Relational Safety and Placement Stability – Outcomes of the TrACK Program (Part 1)

This post is authored by By Noel Macnamara,
Executive Manager Policy and Research
at the Australian Childhood Foundation

Recently Southern Cross University completed an independent evaluation of one of our therapeutic foster care programs: Treatment and Care for Kids (TrACK). This program is for children and young people who have reached the end of the line in the foster care system. These children and young people have issues of individual co-morbidity and complex and challenging behaviours. They may display aggression, they are non-compliant, often excluded from school and have experienced multiple placement breakdowns. Consequently, many have been placed in residential care settings and considered inappropriate for a home-based (family) care placement.

In Australia, residential care is considered a placement of last resort for children and young people requiring Out of Home Care (OOHC) and is used in circumstances where other types of placement options are unsuccessful or unavailable.In 2017 there were 2,394 children in residential care in Australia, almost 5% of the total OOHC population (AIHW, 2017).

A recent report for the Royal Commission into Institutional Responses to Sexual Abuse (2016)  found that most young people in residential care felt that they were at risk of physical violence, sexual threats from their peers and from outsiders and on-going bullying and harassment. They also reported limited connection to trustworthy adults in their lives.

This lack of overall safety and the disconnection from safe and caring adults in the lives of these young people can be said to significantly contribute to the very poor post care outcomes that they experience: homelessness, mental health issues, involvement with the criminal justice system, early parenthood and the removal of their children by child protection authorities.

The outcomes of the TrACK evaluation for these same young people were very positive. The evaluation found that the children and young people had been provided with placement stability, reintroduced to education and their overall health and well-being had greatly improved. However, the most significant finding in the evaluation was that of the impact of relationship. Informed, safe and caring relationships offered these children and young people healing and recovery from the complex trauma they had experienced in early life and in past placements.

Our therapeutic programs combine an understanding of attachment, child development, trauma, systems theory and neurobiology. This enables us to provide a comprehensive approach to the care of children and young people that links mind, body and relationships. The overall aim of the program focuses on changing brain structure and function – rewiring the limbic system (the seat of all relationship bonds) – while at the same time focussing on the child and young person’s strengths and resources and fostering resilience. The carer-child relationship creates the fertile conditions for healing the damage created by toxic stress and supporting the growth of new neural pathways fundamental to wellness and mental health.

As Schore (2016) highlights the experiences someone has in a therapeutic relationship become encoded as implicit memory and a focus on this relationship can help transform negative implicit memories of relationships by creating a new encoding of a positive experience of attachment. This suggests that the therapeutic relationship may create or recreate the ability for a child or young person to bond or develop attachments in future relationships.

We often think of relationship as the means to deliver the treatment option rather than the treatment option itself. What this evaluation clearly showed was that the relationship formed between the child or young person and the carer was the essential ingredient in the changed trajectory for these children and young people.

The number of children and young people coming into care in Australia continues to grow (AIHW 2017) with no sign that this is likely to decrease in the next decade. How we care for the nation’s most vulnerable children and young people is a significant issue for debate.

However, for the Australian Childhood Foundation placing the carer-child relationship at the heart of practice means recognising that despite all the continuing upheavals in the child or young person’s life, caring [will] always begin and end with a human encounter between two or more people and that this encounter, or relationship as it develops, is the medium through which the growth and transformation can be carried out. Therapeutic care is never a neutral activity but can, at its best, offer vulnerable or distressed children and young people the experience of being understood, valued and supported – perhaps for the first time.

References

AIHW. (2017). Child Protection Australia 2014–15. Canberra: Australian Institute of Health and Welfare.

Moore, T., McArthur, M., Roche, S., Death, J., & Tilbury, C. (2016). Safe and sound: Exploring the safety of young people in residential care. Melbourne: Institute of Child Protection Studies, Australian Catholic University. Royal Commission into Institutional Responses to Child Sexual Abuse, Sydney.

Schore, A.N., (2016) The Science of The Art of Psychotherapy. W.W. Norton & Co