Aims To introduce the Residential Support Programme model used in Liverpool To discuss some outcomes of the programme

Mental Health Difficulties & Looked After Children General childhood population 10% (NSF) Children who are looked after 45-60% Children who are looked after in residential care 96%, 25% major depressive disorders (McCann et al 1996) These difficulties are pervasive and enduring

Adverse Childhood Experiences Physical Abuse Sexual Abuse Emotional Abuse Neglect Separation/ Loss of a parent Parental Mental Health Problems Parental Criminality Parental Substance Misuse Domestic Violence Trauma and the effect of the brain, mind and sense of self Cumulative effect and interrelatedness Link to mental and physical health and social problems An ACE Score of at least 7 increased the likelihood of child/adolescent suicide attempts 51-fold and adult suicide attempts 30-fold

Residential Support Programme Containment  Recovery Containment interventions are primarily aimed at issues of emotional and behavioural regulation. This can range from promoting the capacity for self soothing and reducing traumagenic responses to developing an emotional vocabulary to the implementation of behavioural change strategies. This is both necessary and beneficial and requires a comprehensive and well articulated strategy. The majority of this work can be the responsibility of key workers and the wider staff group supported by the CAMHS LAC consultation process.

The Residential Support Programme Therapeutically driven residential placements 3 Local Authority Children’s Homes Working hard to change the narrative of what a Children’s Home is Creating an environment where young people can fulfil their potential A system which can effectively and appropriately meet their mental health needs.

RSP Principles A young person’s social, emotional and psychological functioning and the behaviours they exhibit can be understood in the context of their early childhood experiences and their life history Mental health as more than the absence of mental illness Social inclusion, achievement, quality of life, and developmental stage of the young person should be privileged Positive, safe relationships are key

The RSP Care Team Residential Management Team Key Workers Young People CAMHS LAC

Early ways we work together Joint assessment prior to reception Treatment areas identified Key worker gathers a more full history from the files Presenting issues are contextualized through consultation Cognitive/Psychometric assessment plus observational assessment on reception Treatment plan identified and agreed Exit plan identified (reunification, fostering, semi-independence)

Ongoing ways of working together Staff Consultation Individual and whole team Directed Keyworker modules Team Debriefing where appropriate Clinical Supervision for management team Staff Training Direct therapy for young people Self Harm Protocol

Is the RSP effective? Since 2003 there have been a number of changes New management team New staff team Partnership with CAMHS Referral & Assessment process Difficult to pin down the active ingredient but…

Children’s Home Experience RSP has raised the knowledge and skill base of Residential Workers RSP has promoted a different understanding of LAC needs & behaviours RSP enables Residential Workers to have a clear focus Less focussed on control of behaviour More focussed on understanding the feelings connected to the behaviours