Exploring the borders between residential child care and mental health treatment Eeva Timonen-Kallio, Turku University of Applied Sciences, Finland

STARTING POINT EUSARF 2014 Copenhagen Professionals who are working with children with complex and chronic needs have a great challenge to pose and share multi- professional objectives for care and to benefit the service system in the best interest of the child.

AIMS OF RESME PROJECT The main idea of the RESME project ( ) is to improve welfare and mental health of the children who lives in residential settings. In project we research the current system of residential child care and mental health services and practitioners’ professional competences. Research aims to identify the multi-professional work practices on the borderline between child care work and mental health treatment. The research results are used in designing and piloting the continuing educational course for practitioners in child welfare services. Developed education course aims to increase the multi-professional collaboration between professionals working on the borders of these systems, residential child care and mental health services. EUSARF 2014 Copenhagen

RESME empirical research Literature review: on the borders of mental health and child care systems Comparing mental health and child care systems in partners countries Collecting professional knowledge; experiences and perceptions generated in child protection and mental health care practice Analysing attitudes, mutual knowledge and cooperation practices between systems EUSARF 2014 Copenhagen

Professional identity and roles Mental Health system has clear role and function: –Counselling, assessment, diagnoses & treatment Residential Child Care system more ‘general’ role: –Unpredictable, spontaneous, flexible, demanding –Everyday life, home routines… totality of life –Become citizens, social integration… long-term objectives Difficult to define professional role in residential care –no commonly understood conceptual base Parents? Educators? Specialists? Rehabilitators? Differences in qualification in residential care Profession undervalued by society EUSARF 2014 Copenhagen

Methodology Country Participants Denmark5 interviews (8 participants) Finland 1+1 focus group, 3 mixed groups Germany15 interviews (19 participants) Lithuania5 interviews Scotland7 interviews Spain8 interviews and 1 focus group Total43 interviews and 6 focus groups = 63 interviewees EUSARF 2014 Copenhagen

Attitudes and expectations Asking miracles: –unanimous perception CHCARE workers ask for fast results –demands with lots of pressure and anxiety Lack of information: –No family background, medical history, child development… –Staff changes in visits or during care –Lack of information about changes Hospitalization as respite resource –Demanding psychiatric in-patient treatment, moving responsibility to MHEALHT staff –Lack of contacts and expectations of long hospitalisation MENTAL HEALTH VIEWS EUSARF 2014 Copenhagen

Attitudes and expectations No practical guidance: Lack of knowledge (children’s homes and staff role) Academic jargon: Minimum services (assessment and medication): Scarce feedback: Lack of interest in cooperation Passive attitude, waiting model CHILD CARE VIEWS EUSARF 2014 Copenhagen

Professional identity and new profiles Residential care and young people profiles –More traumatized, more emotional and behavioural problems Need for a more therapeutic model –Life space interventions –Therapeutic milieu –Facing severe behavioural problems –Continuous contact with mental health services Aware of residential workers need for training on mental health –High demand for intervening in areas of no expertise EUSARF 2014 Copenhagen

Perceptions about the own limits and difficulties Clear awareness of limits in mental health –Ratio, time, number of patients… Also in residential child care: –Ratios, stability, traumatised children… EUSARF 2014 Copenhagen

Good practices on cooperation Specific programs for children in care: –Spain: virtual therapy for children in care victims of maltreatment Some professionals as mediators: – Spain, Denmark, some professionals in charge of mediation between systems Close contact and support: –Germany: early detection visiting children’s homes All those professionals have a different perception on child care staff EUSARF 2014 Copenhagen

CONCLUSIONS Very similar attitudes in different countries Need for more contact and mutual knowledge Need for defining roles and tasks in residential care –Particularly about working with very demanding children –“the main tool to do our job is ourselves” Need for value and respect for residential workers –Related to need for qualification in some countries Need for training on mental health issues for CHCARE staff Need for training on child care issues for MHEALTH staff Need for knowledge on the other side’s limits!! Need for shared on-a-job training and forums for discussion EUSARF 2014 Copenhagen

CONCLUSIONS Results support the aims of the RESME project Final product is a training course and manual for multiprofessional training EUSARF 2014 Copenhagen

Questions for training course …. How to incorporate both side’s competencies and expertise for better collaboration? How to promote ’social’ expertice in collaboration with mental health care …  communities, activities, togetherness, normality, inclusion, everyday life… with special children What are ’educational’/pedagogical interventions, models, objectives in practice in everyday life in residential care? EUSARF 2014 Copenhagen

EUSARF 2014 Copenhagen Thank you for your attention!