And the recommendations are… systemic reform towards providing therapeutic care, again

Jul 2024

Written by Dan Howell

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 bring a national focus on reforms to child protection and youth justice, summarising recommendations from 61 reports and inquiries between 2010 and 2022.

The report highlights consistent themes that have emerged over the years to inform effective support systems, and the common thread within these themes was the importance of holistic therapeutic care for children and young people.

 

The need for holistic therapeutic care across all care settings

The systems of care and protection for children and young people need significant reform and investment. With varying state-based responsibilities and political priorities, successful strategies in one are rarely adopted in others, leading to repetitive inquiries and new, untested reforms.

The Centre for Excellence in Therapeutic Care has long advocated for therapeutic care to be at the heart of all care placements, including kinship, foster, residential, and custodial care settings. In the report, over 50% of recommendations focus on supporting children already in the system, emphasising the need for therapeutic and holistic care approaches.

A wealth of evidence has long established links between childhood trauma and contact with the youth justice system, as well as trauma’s significant impact on young people’s development, leading to behaviours that challenge resulting from past adaptive strategies.

 

What is holistic therapeutic care?

Children and young people in custodial settings often have similar traumatic experiences to those in out-of-home care, and similarly need holistic therapeutic care approaches. Developing such a care approach requires a huge perspective shift in how we view “intervention”, away from punitive reactive approaches, towards a supportive culture of rehabilitation and healing.

Tucci, Mitchell, and Tronick (2020, p. 28) describe therapeutic care as a deep understanding of children’s stories and supportive relationships:

 

They go on to cite Mitchell, Tucci, and Macnamara’s key elements of therapeutic care for children and young people:

 

  • Therapeutic care recognises that trauma related to abuse and violence has a differential impact on each child and young person, leading to a unique configuration of impact and downstream consequences;
  • Therapeutic care practice privileges children’s needs as the basis of all of its decisions;
  • Therapeutic care understands that children’s behaviour communicates the efforts made by their internal systems to protect them from the traumatic experiences of violation;
  • Therapeutic care adopts a lifespan approach to planning for children and young people as they grow and change;
  • Therapeutic care honours the strengths of cultural heritage as resources for children and their relationship networks;
  • Therapeutic care adopts the view that children’s experiences of deep visceral safety is both an outcome and a form of intervention;
  • Therapeutic care is active in ensuring that children and young people who have experienced abuse and neglect are not further disempowered by the way practice is implemented;
  • Therapeutic care fosters the authentic participation of children and young people in decision-making processes that are about them;
  • Therapeutic care empowers relationships to be therapeutic;
  • Therapeutic care conceptualises the physical and sensory environments that children inhabit as therapeutic;
  • Therapeutic care expands the role of therapists to become relational brokers, network enablers and system advocates for children in out-of-home care;
  • Therapeutic care is resourced by coordinated collective decision-making that serves the needs and interests of children.

 

Enabling carers and care professionals to be part of the solution

In acknowledging this urgent need for reform, the report highlights the need to train workers in relational and strengths-based practice, to adopt and apply the perspective shift needed of holistic therapeutic care.

The CETC has worked hard to develop a tailored Certificate IV in Youth Justice (CHC40521) that has received overwhelmingly positive feedback. This training uses storytelling and reflective practice to help youth justice workers focus on understanding how trauma shapes the needs of young people, to build their capacity to respond with holistic and therapeutic care.

 

 

You can read the full AIFS report available for download.

To join the conversation on current advances to systemic change, register for our upcoming panel discussion on enhancing trauma-informed care in youth detention.

For further details on our accredited training offerings, click here.

 

References

Mitchell, J., Tucci, J., & Macnamara, N. (2020). What are the key elements of therapeutic care? In J. Mitchell, J. Tucci & E. Tronick (Eds.), The Handbook of Therapeutic Care for Children: Evidence-Informed Approaches to Working with Traumatized Children and Adolescents in Foster, Kinship and Adoptive Care (pp. 35-57). Jessica Kingsley Publishers.

 

 

 

 

 

You may be interested in: Care system Trauma-informed care

What are the 10 essential elements of the Intensive Therapeutic Care System in NSW?
What are the 10 essential elements of the Intensive Therapeutic Care System in NSW?
Concepts of ‘complexity’ and ‘evidence’ are often heard in discussions that seek to find ways to better meet the needs of traumatised young people requiring more intensive forms of care....
Read more
An emerging paradigm - Welcome to our new therapeutic care blog
An emerging paradigm - Welcome to our new therapeutic care blog
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...
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
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 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 and opportunities for change. By choosing to turn toward,...
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
Client mix and matching in intensive therapeutic care
Client mix and matching in intensive therapeutic care
Young people living in residential care are highly vulnerable and have commonly experienced a significant level of trauma and abuse. They often present with complex needs and a range of...
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
Pulse check survey
Pulse check survey
The ITC Pulse Check Survey and Outcome Report provides a point-in-time reflection on the experiences of the reform process by ITC agency staff. To this end, the survey results clearly...
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
‘Drop and run’ - the experience of kinship carers in the Australian child protection system
‘Drop and run’ - the experience of kinship carers in the Australian child protection system
Recent research was conducted by the Southern Cross University and the Centre for Excellence in Therapeutic Care (McPherson, Gatwiri, Day, Parmenter, Mitchell & Macnamara, 2022) into the experience of kinship...
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
‘There was no support’: Getting kinship care support right
‘There was no support’: Getting kinship care support right
We did not and am still not receiving support requested or needed. Case managers or staff change without us being informed. Phone messages left at their offices and drop in...
Read more
Trauma, loss and parenting – care leavers’ experiences of having their own children during transitions from care
Trauma, loss and parenting – care leavers’ experiences of having their own children during transitions from care
This post is written by Jade Purtell, a multidisciplinary researcher and practitioner focused on out-of-home care and transitions from care experiences and policy. This research is funded by an Australian Government...
Read more
Extending care support past age 18 to 21
Extending care support past age 18 to 21
How old were you when you moved out of home for the first time? Did you continue to get support from home, perhaps for an emergency loan, help to file...
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
Agenda for Change: Ensuring a safe and supportive out-of-home care system for children and young people in New South Wales
Agenda for Change: Ensuring a safe and supportive out-of-home care system for children and young people in New South Wales
A system in crisis: A call for transformation The out-of-home care system in New South Wales (NSW) should be a safe haven for children, young people and families. It is...
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
Submission to the NSW Advocate for Children and Young People: Special Inquiry: Children and Young People in Alternative Care Arrangements (ACAs)
Submission to the NSW Advocate for Children and Young People: Special Inquiry: Children and Young People in Alternative Care Arrangements (ACAs)
Alternative Care Arrangements are the symptom of a care system in crisis ACAs have no place in a modern trauma-informed and child-centred out-of-home care system. The retention of foster carers...
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
When systems designed to protect do harm
When systems designed to protect do harm
What comes to mind when you think about the child protection or youth justice system?  Protection and safeguarding? Rehabilitation? Trauma-informed care? These two complex and often interacting systems are intended...
Read more
Trauma-informed... youth detention? The realities of reform
Trauma-informed... youth detention? The realities of reform
Last week, CETC facilitated an insightful panel about trauma-informed care and young people in youth detention. CETC welcomed Joanne O’Connor, Associate Professor Tim Moore and Murray Robinson to share their...
Read more
The overlooked crisis of FASD hiding in youth justice and out-of-home care
The overlooked crisis of FASD hiding in youth justice and out-of-home care
In Australia, children and young people with Fetal Alcohol Spectrum Disorder (FASD) in out-of-home care are at critically greater risk of getting involved with the youth justice system. The issues...
Read more
A Traumatised Organisation: The system as a client
A Traumatised Organisation: The system as a client
The concept of organisations as living systems is not new. Extensive work, particularly in the area of systems thinking, has brought this perspective into the limelight.Out-of-home care (OOHC) organisations are...
Read more