We are acutely mindful that the first principle undergirding therapeutic residential care must be “primum non nocere’’: to first, do no harm. Thus, our strong consensus is that “Safety First’’ be the guiding principle in the design and implementation of all TRC programs.
Given the prevalence of historical and present abuse in group care settings in many countries, our work group was unanimous in designating child safety as “primus inter pares’’ among the building blocks of high-quality therapeutic residential care. While many components including staff screening, monitoring, detailed procedures for detection and reporting, listening to and hearing children and youth, along with community involvement are essential in realizing this first principle, we believe that a well-designed, growth-oriented, carefully implemented, and continuously evaluated program design is central to both prevention of abuse and “deviancy training’’ in therapeutic residential care.
Strong and Vital Family Linkages
Our vision of therapeutic residential care is integrally linked with the spirit of partnership between the families we seek to serve and our total staff complement—whether as social pedagogues, child or youth care workers, family teachers, or mental health professionals.
Thus a hallmark of TRC programs—in whatever particular cultural expression they assume—is to strive constantly to forge and maintain strong and vital family linkages.
Small, Bellonci, and Ramsey (2014: 157) identify three central foci for family-centered practice in therapeutic residential care:
- Preserve and, whenever possible, strengthen connections between the young person in care and his or her extended family, most broadly defined;
- Facilitate and actively support full participation of family members in the daily life of the program; and,
- Promote shared responsibility for outcomes, shared decision-making, and active partnership between family members and all helpers.
While there are many innovative particulars of family engagement, the work group was clear on intent: effective and humane therapeutic residential care is best seen as a support to families who are struggling, rather than as a substitute for families who have failed (Geurts, Boddy, Noom, & Knorth, 2012). We believe the multiple and creative ways in which partnerships with families are being given expression in TRC make visible and salient the oft-quoted mantra of the family support movement—“nothing about us without us.’’ As the essence of our first principle conveys, safety first remains the highest priority for all concerned.
Honoring Strengths & Culture
Our view of therapeutic residential care is one in which services are fully anchored in the communities, cultures, and web of social relationships that define and inform the children and families we serve. We view TRC programs not as isolated and self-contained islands, but in every sense as contextually grounded.
This suggests to us the critical importance of continually striving for what Urie Bronfenbrenner (1979) termed “ecological validity,’’ as well as building data systems, selecting outcomes, custom designing interventions to meet individual child needs, and honoring personal strengths and cultural assets in ways that reduce social exclusion and isolation (Palareti & Berti, 2009). In another sense, we view TRC as a critical element in a rich and varied service array that includes community, family, and foster-family based service alternatives which work together in combination to offer choice and individualized programming to families.
The Power of Relationships
We view therapeutic residential care as something more than simply a platform for collecting evidence-based interventions or promising techniques or strategies. TRC is at its core informed by a culture that stresses learning through living and where the heart of teaching occurs in a series of deeply personal, human relationships.
Many strands of practice research and scholarship contribute to this notion of a “unifying something’’ in TRC—a rich literature from early contributions on the therapeutic milieu (Redl & Wineman, 1957; Hobbs, 1966); on the importance of “the other 23 hours’’ as both means and context for teaching competence (Trieschman, Whittaker, & Brendtro 1969), to seminal contributions on applying the principles of applied behavior analysis in a family style group living context (Phillips, Phillips, Fixsen, & Wolf, 1974), to more recent contributions including Anglin (2002), Thompson and Daly (2014), and Holden et al. (2014) on engaging the total TRC setting in a process of quality improvement. We note here with special significance the opportunities for research at the intersection of what is a rich and deep European tradition and literature of social pedagogy—as thoughtfully summarized by Hans Grietens (2014)—with what Lyons and Schmidt (2014) have described in a North American context as the “transformational role’’ of therapeutic residential care in the lives of young persons.
Evidence Based Models
We view an ultimate epistemological goal for therapeutic residential care as the identification of a group of evidence-based models or strategies for practice that are effective in achieving desired outcomes for youth and families, replicable from one site to another, and scalable, i.e., sufficiently clear in procedures, structures, and protocols to provide for full access to service in a given locality, region, or jurisdiction.
Our work group is informed by the assessments of researchers such as Sigrid James (2011, 2014), Annemiek Harder and Erik Knorth (2014) and others to ascertain the relative efficacy of existing models of therapeutic residential care and/or probe deeply at “what is inside the black box’’ of effective TRC practice. Here we are in agreement with Sigrid James (2011: 320): It is in the best interest of group care settings that genuinely try to deliver quality care to collaborate with child welfare service systems and researchers to identify the essential elements of their program, to critically review their program in light of the needs of the youth they serve, and to consider adopting or learning from the treatment models that already have an evidence-base.
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