Therapeutic Residential Care for Children and Young People: An Attachment and Trauma-Informed Model for Practice

Therapeutic Residential Care for Children and Young People\n......Page 5
Contents\n......Page 9
Foreword......Page 13
Introduction......Page 19
What is child abuse and neglect?......Page 25
The cost of abuse......Page 28
The need for early intervention, treatment and prevention......Page 30
1. The Importance of a Theoretical Base......Page 32
The relationship between theory and practice......Page 33
Theory in the caring professions......Page 35
Psychodynamic thinking......Page 37
Psychodynamic concepts......Page 38
The relationship between the organization and therapeutic task......Page 43
The treatment approach......Page 44
Attachment and trauma-informed theories......Page 45
The influence of Winnicott on therapeutic residential care......Page 46
Individual, family, community and societal wellness theory......Page 47
Conclusion......Page 49
2. Trauma-Informed Practice......Page 50
How traumatization develops in childhood......Page 51
Trauma causes hyperarousal and fear in children......Page 55
Childhood trauma reduces the brain’s capacity to think and regulate emotions......Page 56
Trauma disconnects children from relational resources......Page 59
Trauma-based behaviour has a functional purpose......Page 60
Trauma undermines identity formation in children......Page 61
The impact of trauma on the child’s internal working model......Page 63
Physical wellbeing......Page 65
The basics of trauma treatment......Page 66
Beginnings......Page 70
Information gathering and assessment......Page 75
The intake process......Page 76
Attachment......Page 77
Secure base......Page 81
Commitment......Page 83
Continuity of care......Page 84
Working with loss......Page 86
Creating capacity for relationship building: one-to -one time with children......Page 89
Unique needs......Page 93
Challenging behaviour as a sign of hope......Page 94
The role of touch in the healing process......Page 102
Consequences vs punishment......Page 104
Promoting responsible children: empowerment processes......Page 107
Participation of children and young people in the organization......Page 109
4. Demands and Rewards of the Work......Page 113
Working with challenging and aggressive behaviour......Page 114
Physical and emotional wellbeing......Page 117
Working with anxiety......Page 120
Communication challenges......Page 122
Therapeutic supervision: working with feelings......Page 124
Safety and containment......Page 128
The impact of trauma work on our own memories and experiences of childhood......Page 133
5. The Home Environment......Page 137
Home aesthetics......Page 142
Encouraging play and curiosity......Page 144
Privacy and security......Page 146
6. The Holding Environment and Daily Routines......Page 149
Routines, limits and anchor points......Page 151
Daily programme......Page 153
Use of television and computers......Page 154
The importance of food in the healing process......Page 155
Bedtime and waking routines......Page 163
Play......Page 164
Celebrations as a sense of belonging......Page 170
7. The Organization and Community......Page 172
The language of the organization......Page 174
Trauma re-enactment and its impact on the organization......Page 176
Management and the therapeutic task......Page 178
The Lighthouse Foundation as an open system......Page 182
Leadership......Page 186
Authority......Page 189
Managing change......Page 190
The organization’s vision......Page 193
Sense of community......Page 195
Sense of family and home......Page 196
Organization as family......Page 199
Local community......Page 200
Community committees as a containing membrane......Page 201
Collective wellness......Page 203
8. Therapeutic Group Processes......Page 204
‘I feel like saying’ process......Page 207
Shared history: culture passed on through stories......Page 211
Strong culture......Page 212
Reflective practice......Page 213
Emotional wellness......Page 215
Family meetings......Page 216
Youth forums......Page 223
Clinical supervision (relationship between carers )......Page 224
Clinical peer supervision (carers’ meeting)......Page 225
Mediation processes......Page 226
9. Moving On......Page 228
Transition as separation experience......Page 229
Life membership......Page 231
Transitional planning and transitional objects......Page 232
Transition celebrations......Page 233
Stepping stones: transitional programmes......Page 234
Assessing readiness for transition......Page 235
Carer relationship beyond transition......Page 236
Aftercare programme......Page 237
Outreach......Page 238
Children returning to work with the organization......Page 240
10. Outcomes-Based Practice......Page 241
Outcomes-based approaches......Page 243
The need for evidence......Page 245
Measuring outcomes......Page 247
Challenges in measuring outcomes......Page 249
Potential benefits and value of developing an outcomes-based approach......Page 252
Appendix 1. Susan\'s Story\n......Page 255
Appendix 2. The Lighthouse Therapeutic Family Model of Care\n......Page 261
About the Authors\n......Page 267
References\n......Page 269
Subject Index\n......Page 281
Author Index\n......Page 287