Centre of Knowledge

The Model in Practice: Understanding the Lighthouse Therapeutic Family Model of Care™

Theoretical Underpinnings of TIP Attachment Theory Object Relations Theory Trauma Neurobiology Psychological Wellness Theory

The Lighthouse Experience

Overview of the Model Home PLACE Playful, Loving, Accepting, Caring, Empathetic Family Primary Experience Individualised Care Individual Development Plan Professional Development Plan Staff Developmentally Focussed Not Chronologically Time/Holding Space Therapeutic/ Recovery Oriented Sense of Community

Recovery Process PsychologistsCare TeamCarers Young Person

Intake ProcessPresenting Issues ReferralsIdentify Intake interviewConfusion/diffusion ConsultationMental health issues Psycho-social screeningDrug & alcohol issues Placement meetingsDisconnected Immediate gratification

Induction ProcessPresenting Issues Visit homesAttachment difficulties DinnersCold feet Family meetingsCulture shock Community eventsGuarded Meet carers and young people Debrief with intake worker and carer

Holding Environment ProcessPresenting Issues Primary experienceReactive attachment Attachment with carerTraumatic experiences surface Relationship buildingResistance to boundaries Trust, safety, stability and securitySubstance issues may resurface HomeMental health issues Develop confidence and self esteemFamily conflict Window to futureTransference and counter-transference

Transition to Autonomy/Independence ProcessPresenting Issues Coping skillsResistance to change/separation anxiety Skills developmentRegression Support networksCold feet Established healthy attachmentsInternal conflict Community networksGrief & loss Transitional objectExcitement vs. anxiety Transitional planning

After Care ProcessPresenting Issues Assertive outreachFinancial issues Transitional development planningAccommodation/housing Carer relationshipsMental health support Ongoing relationships with young personSeparation anxiety Inter-dependent livingCommunity support

The Recovery Process

Elements of Recovery Therapeutic Relationships Group Experience Physical Environment Sense of Community Organisational Culture

Therapeutic Relationships A central aim of the therapeutic relationship is to provide a safe relationship in which the child can then work through and integrate unresolved aspects of their traumatic experiences. From the position of being engaged in a positive attachment relationship and through observing other healthy relationships, the young person can then acquire experience and skills to develop and manage other relationships in their life. Barton, Gonzalez & Tomlinson (2012)

Therapeutic Relationships …evidence is accumulating that human beings of all ages are happiest and able to deploy their talents to best advantage when they are confident that, standing behind them, there are one or more trusted persons who will come to their aid should difficulties arise. The person trusted, also known as an attachment figure, can be considered as providing his or her companion with a secure base from which to operate. Bowlby in Barton, Gonzalez & Tomlinson (2012)

The Group Experience Traumatized young people need a healthy community to buffer the pain, distress and loss caused by their earlier trauma. What works to heal the young person is opportunities to increase the number and quality of relationships. If we don’t give children time to learn how to be with others, to connect, to deal with conflict and to negotiate complex social hierarchies, those areas of their brains will be underdeveloped. Perry and Szalavitz (2006)

The Group Experience The group processes provide an opportunity to observe group dynamics and where it is helpful to intervene in a way that disrupts destructive dynamics that may be developing For example, difficulties within the group may be projected onto one person who could then become a scapegoat for the group’s difficulties An opportunity for everyone involved to establish their sense of self by making their own unique contribution. For everyone to reflect on what is happening for themselves, for others and the whole group. This enables the members of the group to learn about their own feelings, thoughts and relationships and to consider this alongside other people’s experiences

Therapeutic Environment Traumatised people benefit from caring environments that are attuned to their emotional states. …where workers can adjust the environment to support emotional regulation, and can provide predictable responses and routines that assist in reducing hyper-arousal. (Tucci, Mitchell and Goddard, 2010)

Physical Environment Child abuse and trauma often happens within a wider context of neglect, where the environment the child lives in reflects the parent’s lack of attunement to their needs. The home is often uncared for, unstimulating, chaotic and sometimes unsafe. The environment is warm, friendly, nurturing, calming and aesthetically pleasing. It contains facilities that can support and enrich a child’s life. The home is a place for growth, development and a means of balancing the need for being sociable with privacy. It is a place where positive memories can be made and life- long relationships established. Most importantly, the home is a safe place and sanctuary. Barton, Gonzalez & Tomlinson (2011)

The Community Sense of community: The feeling that one is part of a readily available supportive and dependable structure. Sense of community transcends individualism in that to maintain such an interdependent relationship one does for others what one expects from others. Sarason (1974)

Sense of Community Ideally, children are raised by their family and extended family within the context of a supportive wider community. Many of the children that we work with have been alienated and disconnected from their local community. Many of the children’s lives are transient, due to running away from unsafe relationships, or being moved around by the system from placement to placement. Barton, Gonzalez & Tomlinson (2012)

Therapeutic Circle of Care

Organisational Culture Traumatized children cannot heal within traumatizing - or traumatized - organisations, and instead such organizations can make children’s problems worse. Bloom (2005)

Organisational Culture Organisational wide understanding child development and impact of trauma Consistent trauma informed approach incorporated across systems and processes Clarity as an organisation of the primary task Young people are provided a holding environment - feel safe & protected Opportunity to learn to deal with grief & loss in a healthy way Long term consistent and repetitive work

Organisational Culture Opportunity for the child to develop healthy attachment Promote the direct expression of feelings Systems that support staff to manage complex nature of the work Enhance motivation for growth and future success Provide opportunity for connections with wider community

Organisational Parenting Organisation Internalised by the child Operations/ relationships attuned to the therapeutic task Relationships, language, communication, leadership and authority = Environment experienced by child All staff role model a healthy sense of community Variety of relationships & circle of care Provides a therapeutic milieu The Organisation as Therapist

TFMC Process of Recovery Individual Development Plan Learning Physical development Emotional development Attachment Identity Social development Autonomy / life skills Relational and community Connectedness Fun / play / recreation Transition planning Psychological Healing Process Identity confusion Attachment difficulties Holding space Trauma work Dealing with loss and rejection Developing insight and awareness Building trust in relationships Internal working models Developing autonomy New skills consolidation Confidence in relationship building Lighthouse Process IntakeInductionLighthouse HomeTransitionAfter Care Time-frameWeeks / MonthsMonths / Years

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