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Therapeutic Residential Care for Children and Young People


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Table of Contents

Foreword. Acknowledgements. Authors' Note. Introduction. What is child abuse and neglect? The cost of abuse. The need for early intervention, treatment and prevention. 1. The Importance of a Theoretical Base. The relationship between theory and practice. Theory in the caring professions. Psychodynamic thinking. Psychodynamic concepts. The relationship between the organization and therapeutic task. The treatment approach. Attachment and trauma-informed theories. The influence of Winnicott on therapeutic residential care. Individual, family, community and societal wellness theory. Conclusion. 2. Trauma-Informed Practice. How traumatization develops in childhood. Trauma causes hyperarousal and fear in children. Childhood trauma reduces the brain's capacity to think and regulate emotions. Trauma disconnects children from relational resources. Trauma restricts the attention capacity of children. Trauma-based behaviour has a functional purpose. Trauma restricts children's ability to deal with change. Trauma undermines identity formation in children. Trauma affects social skills development and impacts on peer relationships. The impact of trauma on the child's internal working model. Relationship and attachment difficulties. Physical wellbeing. The basics of trauma treatment. 3. Therapeutic Relationships. Beginnings. Information gathering and assessment. The intake process. Attachment. Secure base. Commitment. Continuity of care. Working with loss. Role modelling. Personal growth. Creating capacity for relationship building: one-to-one time with children. Unique needs. The importance of the relationship when challenging behaviour. Challenging behaviour as a sign of hope. The role of touch in the healing process. Consequences vs punishment. Promoting responsible children (empowerment processes). Participation of children and young people in the organization. 4. Demands and Rewards of the Work: Staff Support. Working with challenging and aggressive behaviour. Physical and emotional wellbeing. Working with anxiety. Communication challenges. Therapeutic supervision: working with feelings. Safety and containment. The impact of trauma work on our own memories and experiences of childhood. 5. The Home Environment. Home aesthetics. Encouraging play and curiosity. Privacy and security. 6. The Holding Environment and Daily Routines. Routines, limits and anchor points. Daily programme. Use of television and computers. Free time. The importance of food in the healing process. Bedtime and waking routines. Play. Celebrations as a sense of belonging. 7. The Organization and Community. The language of the organization. Trauma re-enactment and its impact on the organization. Management and the therapeutic task. The lighthouse foundation as an open system. Leadership. Authority. Managing change. The organization's vision. Sense of community. Sense of family and home. Organization as family. Local community. Community committees as a containing membrane. Collective wellness. 8. Group Processes. 'I feel like saying' process. Shared history: culture passed on through stories. Strong culture. Child safety. Reflective practice. Emotional intelligence. Emotional wellness. Transparency and openness. Family meetings. Combined family meetings. Whole family meetings. Youth forums. Clinical supervision (relationship between carers). Clinical peer supervision (carers' meeting). Mediation processes. 9. Moving On: Transitions, Aftercare and Outreach. Transition as a separation experience. Life membership. Transitional planning and transitional objects. Transition celebrations. Stepping stones: transitional programmes. Assessing readiness for transition. Carer relationship beyond transition. Aftercare programme. Outreach. Children returning to work with the organization. 10. Outcomes-Based Practice. Outcomes-based approaches. The need for evidence. Measuring outcomes. Difficulties in measuring outcomes. Potential benefits and value of developing an outcomes-based approach. Appendix 1 Susan's Story. Appendix 2 The Lighthouse Therapeutic Family Model of Care. About the Authors. References. Index.

Promotional Information

A therapeutic model of care for traumatized children and young people, based on theory and practice experience pioneered at the Lighthouse Foundation, Australia

About the Author

Susan Barton is founder of the Lighthouse Foundation, Australia, which provides therapeutic residential care for traumatized and homeless children. After fostering children for several years, she founded the charity in 1991 in order to extend to more children in need the therapeutic family model of care that she had started to develop. She has won numerous awards for her work with homeless and traumatized children. Rudy Gonzalez is Director of Care Service at the Lighthouse Foundation. He has worked as a family counsellor and case manager, a psychologist in a forensic setting undertaking therapeutic work with male violent offenders both individually and in a therapeutic community, and has worked as a psychologist with traumatized children. Patrick Tomlinson is a social care consultant. He has many years' experience as a practitioner, manager and director of therapeutic child care services, and is author of several books on therapeutic child care.


From the introduction through the final appendices, I was struck by the constant and integrated presence of thinking, feeling and reflection as integral to meeting the needs of young people, whether at an individual or organisational level... This book offers vision and motivation to those with requisite courage to work towards a more humane system of care for children and young people. -- The British Journal of Social Work, Laura Steckley, Course Director, MSc Advanced Residential Child Care, Glasgow School of Social Work
The simplicity in presentation, however, demonstrates one of the key accomplishments of the authors in having been able to present so much potentially complex theory in having been able to present so much potentially complex theory in a way that is accessible and of great practical use... the authors achieve their aims and more by providing some sound knowledge, inspiration and food for thought for anyone with an interest in residential child care practice. -- Rostrum
This book reports on the therapeutic model of care that has been developed by the Lighthouse Foundation in Australia. In doing so, the theoretical underpinnings of this model are articulated and how this gets translated into day-to-day care is described... Hopefully, this book will stimulate discussion in a range of residential care setting and result in the establishment of some progressive and improved care practices. -- Journal of Children Australia
This truly global book is the product o an interesting and creative collaboration between leaders and practitioners in residential group treatment settings in Australia (The Lighthouse Community) and the UK (The Cotswold Community, SACCS). It is a long overdue contribution towards the theory base required to equip people working in multiple roles in environments that aim to be healing in its broadest sense. I enjoyed it as much for the elements of human testimony as for the attempts made to link eclectic theory with practice. -- Psychoanalytic Psychotherapy
This is one of those rare books that successfully brings together the human and the academic. It provides a comprehensive and clear account of the theoretically based model of care used by the Lighthouse community, whilst bringing this to life with the real-life stories of young people and carers involved with this organization. Theory and concepts are described clearly and with understanding, but most importantly the authors have illustrated how these are used in practice to transform the lives of young people and carers alike. This book belongs in the collections of all practitioners involved with traumatized children and young people living in residential care. -- Kim S. Golding, Clinical Psychologist and author of Nurturing Attachments

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