Our Therapeutic Model
are we work in partnership with the Health and Wellbeing Clinic (HWBC) to offer the best possible environment and care for looked after children. We facilitate and embed ways of working that promote:
- Development of positive relationships
- Learning of key life skills
- Tolerance of structure and boundaries
- Achievement and aspirations
- Safety and independence in adulthood
A Skills Deficit Model:
SAD not BAD:
Skills-deficit And Distress not Behaviour problems And Deviance
Abusive, neglectful early experiences and poor attachment do far more damage than the obvious trauma of those experiences. Disrupted early attachment means that children FAIL TO LEARN key life skills such as the ability to be soothed, to cope with boundaries, to communicate, to make and maintain friends, to control behavioural impulses, to think in flexible ways, to problem solve and to manage emotions. At the same time, children will still be trying to get along in the world and trying to fix problems – in the absence of age appropriate and increasingly sophisticated skills to achieve this, they will fall back on regressed or unsophisticated means such as tantrums, violence, self harm, substance misuse and other behaviourally challenging and socially deviant strategies.
The primary assumption in our model is therefore, that young people who behave in risky, chaotic ways lack the skills to behave in different ways. They are SAD not BAD. A key aim of placements is to teach the necessary skills that children and young people are lacking.
A Relational Model:
Nurturing, safe Relationships 'PAVE the Way' to a better life
The primary vehicle for learning key life skills is via the relationship with your primary carers. Skilled carers
- Promote trust & security
- Are predictable in their responses
- Model appropriate behaviour
- Create a good environment for learning skills
- Teach skills explicitly
- Reward positive behaviour
- Correct unskilful behaviour consistently, proportionately and age appropriately
- Promote increasing autonomy and independence as the child grows up.
And they do all this in an atmosphere of unconditional acceptance and love.
Our model therefore aims to replicate the conditions that promote secure attachment and positive relationships as closely as possible, in spite of the extraordinary challenges young people in care can present.
We do this by Predictability, Availability, Validation, Empathy and always offering a Way back when things have gone wrong. (PAVE the WAY)
This approach is the foundation of the model. It paves the way for all the other skills to be learnt. If this is not achieved there is a limit to what a child or young person will learn.
A Therapeutic Risk Taking Model
Young People who CRASH need to learn to drive, not to have their car keys taken away.
For children and young people who are catastrophically destabilised by the combination of their vulnerability and life experiences, the biggest challenge is that they
a) Experience overwhelmingly distressing emotion
b) While lacking skills for tolerating or regulating this emotion
c) Or inhibiting or controlling the behavioural urges that go with the emotion.
As a result they tend to be highly avoidant (and thus difficult to engage therapeutically) while at the same time use desperate measures to avoid, evade or alter emotion.
These tactics are often dangerous to self and others: Creating chaos, Risk Taking, Aggression, Self Harm. (CRASH behaviours).
The behaviours are damaging to the young person in a multitude of ways. Young people experiencing life as a series of unrelenting crises, are unable to access appropriate education or work, make or maintain meaningful relationships, tolerate normal societal expectations or cope with their own feelings. They also crave acceptance & care and are highly vulnerable to exploitation. Their futures are bleak. The major risks to their future is of course premature death via suicide or reckless behaviours. However this is only 1 risk of many. They are also at risk of
- Unwanted pregnancy
- Exploitation and abuse
- Frequent Hospitalisation
- Unrelenting distress
We also know that once a young person leaves care, the amount of support they are able to access drops off rapidly. Adult mental health services are generally not well equipped to deal with the chronic risks associated with chronically dysfunctional adults. In the end, and usually very soon after turning 18, a person is – sometimes quite abruptly – given complete responsibility for their own safety.
So our model sees a therapeutic placement as a precious opportunity to teach young people how to manage risks and make good choices. We cannot teach risk management while insisting young people live in a largely risk free environment. We can only teach young people risk management by exposing them to risk and supporting them to learn better choices. They need to get it ‘wrong’ so we can explore the real-world consequences of this with them within a supportive relationship. Put simply an absconder needs to learn to choose to stay (or come back) with the doors unlocked. They need the freedom to make the wrong choices in order to learn how to make the right ones.
Our model accepts children lack skills to avoid ‘crashing’. We need to teach them to drive not hide the car keys.
A Team Approach
(Our Teams Teach, Engage, Attach and Model)
Within the model, every interaction with every member of staff is an opportunity to teach a skill, to engage a child via validation or empathy, to promote attachment via unconditional acceptance or to model the behaviours you want to see.
Formal individual therapy is offered but it is not the primary tool for effecting positive change.
Staff are seen as professionals who are fully involved in an overall therapeutic package.
All young people are assessed by a Consultant Clinical Psychologist. The psychological formulations arising from the assessment are shared with the team and embedded in individualised care plans. Therapy needs are assessed and therapy is offered where appropriate. Staff are supported via regular consultation slots with HWBC staff to maintain their ability to stay emotionally in tune with young people despite the challenges, and to structure the environment in ways that support growing skills.
Risks are carefully assessed and young people are given increasing freedom based on the balance of immediate risk to self/others versus long term risks of failing to teach self-control skills. Debriefs after incidents by key-workers are a key part of the package in helping young people make better choices.