What works in Therapeutic Residential Care?

This blog was written by Edith Loch,
General Manager Client Outcomes,
MacKillop Family Services.

The latest in a series of blogs from the members of the newly formed National Therapeutic Residential Care Alliance, here Mackillop Family Services shares their insight into the key design elements of Therapeutic Residential Care homes.

MacKillop Family Services has recently been recognised for an award winning therapeutic residential care program – the recent 2018 Resi Rocks Awards auspiced by the Centre for Excellence in Child and Family Welfare in Victoria.  The  MacKillop TRC home received the Residential Team Award for “Making a Difference: Innovative Ways to Improve Outcomes for Young People”.

This residential care home in regional Victoria and its Equine Therapy Hub allows children and young people to benefit from the healing process of safe and creative relational experiences with horses. This long-standing team delivers therapeutic residential care in line with key essential design elements based on an evaluation of TRC pilots conducted by Verso Consulting between 2009 – 2011. This evaluation has provided a strong evidence base of the positive outcomes that are achieved through the implementation of the critical elements. The elements are outlined in Program Requirements for the delivery of Therapeutic Residential Care in Victoria (2016) They include:

• Therapeutic specialist attached to each unit
• Individual Therapeutic Treatment Plans developed by the Therapeutic Specialist
• Therapeutically trained staff and consistent staffing/rostering
• Higher staffing levels to allow flexibility and capacity to respond to need and outreach
• Effective engagement and participation of the young people including prior to entry
• Therapeutic assessments and appropriate client mix and matching
• Regular care team meetings
• Reflective practice (lead by the therapeutic specialist)
• Organisational congruence and commitment to therapeutic care involving the whole organisational approach to a therapeutic framework or organisational culture. Community service organisations that had a strong organisational congruence had higher levels of staff satisfaction and strong relationships with external stakeholders and government

The major finding of the evaluation was that TRC practice leads to better client outcomes; including significantly improved placement stability, increased healthy lifestyles, increased community connections and significantly improved sense of self.

Specialised and ongoing training is critical to the success of all TRC programs. As with all MacKillop TRC residential staff, the team are trained in the Sanctuary Model and Therapeutic Crisis Intervention in addition to receiving mandatory TRC training. The team use these frameworks to create a safe environment that provides a sense of safety, structure, acceptance and security for young people and staff. The team works hard to promote the rights of young people and act as effective role models.

A commitment to shared learning and development across all areas of therapeutic care is practiced. While the Equine Therapy course was initially undertaken by one carer, this knowledge has been disseminated to all staff as part of the three-year strategic plan for all carers to attain basic knowledge of Equine Therapy. The goal is to deliver the therapy to all young people.

A stable and supported staff team is a key element to create positive and meaningful relationships with young people. The staff are a long-standing team who work collaboratively together to intentionally and intuitively implement their training strategies. These strategies are utilised successfully with young people, with families during contact, and as part of the restorative aspect of healing with a carer following a critical incident.  Crisis co-regulation techniques are used to de-escalate heightened emotions of young people.  In all TRC homes, Therapeutic Practitioners support and guide staff in their day to day interactions with children, conduct assessments, develop therapeutic treatment plans, lead reflective practice sessions and support the congruence of the therapeutic approach.

A safe, supportive, home-like living environment is an important element in TRC homes. To deliver this, carers at the house have a strong focus on developing positive relationships with young people.  The Sanctuary Passport is a tool developed for young people to identify all of their ‘favourites’ (food, footy team, TV shows, etc.), which in turn, allow carers to develop relationships in common areas. This also provides carers with a base to develop conversation starters, for example, while cooking a favourite meal.

In addition, engagement in schooling is important to positive life outcomes for all children and young people. Young people are supported and assisted to attend school until they feel comfortable in this routine.  The development of independence in these day-to-day tasks demonstrates a sense of safety within their new living environment.

Community connections are important both for the TRC program as well as for the young people. The team ensures that the program and the young people are fully integrated in the local community and this was highlighted when they received assistance from local businesses when the property had to be evacuated due to encroaching bush fires. The young people were assured that the neighbours and emergency services would look out for the animals and a local hotel offered beds for the young people and staff.

The team work hard to foster opportunities for children and young people to build strong relationships and have positive interactions outside the home environment. For example, having visitors for dinner on a regular basis, including the Youth Resource Officers from Victoria Police, Child Protection Practitioners, Case Managers, and Therapeutic Practitioners.  By attending the evening meal, the staff and young people have developed a sense of safety with these professionals, as well as a strong culture of attending the evening meal at the table. Young people have been encouraged to share stories of their favourite meals with visitors, or even prepare favourite family desserts.  By discussing these family memories, young people are demonstrating feelings of safety and support from both carers, and Care Team members, which would only be possible in a nurturing living environment.

Planned transitions and allowing young people to have a voice in their care is an important element of successful therapeutic care. An example of this was when a young person who was transitioning into the house visited the residence before they moved in.  Upon entry, they were met with the smell of brownies baking in the oven, which were ready after a look around their new home and offered while sitting down and chatting.  During the transition period, the young person was encouraged to pick out their own décor and paint for their bedroom.  The young person was introduced to Equine Therapy as part of the transition process, and was shown how to care for the farm animals.

The maintenance of healing environments for children and young people placed in residential care requires a strong foundation of shared, skilled and relationship-based practice. The focus of the staff team on paying attention to the essential elements of the TRC while looking for innovative enhancements, such as the equine therapy program, highlights the relevance and utility of this model.