Residential Care: Practice example - RESuLT

• Participants develop strategies to promote positive behaviour and improve young people’s self-efficacy and “relational skills”, which they are helped to model in their homes
• Sessions cover theory about adolescent brain development and the impact of neglect and abuse, which participants use in their practice

ACTION

Sexual exploitation scandals in recent years have raised questions about residential child care staff’s ability to ensure safety and improve outcomes for the most vulnerable teenagers. Training and Developing Staff in Children’s Homes, a June 2015 Department for Education-commissioned report by National Children’s Bureau and social researchers TNS BMRB, says training “is more likely to be of value if it’s rooted in the practice of staff and the needs of the young people they are caring for”.

These are key features of RESuLT, developed by the National Implementation Service (NIS), based at South London and Maudsley NHS Foundation Trust. NIS manages a portfolio of government-funded interventions for children in or on the edge of care and their families, including Multidimensional Treatment Foster Care and Keep, a foster carer training programme. RESuLT grew out of demand from councils whose foster carers had been supported by these programmes. They said children’s home staff also needed help.

In 2011, the DfE commissioned NIS to investigate the training needed, through a consultation in Dudley and Oxfordshire. “Staff said they had lots of abstract, one-day theoretical training, which didn’t relate to what they had to do on shift,” recalls RESuLT lead developer Cath Connolly, a systemic psychotherapist. “It covered early development theories, rather than the practice of looking after teenagers, or applying the theory to that practice.” The young people consulted portrayed children’s homes as environments where poor behaviour was rewarded with attention, and young people needed more support to tap into their strengths.

NIS developed a practice-based, adolescent-focused programme with a whole-team approach, tested on 60 staff in Dudley, Oxfordshire and Greenwich in 2012, then piloted from 2013 to 2015 with 133 staff in Cheshire West and Chester, Blackburn with Darwen, Staffordshire, West Sussex, Norfolk and Suffolk. Around 400 staff across 23 homes have now benefited.

RESuLT provides 10 weekly half-day sessions for a children’s home team, plus two half-day supervision sessions for managers, helping them incorporate the learning into practice. The two facilitators, one from residential child care and the other from Child and Adolescent Mental Health Services, are supported by NIS through direct observation and feedback on filmed sessions.

Staff learn strategies to promote positive behaviour and develop young people’s “relational skills” and self-efficacy, through discussion, practical activities and role play.

This is combined with learning about adolescent brain development and the impact of neglect and abuse, to guide staff in their approach. “If somebody has a single phobia you’ve got a very clear target for change,” explains Connolly. “But with teenagers with complex histories, multiple placements and early experiences of harm, you’re looking at what changes you should be targeting at this particular moment in their development.

“One of the core things they need to learn is how to be in relationships. So what runs through the training is relational skill building and helping staff model appropriate relational behaviour.”

Over the next nine weeks, they learn strategies for “positive reinforcement”, frequently noticing things children do well; “selective ignoring” of poor behaviour, where safe and appropriate; and making careful use of appropriate “consequences” for challenging behaviour, to prevent it escalating. This could include reparative solutions such as allowing a teenager to calm down after smashing a vase in anger, then engaging their help in clearing it up and contributing to its replacement.

Participants also learn how to develop teenagers’ belief in their capabilities and ability to manage new situations, which Connolly describes as “transformative”.

Connolly believes RESuLT plays an important safeguarding role. “We want our children’s homes to be more welcoming than the streets,” she explains. “If young people say: it’s nicer to be here, staff are kinder and I feel a bit better about myself, that’s gold.”

IMPACT

Between 43 and 48 participants completing pre- and post-programme questionnaires between 2014 and 2015 showed statistically significant increases in their confidence in five curriculum areas. Their average scores for “modelling” increased from 3.97 to 4.71, for “positive reinforcement and rewards” from 4.13 to 4.63, communication from 4.13 to 4.58; “ignoring” from 3.95 to 4.65 and “consequences” from 3.94 to 4.70.

“Staff are more aware of how to show us what we’re doing well,” commented one young person in a participating home. “This makes me feel better and more listened to.” Another observed: “Staff being clear and calm has helped me be clear and calm.”

An evaluation by Ipsos Mori and the universities of Loughborough and Bristol started in September 2015, and is due to report at the end of this month.

This practice example is part of CYP Now’s special report on residential care. Click here for more