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

2. 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

3. 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

4. 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.

5. 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.

6. 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

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

8. 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)

9. 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

10. 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…

14. 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