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A System of Care

Constructing Congruent Models of Therapeutic Residential Care: A Systematic Approach Dr. James Anglin School of Child and Youth Care University of Victoria, Canada. A System of Care.

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A System of Care

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  1. Constructing Congruent Models of Therapeutic Residential Care: A Systematic ApproachDr. James AnglinSchool of Child and Youth CareUniversity of Victoria, Canada

  2. A System of Care • An organized and seamless network of services and functions within a community, based on a set of practice principles and goals

  3. System of Care and the Strength/Needs Based Approach represents: Moving From:Moving To: • Seeing families as the problem-> Seeing families as allies and part of the solution • Focus on deficits of parents-> Focus on needs of the children • Plugging families into existing services-> Crafting, individualizing and tailoring services around specific needs • Expert model-> Collaborative model (examples from State of Oregon web-site)

  4. Functions include: Assessment and intake (initial screening, risk assessment, intake, plan of care, etc.) Residential resources (see next slide) Non-residential resources (parent/family support, counseling, recreation, education, etc. Aftercare (see non-residential resources)

  5. Residential services might include: (Foster Homes) Assessment Homes (up to 90 days) Short term shelters (1-5 nights) Longer term homes (up to 2 years) Mental health treatment centre Correctional homes & detention centres Psychiatric unit in hospital Outdoor/adventure programs Specialized homes (detox; pregnant teens; sexually “acting out”; etc.)

  6. Residential care as the tip of the iceberg

  7. Some findings from residential care study a) It is vitally important for homes to have a clear and articulated statement of purpose and that this purpose is understood and respected when placements are being negotiated and made.

  8. b) Each home will have its own philosophy of care and treatment, and this care model is embodied in the leadership of the home (i.e. Board members, Home Director, Managers, Supervisors) c) The actions and understandings of the young residents will reflect the embodied philosophy of care

  9. d)The supervisor of the careworkers has a very significant influence over the care and treatment received by the young residents e) Effective supervision is “supportively challenging”, and finds a balance between these two activities/functions

  10. The state shall ensure competent supervision of personnel of institutions directly responsible for the care of children. (UNCRC, Article 12)

  11. Creating therapeutic care environments

  12. First of all, patience and understanding…

  13. What do we mean by therapeutic care? • In the context of residential care, to be therapeutic is to promote developmental growth and methodically ameliorate problems or psycho-emotional traumas

  14. Example of the flow of congruence in a care model- Yellowdale Learning Centre Manager: “We help kids to use their own controls. We use structure and environmentmanagement: arranged chaos…I am not one for consequences based just on behaviours. I want to know what is creating this behaviour. I want kids to learn and manage what is going on. It is harder than grounding or taking away privileges.

  15. Manager (cont’d.) It is more work to work things through… The talking we do here is quite surprising to the kids; they are not used to that. In my thinking and my work, I do a lot of reading and research…We need to work together to learn about the kids, and they need to learn about us. Explanation is important … I did not want to be another institution, or house. I want to be seen as a learning opportunity.

  16. Careworkers: “Well, when something arises, and we say ‘No, we’re not going to’, ‘We can’t go and do that’, we tell them why we can’t do it. There could be (various) constraints… But telling them why we can’t do it, and asking ‘Do you understand?’” “We offer a learning experience… and I learned through quite a few scenarios how to step outside my box, and let them [the youth] make the mistake… So I think [a good staff member here is] someone who can take theory and put it into practice, or at least be open to learning how to put it into practice.”

  17. Careworkers (cont’d.) “You work with it every day…sort of understanding where they’re coming from, understanding what has occurred.” Yeah, lots of talking and breaking things down. [A resident] has, I think, learnedabout problem solving.

  18. Youth residents: “You realize what you did, and how much you’ve done wrong, and why…I’ve learned here that there [are] better things that you need to do in situations… it helped me learn things and understand them better.” I had to write an essay on why I ran away… I had to state what I did, and what I’d do next time… it taught us basically that in society you can’t just get away with a quick “sorry”, then go out and do it again. You got to really think about it.”

  19. Government Placement Worker: “Well, I think the philosophy is having a good understanding of the kid, knowing about the kid’s problem… They do a lot of analysis with the kid’s behaviors, motivation and so on, and why these kinds of things might be happening… [The manager] is quite good at identifying those kinds of things… and then strategizing around them… They do lots of problem-solving; that’s their approach with kids… He thinks things through.”

  20. How would you characterize the Yellowdale Learning Centre’s philosophy of therapeutic care? Cognitive behavioral? Learning theory based? Resident capacity building? Getting behind behaviors? Problem-solving oriented?

  21. Other philosophies of therapeutic care in the study sample… Relationship-based (attachment theory) Behavior modification Experiential education/reality therapy Narrative therapy

  22. What is treatment? A suggested approach Treatment consists of: • attempting to bring about directed change, • through individualizedattention, • on the basis of an articulated guiding theoretical framework, and • suitably comprehensive and in-depth assessment of the child and family’s situation. (Anglin, 1986)

  23. Directed change = • planned and integrated activities • measurable goals • ongoing recording • feedback to planning

  24. Individualized = • individual treatment plans • personalized attention • frequent review of plans

  25. Guiding theoretical framework = • body of knowledge and research • clinical experience • periodic review of framework

  26. Assessment = • multi-disciplinary • state of the art • over time • regularly updated

  27. However, whatever the therapeutic philosophy of the home, and whether the program can be classified as treatment or not, the findings of this study suggest that the foundation of any effective residential program for young people is…

  28. the creation of an extra-familial living environment that is responsive to the children’s pain and pain-based behavior, and that develops a sense of normality in the children’s experiences, while struggling to be congruent in service of the children’s best interests.

  29. Questions and comments?

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