Therapeutic Care Special Report: Research evidence

Overall, we can conclude that there needs to be easier access to such research and how this can be applied across diverse settings. The writing of this review created a reflective space and process – an essential ingredient in therapeutic child care.

Reflecting on the situation, research exists, but it is dispersed across differing professional interests and journals, many of which are not widely known and are international, and can be prohibitively costly to access. Academic language is attractive to some, and off-putting for others. Extracting the relevant practice from the specificity of some of the situations studied can be a considerable task.

Many articles are by mental health practitioners, psychology, psychiatry, therapy. Teaching and learning connects through attachment work in schools, there is speech and language therapy interest too. Therapeutic child care can include relationship-based social work. Social care attention mostly comes from residential child care, some fostering. However, the wider range of potential family and community applications are largely unaddressed.

Many may not see their practice as “therapeutic”, seeing what they do as “ordinary devoted” or “good enough” parenting or “healing”. Definitions matter. Gilligan offers an inclusive definition in the Introduction to Whittaker, del Valle and Holmes seeing therapeutic care as systematic (true to well-informed principles) rather than programmatic (meticulously implementing the detail of a care curriculum). This challenges US definitions that only include health professions, and also includes social pedagogy. Being inclusive also draws in an extensive range of settings across enabling environments, psychologically informed environments, psychologically informed planned environments and therapeutic communities.

Whittaker et al (1995) offer a contemporary definition of therapeutic child care as one that: “Involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialisation, support, and protection to children and young people with identified mental health or behavioural needs in partnership with their families and in collaboration with a full spectrum of community-based formal and informal helping resources.”

Recent research
A study on the Mulberry Bush School conveys direct work and also the creation of the “staff therapeutic milieu” that supports the group living and group learning through which therapy principally occurs. This approach and these outcomes can be compared with that of the Secure Base method that might have an alternative view of what constitutes as therapeutic.

As schools increasingly are seen as places for a wide range of supports and interventions for wellbeing and mental health investment in evidenced practice will be important. Making the case are Accurso and Garland writing on the efficacy of the therapeutic relationship.
In planning for the future, we need to ask the question of how to make research more accessible.

Being research and evidence minded is not an easy fit for our everyday professional discourse and practice. It has to be embedded in our culture and practice. Having research-minded practice shapes how the work is conceived, its structure and focus. The practice of an individual or team is not restrained by their own experience, but connected to that of others.

For a largely non-graduate and busy workforce the language of research can be a barrier to accessing and absorbing. It requires someone to provide the therapeutic child care understanding and stance in a manageable way making the practical applications operational.

Academia and practice

Essential activities seem to be linking academia and practice. Perhaps even more importantly summaries and translations of research into practice are essential. These have to come from this being seen as a government-funded task more than the What Works Centre, from professional organisations, or by providers sharing the investment. Open access is a crucial threshold for research and evidence to be a common resource.

Therapeutic child care is about the use of self in the “everyday” and “here and now”. There is a three-stage professional development everyone working with young people should use: understand the need for reflection, develop expertise in reflective practice and consciously apply an action research method to what we do.