Therapeutic residential care in Australia: Taking stock and looking forward
- Definition of therapeutic residential care
- Residential care in Australia and internationally
- The current state of therapeutic residential care in Australia
- Theoretical underpinnings of therapeutic residential care
- What does the research literature tell us about the effectiveness of residential care?
- What can practitioners and other experts tell us about what might work in residential care?
- What are the key elements of effective therapeutic residential care?
- The way forward
- Appendix 1
Following the move towards deinstitutionalisation in the second half of the last century, residential care was a mainstay placement option for children and young people who were unable to remain with their family due to protective concerns. More recently, however, it has become a last resort, used when other approaches, such as family support and/or foster care, have not been successful (Bath, 2009). Young people who display highly challenging and disruptive behaviours, such as those associated with conduct disorders, neuro-developmental problems and mental illness, are most often referred to residential care in order to avoid them harming themselves or others (Bath, 2009).
There is, however, an increasing understanding that these young people’s histories are often littered with experiences of abuse, neglect and multiple placement breakdowns, which can hinder their ability to build trusting relationships with others. Many of these young people show signs of complex trauma and post-traumatic stress disorder (van der Kolk, 2005), which contribute to their maladaptive behaviours and emotions. Consequently, there is a growing shift to move beyond a traditional residential model of daily care and accommodation to a needs-based model of care that addresses the challenges posed by these young people’s often compromised and complex developmental needs (Bath, 2009).
This growing interest in how best to offer a healing, therapeutic environment within the context of residential care led to a proposal to hold a national workshop, which was endorsed by the Community and Disability Services Ministers’ Advisory Council (CDSMAC) in late 2009. The National Therapeutic Residential Care Workshop was subsequently held in Melbourne in September 2010. The workshop brought practitioners and service providers together with researchers and government policy-makers. This paper draws on the proceedings of that workshop, Australian and international literature, and information about current models offered by jurisdictions within Australia to provide a picture of the increasing investment in therapeutic residential care and the key elements that characterise this model of care.