Therapeutic residential care: An update on current issues in Australia
Therapeutic residential care in Australia
Therapeutic residential care is an out-of-home care (OOHC) service provision model for children and young people with complex needs. The model looks to respond to the complex effects of abuse, neglect and separation from family by actively facilitating healing and recovery. It offers care based on several guiding principles for: understanding and responding to young people's needs; adopting clear models of practice; and the recruiting and staffing of therapeutic residential care homes. These principles are detailed later in this paper.
There is currently no detailed information about what proportion of Australian residential-care homes deliver services according to the guiding principles of therapeutic residential care. At present, the closest information is the data on the use of residential care for children in OOHC collated by the Australian Institute of Health and Welfare (AIHW) each year in its annual report Child protection Australia (AIHW, 2018).
As of 30 June 2017, approximately one in 20 young people in OOHC were living in residential care in Australia (AIHW, 2018). This is generally consistent with other English-speaking countries, in which residential care is used for a relatively small proportion of young people in OOHC, when compared with mainland European countries (e.g. 54% in Germany; Hart, La Valle, & Holmes, 2015). In Australia, the vast majority of these children were aged 10 years or over (85%); with a median age of 14. Only 3% of children in residential care were aged five years or younger (AIHW, 2018). Anecdotally, residential care may be used to enable sibling groups to remain together when no other alternative is available (AIHW, 2018; McLean, 2015). Aboriginal young people remain over represented in residential care (AIHW, 2018).
Residential services vary widely across the world with respect to unit size and location, length of stay, level of restrictiveness, staffing configuration and treatment goals, populations, models and program rationale (Delfabbro, Osborn, & Barber, 2005; James, 2011; McLean, 2016). Internationally, residential programs are provided to young people with a range of diverse needs (e.g. mental health, youth justice and child welfare needs). In Australia, both 'standard' and 'therapeutic' residential care (Victorian Auditor-General's Office [VAGO], 2014) is used almost exclusively to service referrals for young people in the statutory child welfare system.
While the proportion of young people in residential care has remained relatively stable over the past decade; there has been a growth in the number of Australian services claiming to provide therapeutic residential care (National Therapeutic Residential Care Alliance, personal communication, 12 September 2017). These services will be described in a companion paper to this paper, which will present the results of a 2018 survey of existing Australian therapeutic residential care services (McLean, forthcoming).