Homes for young people with complex needs

ACTION

Essential Therapeutic Care (ETC) is a residential care provider based in Berkshire for young people returning from hospitalisation, or who are on a trajectory towards admission due to mental health problems or self-harming and suicidal behaviours.

Many of the young people they support have a history of serious self-harm, eating disorders and other complex mental health difficulties, as well as autism and behaviours that are a natural response to trauma and adverse childhood experiences.

A recent Ofsted study highlighted that 91 per cent of local authorities “often” or “always” have difficulties finding a home for young people with complex needs. The complexity of their needs mean that many residential providers feel unable to keep them safe and give them the level of support they need.

ETC owner Emma Teasdale wanted ETC to be able to offer homes to these young people, but also make sure they had the right level of clinical and psychological support in place to do so, so she approached Midhurst Children’s Therapeutic Services (MCTS) and our innovative partnership was born.

Key features of the partnership include:

• Offering a robust, therapeutic, wraparound package for young people with the highest levels of need

• The clinicians have become an integral part of the team and are present in the homes throughout the week

• ETC’s clinical team is employed and supervised by MCTS as an external agency, ensuring accountability as well as reduced cost commitment

• A focus on therapeutic organisational culture and the team itself improves staff wellbeing and retention, leading to greater consistency for the young people.

For many providers, it is not feasible to recruit a large in-house clinical team, and many rely on an associate model with a private practitioner offering therapy to the young people weekly and maybe running a group supervision session once a month. Although this works well for many providers, it may not be integrated or far-reaching enough to meet the needs of more complex young people.

One of the most important steps that our organisations have taken is to view therapeutic input not only as essential for the wellbeing and recovery of the young people in the homes, but also for the staff and structures around those young people.

As the young people bring certain anxieties, behaviours, worries and challenges to the staff around them, it is crucial for those staff to feel strong enough to hold these, while also being able to lean on their line managers and supervisors for support.

MCTS brings an established and evidence-based model for Attachment and Trauma Informed Care (ATIC) which has been tried and tested in a dozen services. ATIC focuses on supporting the systems surrounding the young person, so any anxieties are fed up the chain and ultimately held by the clinical team and a supportive, therapeutic culture. The structures and approaches that shape this are designed to be containing, psychologically-minded and safe. They provide a feeling of consistency, predictability and guidance.

The multi-disciplinary clinical team that MCTS provides to ETC includes a psychotherapist and a clinical psychologist. The psychotherapist does the one-to-one therapeutic work with the young person, is on hand for staff support throughout the week, and attends and contributes to reflective practice.

The clinical team undertakes regular clinical monitoring, specialist assessment and evaluation of the young person’s psychosocial needs. This ensures intervention is rooted in data and allows robust monitoring of outcomes, and results in data-driven formulations based on the young person’s strengths, baseline and goals.

The clinical team undertake quarterly reviews of staff wellbeing, including measures of carer–child understanding, compassion fatigue, burnout, secondary trauma and compassion satisfaction, so that we can make sure everyone is able to keep providing consistent and responsive care.

IMPACT

In 2022, we saw 9.9 per cent fewer placement breakdowns in a different service supported by ATIC, when compared with a similar service that was not receiving ATIC support.

Initial findings indicate that residential staff who completed the ATIC Therapeutic Care Training as part of the integrated clinical package reported decreased symptoms of burnout and secondary traumatic stress, increased skills and understanding of therapeutic approaches, and a better relationship with the young person they cared for.

Within ETC’s setting, there has been reduced pressure on hospital emergency departments and child and adolescent mental health services (CAMHS) because of the level of support being provided to the young people by the partnership. CAMHS currently only assists with medication reviews – all other care and support is provided through the partnership package.

• Read more in CYP Now's Residential Care Special Report