central to all that we do. CSFC has been awarded the following: boroughs and Buckinghamshire, Oxfordshire Danielle Evans and Sarah Walton, Calcot and Slough councils. Its purpose is to achieve Services for Children (CSFC) I Investors in People 2003 a coordinated approach to contracting with Calcot Services for Children Therapeutic I ISO 9001 Award – for the quality of independent sector children’s homes and Foundation (CSFC) comprises four therapeutic staffing and business planning used to fostering agencies. communities in Reading, Berkshire, with close empower and improve services to both the links to psychiatric and psychotherapeutic young people and adults based at CSFC Community of Communities is a standards- services. The group was founded to provide I Team Teach Gold Standard 2007 – for based quality improvement programme, alternative ways to look after vulnerable best practice in positive handling which brings together therapeutic children and young people based on: I Community Care Excellence Award 2008 communities in the UK under the umbrella – for work regarding independence with of the Royal College of Psychiatrists. I utilising, in small family-style young people. communities, therapeutic models and Over the past three years, CSFC has been psychodynamic theory The organisation is continually striving to judged ‘excellent’ by the Commission for I having practice centred on the needs of improve its level of service and has highly Social Care Inspection (CSCI) and the community, and living and learning evolved systems of external and internal ‘outstanding’ by Ofsted in all of its together monitoring. communities. This is due to the huge I offering appropriate boundaries and commitment of its staff teams, who aspire consistency External monitoring to excellence in all areas of their practice. I giving young people a chance, space This is achieved through participation in CSFC believes that: and time to heal the Pan-London Consortium and the I valuing diversity, offering a safe and Community of Communities. Integrity is doing it right when no one else loving environment which is jargon free, is watching. and offering unconditional care The Pan-London Consortium was set up in I a high staff ratio of 3–4 adults to 3–4 May 1999 and funded by 31 London children or young people. 23
    • National Centre for Excellence in Residential Child Care Annual conference proceedings Issue 23 – March 2009 Internal monitoring headings, which relate to government therapeutic methods. The young person’s The organisation has a robust monitoring expectations for young people in care. review will assess how well their needs are system, including monthly health and safety being met in relation to Every Child checks, key workers checks, monitoring and The young person’s file Matters outcomes and bring to light any managers checks. This cycle ensures all areas Each young person has a file made up into changes in their situation. The care plan of practice are evaluated and are then 23 sections, which cover contact, health, will be reviewed and amended after their reviewed at the fortnightly community incidents, and so on. These have been Statutory review to allow for these meetings, management meetings and help arranged into five subheadings in accordance changes, it will also be modified after any with the business plan. Regulation 33 checks with the Every Child Matters guidelines: significant changes or events. are completed at the end of each month in accordance with care standard 33. I Stay safe Child-centred practice means staff keep the I Enjoy and achieve interests and well-being of the children Future plans I Be healthy central to all that they do. CSFC also Over the next 18 months, the plans are to: I Make a positive contribution ensures that the children participate in all I Economic well-being. the decisions that concern them; and that I start an education unit (currently the homes are child friendly and look like offered offsite) The file must be regularly updated. It is family homes. It empowers the young I become a learning centre – accredited checked each month using the key workers people to have their voices heard and by the AQA examination board, which checklist for guidance. Young people have actively participate within the home and will offer official certificates on all areas the right to look at their files whenever the wider community. There are daily group of independent living they wish (in accordance with EU Human times for the group to communicate, I begin using a new recruitment process, Rights Directive) and are given the reflect, discuss and support each other; and involving two practice shifts and opportunity to do so by filling out a ‘My monthly young people’s meetings, where interviews, which aims to help beat high File’ form. However, only the author of any the children have the opportunity to put staff turnover rates. It also involves the document can go through this with the their views across on a number of issues. young people. young person, so if there was a letter from a therapist, the young person would need CSFC’s practice deploys various theories Reporting outcomes to request to look through it with them, and models, such as the psychodynamic Young people are assessed on referral and and we would help them to arrange it. model, learning theory, social learning every six months thereafter to monitor theory and humanistic approaches. Direct progress and changes. CSFC use a clearly Care plans and reviews work is undertaken to help the young defined assessment tool, which provides an CSFC plans are completed by the key people to discuss and feel comfortable with easy-to-follow format that follows the five worker and manager of the home after a their own identity, beliefs and culture, to Every Child Matters headings. All data young person’s planning meeting. The discuss and work on their past experiences collected is used to inform reviews, future objectives will be reasonable, and and life events prior to and during their planning decisions for the young person, and achievable within the timescales. Care plans stay at CSFC (for example, life story work). the community annual report. The annual are centred on the available resources that An important aspect of direct work is that report provides information for use in will promote the success of the child or the opinion of the young person is crucial; planning and generates ideas for further young person. They will include the aim for and topics or work areas are chosen with developments. It also provides information to each child or young person; and the the young person, so their views and purchasers, under the Every Child Matters necessary interventions, for example, preferences are central to the work plan. A further aspect of direct work is empowering the young person and supporting them towards independence and responsibility. Work on, for example, boundaries, cooking, health and safety, and sexual health is crucial and allows the young person to feel as though they are learning valuable life skills and age- appropriate responsibility. This work enables the direct worker and young person to build up a relationship of trust and make a safe place where the young person feels they can share their dreams and fears, without fear of rejection or ridicule. Conclusion CSFC is a service continually striving to achieve and improve. Its extensive internal and external monitoring systems seek to © NCB 2009 ensure they deliver best practice and excellent service. The outcome reports enable them to monitor and review the young people’s progression and, through this, can readily provide information regarding their service to providers. … the staff team are constantly looking for ways to improve their practice and learn new ideas. (Ofsted report 2005) 24