Transcript for
Therapeutic residential care: The example of Jo’s

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and today I’m talking with Paula May, Manage of the Therapeutic Youth Residential Care Program at Uniting Communities in South Australia. Paula holds a bachelor of social science from the University of South Australia. And over the past fourteen years, she has worked in various roles within the community, including the family violence sector, youth homelessness sector and most recently, the child protection and LGBTQ sectors. She is responsible for establishing and managing Jo’s, an innovative therapeutic youth residential care program that provides long term residential accommodation to young people under guardianship. In today’s episode, we delve into how the program works and what makes it unique is a model of care.

[00:00:50] Thank you very much Paula for agreeing to come and have a chat to me today. About therapeutic residential care. I wonder if we could start by asking you to tell me a bit about your background and how you came to be managing the therapeutic use of residential care program. Uniting Communities?

Paula May [00:01:08] Yes, sure. And so at the moment, yes, I’m the Service Manager of Jo’s, which is Therapeutic Youth Residential Care, and that’s with Uniting Communities. I also manage Bfriend, which is for new and emerging young people who are perhaps questioning their gender, their sexuality,  and I might need some further support. And I also manage the foster care program, which has specialised foster care also under DCP funded. And so what led me to do this work? So primarily really was about my desire to want to help, yes. Help young people that perhaps needed support in their lives. Myself, I had dropped out of high school, carried a range of jobs that probably weren’t allow me to reach my full potential. Went to university later in life and it was certainly one of the best decisions I made, given that I was able to get a degree in Bachelor of Social Science, which then led to a fairly widespread career.

Sophie Guy [00:02:06] And how did the Jo’s therapeutic residential care program get started?

Paula May [00:02:09] So I guess primarily with Jo’s what Uniting Communities wanted to do was something different. We were awarded funding soon after the Nyland report. So when I was first given the role of service manager, I really just pulled myself over that report, trying to identify, what are the key things that were missing? That I guess weren’t around in residential care. It’s not hard to identify through research. I guess the various aspects as to why residential care often fails or perhaps doesn’t hit the mark with where it needs to be. So for me, it was about trying to draw on what we knew wasn’t necessarily working. Also trying to draw on perhaps what we’d identified in other models of what would work and then trying our best to create something special and something unique.

Sophie Guy [00:03:00] How long has it been going for now Jo’s?

Paula May [00:03:01] So Jo’s started March 2016. One of the biggest things for Jo’s is that we try to create a learning culture. So when we started, we wanted to make sure that we were never going to have a set model, were never gonna have a set way of working. We were going to be continuously improving and reflecting on what we needed to do differently, because as far as the reset we’d conducted, there was no other residential care program nationally and even internationally that was completely hitting the mark. So for us, one of the key things that we did early on in the piece is source high quality homes. If you were to go to most other residential facilities or homes, they often in high density housing trust environments, areas in which there’s little snow community support. The homes themselves are often very rundown. Furniture quality is quite low. And obviously those limitations, it’s often due to lack of funding, lack of resources. And NGOs are almost always just trying their best to make things work with the limited funding capacities that they have. So the first thing that we did was we sourced private investors. And by using that social investment scheme, we were able to purchase properties. And the homes that we sourced are lovely. They’re high quality homes in lovely areas, furniture from high quality manufacturers and stores, making sure that it was an environment that any of us as professionals would be happy to live there. Is there photos on the wall? Is there nice carpet? Is there vegie gardens? Is there all the things that we might also look for in a home?

[00:04:42] The next aspect that we wanted to do was staffing. So what we knew about residential care is that there is often a high turnover of staff. And that’s that’s nationally recognized. You know, often staff will come and go through these programs. And that’s for various reasons, mainly because it’s stressful. And for us, what we wanted to do was anticipate, I guess, a level of having a high turnover, but also prepare young people for more of that home environment. So what you could imagine is we’ve got these wonderful homes that look like any other family home that you might live in. And then we created something called the Jo’s family. And so by creating a concept of Jo’s family, it meant that we could reinforce to young people and staff that sometimes people leave the families, sometimes they come back. But there’s the values and the principles and the meaning behind a family is that, no matter what, we’re all here for each other. And it almost created this concept that was higher than, I guess, the homes, higher than the young people, higher than the individual staff members. Because it meant that it was sustainable, because that concept of Jo’s family, regardless of what members were in there, the Jo’s family concept was always going to be there.

[00:06:00] So not only did that help, I guess, anticipate the high turnover of staff and making sure that young people didn’t feel abandoned. It also created this environment where young people felt part of the family. It also created positive teen culture. So what you’d find, particularly in the Nyland report, is that positive teen culture is one of the best things you can do to eliminate really abusive care. So for us, creating an environment where staff and young people felt part of this family concept, it helped both the young people and the staff alike. As you can imagine, what would sometimes happen is that by referring to the Jo’s family, young people would at various times say ‘well you’re not my family, you’re not my birth family’. That’s why the third aspect of what makes us unique is that we actually work with their birth families. So by working with the family, what we’re able to do is almost bring their birth families into the concept of the Jo’s community. And what we know is that a young person who is removed from their care of their parents, often they don’t want to be. They want to be with their birth family and the birth family want to have those children in their life still.

[00:07:11] So by involving the birth family in such events as inviting the mother and father or any other key members into the home first. Getting to know them, telling them about the program and actually inviting them to speak to their child about moving into Jo’s. Also inviting the birth family to come the moving in date. From there, we get the birth family to attend birthday parties, Christmas celebrations as much as we can do while also managing, I guess the risks associated with these are parents that have had their children removed. We always need to consider getting the approval that we need from the Department of Child Protection. But if both of those stars align and we are, I guess, given free reign to engage with these families, it has proven on numerous occasions that having the family engage with us in that concept of Jo’s family, Jo’s community has seen significant improvements for the young person. Feeling more engaged with the program, not feeling guilty about not living with their parent, knowing that they can trust us because we also work with their families. On the other side of that, it’s helped parents. You know, what you would often find with parents who have had their children removed, they might have grandchildren that they still see regularly. They might have older children still in their care. And so by involving the parents, we’re able to actively role model healthy family functions.

Sophie Guy [00:08:39] Yeah, yeah. I like that idea. Well, first of all, as of calling it Jo’s family. I mean, it makes sense as it’s quite simple. But just having that as the name and that reminder all the time and then the added sort of environment of actually being a home. Because we know that like the ecology of environments surrounding people, surrounding children matters a lot for their mental health.

Paula May [00:09:07] For us, though, by having the home and having that concept of family, it really connects with while we’re therapeutic as well. You know, what we’re trying to do by being therapeutic is in a way treatment. You know, we want to be supporting these young people and these parents moved from the trauma that they’ve experienced to a place of transformation. And so the house concept of Jo’s family are just two aspects for us in the broader concept of our therapeutic model.

Sophie Guy [00:09:35] Could you talk about the therapeutic model?

Paula May [00:09:38] Yep. So for our therapeutic model. What we try to do is operate under self-organising principles, which means that the youth work team self-organise how they support the young people. It’s the youth workers that are delivering the care. It is the youth workers that are delivering the normal parental responses. So we want to make sure that it’s the youth workers that are designing the individual therapeutic directions and strategies to support the young people move on from their trauma. Behind that obviously, though, we need to have a level of accountability within the leadership team. So I guess for the therapeutic model, there’s five different stages which I believe will be available on the website for people that are interested. And a lot of the model reflects, I guess, what we call as the Positive Lives Engagement framework. And within that framework, there’s a range of different options or guest elements that connect with what we need to support these young people with. One of the key things, that we focus on is the support for frontline staff to deliver the model. So when I talk about I guess deliver the model when I’m really referencing is therapeutic strategies.

[00:10:48] So what you’d find with a lot of other therapeutic models often well, research, internationally renowned models, often what can happen is that they, I guess, fall down when it comes to the frontline staff. So what you’d have you would have a wonderful academic mind that has written all these wonderful things about what these young people need. But at ten o’clock at night, you’ve got a youth worker, say three or four, if that, often solo, nor the staff with them. They’ve got a young person that is perhaps showing sexualised behaviours, abuse, violence, all of the things that obviously come with the trauma that they’ve experienced. It’s really hard for that youth worker to be reflecting on a fairly rigorous academic model. So we’ve got a broad concept of what our therapeutic model is. When it comes to the actual therapeutic directions and strategies, we let the youth workers design that. And so every fortnight there’ll be a team meeting. And in that team meeting, youth workers, as the frontline staff, will be talking about what things they’re seeing, what things that need to be doing differently, how they need to be consistent in their approach. And the coordinator of each house as well as the therapeutic specialist is there, I guess, to guide the youth workers and lead them to make sure they’re following best practice and really making sure it links back to the therapeutic model. So making sure that the youth workers themselves feel comfortable with the different strategies and how to actually implement it, even when they’re faced with fairly confronting behaviours from that young person.

Sophie Guy [00:12:32] And so are they strategies that come from a developed model that they can pick and choose. Or as it was coming off of them themselves?

Paula May [00:12:42] It really just depends. And it would be hard to dictate exactly what it is, mainly because they are focussed on each individual young person and whatever it is that they are experiencing at the moment. So depending on what the young person’s going through, it will have a very different strategy. And that strategy may only last for two weeks. That strategy may last for months. One of the key things, though, that I guess is important for us is making sure everyone is following the same support. So one of the key or one of the things that often will fall down with other models of residential care is the youth workers will work on a roster that may cover five different homes. The staff are often perhaps they don’t feel comfortable with some of the normal parental responses, such as a consequences for behaviours that need to be supported. You know, these behaviours might be something minor, such as manifest or some verbal abuse. They might be sexualised behaviours that are going on in the house. But what you’d find is that the staff will be on rotation across numerous different houses so that they’re not burnt out from some of those complex behaviours.

[00:13:55] That not only means that the young people don’t get to form a meaningful connection with staff, but it also means that there’s no consistency in parenting. And that’s one of the key things that I think you’d find a lot of residential care providers have lost that ability to normal parental responses, you know, simply because they’ve got high staff rotation. They don’t know the young people, the staff on often getting together to actually talk about the consistency that’s needed. And so a young person will just carry on. They’re not given the support that they need to learn from an adult about healthy boundaries and healthy ways of communicating with other people.

[00:14:37] So that’s again, one of the key things that we’ve got a set number of staff per house. We have those fortnightly meetings. The staff themselves are talking and designing how we need to be responding to the young people. And then having the coordinator, that’s one coordinator per house as well as a therapeutic specialist. It helps oversee some of those therapeutic strategies and helping oversee the practices of youth workers to make sure that everyone is having the same response. The quicker that we can have a consistency in approach support some of the complex trauma behaviours that we might be seeing, the sooner that the young person is able to have the ability to move past that. But we want to get them to a place where they’re able to engage in meaningful lives, whatever that may look like. It doesn’t have to be Uni, it doesn’t have to be work. It just needs to be something that they’re fulfill in their lives.

Sophie Guy [00:15:34] And so you’re talking before about what can be a bit of the problem of staff working between several houses. How does it differ with the Jo’s model, do staff just get allocated to one place and they stay there?

Paula May [00:15:45] We do. So really for us a house is a therapist. It’s the positive teen culture. Jo’s family, Jo’s community. And within that, that is the set, I guess, staff per house. They do work on a twenty-four-seven roster, but it’s the same seven or eight staff that remain in that house. And as well, another part of our therapeutic model is supporting youth workers to engage in normal parental responses. We’re really aware of not letting risk management get in the way of having those normal parental responses. So often, youth workers might feel scared to have physical contact with a young person for various reasons. Of course, we need to consider abuse in care, we need to consider things like allegations. But unfortunately, what happens with those risk factors is that youth workers feel scared to engage in some of those normal parental responses. Such as a hug when a child is crying a pat on the back, when they’re doing a great job asking the meaningful questions about their lives, and also a youth worker sharing meaningful information about their lives. We’re aware of the risks. You know, we note them, we acknowledge them. But we support youth workers within those therapeutic strategies and directions to push the boundaries for us. The best way that we manage those risks is the engagement that they have with young people needs to be purposeful. Why did you give that young person a hug? Why did you engage in a personal conversation about perhaps your own struggles? Why did you enter the bedroom and tuck them in and read them a bedtime story? These are all normal things that any parent would do. And so all we do to manage those risks is get youth workers to name the purpose of that activity. And that alleviates or somewhat alleviates some of those risk factors. Because the engagement that they’re undertaking is meaningful and it’s purposeful, and it’s for a really valid reason.

Sophie Guy [00:17:51] Okay. I guess I can imagine that just going through that process and making a bit explicit sort of helps to just have that justification that’s there. If it’s needed just in case.

[00:18:02] Obviously we casenote those types of things and making sure youth workers are being really open and transparent about some of the activities that they might do. So it always comes down to what is a normal parental response. If you can identify it as an all parental response, we are going to attempt to do that because that’s what young people need, and it’s often what’s lacking in residential care. Most young people in residential care almost feel like they’re being looked after by a system, a robot or a roster that rotates people that do case notes, check in, check out, put food on the table. Where’s the meaningful therapeutic engagement there? It’s nonexistent. So yeah, we try to do that as well.

Sophie Guy [00:18:51] Yeah, it’s great to hear that because, you know, sometimes it just seems as though everything is so sort of risk averse and you know, everything is sort of part of this big system and it’s too clinical and this and that. So it’s disheartening to hear of an organisation prepared to intelligently assess that risk and put the human needs ahead of that sort of risk adverse mentality.

Paula May [00:19:15] And as corny as it sounds, it’s the heart. It’s the heart behind it. These are young people that have been through horrific abuse. Some of them, you know, through no fault of their own. We are trauma informed. We acknowledge that these young people have been through a lot in their lives. They need to come to an environment that’s nice. It’s got supportive staff, that there’s love, that there’s care and that there’s meaningful connections. Again, going back to the house, you know, we’ve got photos of all the young people up. Their school photos are visible. Everything that you would see in a normal home we have at Jo’s. We don’t have a lockable office where there’s rosters on the wall or staff files, we don’t have any of that. There’s a small walking wardrobe that has a few of those features. Given that we can’t ignore the fact we are a residential facility, there needs to be some lockable items but it is a small walk-In closet. Besides that, the whole house is open. There’s no locked doors, there’s no office environment. It is very much a family home. Which is really important.

[00:20:18] Another aspect is the authentic engagement. So for us, that really connects with those normal parental responses, making sure that we are engaging with these young people in an authentic manner. We name that. We know that they’re under guardianship. We name I guess some of the struggles that that comes with and we try to support them as best as possible with the reality of what they’re faced with. We want our youth workers to be building those meaningful connections. So making sure youth workers are letting the young people know about them, who they are as a person, not just this robot that’s on a rotation roster. You know, we make sure that we hire based on values to ensure that we’re recruiting people that connect with what we’re trying to do at Jo’s. For us, though, there are five stages that we consider get them from a place, I guess support them from a place of that trauma to transformation.

[00:21:08] So stage one, the focus is intake an adjustment. So making sure the young people connect with the Jo’s house, connect with the Jo’s family, and become familiar with the general runnings of how we’re operating as a family unit within that intake stage, it may take six months. It may take a year. It really depends on how that young person is engaging with what it is that we need to provide within that intake period. Lots of ups and downs. You know, we anticipate property damage. We anticipate staff will be verbally abused. We anticipate there may be some physical violence in the house. We anticipate that DCP might be given a complaint from the young person, you know, the Office of the Guardians and so forth, because they’re all things that I guess normal responses for us trying to assist the young person engage with a healthy family home environment. So part of that intake period is when we would make sure they’re engaged in school, dietary needs, health needs. Do they need to be referred to a psychologist, a psychiatrist, speech pathologist? So I guess just making sure all those key life domains are actually being addressed and make sure they’re getting the support that they needed.

[00:22:25] So from their multi systemic needs based behaviour solutions, what that is. It’s stabling some of those initial behaviours that we saw. We don’t want them to feel that they’re in trouble. We know that their behaviours are simply a result of the complex trauma that they have been exposed to. But really, by having a behavioural change aspect to our model, we are trying to get them to move past those behaviours. A key aspect is I guess self awareness is what I’m trying to say. Awareness of their own behaviours. What we often get youth workers to do as an example of some of the strategies is when they’re being verbally abused or when they’re being targeted to show that it’s actually hurting their feelings. What you’d find in a lot of residential care providers, youth workers are often put up a face and put up a guard that no matter what a young person does, they’re going to be tough and they’re going to be okay. That’s not a real world response. If you’re being abused verbally or physically, you’re gonna be upset. you’re going to be hurt. So part of that behavioural change aspect of the model is about that authentic and I guess mirroring and holding up a mirror to some of the behaviours that the young people might be doing.

[00:23:39] Stage 3 is growth in relationships. So for us, what we’re really keen on doing is the therapy specialist Lindy’s is wonderful at writing and talking about all of these things. It’s a bit of a touch and five philosophy. So we’ve stabilised the young person. We’ve addressed their behavioural, I guess, challenges. Now we want them to have growth and engage in external relationships, positive peer relationships, perhaps re-engaging with family, parents in a more positive way. School, work. What we know about young people in care is that they’re often friends with other people in care. So for us, if we can have an influence over the young person, what might we be able to achieve within their friendship circle, you know?

[00:24:25] So stage fours is thriving and small successes. So again, it’s just building on that that growth and relationships. So what you might see is someone thriving is remaining engaged in school, perhaps remaining engaged in vocational education, perhaps gaining some small employment. Something that, you know, that you can see they’re really thriving and enjoying something that they’re getting a sense of fulfilment from. It might just be a sporting club. It might be an achievement at school. You name it, just something that actually sees these young people achieving in the community. And then the final stage, stage five, is personal transformation and exit preparation. So for us exits or how they leave Jo’s good luck, a lot of different things. I mentioned the Jo’s family or the Jo’s community that is really important at this stage. What we make sure young people leaving us feel is that they can call us. They can visit us. Obviously, we need to be mindful of other young people in the house, but we want them to feel that we will always be there for them. And so what you would often find is that we have engaged young people that have left with our head office of United Communities, and there’s lots of different supports that we provide.

[00:25:44] So if we can engage a young person toward the end of them exiting with any other support services that might be available for adults, making sure that they feel that connection not just in the Jo’s house, but within the organisation. And we’ve seen huge success with that. You know, we still have dinners with one of our exit young people. Another young person still pops in randomly to see me at the head office there and catch ups at cafes. So we’ve exited three people and all three young people are still engaged with us in different ways. Again, it just comes down to that normal parental responses. When you’re eighteen, your parents don’t always or often kick you out of the house with no more contact. There’s a support network for them. There is someone that they can call. I guess emotionally, we will certainly always be there for them. And if they did need help with housing, that’s where the strength of the organisation would come in to support them.

Sophie Guy [00:26:40] Ok so like a continuation of care but connection and a sense of belonging.

[00:26:47] Yep. Like I said, it really connects with that. Where possible normal family response. You know, what else do they need once they leave us. What we know is that often young people may not be ready at 18. And we’ve had one young person that we were able to receive in extension of care, simply because it just wasn’t they weren’t ready, you know. And I think for us, there’s lots of different things that we’re advocating for in the world of child protection. But certainly focussing on the individual needs of each young person is a key thing that we’re pushing for. We know that there’s developmental delays, often due to disability, sometimes due as a result of the complex trauma.

Sophie Guy [00:27:27] I know. And even kids who have an experience gonna lose trauma are often not ready these days to leave home at eighteen. Yeah, kids are getting older before they leave. Ok, that’s really interesting. Thank you. Yeah, I was a little bit curious was our focus at the National Workforce Centre for Child Mental Health is kids from infants to twelve years old. So what’s the age range of the kids who are in the Jo’s program?

Paula May [00:27:51] So for residential care historically it was always twelve to seventeen or when they turn eighteen. Recent reform has seen that reduced to ten years of age, which we’re really open and happy for. What you would often find is residential care is not seen as a good option for younger than 10 years of age. And often residential care as a whole can be seen as not a good option for any young person. You know, there’s often a desire for family based care regardless of someone’s age, and we certainly connect with that. We know how wonderful it is if we can make family based placement, kinship placements, foster care arrangements. But for Jo’s, we see our program as being a really great solution for young people that are needing a home and a family. So for us, rather than age or even gender, we try to look at the individual needs of young people. We know we want to be client focussed. So for us in one of the houses, we’ve got a female that’s ten, a male that’s fourteen and a male that’s fifteen. Now, perhaps historically that might have been seen as red flags to placing a female with two older males. But when we looked at the individual needs of those three young people, we identified that there was no explicit risks and it was actually more meaningful for the older boys to perhaps connect with the concept of a younger sibling. And likewise for her to perhaps learn from older males and healthy ways of engaging with family members.

[00:29:21] So of course, we always manage risks and we always explore different decisions that we’re making. But age or gender for us is not as important as the actual placement matching. What we often find replacement matching is we have done similar demographics at the other house and by having two houses where both houses might have girls similar age and boys similar age. We’re able to hold social events and functions in which they’re able to engage in peer friendships as opposed to the different dynamic it has when the young people live together. So by enabling perhaps two of the ten-year-old females to engage with each other who live in different houses, it almost has a bit of a. Cousin feel to it or friendship feel. What’s amazing about that though, it’s under the support of Jo’s to make sure that those friendships are healthy. So we’re able to support these young people to engage in positive peer relationships, which often is one of the major impacts that adolescence can have, is when they’re associating with perhaps other young people that might have particular behaviours that that are hugely influential.

Sophie Guy [00:30:34] All right. Well, it’s been a great conversation. Thank you very much, Paula.

Paula May [00:30:39] Thank you. No worries.

Narrator [00:30:42] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.