Therapeutic Residential Care: Developing evidence based international practice LISA HOLMES, DIRECTOR, CENTRE FOR CHILD AND FAMILY RESEARCH

Workshop structure  Background and introduction  Definition of Therapeutic Residential Care (TRC)  Existing evidence base  Role and purpose of (TRC)  Key issues for consideration

Background  Co edited book  Whittaker, J., del Valle, J and Holmes, L. (2014) Therapeutic Residential Care: Developing evidence-based international practice, London: Jessica Kingsley Publishers

Background  Six themes  Pathways to TRC  Promising programme models and innovative practices  Preparation for successful transitions  Critical examination of existing research base  Exploration of the costs of TRC  Linking focused training and critical evaluation

Context  Two years to conceptualise and edit the book  Launched at the EUSARF conference in September 2014  Subsequent discussions with international groups (AACRC, IaOBER, EUSARF)  Follow up summit meeting  Conference symposiums

Context  UK context  Policy and practice  Cross-national comparisons  Residential sector discourse  Needs analysis and outcomes  Wider looked after system

Definition of TRC Therapeutic Residential Care involves the planful use of a purposefully constructed, multi- dimensional living environment designed to enhance or provide treatment, education, socialisation, support and protection to children and young people with identified mental health or behavioural needs in partnership with their families and in collaboration with a full spectrum of community-based formal and informal helping resources

Existing evidence base  Cross-national comparisons  Transferability of models  Variable use of residential care  Robust evaluation of existing models linked to needs and outcomes

Existing models and innovative practice - MultifunC  MultifunC (Multifunctional Treatment in Residential and Community Settings)  First units established in 2005 in Norway and Sweden  Subsequent units in Denmark  Up to eight young people across two sections  Targets high-risk young people with serious behaviour problems 9

Existing models and innovative practice - MultifunC  Standardised assessment instrument to assess level of risk  Plans for future care  Open rather than secure units but time away from the unit is monitored  Two part treatment process  Within the unit  After care 10

Existing models and innovative practice - MultifunC  Stages during the residential placement  Intake  Treatment  Transfer  Treatment divided into five levels  Development and reward system  Behavioural contracts 11

Existing models and innovative practice - MultifunC  Evaluation of MultifunC  Grounded in research  Principles and methods with young people with complex needs  Initial implementation studies in Norway and Sweden  Treatment effects with control group studies (Sweden 2014 and Norway 2015) 12

Existing models and innovative practice – The Family Home Program  The Family Home Program  Adaptation of the Teaching Family Model at Boys Town  Built on learning over past 100 years  Family style living 13

Existing models and innovative practice – The Family Home Program  Five model elements  Teaching skills  Building healthy relationships  Supporting religion and faith  Creating a positive family environment  Promoting self-determination 14

Existing models and innovative practice – The Family Home Program  Replication and implementation  Quality standards for residential care  Implementation strategies  Creation of a national database (child level data to monitor safety and progress)  Set of core components  Staff recruitment and selection  Pre-service and in-service training  Supervision and consultation  Evaluation and data support  Facilitative leadership 15

Existing models and innovative practice – The Family Home Program  Evidence base  Most described and researched model in the literature (California Clearinghouse for Child Welfare)  Series of outcome studies  Improvements in behaviours and mental health symptoms  Girls make greater gains  Relationship with family and family involvement  Response to criticisms of residential care and treatment  ‘peer contagion’ or deviancy training 16

TRC in the UK  Can TRC be viewed as an integral part of the care continuum?  Learning from cross-national studies  Internal and/or external evaluation  Child level data  Needs, services and costs, outcomes  Cost effectiveness? Across what time frame and budget? 17

Further information  Lisa Holmes   