Report 58: Therapeutic approaches to social work in residential child care settings

Summary

Following a regional review of residential child care in 2007, the five health and social care (hsc) trusts in Northern Ireland introduced ‘therapeutic approaches’ in a number of children’s homes and in the regional secure units.

The term ‘therapeutic approaches’ is used in this report to mean ways to help staff understand:

• how trauma effects children and young people
• how and why their ways of coping with this trauma might be maladaptive
• how and why agencies and staff respond in the ways they do, how some of these ways are not adaptive, and how they might change.

These approaches can help residential child care staff use a therapeutic perspective in their day-to-day social work with children and young people.

Staff in Northern Ireland who are trained in a number of therapeutic approaches reported that this training had improved their practice, particularly in their relationships with young people and their consistent way of approaching this.

Staff reported that as therapeutic approaches did have some limitations – for example in dealing with physical aggression ­– meaning that other models such as Therapeutic Crisis Intervention (TCI) were still an important part of practice.

Young people in residential child care often noticed an improved ‘atmosphere’ and the use of fewer punishments to deal with poor behaviour, even if they did not notice that a new approach was being used.

Some factors that helped put these approaches into practice included training staff, offering follow-up supporting materials, and developing wider systems of working that support the approaches – for example careful planning when a young person is first admitted to a home.

Therapeutic approaches can complement specialist therapeutic interventions – such as trauma-focused and cognitive-behavioural therapy, counselling and so on – but do not replace them. These specialist services are a vital part of the support that looked-after children and young people should have access to.