Therapeutic residential care services in Australia

A description of current service characteristics
CFCA Paper No. 52 – August 2019

Discussion and conclusion

Discussion

This paper appears to be the first to provide a snapshot of current practice in Australian therapeutic residential care, providing new information that can be built on to further inform service development in the future.

Open-ended responses were particularly helpful, and incorporating and quantifying this valuable information will inform the development and enhance the utility of this reporting framework in the future. Many of the comments provided by participants mirror contemporary issues in the literature; namely the referral and matching of young people in therapeutic residential care; the need for augmented and specialised care models, including secure care, for young people with complex needs and high-risk behaviours; the need for services and staff that can support cultural and family connection; and, finally, the need to nurture and retain high-quality staff (Ainsworth & Hansen, 2018; Bath, 2017; McDonald & Millen, 2012; Whittaker et al., 2016).

Notwithstanding the methodological limitations of the survey, some key themes were identified. In relation to funding, block funding was the most common model, either alone or in combination with packaged funding. Block funding refers to contractual funding provided in advance for the placement of a predetermined number of young people. The common use of block funding for residential care has potential consequences for service providers. One inadvertent consequence of this is that services may feel pressured to fill placements; which, in turn, can impact the stability and wellbeing of young people already cared for by the service provider. On the other hand, this funding model provides services with the security needed to plan and staff services effectively. The strengths and limitations of this model of funding, relative to other possibilities, warrants further exploration.It is noteworthy that around one-fifth of services report providing therapeutic care without the corresponding funding. The implications of this for service effectiveness and outcomes also warrants further exploration.

Most commonly, residential care is provided in small metropolitan homes with up to four young people, although other configurations are also used. Further analysis of the strengths and limitations of these funding and service configurations could be a valuable focus of research efforts in the future.

Among therapeutic services, a range of strategies were used to support staff and reduce staff turnover. These are strategies that might be useful in other forms of service delivery for young people with complex needs where relationships may be challenging.

It appears therapeutic residential care is still used most commonly for children under longer-term guardianship, with some focus on care and containment and providing a home until age 18. While the most commonly stated aim of therapeutic residential care was recovery from relational trauma, there was also evidence that the recognition of pervasive developmental and mental health issues that require specialist targeted clinical supports is growing among service providers; suggesting the need to integrate evidence-based approaches to address these issues into 'mainstream' therapeutic residential care. In terms of therapeutic approaches, attachment-based models still influence therapeutic care but recognition of the need for evidence-informed principles and models also appears to be growing in this sector.

There appears to be some division of opinion around who is suited to therapeutic care, with some believing all children can benefit from skilled therapeutic care and others suggesting augmented models might be more appropriate for young people with certain complex behavioural or relational needs. This is an area that could benefit from focused and sustained research in order to develop a more sophisticated and nuanced service sector into the future. Common themes emerging from qualitative analysis include the need to improve referral and placement matching; the need to consider a wider range of specialist models including secure care under prescribed conditions; and the need to make systems, legislation and funding more 'child-centred' to support providers of therapeutic residential care services to be more flexible and responsive to young people's needs.

Conclusion

To date, there has not been much information available about how Australian therapeutic residential care services are configured and currently operating. To some extent, this has meant that the capacity to engage in meaningful comparisons between services has been limited. This study has contributed to our understanding of current Australian therapeutic residential care services and contemporary practice in this sector. The survey results indicate that therapeutic residential care is commonly still used for young people under longer-term care orders, provided in small (2-4 bed) community homes, although some other configurations were also evident. This form of service provision offers the advantage of a 'home-like' environment; but other models may be more suited to young people who need high levels of supervision and oversight, or who may be at increased vulnerability of exploitation in smaller, isolated environments. This is an issue that warrants further exploration.

The views of participants about the effectiveness of therapeutic residential care as it is currently configured were particularly valuable and offered considerable insight into how this form of service provision could further evolve and specialise. Taken together, this information constitutes useful baseline information that can be further built on; for example, to map changes in service design and practice over time, in step with developments and innovations in service provision, based on the recommendations provided by the experienced staff in this study.