The Esland Blog - Family

Therapeutic Care For Children With Complex Needs – Why Family Matters

Most of us are lucky enough to know just how much family matters when it comes to our personal development – but for children with complex needs due to domestic trauma, what role can alternative families play in their therapeutic care?

Local authorities and care providers are under growing pressure in the UK, with official 2022 statistics statistics showing ease on the number of ‘children looked after in the previous year - a continuing trend year on year. Spanning across residential homes, foster placements, and other therapeutic care settings, support for these 82,170 children is largely delivered via private providers, followed by voluntary resources authority facilities*.

Children can end up in the social care system for a wide range of problems, such as behavioural and learning difficulties, addiction and many other medical, physical and mental health conditions. But while many things contribute to the need for care provisions, the majority of looked-after children (LAC) cases stem from issues within the family unit.

The latest data from the ONS**shows the most common categories of need are:

·      Abuse or neglect – 43%

·      Family dysfunction/chronically in adequate parenting – 21%

·      Family in acute stress/temporary crisis – 14%

With familial failings being the root cause of so many cases of children presenting with complex needs, it’s essential to recognise that instilling a sense of family within these affected youngsters can often be the key difference between surviving and thriving.

Complex needs, family values and the care system

Effective intervention often requires a multi-disciplinary approach, with each child’s/families case individually assessed in order to accurately identify the required level and type of support. Through a combination of services such as residential and educational care, group and one-to-one therapies, and even outdoor activities, children with complex needs can be set on a path to a more positive future.

However, it takes more than these elements to provide a foundation for change. Underpinning the success of these support mechanisms, a sense of family and belonging is the crucial bedrock of nurturing positive outcomes. For support systems to stick, the approach is just as important - if not more so -than the clinical content. It’s not a tick-box exercise, and for children who have experienced trauma, connection is key.

This is why a therapeutic approach to care can make such a marked difference in the recovery and future of children and young adults with complex psychological, emotional and behavioural needs.

What is family? Why does it matter?

For many people, family is the centre of their world – for all the right reasons. Whatever that family unit might look like in its individual parts, it’s this group of trusted people that look after them from birth. Taking care of basic needs, such as food and shelter, and providing support, guidance, love, security, education, and a sense of community and belonging.

In turn, the positive attachments formed within healthy families allow children to explore the world around them safely. These relationships help them to develop healthy behaviours, form meaningful relationships, lay down respectful boundaries, and grow into well-rounded adults with the required knowledge and tools to cope with the demands of life.

In families where trust, safety, security, basic provisions, love, care and attention are rarely, poorly or never provided, children’s emotional, mental and physical development can be greatly compromised.

Experiencing neglect or abuse within the family unit - or any environment that should be a ‘safe space’ - can subsequently lead to trauma, unhealthy coping mechanisms and attachments, cognitive development issues, anxiety, depression, disengagement, anger, aggression, addiction and myriad other conditions that can have a lasting, detrimental impact throughout their life.

Alternative families

The concept of family looks different to different people, but for many children with complex needs, their reference is not indicative of the overriding, healthy values of a cohesive family unit, whatever shape of form that comes in.

Therefore, as part of the therapeutic care experience, it’s important to create the sense of an alternative family’: a group of trusted people who will provide stability, security and encouragement, and help them to engage with other aspects of their support and treatment plan.

As with any family, an alternative family in a therapeutic care sense can vary in its structure, and is built through a careful process of assessment. For children unable to be supported from their own family home, they may be directed to a temporary assessment or foster home in a group setting, or a solo residential care placement with an existing family. All options will be explored to ensure the most appropriate intervention.

For children suffering with severe trauma or other complex care needs, they may be supported by a range of experienced providers within a therapeutic care setting, with key workers who will stay with them throughout their care journey, becoming part of their new, alternative family. Relationships will also stretch across to the child’s own family, with support being offered to all parties in order to achieve the best outcome for all.

Every case is different, but the underlying similarity is that these therapeutic services are designed to nurture that all-important sense of belonging, bridging the gap left by their previous experiences. An effective therapeutic care model, and the alternative family that it brings, helps looked-after children to:

·      Learn how to trust

·      Feel safe

·      Build positive attachments

·      Develop personal resilience

·      Engage with education

·      Commit to their treatment plan

·      Make the transition to adulthood

·      Create a meaningful future

With so many looked-after children suffering effects of inconsistent parenting or broken dynamics, this family-led care environment plays an essential role in teaching them what a positive family unit looks like: how they behave, treat each other, contribute and take responsibility for themselves.

Affected children need to be shown that it’s ok to make mistakes, that they deserve love and attention, and that they can enjoy more fulfilling relationships than those they’ve experienced in the past. With the support and care of an alternative family, the efficacy of any other treatments are enhanced, with the stability and consistent support helping them to stay on track and make progress.

Therapeutic care and education

Like any well-adjusted family, a therapeutic care team is made up of a mix of people and professionals, who all bring something different to the table.

It’s well-known that looked-after children and those with complex needs suffer from much lower education outcomes when measured against those in stable family environments. 2021 statistics show that the average Attainment 8 score Children Looked After in care (for 1+ years)was less than half of the general all-children average, at 23.2 compared to 50.9***.

Similarly, the figures also show that just 12% of the general population 19-21 year olds fell into the not-in-education bracket, significantly less than the 41% of care leavers within the same criteria.

In broader social care groups, data for the same reporting year also shows that almost half of all children in need (CIN) had special educational needs, in contrast to just 16% of the overall school student population.

While for some children with SEND support can be provided within mainstream school settings, for many young people in care and those with more complex needs, specialist independent schools are often much more beneficial. Working in conjunction with the child’s care team and alternative family, these learning environments offer a more personalised curriculum and self-paced learning approach, and additional opportunities which may be more appropriate, such as:

·      Individual, group and blended learning

·      Tailored outreach

·      ASDAN awards

·      AQA Unit Awards and Certificates

·      Vocational qualifications

·      Speech, language and occupational therapy

·      Alternative and extra-curricular activities

Schools offering a therapeutic care approach are led by highly skilled and qualified teams, able to manage even the most challenging of behavioural demands, and assisting children with ASC, ODD,PDA and other issues to access education, and ultimately fulfill their potential.

Clinical collaboration

Because of the diverse range of difficulties faced by children and young people in care, finding the right placement and alternative family isn’t a simple process.

Clinical assessment and collaboration is vital from the outset of the intervention process, liaising with local authorities, police or reporting officials, key workers, teachers and the child’s family – as well as working directly with the looked-after children the in-depth and detailed view gained through the clinical assessment stage, the right family, support network and treatment plan can be identified and the real work can begin.

Depending on the individual’s needs, the clinical team will carry out a range of assessments, bespoke interventions, therapies and periodic reviews, which could include:

·      CANS Assessments

·      Trauma Informed Assessments

·      Cognitive and Neuro developmental Assessments

·      Dyadic Developmental Psychotherapy (DDP)

·      Creative Psychotherapy

Good relationships and communication assists these processes, with some aspects of treatments overlapping and resonating with the work of the wider team – their residential home family, their education provider, family social workers and anyone else involved in the child’s care.

The therapeutic care journey isn’t an easy one. These young people come into these environments traumatised, scared, angry, untrusting, and lacking in self-belief and self-esteem. They maybe disengaged, vulnerable, wary and completely overwhelmed by the huge changes they’re experiencing. Some children may have severe cognitive development,speech or communication issues.

To reach out and connect with these children, they need the stabilisation that only a real sense of family and belonging can bring. Every person involved in their care becomes part of their fundamental and extended support system, providing consistency, empathy and encouragement at every step. If their own family are unable to give them the tools required to help and heal them, a well-executed, multi-disciplinary approach delivered with kindness at its core is the next best thing.

Exploring new experiences

For many looked-after children, opportunities for adventure and excitement - to truly live life like a child -have been limited, or perhaps absent altogether.

While providing a safe space, a sense of family, accessible education and clinical support are all essential to achieving positive outcomes, taking children away from the restriction of home and school is the final ingredient of effective therapeutic care.

Outdoor activities, field trips, galleries, museums and other fun experiences help children with complex needs to be bold, engage with others, burn off energy, distract from a crisis, learn to be curious and explore the wider world in ways they may never have previously had the chance to do.  

Cohesive care with family values at the heart

It’s clear that complex needs require a complex approach, with a tailored, multi-faceted treatment plan and care team nurturing looked-after children from all angles, in order to encourage the most positive and long-lasting outcomes possible.

But just as importantly, for these therapeutic care services to reach and connect with children in a meaningful way, there must be a safe, secure and stable place at the heart of it all.

This crucial sense of community and belonging can only come from a therapeutic care environment where family matters – and where family values are lived, learned and reinforced day-after-day, until the child transitions into independent adulthood.






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