Implementation of therapeutic residential care: A multi-informant study

Abstract: Recent reviews of therapeutic residential care models have revealed two key knowledge gaps. The first gap is concerned with the lack of descriptions of what therapeutic residential care exactly entails in practice... [ view full abstract ]

Abstract:
Recent reviews of therapeutic residential care models have revealed two key knowledge gaps. The first gap is concerned with the lack of descriptions of what therapeutic residential care exactly entails in practice (Knorth, Harder, Zandberg & Kendrick, 2008; Harder & Knorth, 2015). The second gap refers to the need to develop an in-depth understanding of how therapeutic care is implemented in the residential care service environment (James, Alemi & Zepeda, 2013; James, 2015). This study aims to address these knowledge gaps. Thirty residential care practitioners across different structural levels and young people in residential care were interviewed. Together, they provided a rich, varied and multi-dimensional account of their perspectives of therapeutic practice and experiences in residential care. This presentation will provide a snapshot of the key preliminary findings of this study and is intended to stimulate further discussion regarding future directions for therapeutic residential care practice.

Objectives: The objectives of this study are to contribute to the development and implementation of therapeutic residential care and to the improvement of outcomes for children and young people in residential care. This will be achieved through the examination of (1) how do residential care practitioners conceptualise therapeutic residential care? (2) what are the current practice elements of therapeutic residential care? (3) what factors facilitate and inhibit implementation of these practice elements? and (4) how do young people perceive their experience in residential care?

Method: A qualitative research design was used including semi-structured interviews of thirty young people and residential care practitioners across various organisational stratum including senior managers, team leaders, clinical staff, caseworkers and direct care workers of three leading residential care service providers in the Australian state of New South Wales. Themes emerged from the data set were synthesised, compared and contrasted across different sample groups and against existing theoretical and empirical literature.

Results: This study identified a number of key practice elements of therapeutic residential care. However, it also revealed a great degree of variability in implementation fidelity across different residential care placements. The results of this study suggest a need for a clear articulation of a therapeutic residential care framework and a paradigm shift in service culture across the sector.

Conclusions: The development of therapeutic residential care is inchoate and its implementation is a complex undertaking. This study identified some promising therapeutic practice elements and opportunities, however, it also revealed several systematic, organisational and individual barriers to implementation. Embedding a therapeutic care culture in service delivery across the sector and building a more integrated system of care with an overarching practice framework could pave the way for improving success of implementation and achieving more optimal outcomes for children and young people in residential care.