Ncercc Confproceedings Spring2007

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Ncercc Confproceedings Spring2007

  1. 1. National Centre for Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007. ISSN 1751/9705 Policy and Practice Meeting Needs: Moving us on to where young people need us to be. In this issue Proceedings of the National Centre for Five challenges for residential Excellence in Residential Childcare Annual child care 1 Keynote address: Conference, 8 November 2006, Leofric Parmjit Dhanda, Parliamentary Conference Centre, Coventry Under-Secretary of State for Children, Young People The Annual Conference served both to launch new NCERCC policy and Families 3 and practice documents and to showcase positive developments across the residential child care sector. As in previous conferences it Developing the workforce 5 also provided a forum for discussion of the key issues and challenges Stakeholder perceptions of facing the sector. The contents of the proceedings include pieces Mulberry Bush Therapeutic developed from the presentations for the conference School 6 Pillars of parenting: new thinking on residential child care 8 Bearing the unbearable: talking about things we would rather forget 10 Health in residential child care 11 Supervision in residential child care – two new NCERCC practice papers 12 Setting up and sustaining therapeutic care – Lioncare and Childhood First 13 Secure settings – achieving Five challenges for residential care good outcomes 16 Care planning seminar 17 An editorial by Ian Sinclair Behaviour and educational This talk does what it says on the tin: it is The five challenges are: achievement 18 about five challenges for residential care. I the problem of defining and The latter term covers a wide range of maintaining a specific role for each Taking care of education – provision. There are, for example, units home improving outcomes 19 dealing with the attachment needs of I the need to gain agreement within the young children, homes that also provide home on what it is about and how Recruitment, selection and education, secure accommodation, things are done professional development 20 assessment units for families, and provision I instability: the great differences there for disabled children. The following covers are between homes – and over time the most common form of residential care within the same home – in the in social services: children’s homes for behaviour and morale of the residents ‘challenging adolescents’. I carry over: the problem of ensuring that gains made by the residents
  2. 2. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 while in the home last after they have home in the near future a long way from dramatically between different homes in left it their homes. ways that cannot be explained by their I the high cost of homes and the impact intake. The level of disorder and misery can of this on other features, such as length The challenge to a home and its management be high. In one study 60 per cent of those of stay. is not only to define its purpose and function with a previous offence committed a but also to maintain these. Staff need to ask further one if they stayed six months, as The talk is based on a review of the themselves how they would describe the role did 40 per cent of those who had no literature in English, on my own research of their home, and whether the characteristics previous record of offending. Four out of and on work by my colleagues in York. fit together to provide a feasible role, and if 10 adolescents said they had thought of not, what needs to change. killing themselves in the previous month – Defining and maintaining a role an experience strongly associated with Homes do better when the managers feel Gaining agreement accounts of bullying and harassment. that they have a clear, feasible role. This is Homes seem to work better if the staff and explicitly or implicitly defined in terms of: the head of the home agree. This means Stability in this sense does not vary with I the residents that they share a common ethos, approach the staffing ratio, the proportion of I the home’s function (for example, to problems from a similar point of view, and trained staff, or whether the head of the provide remand or assessment) are agreed on how to translate this home has a qualification. External I its purpose and rationale (what it seeks common ethos and approach into action. inspection seems unable to produce a to achieve for the residents and how) Such agreement is probably easier if the uniform level of stability. The key seems to I the length of stay home has not recently had a change of lie with home managers, on whether they I the catchment area. role, if the head of the home agrees with are in agreement with the staff and on external managers and if the way the their approach to ensuring that the young These characteristics interact. There are home works is in keeping with what people go to school and do not disrupt the now many fewer homes. So the wish to outside professionals feel is good practice. home. Home managers have to have an place young people close to their own Staff need to ask themselves how far they effective and appropriate approach. They homes makes it difficult for homes to be are ‘signed up’ to the ethos and approach must also be in a position to get this very specialist in the care they offer. of the home, and how can they implement across to their staff. They are likely to find Homes may be asked to take young people this consistently, but in a way that uses this easier if they have clear authority and with very different characteristics or their own strengths. a clear, feasible remit. needing very different lengths of stay simply because they are local and there is Achieving stability So, the challenge is to ensure that the no other home in the neighbourhood. Morale, the incidence of running away and head of the home has a clear and effective Equally, it may be a mistake to place breaking the law, school attendance, approach to managing behaviour and young people who are expected to return bullying and sexual harassment all vary education, and that this is implemented by 2
  3. 3. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 staff and supported by management. So homes need to ask themselves what them. Possibly, there is a need for new Homes have to ask if this is the case. assumptions they make about long-term models (for example, low support effects, how realistic they are, whether accommodation where a small group of Ensuring carry over they occur and how better success could young people live without a member of It is very difficult to ensure that the be achieved. staff on duty at all times). Certainly, the benefits of residential care survive models need to be consistent with costs discharge. Homes can undoubtedly benefit Issues in controlling cost (for example, a home that sets out to young people while they are there. These Residential care is very expensive. In one provide a long-term home is unlikely to effects, however, may not last. For recent study, daily costs varied from £121 succeed if it is so heavily staffed that example, young people who have left to £837 with an average weekly cost of young people are continually moved on to ‘unhappy homes’ may become happier; and around £1600. These costs lead to pressure less expensive placements). By contrast, a those who have left ‘happy ones’ may to close homes and move individuals for home that keeps its young people for a become unhappier. The final outcome may reasons of cost rather than need. There are short period of time can afford to have be much the same. The impact of the also issues of equity and timing. Is it fair high weekly costs. homes shows the power of the immediate to spend so much on a small group of environment. The environment to which young people? And if it is, would a parent So staff need to ask themselves: ‘What are the young person moves is also powerful. with £160 000 to spend on their son or the sources of costs in this home? Is it true daughter spend it on two years of their that they cannot be reduced without Rather little is known about how to adolescence and leave little for what damaging effects on either the young overcome this problem. It seems likely happens next? people or the staff? Are they consistent that very long periods of stay (for with what we are trying to do?’ example, four years or so) may make the These costs are largely driven by staffing but home’s influence persist. It is also likely also vary with the role of the home, its Conclusion that homes should emphasise the skills geographical position and type of resident. Residential care is often on the defensive. that are needed at the next stage. In the ‘Expensive’ homes have as much or as little What is suggested above is that it has former approved schools, those that disorder as others. However, in homes with a questions to answer and that these can be emphasised ‘trade training’ were more high level of disorder, the staff group tend to asked at the level of the individual home. successful in reducing delinquency, and feel that more staff is needed. A possible If a staff group has considered these this approach was seen as relevant by the explanation for this anomaly is that while questions and feels confident in its young people. There is some evidence high costs do not prevent disorder, a high answers, it certainly has nothing to be that work with a young person’s family level of disorder creates the need for more ashamed of, and may well have much to before they go home may be useful. staff (for example, so that the home is not be proud of. Given that much will depend on the left unattended if a staff member has to take new environment, it is logical to set a young person to hospital). Professor Ian Sinclair, Research Professor, Social criteria for discharge (for example, that Work Research and Development Unit, a young person should have a job and Although costs do not appear to determine University of York. Tel: 01904 321294, accommodation to go to). outcomes, it is not clear how to reduce Email: acs5@york.ac.uk Policy and practice meeting needs: moving us on to where young people need us to be Keynote address by Parmjit Dhanda, Parliamentary Under-Secretary of State for Children, Young People and Families It’s great to be here to address the first Secure Accommodation Network are conference on residential child care since running a seminar later this afternoon. the establishment of the National Centre Secure children’s homes are an essential for Excellence in Residential Child Care last resource and we want to ensure that there autumn. will continue to be enough places in these homes to meet demand. The Centre is funded by us, and hosted by the National Children’s Bureau. I’d like to Children and young people living in thank them for all their hard work over the residential special schools and children’s last year, in particular their work to help homes should have exactly the same the government to improve the quality of opportunities as all other children. If this is care in children’s homes and residential not achieved, then the state will have failed education, employment or training at age special schools. in its corporate parenting role. 19 compared to 13 per cent of all young people; and only 6 per cent of young We recognise that residential care can be a By now we’ve all heard the statistics: people who’ve been in care go to university. positive placement option – for some children in care are five times less likely to children and young people it is their achieve five good GCSEs and nine times Since 1997 we’ve invested close to a billion placement of choice and can help them find more likely to get excluded from school. pounds into the Quality Protects initiative. stability and achieve better outcomes. A quarter of people in prison today have We’ve taken steps to encourage adoption spent some time in our care system. Over 30 instead of long-term care. And we’ve put I’m pleased to see that people from the per cent of care leavers are not in local authorities under a duty to improve 3
  4. 4. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 And, overall, the cost of residential care continues to rise, although the number of children and young people placed in the sector remains roughly static. Local authority expenditure on children’s homes alone rose by a total of 33 per cent over the four-year period from 2000/01 to 2004/05. It is, of course, essential that the cost of residential care is justifiable, in terms of the quality of services provided and the outcomes achieved by children and young people. Each local authority must ensure that they have timely access to a range of placement options, including residential care. Children with multiple, complex and challenging needs must have access to the therapeutic and rehabilitative services that are provided by specialist children’s homes and residential special schools. It is, therefore, crucial that local authorities have commissioning strategies based on a thorough analysis of the current and future anticipated needs of their local population of children and young people, strong partnerships with providers, and a multi-agency approach to ensure that health and education services are closely linked to placements. We want to support local authorities who are experiencing difficulties with commissioning: to improve the value for money they secure; to ensure that a choice of suitable placements is offered for each child or young person; and to reduce their dependence on out-of- the educational outcomes for children and Our proposals create a presumption that authority placements. young people in care. But this has not children and young people in care should been enough. The care system can and not move schools in years 10 or 11, unless We’re planning to pilot new regional units must do more to tackle the early it is clearly in their best interests. And they to undertake commissioning functions on disadvantages experienced by children and make clear our intention to abandon behalf of groups of local authorities. These young people before entering care and forever any practice that encourages or, units will bring together procurement help them to overcome them. worse, forces young people to leave care as expertise and sector knowledge, and work early as 16. Instead, we intend to support more effectively with providers in planning Care Matters young people to make a smooth transition local services. They will offer a choice of Care Matters, the Green Paper we into adult life. suitable placements for each child or young published for consultation on 9 October person, leaving final decisions about 2006, sets out what now needs to happen The care system must act more like a individual placements in the hands of social to transform the ‘care system’. At present, traditional loving family, with all the workers in discussion with children and despite the efforts of many committed responsibilities that implies for young people themselves. people, including residential care staff, corporate parents. their managers and social workers, many Despite some excellent provision, children and young people in care are not What Care Matters means for compliance with the National Minimum given the opportunity to achieve the residential care Standards remains a major concern. Only aspirations we have for them. We want Some of our proposals will, I think, be of one-quarter of children’s homes meet 90 their childhood to be secure, healthy and particular interest to you: those which per cent or more of the Standards. To enjoyable. Far too many children and seek to improve local authority tackle this, Care Matters proposes a tiered young people experience care as a time of commissioning and placement practice, national framework of qualifications and great instability, with frequent placement and those which seek to improve the competencies for children’s homes staff and moves. quality of residential care. While there is foster carers, with opportunities to progress good commissioning and placement towards degree level for qualified staff. Whilst developing our proposals, we talked practice in individual local authorities, to children and young people in care; some overall this continues to be variable. I’m We also intend to look in more detail at said they see as many as 30 different social particularly concerned to hear that some what constitutes excellent practice in child workers. We found that over one-third had local authorities are moving children and placement, including in residential care. been placed outside their local authority young people on from residential We need to know how the best providers area, away from friends and relatives. placements where they have settled and are able to make care in children’s homes Others go through as many as 10 different are progressing well. and residential special schools such a placements in a couple of years. 4
  5. 5. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 positive experience for children and young children’s homes staff constructively Care Matters challenges us to recognise our people. And we plan to reinstate the duty manage children’s and young people’s responsibility for giving children in care an requiring social workers to visit children behaviour. experience that enables them to flourish and young people placed in children’s and grow into fulfilled adults. It sets out homes at a specified minimum frequency, As you may already know, we are currently what we think needs to be done to make with a greater frequency of visits for those reviewing the existing National Minimum this happen. But it’s only the beginning of placed outside their local area. Standards for Children’s Services, and the debate. My ministerial colleagues and I underpinning regulations. The review will want to know what everyone, including At a meeting I had with the Magistrates rationalise, clarify and focus the National children and young people, think of the Association earlier this year, I was shocked Minimum Standards on achieving positive approach we’ve set out. Will our proposals to hear that children and young people in outcomes for children. It will put in place a make a real difference to the lives of care are being brought before the courts process that targets inspection where children and young people in care – enough for incidents that children and young improvement is needed or concerns have to achieve the transformation we want to people not in care have resolved in the been raised – and avoids placing see? If not, what more should we do? family home, without the involvement of unnecessary burdens on service providers the police. To help address this, we will who provide good quality services. (The Parliamentary Under-Secretary of build approaches to management Following the introduction of the revised State for Children, Young People and behaviour, such as restorative justice, into Standards, we propose to introduce a new Families then urged delegates to the tiered national framework of ‘special measures’ regime to ensure swift contribute their views through the qualifications and competencies. And we action where standards are not met in consultation process, which ran until 15 will build into the revised National children’s homes. This will build on the January 2007 and wished them well with Minimum Standards, which we aim to existing enforcement powers of the the rest of the Conference. He looked introduce in 2008, an expectation that inspectorate. forward to hearing feedback from it.) Developing the workforce Ann Harrison, National Development Manager Social Care, Children’s Workforce Development Council (CWDC) gave the following account of CWDC’s work over the previous year and the current policy context in relation to workforce development As part of this article I hope to update you To realise the Options for Excellence vision on some of CWDC’s activities over the last for 2020 – of a qualified, motivated and year and will also refer briefly to the flexible workforce – work needs to start findings from Options for Excellence, which now to develop and change working sets out key elements of good workforce practice. development. The main prerequisites to achieve this are: The Green Paper on looked after children, I strong leadership Care Matters, also proposes changes to I a comprehensive workforce plan and social care workforce development for the strategy that reflects local need and future and we look forward to working addresses diversity with the DfES on taking this forward. It’s a I effective human resource processes that good start – although the Paper needs to outline recruitment, retention and Learning organisations be clearer about the role of the residential development opportunities The first phase of the development of an workforce and the value of residential care I a clear commissioning framework that Integrated Qualification Framework is for some children and young people. addresses quality in outcomes for nearing completion. The CWDC publication children and for the workforce. Clear Progression, which is on our website, The residential workforce needs a higher sets out a unit-based framework with profile if we are to see better outcomes for Recruitment and retention generic units based around the common children. Both the Green Paper and the Although the comprehensive spending core, providing clear pathways for General Social Care Council’s (GSCC) review will not report until Autumn progression, credits and value for previous proposed next stage of registration should 2007, CWDC has published the second experience, with clear routes into higher help this through further professionalisation report into rewards and incentives, and education and qualifications. From the of the residential workforce. recommends the development of residential worker’s viewpoint, it should mechanisms that can support enhance their role by supporting access to Options for Excellence describes a process modernisation of skills, job roles, higher-level awards and progression across in which social care is at the heart of responsibilities and pay and rewards. integrated settings. healthy communities; and where the most This should include strategies to vulnerable are supported – a social model encourage greater mobility, reducing CWDC has also been working jointly with in which users and carers play a key role at barriers to entry and exit. CWDC will also Skills for Care on the development of the the heart of the process – including young be working with the DfES on local Continuing Professional Development people and children. While we know that solutions to using temporary/agency staff. strategy, which was launched in October the spending review is not likely to be CWDC work with local employers to 2006. There will shortly be a web-based tool generous, CWDC is already working on support local workforce strategies to advise on careers, training and some of the areas outlined in Options continues and there will be further qualifications on both the CWDC and Skills for Excellence. consultant support in 2007/08. for Care websites. 5
  6. 6. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 The joint CWDC/Skills for Care Leadership In summary and Management Strategy, part of the The key to good workforce development Options for Excellence work, is now practice is, as I said at the beginning, complete. The supervision module and draft robust leadership, clear workforce planning, management induction standards was comprehensive training and development piloted early in 2007 in a number of social linked to career progression, and care areas; these will also be used within a commissioning for services that address number of integrated settings linked to quality outcomes for the workforce and Championing Children work. service users. A comprehensive workforce plan and development strategy needs to Commissioning have these in place – or be working CWDC’s joint work with Skills for Care towards this – and needs to be involving continues around developing National workers and service users in the process. Occupational Standards in Commissioning. The strategy also needs to be resourced This sets out key skills, building on the DfES appropriately. framework to ensure an integrated approach. Ann Harrison, National Development Manager Social Care The revision of the National Minimum Children’s Workforce Development Council Standards (NMS) also needs to reflect key 3rd Floor Friends Provident House and core requirements for developing the 13–14 South Parade Leadership workforce, and CWDC would hope to Leeds LS1 5QS Strong leadership is key to ensuring that influence this. For example, there should be Tel: 0113 244 6311 the workforce is developed and supported consistency in approach between the NMS appropriately. As you will probably know, for children’s social care services and some The CWDC website is at: www.cwdcouncil.org.uk the residential managers’ National adult services, and they should also be Skills for Care is at: www.skillsforcare.org.uk Occupational Standards (NOS) are being applicable in the early years sector. There reviewed, and that includes the NOS for are many providers that operate across children’s managers. This is a UK-wide sectors and some services – such as mother approach and it is about to go out for and baby homes, children’s centres, home consultation, so you will need to add your care – that provide to both adults, young views – initially online through our website people and children. and Skills for Care. The proposal is to reduce the number of NOS and have Part of commissioning for services and specific elements for all managers in social understanding the local environment is also care, and some that are for those working knowing about the workforce out there. It is in children’s services. This could raise the important to encourage use of the Skills for profile of residential services by Care National Minimum Data Set – perhaps underpinning pedagogic skill and there is a role for CWDC in supporting some knowledge requirements. providers to use the data set. Stakeholder perceptions about the Mulberry Bush School Providers of relatively expensive programmes of therapeutic care increasingly need convincing evidence to demonstrate to purchasers the specific and added value of such placements. John Diamond, Director, Mulberry Bush School, and Jane Barlow, Reader in Public Health, University of Warwick, gave an account of research which they undertook to this end The Mulberry Bush is a therapeutic school The provision placements, external evaluation is providing care and education for boys and The school’s 38-week per annum provision, increasingly important to provide girls aged 5–12. For 58 years it has undertaken in partnership with parents, convincing evidence of the added value of provided high-quality and integrated carers and referrers, aims to reintegrate the the service. To this end, Mulberry Bush therapeutic care, treatment and education child into a home and school environment. commissioned independent researchers at to severely emotionally troubled children The 38-week limit is important, as the the University of Warwick to undertake a who are clinically defined as school believes that 52-week provision can series of case studies (qualitative) of ‘unintegrated’, ‘multiply traumatised’ or lead to ‘warehoused’ and institutionalised stakeholder perspectives of the benefits of have ‘disorganised attachment’ patterns. children. the school. There is little evaluation of this Their early childhoods typically include type currently available, which is an area highly adverse early life experiences, The work of concern for policy makers, education including abuse and neglect. Many will As already indicated, the school works with and social care providers alike. have been cared for by local authorities severely emotionally troubled children and had several disrupted foster from all over the UK. After three-year Aim and methods placements. Without specialist intervention placements many children return to their The aim of the research was to explore the their futures are bleak, with a likelihood home and mainstream schools. As perspectives of a range of stakeholders of relationship difficulties, criminal suggested in the introduction to this regarding the benefits and disadvantages activity and a continued cycle of abuse article, because fees from referring local of attendance at a residential school for and neglect. authorities with hard-pressed budgets fund children with severe emotional and 6
  7. 7. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 behavioural problems. Once ethical ‘She enjoys reading, she likes to sit The research did also note less positive, approval had been secured, interviews there and write. It’s something I’ve unintended consequences of placement at were conducted with pupils, parents/carers never seen or had from her before … the school. Children might learn new and and staff. The children involved were three She makes us her own cards and sends undesirable language and behaviour from boys and three girls, whose ages ranged them to us. She’s come a long, long peers. They might miss out on family and from nine years and six months to 11 years way.’ (Carer) home life and their choice of local friends. and eight months, with a mean age of 10 Parents might feel a loss of control and years and nine months. Basic reading skills I Behaviour and adjustment improved. uncertainty as to what was going on. ranged from 0.2 to 3.4 years behind the Some were disappointed with the degree level expected for each pupil’s ‘Before he went to the school he was of academic progress, while conceding that chronological age (average 1.7 years below out of control. He would run away. He simply attending and participating in class expected). Mathematical reasoning ranged would wreck things in shops … I never, represented a huge advance, bearing in from 0.5 to two years below expected ever took him anywhere on my own mind the emotional state of the child levels (average 1.4 years). without another adult, because you when placed at the school. couldn’t, say, pay and watch him … Research findings – observed [Now] I go all over the place, anywhere The research has its limitations, such changes in the pupils I want to … He’s an absolute joy to be as the relatively small numbers of I Children learnt to trust adults again. with … He is a very different child.’ stakeholders involved and the limited (Carer) time frame on which it focused, but ‘He wouldn’t trust anybody, and now nonetheless it did yield some valuable he will.’ (Carer) I Parents/carers were helped by the insights into the ways in which placement respite given during the child’s at a residential school of this nature can I Children learnt to ‘be a child’. placement. As a result they felt better be effective for children with severe able to cope with a previously fraught emotional and behavioural difficulties. ‘He’s actually coming to the conclusion relationship and no longer felt there There is consistency across stakeholders that being a child’s not such a bad thing was no happy future for the child. about the problems experienced by these after all, that he doesn’t have to be a children and the ways in which a grown up.’ (Carer) ‘I no longer see [X’s] future in terms of residential school can help them. Further reform school, borstal, lock-down units, research is needed into longer-term ‘He is more able to accept that he is a prison. I see his future as probably outcomes and comparisons. child and that adults look after children, tumultuous. But I actually see him that he is not an adult so he doesn’t having a future … all the things that John Diamond, Director, Mulberry Bush School, have to look after everyone else.’ (Staff were totally impossible two years ago and Jane Barlow, Reader in Public Health, member) are now possible for him.’ University of Warwick. (Carer) I Self-esteem improved. ‘His self-esteem is something I didn’t honestly believe I would ever see.’ (Carer) I Ability to deal with, and articulate, feelings improved. ‘He can express himself properly, he can tell you, he can come and say to you “I’m angry”, or “I’m sad.” He knows he can tell you, which is excellent.’ (Carer) ‘I used to smash things, used to climb trees. I used to punch adults … [now] I just swear, and just – calm down … Me and [another pupil], we just talk about it and we tell the adults … they try and make us learn how to [talk about it] … If you just mess around you don’t get what you actually want.’ (Pupil) I Children were enabled to stay in class and do their work and there was academic progress. ‘He stays in class now without running out, which is a big, big change … he listens and participates … A year ago if he couldn’t cope with certain situations, he just ran out, and fought, and hit out, and would be violent and rowdy, so that’s been a major change.’ (Carer) 7
  8. 8. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 Pillars of parenting: new thinking and approach to residential child care. Authentically warm child care: understanding and supporting children in care Sean Cameron, Child and Educational Psychologist and Colin Maginn, Residential Care Consultant, described the essential elements for successful parenting and caring in residential child care Assuming parental responsibility for children other activities essential for successful and young people who have suffered parenting and caring which we have begun In the case of children and young people in negative life experiences is not only to refer to as the ‘pillars of parenting’. In care who have ‘lost’ their parents or challenging but requires levels of Table 1 we have listed the (currently) seven families and who face the transition to an understanding, compassion and patience pillars, together with some examples of the unknown care setting, Cairns (2002) has beyond those of your average saint. The adult actions which support each pillar. A outlined a particularly useful model that good news is that positive changes in the full account of this approach and its illuminates the nature of support and emotional, social and behavioural underpinnings from psychological research management likely to be required. These development of children and young people and theory will appear in a future issue of phases of support are: will take place when their needs are The British Journal of Social Work (see I Stabilisation: providing a safe, valuing understood and addressed. It is meeting Cameron and Maginn 2007). and predictable physical and these needs with the combination of psychological environment. responsiveness, clear expectations and high While the ‘pillars of parenting’ have been I Integration: aiding a child or young aspirations, which over time enables the deliberately written in a positive style, it is person in the processing of the trauma, child or young person to build trust and also recognised that some carer behaviours i.e. helping them to make sense of the move on. ‘Parenting’ is one of those (often unintentional) can have a negative traumatic event(s) that occurred in their activities which most people take for impact on vulnerable children. Such ‘pitfalls’, lives and beginning to ‘put the past in its granted and most parents learn their skills which are threats to an effective and warm place’. through bringing up their own children. parenting style, can include the use of ‘put- I Adaptation: enabling the child or young However, for professional carers who are downs’ or comparing a child unfavourably person to re-establish social often looking after vulnerable children and with another child. connectedness, develop personal young people, the skills and knowledge of efficacy and rediscover feelings of parenting need to be unpacked, analysed, Support for post-trauma stress well-being. understood and then put into action, often There are a number of psychological theories in difficult circumstances. (notably Spall and Callis 1997, and Kubler- As well as providing ‘authentically warm Ross and Kessler 2005) that attempt to chart parenting’ which shows children that they The pillars of parenting the emotional impact of major life are cared about, residential and foster Meeting a child’s physical needs is only the transitions, including those that involve carers also need to develop a deeper beginning of ‘good parenting’ and there are considerable trauma and loss. understanding of the emotional and cognitive processes that are taking place while children ‘work through’ and adapt to their earlier negative experiences. Even for the most skilled carers, the task of providing ‘authentically warm emotional support’ can present a huge challenge, especially when faced with a child or young person whose behaviour could be perceived as deliberately vindictive and hurtful, and who may frequently reject/spurn or exploit acts of carer or peer kindness, affection and good intent. At such times, knowledge of the process of post-traumatic stress and loss becomes an essential aid both to ascertaining a child’s or young person’s emotional needs and to guiding sensitive support. In Table 2 we provided some examples of the adult actions that can support a child or young person through each of the stages towards adaptation following parental rejection, abuse and neglect. Final comment Of course, children and young people will respond to and attempt to cope with adversity in idiosyncratic ways. However, the ‘authentically warm child care’ approach is designed to help residential and foster care staff to establish a safe and stable environment where the child or young person is able to talk, and learn 8
  9. 9. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 Table 1: An outline of the Pillars of Parenting, with some suggested support activities by carers. © Cameron and Maginn (2007) Primary care and Secure Positive self- Emotional Self-management Resilience A sense of protection attachment perception competence skills belonging • Sensitivity to a • Secure attachment • This allows the • This ability • Self-management • Resilient individuals • Research and child’s basic needs appears to act as a child to develop a underpins the is the insulation, seem to be able to theory in shows the child buffer against positive self- successful which prevents understand what relationships have that we care and risks and to image. development of inappropriate has happened to established human that they are operate as a • Positive and relationships behaviour when them in life beings as important. protective negative outside the family enticing or (insight), develop ‘fundamentally, • Education is mechanism. statements have a and may moderate compelling outside understanding of extensively social’ included here powerful impact susceptibility to factors try to others (empathy) and highlighted because in our Why? See on self- and propensity for intrude. and experience a the need to complex world Ziegenhain (2004) perceptions. later mental health quality of life that belong. knowledge and for a summary of problems. Why? See Lewis and is often denied to skills are essential the considerable Why? For more Frydenberg (2002) others who have Why? For details of to survival. volume of the details, see the Why? A useful on the topic of suffered negative the link between research on research paper by overview of this personal problem- life experiences rejection and Why? See Maslow attachment. Burnett (1999) or important, high-level solving methods (achievement). aggression, anti- (1971) for his the book by Emler skill area has been used by children and social behaviour and universally known (2001). provided by Saarni young people and Why? See Cameron poor self-regulation, pyramid of human (1999). Zimmerman (1998) and Maginn (2006) see the review article needs. for a description of or Newman and by Baumeister the link between Blackburn (2002), for (2005). self-management summary of the and academic research on attainment. resilience and its implications for ‘parenting’ of looked after children. Some examples of Some examples of Some examples of Some examples of Some examples of Some examples of Some examples of good practice good practice good practice good practice good practice good practice good practice suggested by carers suggested by carers suggested by carers suggested by carers suggested by carers suggested by carers suggested by carers • tuning into a child’s • encouraging the • celebrating the • maintaining your • guiding and • ensuring stability • individualising fears and offering child to explore child’s adult role during setting limits for and continuity in bedroom a reassuring word • tuning into the developmental any conflicts with behaviour as the care accommodation or hug child’s perspective advances the child child grows up • promoting • developing • attending to a of the world • recognising and • teaching the • mentoring basic friendships with functional child’s appearance • being consistent in rewarding good language of skills and helping pupils doing well friendship groups so that they look your own behaviour; emotion child to achieve at school • encouraging and feel ‘good’ behaviour and • protecting the • teaching empathy, difficult skills • locating one adult friendships in the (and do not attract your expectations child from e.g. How do you • teaching self- who can act as a neighbourhood. hostile or hurtful for the child’s disapproval, think that Chris reflection. mentor. comments from behaviour teasing or violence feels now? adults and peers) • listening and • setting high but • seeking communicating reasonable opportunities to responsively. standards for help the child to learning and succeed at school. behaviour. Table 2: The Cairns model of trauma and loss, together with some good practice suggestions by carers. © Cameron & Maginn (2007) Stabilisation Integration Adaptation (providing a safe and predictable physical and (aiding a child or young person in the processing (enabling the re-establishment of social psychological environment) of the trauma, i.e. putting the past in its place) connectedness, personal efficacy and rediscovering of the joy of living) Some examples of good practice suggested by Some examples of good practice suggested by Some examples of good practice suggested by carers carers carers • protecting the child from teasing, bullying and • stressing the normality of feelings associated • helping the child to recognise and accept the intimidation with previous traumatic events changes, that have occurred • establishing a clear and predictable pattern of • helping the child to manage post-trauma • supporting the child’s own efforts to adapt to daily events for the child. feelings of shame, guilt and anger. the changed circumstances. more, about the circumstances Contact details: Dr Sean Cameron, Child and Cameron, RJ and Maginn, C (2007) ‘Parenting and surrounding their trauma; to begin to deal Educational Psychologist (r.cameron@ucl.ac.uk) professional childcare: The authentic warmth with the feelings that accompany such and Colin Maginn, Residential Care Consultant dimension’, British Journal of Social Work. information; to process, control and (colinmaginn@hotmail.com). Kubler-Ross, E and Kessler, D (2005) On Grief and manage any resulting psychological or Grieving: Finding the Meaning of Grief through physiological reactions; and finally, to References the Five Steps of Loss. NY: Scribner. receive the type of support that re- Cairns, K (2003) Attachment, Trauma and Sprall, B and Callis, S (1997) Loss, Bereavement establishes social connectedness and Resilience. London: British Association for and Grief: A guide to effective caring. develops personal efficacy. Adoption and Fostering. Cheltenham, Glos: Stanley Thornes. 9
  10. 10. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 Bearing the unbearable: the need to talk about the things you would rather forget Christine Bradley, independent consultant Recent government thinking, for example, in However, before I had a chance to finish, she ‘Well, that is important,’ I said, ‘because that the Care Matters and Every Child Matters had run off down a corridor crying, ‘Oh no, way it may be possible for you to feel as programmes, has addressed factors important oh no. I don’t want you to come. That means comfortable in thinking about yourself, as in changing thinking and skills. However, something horrible will happen to me’. I you feel about putting together a tent.’ there are also some gaps, which need followed her and told her I was sorry that addressing urgently if we are to bring about the possibility of my coming to join them This has made me reflect on how important it true emotional recovery in the world of had troubled her so much. is that we are able to think about the emotionally distressed and troubled children unbearable aspects of life for children and and young people. ‘It seems to me that sometimes adults who young people. In my view, it is very important are trying to help and respond to you can we have a strong and deep understanding In particular, we need to develop a better make you feel and believe that something about dealing with the concept of how to understanding of how we, as professionals awful is going to happen. Now, this bear the unbearable in our work. working with children and young people in suggests to me that you have some care, ‘bear the unbearable’ when living horrible feelings deep inside you that How can we develop our understanding so alongside children and young people belong to an earlier stage of your life that children and young people’s anxieties profoundly traumatised by events in their when you experienced some hurtful and can be heard and thought about? lives. Through developing this understanding very painful times. How easy and quick it is we are better placed to help them cope with for you to feel that those who are Too often, those working with children and their own unbearable pain. I would like to responsible for taking care of and young people confuse their own anxieties give an example from my own work. protecting you might hurt or attack you. with those of the children and young people. That fills you with some unbearable It is crucial that organisations feel able to I regularly visit a children’s unit to provide feelings, which consist of more than anger talk about what is unbearable to them, as a consultation and specialist training that and sadness – a kind of panic and despair way of understanding the children’s and supports and helps staff to develop the level that makes it difficult for you to think young people’s unbearable anxieties. of insight and understanding necessary to about what is actually happening. All of achieve and deliver important and crucial this feels too much for you to deal with.’ Also, we must help workers to think about treatment methods, knowledge and practices and manage their own tensions and anxieties with children and young people. I went on to say that because of this it was so that they can help the children and young important that I try to help the grown-ups people with theirs. It is crucial that workers One particular visit coincided with the around her to understand and recognise how understand the difference between children and young people’s annual summer they could help her with her feelings. At that responding and reacting to children’s and holiday with their workers. While there, a point there were tears in her eyes. She put young people’s difficulties. The result will be young adolescent girl approached me and her arm around me and said that she would that they are able to live alongside the spoke about how she was looking forward to try to have a good holiday. children’s or young people’s pain and the holiday. She had experienced a number vulnerability and support them. of painful experiences and relationship I saw her again a few weeks later. I breakdowns in her early life, which were at a recognised that because of our previous In every piece of work undertaken with a very deep level and included missing out on encounter it was important for us to attempt child or young person there must be a meaningful attachments and failing to have to do something practical together. We put a beginning, a middle and an end. It must be her dependency needs met. tent up. I told her she was much better than assessed, planned, delivered and monitored me at this task and I had learned something to ensure the outcome is that the child or She asked me if I was coming on the holiday from her. She replied, ‘Yes, but you are very young person is able to make a healthy too. I began to explain that I was not, and good at helping people to understand about transition to the next phase of their life, gave my reasons, wishing her a good time. their feelings.’ whether they remain within their current placement or are in the process of moving to another. If this is not explicit in the work, it will overwhelm the child or young person with fears of abandonment and separation, which does not lead to a successful outcome. As argued above, children in care often have profoundly traumatic personal histories. The unbearable feelings associated with those histories, the anger and sadness, panic and despair, can overwhelm them and make relating to others, including those who are trying to help them, very difficult. As professionals working alongside such pain we need to develop an understanding of both its sources and also how best to help the child understand and resolve their feelings. In this way we can help them to bear the unbearable and move on in their lives. 10
  11. 11. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 Health in residential child care Care workshop Zarine Katrak and Sharon White, NCERCC Associates The NCERCC project licensed by the Department of Health to to consult with LAC/YP regarding their NCERCC took on the job of finding, sharing provide care, education and treatment to issues. and developing tools for good practice in eight children or young people who display I Develop active participation of LAC/YP. promoting health for children and young significant behavioural problems, are I Set up a ‘health forum’ within the home. people in residential child care. We elected awaiting trial or are sentenced by the Involve everyone with responsibility for to work in partnership with the Healthy courts for criminal offences. ‘corporate parenting’ of LAC/YP. Care programme at the National Children’s I Develop wider partnership working Bureau as it is a well-developed and Alloefield View, Halifax, is a local authority between agencies to share experience, researched multi-agency framework to children’s home operated by Calderdale knowledge and access to other services promote a healthy environment of care. MBC. It provides a home for six young relevant to LAC/YP. people, currently aged from 12 to 14. The I Look on the Healthy Care, NCERCC and The NCERCC project wanted to find out aim of the home is to prepare young other websites for free downloadable how the Healthy Care resources could be people for a return to family, or a move to resources. used in individual care establishments. a substitute family. It is one of three I Liaise with partners about funding From this it wanted to produce a toolkit for residential homes in Halifax that work as a opportunities. practitioners that would raise awareness ‘cluster’ and offer each other mutual and develop positive practice on issues of support. health and well-being. A key piece of learning Hollybank Trust, Mirfield, West Yorkshire, The close working between the looked The project worked with three pilot caters for children and young people with after children’s nurse and head of partners in Yorkshire and Humberside, to profound multiple disabilities. It provides residential services was vital to success. support them in carrying out a Healthy 38- and 52-week residential placements Care audit. This produced practical ideas with 24-hour individual programmes that that have informed the toolkit. are incorporated through on-site Final thoughts from a pilot partner education, physiotherapy, occupational Format of the toolkit therapy, speech and language therapy, ‘The Healthy Care audit tool gave me The toolkit summarises National Policy nursing and social care. the opportunity to identify the gaps and Guidance, explores the Healthy Care and the areas of development required evidence base, highlights the challenges The findings to enhance the services we provide. and successes experienced by colleagues I When deciding to carry out a Healthy The overall outcome from completing in the field and includes case examples, Care audit ensure that you talk to staff, the audit has been very positive as it a practice checklist, resources lists and children and young people about why not only identified the areas we are ideas for training. you are doing this and what it may delivering successfully but also involve. highlighted the need to not become It builds on the Healthy Care Standard. I Allocate designated time to prepare and complacent.’ Alison Howard, Hollybank Children and young people in a healthy carry out the audit. Trust. care environment will: I If there is resistance to certain actions, I experience a genuinely caring, bring in an external expert mediator to Both the NCERCC and Healthy Care websites can consistent, stable and secure challenge ‘institutional’ behaviours of be accessed via www.ncb.org.uk relationship with at least one some staff and to reach ‘common committed, trained, experienced and ground’. supported carer I If resistance persists, consider training. I live in an environment that promotes I Recognise that you may be instituting health and well-being within the wider the beginnings of a wider cultural community change. I have opportunities to develop the I Find out if you have a local Healthy personal and social skills to care for Care or Multi-agency Partnership who their health and well-being now and in could provide networking opportunities, the future; and receive effective examples of good practice, guidance, healthcare, assessment, treatment and training information and support. support. I Read through the audit tool and don’t get overwhelmed. It covers specific issues on health and I Reduce it to ‘bite-sized chunks’ under emotional well-being: the four headings of policy, partnership, I emotional health and well-being participation and practice. I mental health I Prioritise action points relevant to you. I healthy eating I Use the audit tool to identify and I play and creativity celebrate existing good practice. I sexual health I Think ‘holistically’ about health. I drugs/substance misuse. I Seek out your local LAC nurse and find out how your home could utilise them The pilot partners fully in carrying out the audit. Aldine House Secure Children’s Centre, I Identify other partners, specifically Sheffield, is a secure children’s centre Children’s Rights’ participation workers 11
  12. 12. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 Introduction to two practice papers on supervision in the residential care of children and young people Richard Rollinson, Independent Child Care Consultant and NCERCC Associate, and Sarah Leitch, NCH Manager and NCERCC Associate, introduced two practice development papers on supervision that will shortly be made available on the NCERCC website Supervision: guiding practice support living and learning/changing/ Finally, we believe that in the largest part it is These two papers are intended to be growing not simply in groups but as a prior good experience of being supervised complementary to one another and groups. Therefore, no system of that most often seems to be the greatest constitute together a basis for managers and supervision in residential group living can factor in determining that a person then practitioners in residential settings to think be complete and fully effective if it does becomes a ‘good’ supervisor in turn. Certainly, widely, and wisely, about how best to utilise not utilise the very medium through this is often the testimony of supervisors supervision to improve staff practice and the which practice is enacted. Of course, the themselves who have been commended as life experiences and outcomes of those for opportunity for individual supervision ‘good’ by those whom they supervise. whom they care. One paper (by Sarah Leitch) must remain available if only so that each Therefore, it is of the utmost importance that attends mainly to issues for individual person is located clearly within the we identify a way of supervising in/for supervision, while the other (by Richard discipline of a programme of individual residential care that will most reliably ensure Rollinson) focuses on group supervision. Of oversight and accountability. Nevertheless, the transmission of good supervisors and, course, as readers will see when they read it is our view that group supervision can hence, good supervision across the profession the full papers, there are large areas of well prove to be the key element that will and its generations. overlap between the two papers, given the assist us most in carrying out our common subject of supervision. residential purpose and task, and in our For the full documents, see the NCERCC website professional development. at www.ncb.org.uk/ncercc and follow the links Indeed, our own position is clear in relation under Practice Documents. to this subject, and we summarise key points here. First, there are countless, and still proliferating, frameworks to ensure supervision happens. Most of them address the instrumental activity that is unquestionably a part of our professional task and for which any worker must be accountable. These sorts of supervision are well known, clearly needed and usually well covered in organisations, being amenable to satisfying external audit/scrutiny. Even here, the effective use of any such framework will require a clear understanding of the purposes of supervision beyond simply complying with regulation. At the same time, in residential work it has long been recognised that one of the most professional aspects of our work is our ever-more conscious use of ourselves as the most valuable resource available to help residents, particularly when young, to change and grow. In effect, the feeling of what happens does not simply lie at the heart of the matter; it is the heart of the matter. That being so, we contend that in residential work our experiences, and the impact upon us of those experiences, must be at the centre of supervision. Only then shall we be able to capture what will most help us to recognise and understand the expressive dimension of living together in a manner that we can utilise to inform our continuing interventions with residents, with colleagues and with ourselves. Second, the model of supervision must match the major mode of practice in any organisational setting. Thus, groups and groupings are key here; our task is to 12
  13. 13. National Centre For Excellence in Residential Child Care Conference Proceedings Issue 22 – Spring 2007 Setting up and sustaining therapeutic care — Lioncare Matt Vince, Director of the Lioncare Group, a private sector organisation based in Brighton and Hove We offer specialist residential care and Our practice was based on common sense demands of the newly appointed inspection education to children and young people and basic parenting skills, following the units, and difficulties in adapting their who have experienced abuse, neglect and guidance set out in the 1989 Children Act, practice to meet the needs of the more traumatic situations in their early life, and with a view to trying to accommodate challenging children now referred to them. who subsequently face difficulties in whoever we were asked to. coping with the emotional and practical Seafields faced a choice – continue as we pressures and demands of day-to-day So, why did we introduce a therapeutic were, hoping the change in the care system living. This article will seek to answer two model of care into Seafields? was a passing phase, or recognise that questions. Around 1993, the full effects of the 1989 something quite fundamental had changed, I Why do we follow a therapeutic Children Act began to be felt by Seafields. embrace this change, and begin a process of approach? The trend towards placing more children in transforming the services we provided, from I How do we do it? foster care, meant fewer referrals for sibling being a regular and basic children’s home, to groups who simply needed a nice place to becoming more specialised. The Lioncare Group began with the opening live. Instead, we seemed to be increasingly of Seafields Children’s Home in 1991. At that asked to look after children who displayed After several months of heated debate, time, there was no mention of therapeutic more severe challenging behaviour with discussion with our consultants, and having care, transferential relationships, or any histories of severe emotional neglect and seen more homes disappear, we decided to other complicated words to describe what trauma. begin transforming our service. we did. We didn’t call our practice therapeutic – we simply described ourselves At the same time, we watched as many The need to survive in the face of an as a home that provided care and children’s homes around the country closed increasingly hostile and selective business accommodation for children. after failing to keep pace with the changing environment gave us the motivation and energy we required to accept the need to change, review our tried-and-tested approach to caring for children, move out of our comfort zone and step into something altogether unfamiliar and new. Acknowledging the need to change was relatively simple. Agreeing on the direction we should take was harder. Our consultant provided us with a possible direction. He suggested considering adopting a psychodynamic approach to our practice, arguing that we already worked along similar principles but lacked the confidence and authority to call ourselves ‘therapeutic’. He felt it would not take much to introduce a fully functioning and workable model of psychodynamic care to Seafields. Since I already held a degree in psychology I was nominated to undertake training towards gaining a qualification in therapeutic child care. I registered for the Diploma in Theraputic Child Care at Reading University. This led to lively discussions amongst staff at Seafields as the information I was gaining was leading to suggestions for changes to long- established practices. My manager supported me and once she and my director gained an understanding of the benefits of working therapeutically, both attended therapeutic training themselves. The level of understanding of therapeutic practice improved within the home. However, the wider staff team was divided on the need for change. It was recognised that, in face of such resistance, if we were 13

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