Children’s homes are getting smaller, placement by placement, policy by policy, until “care” can start to look like isolation. I sit down with social care leader Dr Kevin Gallagher to ask a hard question that affects the UK, Australia, and any out-of-home care system under pressure: what do young people lose when we design residential care around risk avoidance instead of recovery and relationships?
We break down what a residential therapeutic community actually is, and why the word “community” matters. Kevin explains therapeutic childcare as an intentional, whole-of-organisation approach where boundaries and safety come first, then routines, staff support, reflective practice, and clinically informed relational work shape the day-to-day “emotional climate”. We also tackle the messier reality that “therapeutic” is often used as a broad label. If commissioners and regulators cannot tell the difference between models, children end up in a postcode lottery where the service description does not match lived experience.
From there, we zoom out to system design: the UK can show oversupply on paper while still lacking the right mix of provision. We explore why smaller two-bed homes have become the default, how that affects cost and staff isolation, and why well-run group living can offer unique therapeutic benefits like peer learning, belonging, and practising life with others. We also name the limits clearly: larger groups only work when they are planned and purposeful, matched to need, and built on containment.
If you care about trauma-informed residential care, commissioning, leaving care transitions, or the future of therapeutic communities, this conversation will sharpen your thinking. Subscribe, share this with a colleague, and leave a review to help more people find the show. What should the “right mix” of residential care look like where you live?
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Transcript:
Cold Open On Therapeutic Communities
Kevin 0:00
The idea behind therapeutic communities is very much using living and learning together in groups as a therapeutic tool in and of itself. Therapeutic childcare is more of the overarching category. And that actually therapeutic communities are a very particular group expression, large group expression of therapeutic childcare practice. The group environment, the use of groups, the use of the structure and the routine and how the service functions, that is harnessed much more explicitly in a therapeutic community as part of the therapeutic method. All residential childcare should be seen as therapeutic by nature of the work that it’s been asked to do. On paper, we’ve got significant oversupply. In reality, we don’t have the right types, the right mix of provision. There’s something about a lived experience of transitions that can be worked with in order to help young people prepare for their own transitions. You can’t just bring young people and staff together in larger groups when you’re dealing with trauma without it being done in a very planned and purposeful way. This is not easy. I think our services need to be shaped on a real understanding of what children’s needs are, and then from that, what are the shapes and sizes and locations of provisions that are best suited to meet those needs.
Welcome And Guest Context
Colby 1:48
Hello and welcome to the Secure Start Podcast. I’m Colby Pearce, and rejoining me for this episode is Social Care Leader and Managing Director of Amberleigh Care, Dr. Kevin Gallagher. Before we get to our conversation, I’d just like to acknowledge the traditional custodians of the lands I come to you from, the Kaurna people of the Adelaide Plains, and acknowledge the continuing connection the living Kaurna people feel to land, waters, culture, and community. I’d also like to pay my respects to their elders, past, present, and emerging. Now let’s get to the conversation. So welcome back to the Secure Start podcast, Kevin. It’s good to have you here.
Kevin 2:40
Yeah, thank you very much, Colby. It’s uh nice to be invited back. Uh I’m Kevin Gallagher. I’m a social worker uh in the UK, managing director of uh Amberly Care, which runs two therapeutic communities for teenage boys, um, but also a trustee of practice charity, the consortium for therapeutic communities. It’s great to be with you.
Colby 3:02
Yeah, yes. And uh um we recently had Marie on, one of your your staff, um, to talk about the work there at Amberly Care as well. Um Yeah, it was lovely.
Kevin 3:15
It was really great to see her. Um it was a first opportunity for doing something like this, and I know she uh she got a huge amount out of it, and I was so pleased that she had an opportunity to share some of her experiences and reflections on on practice.
Colby 3:30
Yes, yes. Well, we we’re um we’re not going to talk specifically about amberly care, I guess, today. We’re we’re really um I’m wanting to address the um this issue of um uh of therapeutic or of residential childcare homes becoming smaller and smaller. And um I know that that’s something about which you you have um considerable knowledge and and important perspectives to share. Um I wonder though, if we could just start, because the idea of a of a therapeutic community, for example, is not necessarily well known across all the jurisdictions of where people come from who listen to this podcast. So maybe if we can just start with you um describing what a residential therapeutic community is for children and and then how that is similar and different or or contrast that with um a children’s home.
Kevin 4:34
Yeah, absolutely.
What A Therapeutic Community Is
Kevin 4:35
And it’s interesting because my own experience in practice over 30 years um was in residential childcare settings of different types, becoming increasingly therapeutic, and then I fell across therapeutic communities almost by accident, and have been deeply involved in that work for 20 years now. Um but but actually, now in terms of where the debate and the and the dialogue is about practice settings, I’m I’m almost returning more to therapeutic childcare and really understanding the relationship between these two different expressions of uh relational care. I think um therapeutic communities as a concept have been around for many decades, um, not only in children’s services but also in uh adult mental health. In fact, a lot of the early work was arising out of adult mental health and sort of social psychiatry perspectives and a recognition that um people trying to recover from traumatic experiences in their in their lives, um, it’s the impact on their ability to understand themselves and relate to others and relate to the world that causes a lot of the distress. Um, and so the idea behind therapeutic communities is very much using living and learning together in groups as a therapeutic tool in and of itself. So that’s very much a kind of an underpinning principle. Um I think when those kind of ideas are then applied in a residential context, um, you’re talking first of all about individuals who may have a higher acuity or a different mix of needs. Um, and and often these are complex systems where you might have multidisciplinary work going on in a children’s therapeutic community like ours, for example. There’s residential care, which is a regulated activity, there’s registered education, which is a regulated activity, and then there’s a range of different um direct therapy uh and clinical inputs, which are also regulated. So it’s something about the bringing together of those different professional activities deliberately in a in a combined system with a shared understanding of how we’re going to harness relationships as a key part of the intervention. So, in that sense, the idea of um having a group becomes important, and so we’re focusing not only on you know in individual um case management and assessment and intervention, that’s obviously very important, but also what’s happening in the group dynamic, um, and that can be the group of young people together, um, it can be what’s going on within the group of staff, it could be between the the intersection between different disciplines, different sub-teams, um, and the idea that um everybody who is in this the community, whether they’re a resident or whether that’s their workplace, on one level they have a shared status that they are all members of that community, and therefore there’s you can you can work with that very consciously in terms of power, voice, participation, agency. Um but of course, before you can access any of those uh opportunities, like in any therapeutic relationship, you have to start with boundaries and safety. And I think that if I were to make a a lot of what I’ve just said is very applicable in group um or therapeutic residential childcare. And I know we’ll talk a little bit later about how that might play out in different group sizes. So I think I think my own uh I was talking to somebody at a uh an event recently about this very issue. I think my own thinking about this is actually changed or changing. I think for a long period of time when I’ve been very um focused on therapeutic community practice, because that’s what I do in my day work. Um I would have seen therapeutic communities as a very distinct um a very distinct form of residential care. And that’s why you know that there are parallels with prison therapeutic communities or addiction therapeutic communities. There’s some common ground there. Um but actually I I’m beginning now to lean more towards uh the idea that therapeutic childcare is more of the overarching category, um, and that actually therapeutic communities are a very particular group expression, large group expression of therapeutic childcare practice. Um again, I’ll touch a bit later, maybe we we have we have um service standards that help shape um the kind of governance for both therapeutic communities uh that existed about 20 years in the UK, and in more
Therapeutic Childcare Versus Communities
Kevin 10:05
recent times, a set of those standards has emerged for therapeutic childcare. And they are they’re probably 95% the same. Um I think it’s some of the systems or the structures or the some of the language that is slightly different when you’re deliberately harnessing the group environment, the use of groups, the use of the of the structure and the routine and how the service functions, that is harnessed much more explicitly in a therapeutic community as part of the therapeutic method. Um that so that yeah, I hope that helps unpick it a little bit.
Colby 10:52
If I yeah, so if I could just jump in, I think that what I’m hearing you say is in a therapeutic community, the the key word is community. And that the the community is more than just the young people who are being looked after. The community is the staff, you know, it’s the educators. Um when we talk when I’ve talked to other um uh guests who have uh worked and lived in therapeutic communities, they’ve you know it’s even down to the you know the other staff, the domestic staff, the the people who run who who perform other activities within the community, they’re all seen as part of the um the one enterprise as such. And and and and and the the they all are um um following a primary ta a common primary task. The idea of the therapeutic community is that is that it’s everyone is in it. It’s not kids and staff as such, or yeah, it is it is a community together. And that probably, I guess, ref is consistent with and reflects what you were saying about the similarity between it and therapeutic residential childcare as it is evolving, because there’s also quite a uh a focus in those endeavours on um staff development and staff support and uh and the idea of um you know we want containing staff so that they be they’re good containers for the children. Um but perhaps you might you might want to say a little bit more about you know what what you understand to be therapeutic residential childcare uh as well.
Kevin 12:44
Yeah, I mean I uh yeah it’s it’s interesting because we’ve uh we’ve I we in the UK case system, we’ve we’ve adopted um an international definition of of therapeutic childcare that was developed by um Professor Lisa Holmes and James Whitaker and others, um, which was talking about trying to arrive at some consensus about what are some of the components that that uh shape therapeutic childcare. And they talk about um an environment, I’m not going to be able to quote it verbatim, but an environment that is planned and purposeful, um, that it’s multidimensional, and that it’s being the work and the settings and the use of relationships are being harnessed to provide or enhance treatment. Um so there’s something very deliberate about tasks, about being clear about what’s the what’s the task, how do we understand this work, how are we deliberately coordinating our activities and the different roles and and professions within that. Um and you’re right, for for uh in this kind of therapeutic care where you’re using relationships and you’re working with young people who often have um uh challenges in attachments uh and issues with uh trust, and they may have had developmental delays or uh uh or or other other forms of um of abuse and neglect, and then that that then leads them to have learned some maybe dysfunctional um communication uh styles or ways of behaving that are not serving them well, so there are issues of risk. Um so we’re trying to use a corrective relational experience in the day-to-day, but quite professionally delivered. So in a in a very domestic sense, um the experience in the day-to-day is quite familial. Um, and in many families, a lot of this learning and communicating and negotiating and being seen and being challenged and so would happen around the kitchen table or in very kind of um almost natural on-the-hoof interactions. But in order for that to be uh partially replicated, or for the adults to be attuned to work in that way, to create those opportunities, or to feel confident to take advantage of them when they see them, to recognise them and and engage with them, requires a much more sophisticated approach in the background to how are we organizing ourselves and how do we use supervision and what are we training people in, and how are we um how are we integrating the quite technical input that might come from a therapist or a psychologist into the wider milieu. So there are some very kind of structured things that might be happening, but a lot of the work is in the richness, the relational richness that happens around those structured processes. And we know this from you know, you talk to you talk to um young adults or or older adults um who’ve been in therapeutic settings, and they’re not often quoting the the model and the theory and the the framework. They’re talking about the people that they were with, and they’re remembering specific moments and things that were of value to them, and you can’t always know what that’s going to be when you’re applying a model from a textbook, so to speak. So Yes.
Colby 16:34
I wonder if I wonder if in it this um this notion of a therapy of therapeutic residential childcare and what that looks like, and that it does, it’s a whole of it’s another way I would think of it as like a a whole of organization endeavour as opposed to as opposed to an endeavour that is specifically and perhaps in a fairly prescribed way is just focused on the children who are in the residential care environment. Um I wonder too. I do wonder whether that a lot of the development of therapeutic residential childcare, perhaps in the UK and perhaps in other other jurisdictions as well, has emerged from therapeutic communities like the Cotswold community, the uh um the Mulberry Bush um and and and and therapeutic communities of that that ilk.
Kevin 17:34
Yeah, I think so. I think that um in a UK context, um
What Makes Care Truly Therapeutic
Kevin 17:40
we see this in complicated uh systems that sometimes some some new um framework for practice or some some revisited concept becomes the thing that everyone is focusing on. So for several years it was all about attachment theory. Um in more recent times, the language has been about um trauma-informed and trauma responsive. Um and I think therapeutic childcare uh was a kind of a precursor to all of that. I think there’s there has always been a very long and rich um tradition of relational therapeutic childcare in a variety of different shapes and sizes, whether that be um you know education settings or larger therapeutic communities or um smaller therapeutic children’s homes where therapists were directly part of the staff teams. I was thinking of an organization like SACS in the UK, yes, um, that that was around for a number of years that was doing some pioneering work in this field. So these things have always been around. Um, I think it became complicated. Uh, one, there is a complication in the UK context about what do we mean by therapeutic, um, both from a provider from a service uh level, but also in terms of the local authorities, either in terms of social workers that are seeking to place children or the local authorities that are looking to kind of coordinate and commission services. Um these are these are delivered um mostly in a kind of contracted way in the in the UK, that’s to do with how they’re funded. But it but it does bring an issue about what do we mean, and and therapeutic childcare, I think, often gets talked about as if it’s a single descriptor. A bit like residential care gets talked about like it’s a single descriptor, rather than understanding it as a continuum of different expressions based on the same principles. So you get confusion between models and frameworks, or you know, does a home, if a home has a therapist, does that make it therapeutic? Or how do you know the difference? If you’ve got a psychologist that’s maybe visiting and consulting and working through the team with formulation and reflective spaces, and maybe not doing direct work with children, is that therapeutic? Um, and and how do for I think for commissioners and for regulators, how how do you know what you’re looking at? How do you know what questions to ask in terms of the governance of the system that facilitates the practice? And I think that’s that’s right where we’ve been at in the UK for a number of years. So when you talk to social workers, a a lot of organizations um describe themselves as therapeutic, and that term gets used very broadly. Um it’s something that is a live conversation. We’ve just been involved in some some work with uh the UK government, so it’s the Department for Education that that oversees our sector. Um, and they’re about to produce a report around residential childcare and its purpose. Um, and I know we’ve had some kind of headline indications of what that’s going to say. And you know, it’s talking about all residential childcare should be seen as therapeutic by nature of the work that it’s been asked to do. That’s me paraphrasing. Um, and so that is going to open up a really healthy and helpful conversation at a systems level in the UK about so what does that mean and how do you measure it, and what does it look like for staff? And and we have the tools already in place to be able to um answer those questions. So it feels quite exciting in terms of there being more um a bit of a spotlight shone on the reality of um the important and sophisticated work that that should go on in all children’s homes, and and sadly it doesn’t at the moment. We don’t you know children don’t have access to what they need when they need it. And it’s about this focus on practice.
Colby 22:06
We would say that it would it that an endeavour like that will put some more meat on the bone, so to speak. It’s very easy to say, you know, that we run a therapeutic service. Um, but I think what I’m hearing you say is that there’s not really broad spectrum agreement on what what that means, what that looks like, a therapeutic service.
Kevin 22:27
It can be puntured. Yeah.
Colby 22:30
And and I guess I just from from my own perspective, and I just checking out this understanding again with you, is that I would see a therapeutic service as being one that has a primary task and the and as one that uh privileges um staff containment, staff support and staff development in a way that is aligned with the primary task and also and facilitates the delivery of the primary task to the children. So that I I see that as an organization that is um is very much focused on alignment right down through um through the organisation in terms of the therapeutic uh service, the therapeutic tasks that we’re delivering. Yeah. I wonder if that what does the the UK context look like? Um because I I’m using the UK and speaking to you because it is a very large um uh context uh jurisdiction for for looking and and there is quite a diversity in the expression of residential childcare and the delivery of residential care childcare. What does it look like from you know, from your perspective?
The UK Market And Commissioning Reality
Kevin 23:55
Yeah, it’s evolved. I mean, I I’ve been doing this work for 30 years, and uh I initially started in the in the local authority in the public sector, and that was right at the time when local authorities were beginning to move to an outsourced model. It was the very it was the very early days of the kind of independent or private sector. Um, a lot of the large charities that had been involved in residential care previously had kind of really withdrawn. Um local authorities, uh, I think one of the issues was that local authorities, in terms of their estate and the kind of physical premises and the buildings that hadn’t really had a lot of investment over a long period of time. It was coming off the back of abuse scandals, and there was a there was a move towards outsource uh outsourcing, which was quite a painful period of transition for for many. Um, but many of those early um independent sector provisions were experienced practitioners already doing the work who then opened and established services. Um and you talked about you know Cotsall community and Morbury Bush and Sachs and you know a number of other a number of other uh organizations, and so it kind of grew organically from from there. Um I think with the benefit of hindsight when we look back now, I think that um a lot of the early those early splits, the early pain of moving to this more outsourced model, there was a lot of suspicion and mistrust about an independent sector delivering this work. Those conversations are still live today, perhaps for different reasons. Um and I think that um local authorities were not able to engage in their um authority to really specify what it was that they wanted out of residential childcare. So it was broadly left to the market, in quotes. It was left to providers to decide what sorts of services they wanted to offer and whereabouts and what they were going to look like, and and and that concept has broadly remained unchanged over 20 odd years. So we’ve ended up with a landscape in terms of the shape of provision, we’ve got a landscape which has lots of very long-standing and robust practice-based services. Um, you’ve got organizations that are now owned by private equity organisations, and they come in different flavours. Um, some of them have very large geographical footprints, and in terms of their volume and how they’re able to invest in practice innovation and specific services, there are some really amazing um uh technical services that are providing real support to children and young people. Um uh, but they still make up less than half of uh you know the provision that we have. Most organisations are small and medium enterprises. We’ve now got the beginnings of some more public sector provision opening, um the concept of rebalancing the market, and actually many local authorities are finding that exceptionally challenging. So there’s all sorts of things we’ve got, some local authorities are opening their own, some have gone into partnerships with different sorts of organizations, and a lot of that has been with varying degrees of success. And I think the learning that’s coming out of that is that um, as you touched on earlier, to actually establish and sustain and maintain these complicated systems that ultimately are delivering a relational experience with some quite vulnerable young people on the ground, it’s really complex work that is rooted in practice and it’s trying to find ways of navigating a communication between procurement and commissioning, regulation, and operational practice. And within that, um you know, there is this diversity of uh therapeutic provision. And when you talk to local authorities uh and and people who are placing children, um there are some services they know they’re gonna get exactly what it says on the tin. Uh, there are others where it can be uh you know a bit of a mixed bag. There are services that are um incredibly well-meaning, uh, with really strong values and motivation, but maybe um uh would benefit from developing their sort of technical understanding and competence, and that that’s work that the practice charity that’s involved in does. Um and sadly, we also have a situation where you know therapeutic has become a bit of a marketing badge, as has attachment informed and trauma informed. And so you have organizations, maybe consciously or otherwise, um, don’t really know what they’re what they’re offering, might they might claim things, but it’s not really being delivered in practice. Um and so from a from a from a young person’s point of view, um, it can be a bit of a lottery uh in terms of whether they get access to what they need. And this is where the UK kind of political conversation is at at the moment. With the the UK landscape, we have more children’s homes, we’re approaching 5,000 children’s homes registered in the UK now, which provide approximately 15,000 uh places. Um and if I use some and if I use some round numbers, we have approaching 10,000 young people who might require residential care. All of those numbers are are record highs in my in my 30 years, and despite that, we have a growing number of young people who are not getting access to the right type of services where and when they need them. So on paper, we’ve got significant oversupply. Um, in reality, we don’t have the right types, the right mix of provision. And it and in that mix, you’ve got all kinds of other questions about profiteering and you know, use of illegal children’s homes, and you know, local authorities sometimes in impossible situations where they have the statutory responsibility of being able to provide a service for a young person and a system that is unable to offer anything. And so you end up with uh young people being placed in what are called um you know unregulated and unregistered children’s homes, which is or situations where risk is being managed with um extra staffing, or children are um uh living by themselves or increasingly smaller numbers as a way of responding to risk. So that there’s a number of different things that are at play here. Um and you won’t be surprised to hear me say a focus on practice is the is the solution to that.
Colby 31:37
If my math is correct, um I think it is. Um the way hearing you talk about the number of children, the number of providers, it it works out to perhaps on average two kids uh per provider. If I heard you correctly, 10,000 young people, 5,000 uh um children’s homes of various um shapes and sizes. And I guess that contract for me that contrasts with what we were talking about earlier was this idea of the therapeutic community where a um where it is a community and there are large it’s larger group care and you’re harnessing the group. Um Richard Rowlinson from you know an elder of the of the uh Mulberry Bush and has been on this podcast a number of times. One of the quotes that really sticks with me is that he said, Children come to the Mulberry Bush to learn to live with themselves and with other people. And that yeah, and and we know that you know the the idea of it takes a village to raise a child. Thank you, Patrick Tomlinson, who keep who reminds me of this, includes other children. It it includes it includes having other children around. So I guess um we have this situation, it sounds like, where a lot of provision is not harnessing the or or perhaps not not um addressing the power of the group or the the potential therapeutic benefit of of larger larger groups um for children in out-of-home care who are in residential care. And if if I could just go on my own jurisdiction, you know, often our children uh in our jurisdictions who are in residential care are not in school very much either. So they’re really not in a group anywhere. So yeah, am I right in in thinking that we’re we’re talking about a move from larger, you talked about the those perhaps those are institutions or referred to as institutions, but those are the larger um um group homes that were run by charities, and it’s you know, there’s been this proliferation of smaller group homes.
Why Children’s Homes Keep Getting Smaller
Kevin 34:08
Yeah, this is this is again very live uh debate in the UK. Uh, and as you touched on earlier, it’s something that’s um that I’ve been quite engaged in. I was part of uh I contributed a chapter to a book that was published uh in the summer um from a range of perspectives looking at the question of um why children’s homes have been getting smaller. Um so without a shameless plug, I would definitely encourage anyone to have a look at that. It’s called um The Perfect Little Children’s Home. And it it looks at both the kind of historical, um, some of the historical perspectives that have shaped um residential childcare in a UK context, but it also looks at the economics, um the practice issues around group size, the lived experience contribution, commissioning, and a lot of um a lot of this drift towards smaller has been it’s driven by a number of things. So I think within the UK legislative framework, back here, the Children Act in 1989, there is a whole kind of family first, families are the best place to raise children, um if it can’t be in their own families fostering, and and of course, of course, that’s the solid principle, and it’s also not right for everybody, um, and it’s not what all young people want. But because the the system and the legislation, and there’s something about at a societal level about what we might imagine goes on for children in care and what that work is about, I don’t think there’s a very open societal conversation about the reality of the work. So we end up with these kind of false um false assumptions um that would say, well, children’s homes need to completely replicate what a family home would look like. And and in many instances, you know, yeah, they should. Um, but it’s a much more sophisticated piece of work that’s going on in that address. And uh the idea of living in in smaller and smaller groups, a lot of that’s been driven by risk um in the in the UK, and that has now got to a point where um often the local authorities and the placing social workers uh almost believe that, well, young people need to be managed in smaller groups to manage risk. And then you match that with the kind of concept of a more individualized approach to care planning and and in involvement and um assessment and intervention, which again is is right from a case perspective, but that can happen in a group context. So there are lots of things that have worked together that have seen us drift to smaller and smaller homes. So the most common registration category that we have in the UK, uh, in terms of new homes opening, are two placement uh EBD homes, emotional behavioural difficulties. And you know, I’m certainly positing that I think emotional behavioural difficulties is too broad a category. Um it it it’s almost meaningless in terms of in terms of the actual profile of complex lives that that residential care is needing to respond to. Um we need a more sophisticated conversation. I think children deserve us to have a more sophisticated conversation so that we’re shaping the services around them. Um and it drives up cost, it drives up cost and it’s more isolating for staff and it’s it’s harder to manage and you you can’t access the group dynamics, there are power imbalances, there are all kinds of um of issues. It’s not to say that smaller homes aren’t needed for some children, but I think it’s about going back to that definition, planned and purposeful. And and I would argue if we really scrutinized the the purpose of many of the homes that we’ve got, they don’t need to be as small as they are, and we’re missing out on um many practice opportunities rooted in theory as a result.
Colby 38:37
I really I want to get into that. But before I do, when you were saying that uh that the the legislation was kind of you know pointing towards we want we want um um care options for children and young people who can’t be safely cared for at home to be in a um in a in a uh uh an environment that is much like a family a family home environment. The thought that was going through my head was whose family?
Kevin 39:11
Yes, yes, whose family?
Colby 39:16
Yeah, yeah. I mean families are perhaps in some ways even more diverse, less uh homogeneous than than than residential childcare provision. So um yeah, so that the thought that the thought was, well what are we really talking about here? And I one of my bugbears is the standards that are often used by statutory authorities against which to assess others, you know, from right from birth parents to service provider or uh social care service providers. And um they’re often so woolly and imprecise and poorly defined, and such that we become arbitrary people become arbitrary in the way in which they uh assess a service or assess a family. Um anyway, that’s that’s just my hobby horse. I uh one of one of the things.
Kevin 40:16
I mean I think I mean I think I mean you’re not you’re not you’re not alone. I think Henderson produced a book last year um which really unpicks a lot of these societal legislative policy systems assumptions. Um, and certainly in terms of you know, because the common narrative is that uh well we know that residential care gets used as a placement of last resort. So children have to have to repeatedly fail before they’re able to um uh to access that type of provision. And then we make comparisons about the outcome of outcomes of children in different forms of care without maybe acknowledging the starting points or the journeys they’ve been on, and especially for residential care, which is always seen as um you know it it conjures up either images of um you know institutional settings um or abuse or um you know delinquent behaviour and and uncontrolled environments that are not loving and not caring. You know, these are all of the perceptions, and you know, there’s a very strong the research narrative, the critique of a lot of the research around residential care is that it isn’t clear on what it’s describing. So it talks about residential care as a single thing, it doesn’t really make any distinction between different theoretical models of practice that might be applied in different contexts. Uh and I think in the in the I might be able to remember the um the specific um uh piece of evidence. Um, but I know that there have been studies that have made comparisons between the outcomes of children in fostering provision versus quite defined therapeutic residential group care. Um, and the residential care performs at least as well as. So, but in our in our in our psyche, I think at a systems level, yeah, residential care is the is the poor relation and often overlooked and not purposefully used.
Colby 42:24
Um yeah, and I think you know that’s all with the best intentions, you know, people say, oh, you know, a family the family is best for children, and so a family environment, if children can’t be safely cared for in home, would be the best um the best alternative. But the reality is the children have been hurt in a family environment. And that is one of the, I think, one of the prime issues or prime drivers of placements being of family-based placements being put under tremendous strain and falling over from time to time, and children ending up going through a succession of placements and then into um into a residential placement. And yes, I had Bruce Henderson on the on the podcast uh some time ago as well. I’m doing the rounds, Kevin, um and going around again, uh you you might say. Um and uh yeah.
Kevin 43:20
That thing about family, sorry, that thing about family and size though, the the and and and institution and what do we mean. So, you know, in in in the services that I work with, they are unusually large, even by a UK context. One of our communities is 16 young people, and the other is up to 90. So these are very large. Um, and many you know, social workers or visitors or people that you talk to, you know, initially they have a preconceived perception of what they think it’s going to be like. Um, and although it’s a large, busy environment, it’s very domestic and it’s very Familial in terms of the the um I’m gonna borrow a phrase from uh Laura Steckley, uh who I heard speak at a conference recently, who talked about the emotional climate. So she was talking about you can have tension or breakdown in a in a relationship in the moment, in terms of the emotional weather that might be going on, but that’s episodic, and that happens in the context of a broader emotional climate. And I really like that because there’s something about um the rhythm and the routine, and how we are with each other, and how you find your place and are held and valued and challenged when you need to be and contained, and how you have a voice and are able to participate. These are all features of um uh uh you know a healthy family experience, and we have all of those um in spades in our therapeutic communities because we deliberately work to create and sustain them. So rather than it just evolving organically as it might in a you know, in any kind of family matrix, we’re recognizing that those things are really important and we are actively creating the milieu and the environment for that to happen.
Colby 45:23
There’s an intentionality about therapeutic care generally, and therapeutic care initiatives occur in foster and kinship uh endeavours as well, but there’s an intentionality to facilitate a care environment that is uh that achieves certain um outcomes, including things like the emotional climate and the way children are responded to and and the like. I do I do also do want to kind of focus our attention a little bit on this move to smaller and smaller homes, you know, whatever the the rationale has been for that, what what do you think that um children get,
What Larger Groups Give Young People
Colby 46:10
children and young people get and benefit from in the larger group setting that they don’t have the opportunity to experience or or they don’t uh benefit from in that in that smaller care uh home?
Kevin 46:27
I think there’s something about the you know the the size of a group again also needs to be deliberate in terms of the task, in terms of the the age or the particular needs of a particular group of children. Um I think that you know from my own experience and and from my own research and from what I hear uh from the care experience community, there are really strong bonds. There are all kinds of things that you benefit from in being part of a group. There are downsides as well, of course, but yeah, there are there are all kinds of benefits. So um, young people have spoken to me about um the therapeutic value for them of being part of a conversation in helping somebody else who’s going through a struggle, and when that’s done in a community context, the the bearing witness, seeing somebody, you know, when you when you’re working in a group, young people, the group is changing all the time because young people are moving on and new young people are arriving, same for staff as well. So there’s something about a lived experience of transitions that can be worked with in order to help young people prepare for their own transitions. Um, you also have the sense that young people are at different stages in their therapeutic journey, and we know that these journeys are not linear and uh it’s very individual. So some young people will make rapid progress and then maybe um you know have a period where they maybe feel a bit stuck, or there might be something goes on and there’s some regression or some acting out, um, some breaking down of relationships that you can then work through and repair. And young people are either directly involved in, or they’re um observing or on the periphery, or they’re playing a supporting role, and all of those different positions have therapeutic value depending on where each young person is, as long as that’s harnessed deliberately. Um, I think you know, Adrian Ward talked about um opportunity-led work, and there’s there’s something here about uh from therapeutic community language, the idea of the living learning environment. That’s what Rich was uh Rich Rollinson was speaking to. The idea that you are you are learning about yourself, you’re learning to live, and you’re using this group living environment to learn about yourself and others and how to negotiate relationships. So in a larger group, and this gets proportionally larger, um, you have a significantly more complex relational matrix. So that the the opportunities, the multiple um number of opportunities that present themselves in unexpected ways, even in the informal, relaxed, you know, outside the structure of the therapeutic program or the school day, there’s huge richness that is about human relationships and learning about myself and understanding my feelings and sharing and being part of something and having identity. So that is all enhanced or can be enhanced in a larger group setting. So I think you you you I think some of these ideas, if we think practically in terms of numbers, um in you know, if if we’re if we’re having two young people or three young people living together, we know from kind of um you know dynamics and group processes um what happens when you have the power of a two against uh maybe a group of staff, um, or the power of the triad. Um, and if there are two already formed, what it’s like when the third person comes in and the experience of that, then we think about fours and fives and so on. I think when you when you get to a group of five or more, um you know, I I I think you start to have a um a group, a group size that almost has it has enough size of itself in a in a peer group to be able to start to really reflect on the interplay between the different combinations of relationships. I mean you it’s more comp it’s it’s significantly more complicated and more diminished, I would say, the smaller the number of groups in the group. And I think when you’re into three and two and solo provision, we’re talking about something else. Uh, you know, where it’s far more difficult to harness uh a deliberate relational um experience in those settings. I think it looks very different.
Colby 51:29
Um a live issue, it’s always a live issue. It’s been a it’s a live issue in my jurisdiction to even today. I I’ve been commenting on some some uh related posts on social media, is the transition from care for children and young people post-18. And um one of the things uh I had uh Tanya Abu, who is in is a care lever, uh who’s uh also a social work uh academic in um in Germany, talked very powerfully about um the transition from care being um not just about you know knowing how to cook and clean, you know, wash your clothes, pay your bills, access your money. You know, it’s not just about skills, it it’s about relationships. And it occurs to me that um that we should be preparing our young people to be able to live with other people. That y you know, like and I I see it too often, these single placements that are, you know, for risk reasons, you know, often for for genuine reasons, where the the young people turn 18 with no functional learning uh and experience around being able to live with others and then we we put them out into the world where they kind they kind of have to. They’re gonna they’re gonna end up with others uh anyway. And I I wonder if that’s one just one of the real standout um, and I think this is what you’re saying, one of the real standout benefits of a larger group home, that it does facilitate that opportunity to live with others.
Kevin 53:28
I mean, I think I think it depends on even even the language here, it depends on what we mean by larger group. Um I think that changes over time. You know, in a UK context, I think many people would think that five or six uh is a is a is a larger group because it’s become so so um uh you know uh um dominant that homes are smaller and smaller. So I yeah, I I think that um yeah, yeah, I mean you’re right. I think that there is a need, some young people um uh at particular points in their complex lives may require very intensive support to help stabilize them and keep them safe. Um and I think that in those situations, those are likely to be our most vulnerable young people in our system and worthy and deserving of the most technical and clinically informed support. I think those services, um there is a need for them. I mean, you’re you’re in the territory of um, you know, some young people maybe be being in uh in uh uh mental health uh inpatient services, or maybe young people coming out of other types of secure settings, or young people maybe not not meeting those thresholds, but having quite complex lives. Those situations clearly occur. Um but they should be um exceptional, um, exceptional in their use and exceptional in their practice, I would argue, and and really clear about what is the route back to relationship with others, what what’s the route back to living with others? Even if those are incremental steps, um that has to be the that has to be the one of the primary tasks. It has to be part of the purpose. Oh well, I just think in terms of you know linking it back to the idea of of leaving care. I mean, again, in the UK context, and I and I do hear this in other jurisdictions as well, the idea of the cliff edge and young people leaving care and then going into other settings where maybe housing is insecure or the or the relational support falls away, or you know, other types of complexities. And of course, so it’s a real um it’s a real postcode lottery in the UK. Um, and that’s one of the issues in terms of living in a group. You know, we have young people at an earlier stage in their in their journey with us who are bearing witness to the journeys of older peers navigating transition. And some of that goes well, some of that goes as planned, some of it the plans change at the 11th hour, some of it there is huge uncertainty. Um, you know, getting to witness how somebody who might be seen as one of the real um, you know, peer mentors and the real kind of successes in the service then start to approach transition and have a period of regression through anxiety, and how that’s
Leaving Care And Learning To Live With Others
Kevin 56:40
worked with, there is something about holding on to hope and and and bearing witness to the reality of the journey that is therapeutic in itself. Uh, I mean, I I don’t want to make excuses, I don’t I don’t want to say that we’re engaging in therapeutic work to almost help provide greater resilience for the potential pitfalls uh of the system that lie ahead, but there is something about try the therapeutic tasks, about trying to help young people develop their sense of self and those internal capacities and resilience to be able to engage in whatever life is gonna throw at them because life is complicated for all of us, isn’t it? And we we all have to navigate you know different different challenges. So there is there is it operates on different levels, I think, in terms of you know using a group experience to help better prepare young people for life life beyond. And we find that the relationships in terms of our uh the contact that we have in our service with the young people who’ve moved on over many years uh is very strong. And I think there’s something about um the strengths of friendships or the strengths of relationships that young people might afford with particular members of staff over a period of time. Um, they stay with them. So when we do our kind of we do online forums and reunions, and we have young people coming back for um, you know, celebration days or to come back as peer mentors, there are all kinds of different ways that they can they can uh remain involved and connected. Um and there’s something about having an attachment and a connection and a memory to people and place that’s part of your life story, if we if we use that that language, that is really powerful in terms of um making sense of identity, I think.
Colby 58:48
Yeah, I remember um when I spoke to John Turbival, he they at the Maubreybush, they also they have um alumni that have reunion days, and he spoke about um you know a mother coming back and saying, you know, without having that had that experience of being at the Mulberry Bush, she could never have been the mother that she is. She could never have been a mother. The you know, powerful, powerful influences that when you think of when you when you get perhaps caught up in the the idea that that residential care is low-quality care is option of last resort, it it almost seems fanciful to you know to hear these stories. But a c a couple of other examples. One is the the the the um the folk at livramento in in Portugal um very much um demonstrate what you what you were talking about, about the you know, kind of like the younger siblings observing the older siblings g go through that transition to independence. And and I mean they they have um transitional program that goes to 24 odd years old, the girls in, but they go from the it is a um a large uh care environment and they they transitioned into smaller and then into apartments in the community and they continue to be um supported and but they’re still part of the Livermento community and and the younger girls get to see this. And the other thing that I that was on my mind when you were talking, and part some of it, one of the stories relates to what Marie was talking about, Marie Clutton when she was talking about uh Amberley Care. Um John Turberville, I think, also mentioned it um in relation to the mulberry bush. Is this and this really goes back to this idea of it takes a village, I think, or is it at least congruent with it. Is these um these examples of the young people starting to model the therapeutic task or the therapeutic model that of young people taking the younger ones under their wing, you know, uh and and and looking after them, which again if we’re thinking about whose family, you know, we’re replicating a family environment, you know, that’s not dissimilar to what in in ideal circumstances, hopefully ordinary, um you would expect the older siblings to be doing with the younger siblings, or at least hope that there was there was some measure of that, some element of that. And yeah, uh yeah, and it’s it’s kind of hard to see how that could be how that could happen often or routinely when in those very you know, in when there’s only a couple of young people in a home.
Kevin 1:01:51
And of course it’s not gonna happen if there’s only yeah, but these a lot of these opportunities are um significantly diminished by by the reduction in the relational um opportunities by the kind of relational matrix. Yeah, they’re just not they’re not there by bends of the reducing size of the group. Um, and I would also argue that um they’re also not there because that concept in terms of the kind of the theory and the practice that would sit behind that isn’t recognised in those services in the same way. But I would also want to counter the you know, just offer the the opposite position because um you can’t just bring um young people and staff together in larger groups when you’re dealing with trauma um without it being done in a very planned and purposeful way. This is not easy, and um, and there would be some tolerances and some limits there depending on the nature and the profile of the work that you are undertaking. So to give an example, so um Mulberry Bush that we talked about is working with primary age children um in a in very much a kind of residential school type environment, like a campus with the school and individual smaller group, I think they’re six or seven children in each of their um their houses on the campus, and and the entirety of that is a therapeutic community. Um now, when they’re working with those younger children where the focus is significantly more on that nurture and that recreating some of those um uh early parenting experiences for children of that age, that scale of the living part of the environment makes perfect sense. Um, when we’re working at Ambly with uh mid and older teams predominantly, um, with a slightly different profile of need, also with the school, but we’re doing that on a large group model because our young people are able to engage in a more um uh conscious talking type, use of community meetings, use of voice, um playing and active participation, taking on roles and responsibilities, things that are more developmentally appropriate for the age group that we’re working with. Um, and there are probably spaces in the middle. Um, you know, I if you think of so whilst we work in a large group of maybe uh 14 or 16 or or more, um I can think of other cohorts of young people and their particular risk presentations where working in groups of that size would not be conducive to the therapeutic task because you’ve got to the safety and containment and the use of boundaries that is required as the absolute underpinning, and everything we’ve been talking about today cannot happen without safety and containment as the foundation, and so that’s the bit about planned and purposeful. Who are we working with? How can what what’s the shape and size of our environment that can be safe and contained to do the work? And that’s why you you know we need different shapes and sizes of provision in different locations, um, uh providing a richer network. That’s how young people get access to what they need, where and when they need it, which is what we don’t always have at the moment.
Colby 1:05:40
Yeah, there’s no one size fits all. There needs to be diversity in the offerings. And um I had Doug Faircloth on uh
Safety First And Right Sizing Groups
Colby 1:05:50
fairly recently, he he was part of a significant evaluation or some you know, over the last nearly 20 years, significant evaluation endeavors of residential. care and residential therapeutic residential care here in Australia. And he talked about the importance of there being redundancy in in the system as well. So not not just diversity but but also some redundancy so that we’re not forcing we we can do the the planned and purposeful placing of children rather than forcing forcing them together in in circumstances where their needs may be incompatible.
Kevin 1:06:34
Yeah we know when it’s not when when it’s not um when it’s not done thoughtfully uh we know and we hear about um uh you know that uh distress and bullying and and incidents and environments becoming chaotic and um you know there is not an inevitability but but when you’re working with very complex trauma um which can include challenging behaviors or all kinds of other risks or self-indurous behavior or um you know whatever that might look like um there are going to be periods where things are difficult and things need to be worked through. It’s the way in which that is done and the way in which that is managed is what makes the difference in terms of the learning and the growth that comes afterwards from reflection.
Colby 1:07:30
So it’s not to say that all of these planned and purposeful environments are going to be um idyllic with with uh never a relational storm in the climate um because there isn’t a family in the country that that operates like that um but I think it’s it is about it is about being intentional that was the word that you you used earlier really intentional about what are we doing who with what’s the shape of their needs how do we understand that from a a theoretical and a practice perspective how do we create the environment that is going to feel the most natural and helpful and relational in the day-to-day experience I mean that’s the key to that living learning environment um it’s absolutely not one size fits all the concepts and the principles are universal and that’s how we have therapeutic childcare standards that can help shape the kind of the frameworks and the systems and the processes but the way that they are put together are in unique combinations related to the the primary task of different services I think and not unlike the fact that there is diversity in any caregiving endeavour including in families yes whose exactly whose family yeah whose family were were they intending for all children’s care in de uh initiatives to mimic in some way well yeah very much a focus what I’m hearing on where the children are at and what their needs are as well and we need we need to be we need to be very uh thoughtful I think about that and we need to have uh out-of-home care systems uh uh or social care system that caters to the diversity of um of children’s presentation and need yeah I think linking that back to the point made earlier I think in a UK context and I think this is this is true in in some other jurisdictions for a long time our systems were coordinated based on volume of places rather than diversity of practice and um over a period of time as the the complexity of lives and the complexity of need um that residential care was being asked to respond to changed and increased our approach broadly at a systems level our approach to how we were kind of planning and um curating um our our provision didn’t really change in response.
Kevin 1:10:15
And so we ended up with a situation where the map of what we’ve got against the map of what we need has gradually become more and more out of sync. And in that context this is where you get this this um growing number of young people that are not able to access what they need and in all kinds of just unhelpful and inappropriate arrangements. And I would include in that um the unnecessary use of extremely small provision. I think that’s a I think that’s a consequence of what I’m talking about. And that’s not to say that those services aren’t you know many of them aren’t trying to do um really well meaning well meaning work but I but I want to take a step back and at a systems level and kind of question and and and why have we got there that we think that this is the solution that more and more and more children need because it seems to be taking us further away from what we know about relationships and recovery from trauma and healing and child development and all of that good stuff. It feels like some of the some of the some of the the the point of delivery seems to have gradually been pulling away from the core principles about relational um human scale um domestic familial um uh type type provision you’ve probably already answered it um you undoubtedly have but if you could kind of succinctly pull it pull it all together what would what would a what would a an improved um social care system look like in the UK or you know and what what’s appropriate into UK is probably very much appropriate in many Western jurisdictions as well I think I think our services need to be shaped on um a real understanding of what children’s needs are um in terms of a granular understanding of children’s needs so that’s that’s about assessments and use of data to then be able to commission and specify the diversity of practice responses in in terms of the kind of the technical work that’s going on here what’s the theoretical technical response to children’s needs almost from a clinical perspective um and then from that what are the what are the shapes
Building A System Shaped By Need
Kevin 1:13:00
and sizes and locations of provisions that are best suited to meet those needs and I think if we approached it that way round um it it kind of counters this in almost feeling inevitable drift to smaller and smaller homes. There absolutely is a place for small provision planned and purposeful but I would like to see a a reorientation back towards more group living group living on different sizes whether that’s four five six eight because it’s purposeful um these are not forever these are not forever homes no they’re not forever homes they’re they’re they’re they’re places that are the young people’s home where they need to feel loved and valued and seen and protected and cared for um but they arrive at a specific point in their lives they’re not with us for very long and we have a responsibility to to to get the work right and make sure that their experience whilst they’re with us is as healing and restorative and as um productive as it possibly can be to allow them to leave lead fuller and happy lives.
Colby 1:14:18
Yeah and I think relationships are at the core of that and you know our children who come into care have been hurt in in in relationships and I’ve I’ve long put put at the the position that um when children have been hurt in relationships we need to facilitate opportunities for as many positive and supportive relationships as we as we can achieve with them. It’s absolutely yeah yeah and uh look I in my mind I I I’ve been thinking about some of the wonderful things that um that Marie talked about you know with Amberly care you know the the the young people having um some input into staff selection when new staff uh are taken on um the uh the the meetings that they run uh and and uh you know at that sense of agency that they get from them reminds me a little bit uh too of uh Doug Fairclough talking about um homes where when another young person is is um um is going is potentially going to enter a home that they that the young people get to meet each other and decide whether they think it would be a good idea to live with each other and yeah yeah yeah I yeah I think when you asked me at the very beginning about um about some of the differences between therapeutic community and therapeutic childcare some of those things that you described are some of the structural things that are done deliberately in therapeutic communities because you’ve got a group environment to be able to draw on those resources as part of the therapeutic method so it again it’s it’s this it’s a particular expression of planned and purposeful um but it’s being harnessed for its therapeutic benefit um it’s it’s uh it’s something that’s deliberate and conscious and young people as they go through that that therapeutic journey they have their own different stages they’re less likely to be involved in some of those things at the beginning and as they grow in confidence and as they see other people doing things and they get a sense of um of value out of making this contribution this idea of um uh finding a voice and learning how to use that and then using that as a platform for very active participation not only in your own care and treatment but but an active participation in the community in which you live um that’s the that’s what gives the foundations for agency that you can take out into the wider world this is very much rooted in child development um and that corrective relational experience that you were that you were talking about.
Final Reflections And Goodbye
Colby 1:17:21
Well thank you thank you Kevin for coming on again and and having this conversation and uh fingers crossed next time we speak to each other we may actually be on the same terra firma uh and not on uh respect respectively the opposite sides of the world yeah thank you so much it’s been great to be able to connect with you again and uh yes in real life next time yeah yeah well hopefully 2027 like I said I’ve been saying it for probably the last eight years but there was there was a lot going on betwi in the in the last uh eight years all right thanks Kevin thank you so much thanks Paul we take care have a good evening
About Kevin:
Kevin is a qualified social worker, organisational consultant, and managing director.
He has worked in residential care and education for 30 years (with Amberleigh since 2015), from front line practitioner, through management roles and into leadership in a diverse range of organisational structures, both public and private.
Kevins passion is for therapeutic residential care and education, promoting the use of quality improvement standards.
He is an Advisory Group member and Therapeutic Care Specialist at the Royal College of Psychiatrists.
Kevin has been a trustee of The Consortium for Therapeutic Communities for over a decade, supporting and developing therapeutic practice across the UK, in particular, supporting local authorities to commission specialist provision.
Additionally, Kevin assists providers in strengthening models and practice.
Kevin is a very public campaigner for better understanding and use of residential care through a focus on practice evidence.
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Disclaimer:
Information reported by guests of this podcast is assumed to be accurate as stated. Podcast owner Colby Pearce is not responsible for any error of facts presented by podcast guests. In addition, unless otherwise specified, opinions expressed by guests of this podcast may not reflect those of the podcast owner, Colby Pearce. Finally, all references to case examples are anonymised to the extent that the actual case could not be identified, or are fictional but based on real-life examples for illustrative purposes, or have client consent to talk about in an educative context.
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