Therapeutic residential care services in Australia

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

Introduction

Therapeutic residential care is a relatively recent development in out-of-home care service provision for young people who are unable to be placed in family-based care for a range of reasons. International research suggests that therapeutic residential care can be a positive and effective choice for some young people; and our knowledge about 'what works' in residential care continues to grow (see McLean, 2018).

Despite this, much of what occurs within residential care services remains a 'black box'; meaning the processes and activities of residential services are not transparent or well understood (Axford, Little, Morpeth, & Weyts, 2005; Harder & Knorth, 2015). This research was commissioned by the CFCA information exchange at the Australian Institue of Family Studies in order to better understand what service characteristics and activities currently exist in therapeutic residential care services in Australia; in order to contribute to the further development of this form of service for young people in care.

In particular, more detailed information is needed about: how residential care services are configured and funded; who they provide care for; and what activities they undertake, in order to assist funding bodies and service providers in planning and meaningful decision making regarding service delivery. This will provide a foundation for a more nuanced understanding of residential care services; and, ultimately, build capacity for the commissioning and evaluation of services based on the sound knowledge of service elements and therapeutic activities involved.

In recognition of this need, Lee and Barth (2011) argued for the adoption of a standard reporting framework that could facilitate meaningful comparison between residential care services, and help develop a shared understanding of the effective components of residential care over time. They proposed a set of reporting criteria that could be used to more clearly describe the staffing, program and therapeutic elements of residential care programs; thereby enabling us to see inside the 'black box' of residential care. While this reporting framework was based on international models of residential care, it does offer a foundation for adopting a similar structured approach to documenting Australian residential care services. Accordingly, this paper reports on the application of a reporting framework, adapted from the reporting standards of Lee and Barth (2011), to describe the configuration of Australian therapeutic residential care services.

The current research is intended as a companion to a related paper previously published by this author: Therapeutic residential care: An update on current issues in Australia (McLean, 2018). The previous paper (McLean, 2018) provided an overview of the developments in therapeutic residential care service provision since it was first recognised as an emerging form of service delivery (see also McLean, Price-Robertson, & Robinson, 2011; for a description of the history of therapeutic residential care in Australia).

The purpose of this paper is to provide a snapshot of current practice in Australian therapeutic residential care. It uses a reporting standards framework to capture emerging evidence about the key characteristics of Australian therapeutic residential care. Accordingly, this paper reports the results of an online survey of Australian services, adapted from the reporting standards originally proposed by Lee and Barth (2011). Four main areas will be explored in this paper:

  1. the service and staffing characteristics of therapeutic residential care
  2. the care needs of young people being supported
  3. the therapeutic frameworks, models and activities that inform therapeutic residential care
  4. participants' views about the key issues to consider to inform future developments in this sector.

The methodology for this paper is detailed in Appendix A.