Therapeutic residential care in Australia: taking stock and looking forward

摘要

Therapeutic residential care is becoming an increasingly relevant out-of-home care option for children and young people with multiple and complex needs. It is a new and developing approach in Australia, one aimed not simply at containment of the “hard cases” - as is often the case in traditional residential care—but rather at actively facilitating healing and recovery from the effects of abuse, neglect and separation from family. In this Issues Paper, therapeutic residential care is described and contrasted with other models of out-of-home care. The theory and evidence supporting the use of this form of care are examined and used to develop a set of key elements, which, it is argued, should guide the provision of therapeutic residential care in Australia.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. 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.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, 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.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.