High Risk Adolescents, Residential Care, Treatment complex trauma

Why higher educational qualifications for staff will not improve outcomes in residential care.

Numerous enquiries into residential care[i] have recommended raising education qualifications of resi-workers to improve both the quality of care and outcomes for young people. However, a recent US study implies that this strategy may not be wholly successful.

Nov 17 Child cupboard
Cupboard in a child’s bedroom in a residential care unit. Source: Report by the Victorian Child Safety Commissioner, 2015 “. . . as any good parent would. . “

The researchers asked staff how they learnt the skills necessary to be an effective resi-worker. Unsurprisingly, most reported that they believed that resi-workers were ‘born’ not ‘made’. However, further investigation showed that new staff placed considerable emphasis on learning from older, more experienced workers (i.e. ‘old hands’) via the so-called master-apprentice approach. This will come as no surprise to Practitioners.

The master-apprentice approach assumes that most of the old hands are competent and/or are delivering care in accordance with their organisation’s principles. However, the authors warn:

Management should expect that newcomers working alongside those with low levels of expertise may never develop the desired knowledge and skills.

 

New resi-workers are strongly motivated to adopt the practices of the old hands simply because of the risk of violence that is inherent in resi-care.

quote for 17 Nov blog a
14-year-old child living in residential care, March 2015. Report by the Victorian Child Safety Commissioner, 2015 “. . . as any good parent would. . “

The problem

This is the dilemma faced by resi-care agencies. The extent to which organisations’ place new recruits alongside old hands whose standard of care is less than is required influences the learning process of these recruits, almost certainly leading to new staff that will adopt inappropriate standards. Moreover, no amount of pre-service or in-service training is likely to change this situation. Therefore, how can agencies hope to improve outcomes for young people in resi-care?

The problem of small unit sizes and geographic isolation

Prior to the implementation of de-institutionalisation policies, young people resided in large-sized facilities. One of the few advantages of this model was that professional staff, e.g. psychologists and social workers, could readily supervise the day-to-day activities of staff. Post-de-institutionalisation saw small-sized units (typically less than four residents) emerge that were geographically dispersed from the head office. The result of this action was that professional staff could no longer  readily supervise day-to-day activities of staff.

Potential solution: Designated ‘training’ resi units [ii]

Agencies could designate a small number of units as ‘training’ units. In these units, half the staff would be highly experienced and recognised for their ability to deliver care to the standard required by the agency. The other half would be trainee resi-workers who would be spend 3-6 months in the training units before moving on to other units. About 80% of their time would be spent on shift and the remaining 20% attending a specifically designed in-service training course. (In the next blog post, I will argue that the sector needs to move from pre-service training to in-service training).

 

 

Silberg, J., et al. (2015). “Age of onset and the subclassification of conduct/dissocial disorder.” Journal of Child Psychology and Psychiatry 56(7): 826-833.

 

[i] See “. . . as any parent would . . .” Report by the Victorian Child Safety Commissioner into residential care (2015) page 114 or for the UK see Residential Care in England: Report of Sir Martin Narey’s Independent Review of Children’s Residential Care (July 2016) page 55

[ii] Note this is the opinion of the blog author not Silberg, J., et al.

About graemembaird

I am a psychologist with a special interest in improving the outcomes of families, children and young people in the Out of Home Care and Juvenile Justice systems.
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