Therapeutic Residential Care for Children and Young People
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Therapeutic Residential Care for Children and Young People by the same author A Child’s Journey to Recovery Assessment and Planning with Traumatized Children Patrick Tomlinson and Terry Philpot Foreword by Mary Walsh ISBN 978 1 84310 330 1 Delivering Recovery series Therapeutic Approaches in Work with Traumatised Children and Young People Theory and Practice Patrick Tomlinson Foreword by Paul van Heeswyk ISBN 978 1 84310 187 1 Community, Culture and Change series of related interest Reaching the Vulnerable Child Therapy with Traumatized Children Janie Rymaszewska and Terry Philpot Foreword by Mary Walsh ISBN 978 1 84310 329 5 Delivering Recovery series Living Alongside a Child’s Recovery Therapeutic Parenting with Traumatized Children Billy Pughe and Terry Philpot Foreword by Mary Walsh ISBN 978 1 84310 328 8 Delivering Recovery series The Child’s Own Story Life Story Work with Traumatized Children Richard Rose and Terry Philpot Foreword by Mary Walsh ISBN 978 1 84310 287 8 Delivering Recovery series Just Care Restorative Justice Approaches to Working with Children in Public Care Belinda Hopkins Foreword by Jonathan Stanley ISBN 978 1 84310 981 5 Children and Adolescents in Trauma Creative Therapeutic Approaches Edited by Chris Nicholson, Michael Irwin and Kedar N. Dwivedi Foreword by Peter Wilson ISBN 978 1 84310 437 7 Community, Culture and Change series A Practical Guide to Caring for Children and Teenagers with Attachment Difficulties Chris Taylor ISBN 978 1 84905 081 4 Therapeutic Residential Care for Children and Young People An Attachment and Trauma-Informed Model for Practice Susan Barton, Rudy Gonzalez and Patrick Tomlinson Foreword by Brian Burdekin Jessica Kingsley Publishers London and Philadelphia Extracts from Hannon, Wood and Bazalgette 2010 are reproduced by permission of Louise Bazalgette, Demos. Figure 1 from Prilleltensky, Peirson and Nelson 2001 on p.23 is reproduced by permission of Isaac Prilleltensky. Figure 10.1 from Friedman 2005 on p.242 is reproduced by permission of Trafford Publishing. Figure A2.1 from Prilleltensky 2006 on p.260 is reproduced by permission of Isaac Prilletensky. First published in 2012 by Jessica Kingsley Publishers 116 Pentonville Road London N1 9JB, UK and 400 Market Street, Suite 400 Philadelphia, PA 19106, USA www.jkp.com Copyright © Lighthouse Foundation 2012 Foreword copyright © Brian Burdekin 2012 All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher. Warning: The doing of an unauthorized act in relation to a copyright work may result in both a civil claim for damages and criminal prosecution. Library of Congress Cataloging in Publication Data Barton, Susan, 1951- Therapeutic residential care for children and young people : an attachment and trauma-informed model for practice / Susan Barton, Rudy Gonzalez, and Patrick Tomlinson ; foreword by Brian Burdekin. p. ; cm. Includes bibliographical references and index. ISBN 978-1-84905-255-9 (alk. paper) 1. Child psychotherapy--Residential treatment. 2. Adolescent psychotherapy- -Residential treatment. I. Gonzalez, Rudy, 1973- II. Tomlinson, Patrick, 1962- III. Title. [DNLM: 1. Stress Disorders, Traumatic--therapy. 2. Adolescent. 3. Child Abuse--therapy. 4. Child. 5. Residential Facilities. WM 172.5] RJ504.5.B38 2012 618.92’89--dc23 2011017938 British Library Cataloguing in Publication Data A CIP catalogue record for this book is available from the British Library ISBN 978 1 84905 255 9 eISBN 978 0 85700 538 0 Dedication This book has been inspired by the love that we have for our own children and the children that we work with. Who constantly inspire us to lead from the heart. We hope that this book inspires the community to respond to every child in a way that fills them with a sense of love and belonging. Rudy To Patricia, Lucas, Thalia and Giselle for your love and support. To my parents for instilling in me the importance of family and community and a belief in the value of education. Susan To my beloved grandchildren Sienna, Tahnee, Maia, Isaiah, Asher, Ethan, Jedd, Yasmin, Anastasia, Eloise, Otelia and to my grandchildren yet to be born to our family. Good enough reasons to change the world. I am thankful knowing that you belong to such devoted and loving parents. I long for each moment with you. How blessed I am to have you all in my life. Remember to always lead from the heart. Patrick To my daughter and son, Patsy and Daniel. Contents Foreword by Brian Burdekin 11 ACKNOWLEDGEMENTS 13 AUTHORS’ NoTE 15 Introduction 17 What is child abuse and neglect? 23 The cost of abuse 26 The need for early intervention, treatment and prevention 28 CHAPTER 1. The Importance of a Theoretical Base 30 The relationship between theory and practice 31 Theory in the caring professions 33 Psychodynamic thinking 35 Psychodynamic concepts 36 The relationship between the organization and therapeutic task 41 The treatment approach 42 Attachment and trauma-informed theories 43 The influence of Winnicott on therapeutic residential care 44 Individual, family, community and societal wellness theory 45 Conclusion 47 CHAPTER 2. Trauma-Informed Practice 48 How traumatization develops in childhood 49 Trauma causes hyperarousal and fear in children 53 Childhood trauma reduces the brain’s capacity to think and regulate emotions 54 Trauma disconnects children from relational resources 57 Trauma restricts the attention capacity of children 58 Trauma-based behaviour has a functional purpose 58 Trauma restricts children’s ability to deal with change 59 Trauma undermines identity formation in children 59 Trauma affects social skills development and impacts on peer relationships 61 The impact of trauma on the child’s internal working model 61 Relationship and attachment difficulties 63 Physical wellbeing 63 The basics of trauma treatment 64 CHAPTER 3. Therapeutic Relationships 68 Beginnings 68 Information gathering and assessment 73 The intake process 74 Attachment 75 Secure base 79 Commitment 81 Continuity of care 82 Working with loss 84 Role modelling 87 Personal growth 87 Creating capacity for relationship building: one-to-one time with children 87 Unique needs 91 The importance of the relationship when challenging behaviour 92 Challenging behaviour as a sign of hope 92 The role of touch in the healing process 100 Consequences vs punishment 102 Promoting responsible children: empowerment processes 105 Participation of children and young people in the organization 107 CHAPTER 4. Demands and Rewards of the Work: Staff Support 111 Working with challenging and aggressive behaviour 112 Physical and emotional wellbeing 115 Working with anxiety 118 Communication challenges 120 Therapeutic supervision: working with feelings 122 Safety and containment 126 The impact of trauma work on our own memories and experiences of childhood 131 CHAPTER 5. The Home Environment 135 Home aesthetics 140 Encouraging play and curiosity 142 Privacy and security 144 CHAPTER 6. The Holding Environment and Daily Routines 147 Routines, limits and anchor points 149 Daily programme 151 Use of television and computers 152 Free time 153 The importance of food in the healing process 153 Bedtime and waking routines 161 Play 162 Celebrations as a sense of belonging 168 CHAPTER 7. The Organization and Community 170 The language of the organization 172 Trauma re-enactment and its impact on the organization 174 Management and the therapeutic task 176 The Lighthouse Foundation as an open system 180 Leadership 184 Authority 187 Managing change 188 The organization’s vision 191 Sense of community 193 Sense of family and home 194 Organization as family 197 Local community 198 Community committees as a containing membrane 199 Collective wellness 201 CHAPTER 8. Therapeutic Group Processes 202 ‘I feel like saying’ process 205 Shared history: culture passed on through stories 209 Strong culture 210 Child safety 211 Reflective practice 211 Emotional intelligence 213 Emotional wellness 213 Transparency and openness 214 Family meetings 214 Combined family meetings 221 Whole family meetings 221 Youth forums 221 Clinical supervision (relationship between carers) 222 Clinical peer supervision (carers’ meeting) 223 Mediation processes 224 CHAPTER 9. Moving On: Transitions, Aftercare and Outreach 226 Transition as separation experience 227 Life membership 229 Transitional planning and transitional objects 230 Transition celebrations 231 Stepping stones: transitional programmes 232 Assessing readiness for transition 233 Carer relationship beyond transition 234 Aftercare programme 235 Outreach 236 Children returning to work with the organization 238 CHAPTER 10. Outcomes-Based Practice 239 Outcomes-based approaches 241 The need for evidence 243 Measuring outcomes 245 Challenges in measuring outcomes 247 Potential benefits and value of developing an outcomes-based approach 250 APPENDIX 1: SUSAN’S STOry 253 APPENDIX 2: THE LIGHTHOUSE THERAPEUTIC FAMILY MODEL OF CARE 259 ABOUT THE AUTHORS 265 REFERENCES 267 SUBJECT INDEX 279 AUTHOR