Sir Martin Narey’s Review of Residential Care: Contribution from MOTIVATIONS.

 

This submission has been prepared by Mark Waddington and Cliff Faulder on behalf of Motivations Care. Motivations Care provides three children’s homes and is located in Birmingham.

 

We start this submission with a brief case history of a typical Motivations resident to help put our observations in context.

John is fifteen, and has lived in his children’s home for nearly two years. This is his seventh placement since becoming looked after at the age of eight. He had two long-term foster placements, both of which broke down in the face of angry and non-compliant behaviour. In retrospect he can recognise that he was “taking it out on the wrong people”, but at the time there was no one else who mattered, and his carers had little help to make sense of what it was that was happening to them.

He has also had four different social workers in the last two years, through processes of reorganisation and efficiency. In addition he has changed school because his behaviour has made it difficult for the students around him to get on with their learning. His IRO has remained the same and has consistently led his LAC review process, but John’s fury at the unfairness of life makes it difficult for him to do much more than fight with these processes..

John has siblings and separated parents, but combinations of geography and his family members’ chaotic lives make contact unpredictable and rare. It is evident that the difficulties each family member has in getting on with their own lives mean that, while family bonds are recognised as being important, they cannot provide the emotional nurture a vulnerable young person like John so desperately needs.

So, all in all, there are very few constant figures in the life of this young person whose early history left so little opportunity for good attachment experience.

It will also now be clear that John’s relationships with staff and residents in his children’s home are the central anchor in his life -The predictable pattern of familiar faces who take turns to look after him, has the potential to join the dots, and to ensure his disparate experiences can be brought together to make sense.

The staff around John have helped navigate the changes of social worker and school, likewise it has been these staff who have cleaned up the mess (physical and legal) when his complicated behaviours put him at odds with those around him.

This review has been termed a root and branch assessment of residential care homes with the explicit aim to “help put an end to a life of disadvantage for some of the most vulnerable children in care”.

These terms could be understood to locate the causes of the life of disadvantage within the care sector. This pattern of thought is easily achieved. The failings of children’s residential care readily attract media attention, there are regular reports of “out of control children’s homes” with the police in attendance, or homes targeted by paedophiles and traffickers, seeking access to children vulnerable to sexual exploitation.

An alternative perspective starts with an acknowledgment of these young people’s history prior to placement, and the ways this will have affected them. Often they will have been trapped in impossible situations within their own families ~ The constituents of those impossible situations will be their traumatic experience of domestic abuse, sexual abuse, neglect, mental health issues etc. and the interventions that have resulted in their looked after status will have taken place in response.

These young people have had limited opportunity to develop the ordinary coping strategies children employ to let adults know about their difficulties and little expectation that anyone might listen or understand. Furthermore they will not expect adults to be able to regulate their own behaviour and stop it having a negative impact on children. They will be likely to communicate their own difficulties by behaving in ways that put those around them in apparently impossible situations. These behaviours reflect the circumstances in which they have grown up, and indeed there is a fair chance that their parent’s experience would have been the same.

So the task of looking after these children must start with recognition that there will be points where their conduct will be likely to undermine relationships and damage the environment. It is these indigestible aspects of behaviour that make it difficult to look after this particular demographic in foster care. And, it makes it immediately clear that behaviour management will be a key task within residential settings like children’s homes.

Like many other providers, Motivations is a small organisation with three homes. In our view, our staff are the unsung heroes in this sector. Their steadfast and persevering work over months and years has required them to stick with complex and frightening behaviours. Their resiliency and capacity to provide understanding is obvious in their daily work to maintain a homely environment for our children.

This constant process of reorganisation and repair to preserve order has enormous therapeutic value. A crucial element of therapeutic experience is the consistent assertion of compassionate boundaries. A good therapist will constantly understand the client’s traumatic experience as traumatic and will actively resist invitations to minimise or diminish its emotional actuality. The task of caring for complex children in a residential setting requires staff in children’s homes to resist behaviours calculated to get them to not care about constantly reappearing mess, and to continue to insist on knowing a child’s whereabouts in the face of a young person’s insistence that they are perfectly capable of looking after themselves and that they are entitled to privacy. The sensitive and effective management of these complicated challenges requires a determination not to give up, and a most particular skill-set which often goes unnoticed precisely because these skills are most obvious when they are absent and things go wrong.

It is also worth noting that these chaotic behaviours can make it difficult to achieve regular attendance at appointments. It is already enormously difficult to source appropriate therapeutic input for LAC children through CAMHS and in these times of limited resource, these factors of unreliability mean that it is no surprise that this particular demographic have limited access to this resource. Again, this means that the primary therapeutic input received by these young people will be located within their experience of residential care – The relationships they have with the residential staff on a daily basis are these young people’s best chance of therapeutic experience to redress the impact of early trauma.

These residential skills can be taught and developed and comprise part of a “professional toolkit” for residential care.

We strongly advocate further development of a formal professional pathway which recognises the specific capability to manage and synthesise these multiple and complex factors. Key components of this pathway would include supervision and consultancy to support day to day delivery of the core task, alongside essential practical and theoretical training inputs. Crucially this approach locates staff development within the delivery of the core task, and promotes an agile learning experience for residential workers. This will improve inputs and outcomes for young people currently resident in children’s homes rather than defer improvement for the “next generation”. Growing up is all about learning from experience and this model immediately helps constructively replicate those processes for young people and staff within residential care.

 

Mark Waddington & Cliff Faulder, December 2015

 

Mark Waddington is a doctoral researcher and specialist in residential therapeutic childcare consulting to Motivations.

mark@mwcollaborations.com 07751 702814

 

Clifford Faulder is Responsible Individual at Motivations Care.

cliff@motivationscare.co.uk