An emerging paradigm – Welcome to our new therapeutic care blog

Mar 2019

Written by Janise Mitchell

Over the past two decades, the term therapeutic care has emerged as a new paradigm used to integrate constructs that had traditionally been considered separate – therapeutic processes and the care of young people, many of whom have experienced significant trauma and present with a range of complex needs and challenging behaviours. National and international research has long told the story about how difficult it has been for traditional approaches to residential care to effectively meet the needs of these young people.

The explosion of knowledge about the neurobiology of trauma and development has fuelled a much deeper understanding of what young people in out of home care need, especially in relation to reparative experiences for the direct threat that they have experienced arising from experiences of relational disruption and significant violation. It has confirmed what we have known for a long time. For as much as relationships are the vehicle through which such trauma is deeply embedded in the brains and bodies of young people, relationships are also the resources that help young people to heal.

 

 width=
Relationship is key; across the multiple contexts inhabited by young people

Therapeutic Care has focused our attention on how relationships come to work for young people in real time. They depend on relationships across the multiple contexts in which they inhabit. The impact of their experiences is so severe that they need multiple relationships to work for them, to help support the healing their brains and bodies are so desperate for. They need relationships to be sensitive to their needs in a consistent way across settings and over time.

This is the context in which the paradigm of Therapeutic Care has surfaced. It is a recognition that traumatised young people benefit from experiencing relationships around them which embrace therapeutic intent and hold therapeutic capacity. It means that for healing to occur, these day to day relationships of care need to be purposeful and oriented to being used as resources in transformation.

The NSW Government has set out a reform to once what referred to as residential care. It has reconceptualised it into an Intensive Therapeutic Care System. The vision for the system is for it to become evidence-informed, trauma responsive and promote stability and positive wellbeing outcomes for young people over the age of 12 with high and complex needs. It has introduced a number of elements which are explained in more detail here: NSW Intensive Therapeutic Care System.

It has also funded Australia’s first Centre for Excellence in Therapeutic Care which is run by the Australian Childhood Foundation in partnership with Southern Cross University. Its purpose is to

 

  • systematically build, synthesise and translate knowledge;
  • support the development of a collective understanding and capacity to enact therapeutic care across the ITC system and related sectors; and,
  • foster a shared ownership for the achievement of high-quality outcomes for young people.

The Therapeutic Care Blog is an initiative of the Centre in pursuit of its vision. For me, it is a place where practitioners, researchers, cultural experts and service leaders can come together to explore ideas and approaches for the provision of high-quality therapeutic care to young people not only in the NSW ITC system but wherever it is relevant to do so.

The field of Therapeutic Care continues to grow and evolve. This blog is an important place to share emerging ways of thinking as we come to learn more about what is helpful for young people who need our care and support. It’s a great place for you to share your work with colleagues as we generate thinking about the provision of Therapeutic Care in the Australian context.

I look forward to our collaboration in bringing the blog to life.

Janise Mitchell
Director, Centre for Excellence in Therapeutic Care

You may be interested in: Trauma-informed care

What is effective therapeutic care? Research brief
What is effective therapeutic care? Research brief
This research briefing is an introduction to therapeutic care as a preferred response for children and young people who have experienced complex trauma and are unable to live at home....
Read more
The evidence base for therapeutic group  care:  A systematic scoping review - Research brief
The evidence base for therapeutic group care: A systematic scoping review - Research brief
The NSW Government has undertaken major reforms over the past two years aimed at improving outcomes for children and young people in out-of-home care. Following a review by Verso Consulting...
Read more
The role of emotions in therapeutic care
The role of emotions in therapeutic care
The role of emotions within human service work may at first glance appear to be intuitively obvious and incontestable. Indeed, Howe (2008) described the day of a human service worker...
Read more
The needs of LGBTIQ young people in out-of-home care - Research brief
The needs of LGBTIQ young people in out-of-home care - Research brief
Young people who are same sex attracted, trans or gender diverse – a population who will be referred to in this document as LGBTIQ (lesbian, gay, bisexual, transgender, intersex and...
Read more
Safety from the outside to the inside
Safety from the outside to the inside
At the recent Therapeutic Specialist’s forum, there was lots of discussion about the concept of physical and relational safety in Intensive Therapeutic Care (ITC). We all agreed that it is...
Read more
Understanding and supporting young people who self-harm in residential care
Understanding and supporting young people who self-harm in residential care
Some of the young people we care for in the ITC programs deal with emotional distress and pain by hurting themselves physically. Young people hurting themselves is distressing to them...
Read more
The role of praise in working with young people
The role of praise in working with young people
We can see each of our daily interactions with each of the young people we care for as bids for connection.  By choosing to turn toward, to turn away, or...
Read more
The healing power of friendship
The healing power of friendship
Can the friendships and connections that can develop in Intensive Residential Care be nurtured and grown rather than feared? I would like you to take a moment to think back...
Read more
Preventing self-harm among young people in out-of-home care - Research brief
Preventing self-harm among young people in out-of-home care - Research brief
Many young people in out-of-home care are at an elevated risk of self-harm and suicidality. The reasons range from early exposure to abuse, disconnection from family, instability of their living...
Read more
The 10 essential elements of Intensive Therapeutic Care NSW - Practice guide
The 10 essential elements of Intensive Therapeutic Care NSW - Practice guide
This guide has been developed to describe the 10 Essential Elements that form the basis for Intensive Therapeutic Care (ITC) service provision in NSW. The 10 Essential Elements have been...
Read more
Vicarious trauma and secondary stress in therapeutic residential care - Research brief
Vicarious trauma and secondary stress in therapeutic residential care - Research brief
It is generally accepted that child welfare professionals are at high risk of experiencing vicarious trauma: the manifestation of traumatic symptoms resulting from working with individuals who, themselves, have encountered...
Read more
What works? Promising practices to support young people who self-harm
What works? Promising practices to support young people who self-harm
Why do young people in out of home care self-harm? What are the best predictors of suicide and self-harm? What really works when supporting young people who self-harm in out-of-home...
Read more
Q&A with Cate Keady from the Elver Program
Q&A with Cate Keady from the Elver Program
Since 2018, Cate Keady has worked within the Department of Communities and Justice to establish and manage the Intensive Support Services Elver Program - in partnership with South Western Sydney...
Read more
A story you may recognise
A story you may recognise
Peta had worked in residential care for 18 months. She took the position because she had had a difficult childhood and she felt that she had a lot to offer...
Read more
How do you prepare for the transitioning of young people into an Intensive Therapeutic Care house? Part 2
How do you prepare for the transitioning of young people into an Intensive Therapeutic Care house? Part 2
In the first part of the Blog, we explored limit and expectation setting, maintaining a state of occupancy and the planning process for a successful transition. In part two of...
Read more
How do you prepare for the transitioning of young people into an Intensive Therapeutic Care house? Part 1
How do you prepare for the transitioning of young people into an Intensive Therapeutic Care house? Part 1
This is a two-part blog and will focus on the transition of young people into an Intensive Therapeutic Care house; however, most of the content is transferrable to other placement...
Read more
Changing your practice to being trauma informed in therapeutic residential care
Changing your practice to being trauma informed in therapeutic residential care
Whilst the following Arabian proverb takes a bit to get your head around it leads rather nicely into this blog and our brief introduction on the relevance of the conscious...
Read more
Supporting children in out-of-home care to cope with ambiguous loss
Supporting children in out-of-home care to cope with ambiguous loss
When you think of grief and loss, what comes to your mind? You may think of the immense sorrow one may experience. For some of us, we can seek solace...
Read more
Trauma-informed care - Research brief
Trauma-informed care - Research brief
This research briefing aims to define and clarify what trauma, complex trauma and trauma informed care are. Extensive literature has now surmised that exposure to adverse experiences such as child...
Read more
Trauma-informed relationship based recovery reflection tool
Trauma-informed relationship based recovery reflection tool
“Childhood trauma has the potential to interrupt the normal physical, physiological, emotional, mental and intellectual development, of children and can have wide-ranging, and often life-long implications for their health and...
Read more
Secondary traumatic stress and staff well-being: understanding compassion fatigue, vicarious trauma and burnout in therapeutic care - Practice guide
Secondary traumatic stress and staff well-being: understanding compassion fatigue, vicarious trauma and burnout in therapeutic care - Practice guide
This guide has been developed to support organisational congruence and in the provision of trauma informed therapeutic care and the critical need for a well-supported, capable, and stable staff group...
Read more
Frequently asked questions by foster carers: Behaviours that challenge
Frequently asked questions by foster carers: Behaviours that challenge
In Australia, there are about 18 thousand children and young people in foster care. Most foster carers will be the first to tell you how rewarding it is – but...
Read more
12 ways foster and kinship carers can promote compassion and self-compassion in children and young people
12 ways foster and kinship carers can promote compassion and self-compassion in children and young people
What are Compassion and Self-Compassion?Compassion is the ability to feel and connect with the suffering of another human being, self-compassion is the ability to feel and connect with one’s own...
Read more
Trauma-sensitive family time is about connection and repair
Trauma-sensitive family time is about connection and repair
Relationships with family come with good times and challenges for everyone, but for children and young people in care, this birthright of family connection can often be deprioritised for the...
Read more
Trauma-informed care connects to children’s needs; trauma-informed carer training should connect to carers’ needs
Trauma-informed care connects to children’s needs; trauma-informed carer training should connect to carers’ needs
The CETC is thrilled to announce our new online course “Caring for Children and Young People with Trauma” is now live and free for all South Australian kinship and foster...
Read more
Can we provide trauma-informed care for children without changing our beliefs about their behaviour?
Can we provide trauma-informed care for children without changing our beliefs about their behaviour?
This blog article was written by Noel Macnamara, Executive Manager - Research and Policy and Deputy Director, Centre for Excellence in Therapeutic Care, CETC. There is a growing tendency to...
Read more
The role fear plays in the lives of children and young people in out-of-home care
The role fear plays in the lives of children and young people in out-of-home care
Fear is a fundamental human emotion triggered by a perceived threat. It serves as a basic survival mechanism that signals our bodies to respond to danger with a fight, flight,...
Read more
The effective and efficient approach to preventing placement breakdowns
The effective and efficient approach to preventing placement breakdowns
For children with complex trauma, the out-of-home care sector is more often reactive rather than proactive or preventative. Not many programs exist to provide significant early intervention support, as opposed...
Read more
Q&A with the trainer: Trauma-informed supervision
Q&A with the trainer: Trauma-informed supervision
Over the recent decades, we have seen leaps in research and practice promoting the importance of taking a holistic trauma-informed approach to caring for children and young people with trauma....
Read more
Q&A with the trainer: Behaviours that challenge
Q&A with the trainer: Behaviours that challenge
One of our most frequent requests at the CETC is for more training on how to respond to the behaviours of young people in out-of-home care that caregivers can find...
Read more
And the recommendations are… systemic reform towards providing therapeutic care, again
And the recommendations are… systemic reform towards providing therapeutic care, again
The Australian Institute of Family Studies recently released a report titled Improving the Safety and Wellbeing of Vulnerable Children: A Consolidation of Systemic Recommendations and Evidence. This report aims to...
Read more