Children who need a therapeutic residential experience

By Cynthia Cross

Date Posted: Saturday, 11 December 2010


Cynthia Cross is a freelance child care consultant and trainer. She is a valued and generous contributor to the goodenoughcaring Journal.


Children who need a therapeutic residential experience


There is no doubt that when I started as a residential worker in a “cottage home” in 1960 a fair proportion of children there should have been supported at home with their families. The current policy was to get children away from their impoverished families and give them good food and fresh air away from the inner cities. The regimes were by necessity very institutional. The “cottages” I worked in had 16 children of an age range of 18 months to 16+ years with a maximum of 3 staff on duty, doing the cooking, most of the housework and most importantly keeping the boiler alight. Staff worked six days a week and a split shift, in real terms you were lucky if you got 2 hours to yourself in the middle of the day. The children were in 2 dormitories and there was one downstairs bathroom and a “day room” which served as a playroom and dining room combined. Two of the staff had small bedrooms in the house for which they were charged rent.

How different this was from the present situation. The pendulum has swung the other way, with the belief that family life is always best and children must be kept at home at all cost. If that proves impossible, i.e. too anxiety provoking, then the preferred option is always foster care. The situation is that most children have to have endured years of severe emotional abuse before they come into the care system. Parent(s) must be given chance after chance unless it is thought that their children have been physically or even more significantly sexually abused. Then the children may be unceremoniously removed from their family, or other places without preparation or much thought being given to what should happen next.

Children, who all those involved with them know, will be impossible to cope with, and will not get their needs met in foster care, are nevertheless placed with carers further damaging the child and others.

When I worked with a family placement scheme, the stated aim was to get adolescents out of “institutional care”. Children were put forward by social workers often without the child or the residential workers knowing. Fortunately I was able to change that. I remember on one occasion when I said I thought a boy would be better staying in the children’s home where he was settled and had relationships, I was told “you can’t condemn a boy like that”. He had more sense than the workers and refused to be moved.

Although we would all agree that whenever possible children and families should be given all the support possible to stay together. The Commission for Social Care warned in October 05, those services for looked after children and those in need of protection are being improved at the expense of lower level support services for other children and families in need; this clearly is not acceptable. However, sometimes it is plain to see that because parents’ own basic needs have not been met they are unable to meet those of their children. We should be able to sort out which children fall into the different categories if workers knew what they were assessing.

There seems to be great resistance to identifying vulnerable children early and finding ways of meeting their needs, which may be in a minority of cases be away from their families. When in June 05 it was revealed that the government had plans to identify three year old children in nurseries who showed by their behaviour that they were at risk of growing up as criminals there was outrage about the “labelling”.

While it is clearly wrong for three year olds to be branded as potential criminals, there is no doubt that it is possible to see from young children’s behaviour that they are being psychologically damaged and that they are not receiving what they need to maintain healthy development. Such children, if not helped, may well when older, be unable to sustain relationships, suffer from mental health problems or manifest their distress through criminal activity, drug or alcohol abuse or domestic violence; some will inevitably end up in psychiatric hospital or prison.

The concern about labelling is to a large extent spurious, as we have no need to label these children; they label by themselves by their behaviour and very soon become rejected and vilified by most of the people who come into contact with them. I believe that we should target resources at children who are not getting their emotional needs met. This can be done much earlier than at three years old, health visitors should be able to see when a mother and baby are not bonding and be able to instigate an appropriate intervention. If we could achieve this then there would be fewer parents unable to care adequately for their children in the future.

At the present time, there are still many children who come into care who may have had a good enough first two years before things went wrong in their lives, these are children for whom foster care could be a viable option. However there are a proportion of children whose needs are so great that they need more that a foster home, however good, can give them. The placements break down and they destroy marriages, damage birth children and their failure is compounded. Specialised residential care is needed for these children, where therapeutic environments provide for social, emotional and educational needs, integrated and planned for individuals, at different levels, 24 hours a day.

Unfortunately many local authorities have policies which dictate that if at a last resort it is agreed that a child must be looked after away from home then fostering must be tried first, regardless of the fact that everyone who knows the child believes that it is almost certain to break down. If no foster carer can be found, or fostering has repeatedly failed then the child has to go into residential care, the child and family is often told, “we have tried everything and the only thing now left is for you to go into a children’s home”. What a message for the child, particularly when this may well be followed by “it will only be for a short time until we can find a suitable foster carer”.

The odds are stacked against the child and the placement. How can workers be expected to communicate worth to the child when the service has been so devalued? How can a child be expected to respond and trust people when he/she has been told you won’t be in the residential placement for long and it is not the best place for you anyway?

We hear all the rhetoric about cutting the number of placements and giving children stability, but it appears that policy makers have no fundamental understanding about children’s needs let alone how to even begin to meet them effectively.