Mum and girl

Can we provide trauma-informed care for children without changing our beliefs about their behaviour?

Jun 2023

Written by Noel Macnamara

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 view trauma-informed care for children in out-of-home care as a form of behavioural intervention. However, this approach undermines the true essence of trauma-informed care, which involves genuinely seeing children beyond their behaviours to address their unique care needs. When we solely focus on behavioural change, we disregard the individual identities and experiences of children who may exhibit behaviours that carers find challenging.

To embrace a trauma-informed approach to caring for children and young people who have experienced adverse childhood events, we need to shift our focus. A care approach that focuses solely on behavioural change fails to acknowledge that individuals with diverse behaviours have their own distinct experiences and ways of navigating the world. It is essential to prioritise seeing these children’s core authenticity and embracing their uniqueness.

In Western culture, there is a predominantly left-brain approach to conceptualising care. The left and right hemispheres of the brain each specialise in different types of behaviour and thinking.

The left brain tends to categorise things as “good or bad” and “right or wrong”. This mode of processing objectifies and limits our ability to genuinely see and connect to others. Our cultural conditioning in providing care often leads us to perceive behaviours of children in our care as a reflection of our own goodness. However, this belief can be detrimental and ultimately dehumanising in the context of the caregiver-child relationship.

Therapeutic parenting, also known as trauma-informed care, is more a right-brain-to-right-brain approach that is attachment-based and emotion-focused. Its aim is to understand and remediate the developmental harms of early adversity on the capacity for post-traumatic growth. This approach promotes resilience and healing to activate and rewire the early unconscious patterns established in the right hemisphere of the child’s brain.

Relational trauma necessitates relational repair.

It is deeply ingrained in our society that good caregiving is synonymous with controlling children’s behaviour. Family, friends, neighbours, schools, and professionals perpetually reinforce the idea that good carers have well-behaved children. When children’s behaviours deviate from these expectations, carers often feel embarrassed, and increasingly doubt their skills and aptitude for providing quality care.

This emphasis on control is dangerous for the care relationship. Power struggles and battles for control undermine the true healing that comes with bonding and attachment through daily care. Children who do not feel a sense of ease and safety with their carers may perceive consequences and punishments as threats to their relationship and identity, triggering a fight/flight/freeze response. In such states, their brains prioritise detecting danger rather than rational thinking, making it difficult for them to reason or consider future consequences – the very essence of traditional behaviour modification techniques.

Caring with a trauma-informed approach means exploring complex emotions to nurture a child’s authentic self, helping them recognise the good person they truly are, through providing experiences of co-regulation, connection, and felt safety. This approach helps children develop a positive sense of self and improves their capacity to cope with stressful situations, regulate emotional arousal, overcome fears, accept disappointments, and tolerate frustrations. While the end result is often an increase in children’s cooperative behaviour, this is only a side-effect of their improved emotional security in their relationships, environments, and self.

Although our care can influence children’s behaviour, we must recognise that the goal is not to control. Instead, our focus should centre on creating an enriched relational environment that supports self-regulation, connection, and multi-layered safety. We can assist children to be open to learning new things and accept strengths-based guidance. This approach requires carers to work on themselves, actively engaging in reflective self-awareness and self-compassion. Carers must recognise their own “window of tolerance” for emotional arousal while being supported compassionately by the team around them.

Trauma-informed care requires us to move beyond the concept of behaviour modification to see children and young people for who they truly are. Our approach must focus on authentic emotional connection and support regulation and safety. By understanding the multifaceted nature of trauma and embracing the unique experiences and identities of our children, we can create a more compassionate and nurturing environment for both ourselves and the children in our care.

You may be interested in: Behaviours that challenge Therapeutic care Trauma-informed care

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
Creating positive social climates and home-like environments in therapeutic care - Practice guide
Creating positive social climates and home-like environments in therapeutic care - Practice guide
This guide has been developed to support the implementation of Essential Element: Physical Environments from the Ten Essential Elements of Therapeutic Care. It explores how to create therapeutic care contexts...
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 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
Making sense of complex and challenging behaviours
Making sense of complex and challenging behaviours
An inability to understand trauma-based behaviours often sees young people 'labelled' in ways that can create a 'spiral of negativity'. A trauma-informed approach orients us to be curious about what...
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
Exploring the meaning that lies beneath young people’s behaviour and supporting change - Practice tool
Exploring the meaning that lies beneath young people’s behaviour and supporting change - Practice tool
This resource has been developed to support professionals to unpack and plan how to respond to identified behaviours that are concerning, challenging and disruptive for young people in their search...
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
Behaviours that challenge: What has happened to you?
Behaviours that challenge: What has happened to you?
Children and young people living in Therapeutic Residential Care in Australia often present with a range of behaviours that challenge us. The complexity and difficulty in working with these challenging...
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
Applying polyvagal theory to relationship-based therapeutic care - Practice tool
Applying polyvagal theory to relationship-based therapeutic care - Practice tool
Relationship-based practice is at the core of effective therapeutic care. Key to understanding how to build effective relationships with young people who have experienced trauma is to understand how the...
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
Book review: What happened to you? Conversations on trauma, resilience and recovery by Dr Perry and Oprah Winfrey
Book review: What happened to you? Conversations on trauma, resilience and recovery by Dr Perry and Oprah Winfrey
Dr Perry and Oprah Winfrey recently released What Happened to You? Conversations on Trauma, Resilience and Recovery. The book tells the story of how adverse childhood experiences cause deep emotional...
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
Responding to behaviours that challenge - practice guide
Responding to behaviours that challenge - practice guide
Much has been written about understanding and managing the challenging pain-based behaviours of children and young people who have experienced trauma and live in therapeutic or out of home care....
Read more
Creating a balance between empowerment and limit setting in therapeutic care - Practice guide
Creating a balance between empowerment and limit setting in therapeutic care - Practice guide
This guide has been developed to support Therapeutic Care carers and staff to navigate the critical balance between empowering children and young people and setting limits. One of the most...
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
What Was I Thinking? Handling the Amygdala Hijack
What Was I Thinking? Handling the Amygdala Hijack
Remember that time when you put the child you care for back to bed for the fourth time? Your thoughts suggested a level of desperation and wishful thinking, hoping that...
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
Fight, flight, freeze, and fibbing: Lying as a trauma-based behaviour
Fight, flight, freeze, and fibbing: Lying as a trauma-based behaviour
In almost every session I have run for foster and kinship carers, someone tells a story about a child or young person in their care who regularly lies. I can feel...
Read more
New years' resolutions and other goals for teens in care
New years' resolutions and other goals for teens in care
When I was a teen in care, I found the (well-intentioned) focus on my progress from case workers and other adults exhausting. If I tried hard, I made “progress”, but...
Read more
Living with the Fast and the Furious
Living with the Fast and the Furious
You have opened your homes and your hearts to children who are unable to live with their parents. You want to help them access a better life. To feel safe,...
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
How are restrictive practices interpreted in therapeutic residential care?
How are restrictive practices interpreted in therapeutic residential care?
This blog article was written by Glenys Bristow,  Senior Specialist, Therapeutic Residential Care, CETC. Restrictive practice in therapeutic care The Royal Commision into Violence, Abuse and Exploitation of People with...
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
Hard vs soft skills: which are more important in residential care work?
Hard vs soft skills: which are more important in residential care work?
Not everyone is suited to being a therapeutic residential worker. Working in therapeutic care requires special skills and qualities, some that can be taught or mentored, and others that are...
Read more
Untangling the challenges of FASD and trauma
Untangling the challenges of FASD and trauma
In honour of FASD Awareness Month this September, the CETC brought together esteemed thought leaders Dr Julia Shekleton, Prue Walker, and Noel Macnamara to delve into the complex intersection between...
Read more
The most difficult thing about residential care work
The most difficult thing about residential care work
The most difficult aspect of working in residential care is not managing the behavioural challenges of the children and young people, the demanding shifts, or the lack of resources. Rather,...
Read more
Research Update: Understanding Relationships in Therapeutic Residential Care
Research Update: Understanding Relationships in Therapeutic Residential Care
The Centre for Excellence in Therapeutic Care (CETC) is engaged in ongoing research to understand how positive, trusting relationships and social connections can be fostered for young people in Therapeutic...
Read more
Meet the CareSouth team
Meet the CareSouth team
CareSouth was recently awarded the Outstanding Therapeutic Residential Care Team Award at Youth Action NSW's Youth Work Awards. The CETC proposed the new Outstanding Therapeutic Residential Care Team award category...
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