Children in desperate need: their placement in specialist residential settings

Roger Clough

This study reports on a cluster of small projects undertaken between 1995 and 1997 designed to examine the process by which children and young people move into therapeutic communities: how are they identified? what are the procedures by which such a special placement is agreed? how is a decision made as to a particular establishment? The research was directed by Roger Clough of Lancaster University. A major project within the research was undertaken at Bristol University by Phyllida Parsloe and Liza Bland. The main conclusions are:

At their best therapeutic communities provide a place where children can be healed and grow. "It was the first time I felt that anyone really cared about what I felt inside and who I really was."

The children who eventually move into therapeutic communities will have experienced a process of yo-yoing between home and placements and between different placements, often without chance to prepare and settle, with losses possibly of siblings, localities, education and a sense of belonging.

In terms of experiences, they are likely not to have had sufficient bonding with their mothers, to have been bullied, abused or to have abused themselves, to have been educationally disadvantaged.

The children have come to be seen by staff as different from their peers: - dangerous, not being tough enough to survive the local authority care system and vulnerable; having nowhere to go; as not making sense.

Most SSD (social services department) staff seem to have little understanding of the children's pain.

By contrast the social workers who argued for and were instrumental in achieving a move to a therapeutic community knew the children well and were worried about their future; they acted as the children's champions.

The social services staff with responsibility for their welfare have reached a view that they cannot find an alternative option: in this sense a therapeutic community is regarded as the last chance for the child.

The placement in a therapeutic community offered hope to all parties that healing and development was possible both in prospect and reality Some parents who thought they had lost their child found they could be with their child again; some children said that they felt for the first time that they were cared for in a family; social workers noted the ability of the communities to provide very good day to day care, to care for the whole child, to supply good education.

The processes by which the children are identified, the case for a special placement is made and a particular place is identified are haphazard.

The complexity of 'sharing care' is illustrated by the stereotypes which therapeutic community staff and social services staff hold of each other and by different perceptions and systems for determining whether a child should be placed in a particular place.

Background

The numbers of young people living in residential homes at any one time has declined rapidly in the last twenty years, though there has been a small increase in the numbers in 'special' residential schools. In part this drop mirrors the drop in child and teen-age population; in part it is the consequence of practices designed to ensure that all other resources are tried before children and younger people move into residential homes. Both current practice wisdom and economy assert the primacy of keeping children close to home and in contact with family. This research project reports on the ways in which a small number of children and young people will be placed in specialist provision. The term 'children' will be used in the rest of this text to refer to children and young people under the age of 18.

Planning for children

A major theme of recent research into the welfare of children being looked after by local authorities, summarised by Rowe (1985 and 1991) has been the importance of planning. Rowe (1991) makes several points. 'Planning for an individual child always involves weighing up the pros and cons of the various possible alternatives.' (p.65) Yet there is a lack of clear evidence on which decisions are made: 'Scattered through recent research reports are strong indications that impressions, assumptions and personal or social values too often take the place of systematic observation or confirmed facts.' (p.69) She states that research evidence suggests there is 'much food for thought about how well residential and field social workers really know the children for whom they are planning'. (p.70)

The focus of this research is on understanding more of this process.

Discussion

The research findings reported here suggest that too often current practices in SSDs are counter-productive to thorough review of individual children and a thorough review of the best options for their futures. In part this is the consequence of staff in SSDs not holding on to different and at times competing objectives: the welfare of the child means consideration of both maintaining links with families and the placement that best matches the individual needs of the child. In part this is the consequence of a combination of budgetary constraints and tariff systems which mean that all cheaper alternatives must have been tried before a more expensive option is considered. In part this is the consequence of management or administrative systems which fail to keep an understanding of the child at the heart of decision-making.

However, the research findings also draw attention to the significance of individual workers in the larger systems: some social workers in some authorities know the child, struggle to understand their needs and the best options for them, and work within the system to produce 'hopeful outcomes' for children.

Therapeutic communities have a vital part to play in the healing, treatment, control and care of some children for whom the placement is seen as their last chance. (Strangely it may seem as if it is their first real chance).

There are some interesting clusterings of what initially seem divergent findings. SSD staff criticise therapeutic communities for being in-turned, not welcoming of them as visitors, perhaps pretentious. Yet social workers and parents report that some parents are received more warmly than at other places. A possible explanation is that therapeutic communities work well at what they take to be their primary task. They have improved their practices with parents and work well with them because they have a deep concern for their children. They may perceive SSD staff as of less importance.

Secondly, during the research we had experiences of therapeutic community staff being defensive with outsiders in some settings and yet surprisingly open in situations where potential funders were present.

Thirdly, we were surprised at how rarely the community staff mentioned young people and parents as significant parties in decision making about a placement. Yet SSD staff state, as do the communities, that no placement will go ahead unless it is with the agreement of the young people. This appears to be related to the timing of discussions. SSD staff and community staff are reluctant to hold discussions too early with the child because if a placement is not viable, to have raised the child's hopes appears to have added to a long list of failed events.

To us the examples of SSDs and communities both wishing to take responsibility and assert authority for a child are indicators of tensions as to the work and concern of the other group. While recognising the importance of not raising and dashing children's hopes, we think that the children have to be brought more fully into discussions of their present and their future. Systems requiring consultation and permission, and specifying rights are designed to bring children and parents into the discussions. It is particularly difficult to do this when parents and children have so little knowledge of options. We have seen that it is difficult enough for SSD staff to find out what is available.

Finally it is worth noting what may seem a discrepancy between the perspectives of the therapeutic communities and others as to what is the core work that they do. SSD staff may consider that what the communities provide is high quality, basic care of a type which is not often found in other residential homes; parents may report on the opportunities available for their children (education, activities) and for them in terms of being with their children; the communities may see as their special characteristic a particular interpretation of behaviour, or particular treatment. We suggest that the reasons why the communities manage to hold children and provide good basic care is consequent on:

a theoretical base which informs the understanding of children's behaviour and of their treatment and is accepted by all staff in the therapeutic community; staff who, whether trained or not, understand sufficient of the theory; daily routines which are developed from the theoretical base.

In other words these factors which underpin good practice are demonstrated in everyday events. It may be that the community staff should talk to outsiders less of their theoretical stance and more of the quality of what they achieve.

Our findings support the view that therapeutic communities are a vital resource for a small number of the most damaged and vulnerable children. Yet they are surrounded by mystique and the use of them is haphazard. It is consideration of the intermeshing of the therapeutic communities' systems and those of SSDs to which we turn in conclusion.

Implications

The implications of the findings for therapeutic communities to consider are:

a review of their use of the term 'therapeutic community' which has more or less coherence for staff of the communities but none for those outside; an examination of the nature of groupings of those places with a common interest, such as the Charterhouse Group, to consider the nature of their association: is it to be, for example, a trade association, a kite-marking group, an enquiry and referral agency? in particular they should consider whether or not such groups are in a position to give SSDs any guarantees of quality in relation to members; a study of their selection procedures so that they can work better with SSDs; a consideration of the ways in which they write and talk about their work to see whether the richness can be described in language which does not exclude others; a review of the ways in which they receive SSD staff and other visitors and, subsequently, of their systems of liaison with SSDs and of advertising.

By and large the findings in relation to SSDs shed further light on the planning process described by Rowe (1985 and 1991). The implications are central to the welfare of individual children, indeed to larger matters within welfare provision. SSDs could consider:

how to ensure that the systems which properly need to be in place do not lose sight of and touch with each individual child; the systems properly need to ensure that there has been review of children and options, that what is proposed for a child is not the outcome of the whim of a particular staff member, that there is liaison with health authorities and education departments, that the budget is managed and that rationing is just; how to recognise at an earlier stage earlier children who may need special placement and how to produce the placement; how to move away from planning built from individual and team assumption to a more through examination of child's behaviour and treatment options.

References
Rowe J (ed.)(1985) Social Work Decisions in Child Care, London: HMSO
Rowe J (ed.) (1991) Patterns and Outcomes in Child Placement, London: HMSO

Feb. 2000