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Ncercc Confproceedings Spring2007
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. 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
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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
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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.
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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.
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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
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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)
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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
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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. 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
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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
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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
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