Definition of Therapeutic Care
Therapeutic Care is achieved through positive, safe, healing relationships and experiences, informed by a sound understanding of trauma, disrupted attachment and individual developmental needs.
Therapeutic Care is designed to facilitate recovery from the impacts of physical, psychological and emotional trauma resulting from experiences of harm or risk of harm. It views early adverse experiences in a developmentally sensitive way based on current knowledge of the neurobiological effects of trauma.
Therapeutic Care focuses on supporting children and young people to feel safe and to encourage a shift from a state of maladaptive survival responses and withdrawal, to a place of healthy adaptation and engagement. This involves the development of skills such as distress tolerance, emotional regulation, capacity to trust and integration within the community. These are areas often lagging due to experiences of childhood maltreatment.
CASPA provides creative therapeutic interactions, involving opportunities to express, reflect, process, reframe and integrate experiences of trauma and disrupted attachment in order to move towards a place of adaptive functioning and growth. The trauma specific interventions used by CASPA are those proven to treat complex trauma, as opposed to trauma caused by single traumatic events.
CASPA prefers to operate through a collection of therapeutic approaches designed to meet the varied, complex and ever-changing needs of individual children and young people. All interventions are developed upon the basis of individual assessment of need.
Acknowledging the need for a collective approach has been based upon an understanding that a child or young person will require a range of services and a multi-elemental approach to meet their needs. To be equipped to manage the variety and level of complexity within our service continuum, no singular approach will be applied.
The Framework is designed with a ‘restorative’ and ‘healing’ overtone whilst assisting children, young people and their families to build resilience and strength whilst planning their lives ahead.
We want to extend a view that the children, young people and their families are not alone in their journey. We will provide quality care and support at all times, during the course of service delivery. They can trust us to maintain confidentiality, provide protection where needed, advocate on their behalf, offer guidance to make the best choices possible and offer encouragement to have a voice around decisions that affect their lives.
Effective case planning will uphold the rights of children and young people in relation to education, social inclusion, connection to family, cultural identity and specific cultural needs. Children and young people are included in decisions about their placement, care, interventions, education and wellbeing. In all its practice principles, CASPA acknowledges the need of the child or young person to build positive relationships with family, peers, care givers and significant others in their life. Effective case planning with regular reviews by a multi-disciplinary team, ensures that current and emerging needs are captured. The wellbeing of the child or young person is central to all decision making.
All users of our service will be supported by professional and specially trained staff/caregivers who are trauma informed, non-judgmental and understand their individual needs.
Assessment is at the heart of all processes required in ensuring that the child or young person’s needs can be addressed. Developmental, cognitive, health, educational and emotional assessments are initiated at regular intervals to assist in identifying needs.
CASPA provides a ‘safe’ environment aimed at stablising a child or young person’s behaviours, leading them to a state of readiness for new learning and change that may not have been achievable while in a state of continual fearfulness and hyper-vigilance. Our aim is to minimise reminders of trauma that induce reactive emotional and behavioural symptoms and to build healthy, supportive attachment figures that can help children and young people overcome issues around negative and/or lack of a sense of identity. A benefit of the supportive environment is that individuals may learn to trust, confide and work through fears and conflicts with positive attachments, which can serve as a bridge to other relationships.
CASPA’s Therapeutic Principles include the following:
- Developing an understanding of both the cause of the complex issues and matching a therapeutic response
- Flexibility of structure and service models
- Active involvement by the child, young person and families
- Support for the child or young person in decision-making utilising a strength based approach
- Concentration on quality of relationships and interactions between the child or young person and care givers
- A commitment to training in the latest innovations in trauma research and attachment-focused strategies. Staff are trained in how to respond to acute situations appropriately and in accordance with the principles of trauma informed care. This training is mandatory for all CASPA care staff
- Cultural awareness and support for connection to heritage
- Encouragement of peer support
- Provision of a safe and homely environment. We place most of our young people into homes in the community away from the administration staff and buildings
- Active advocacy
- Continuity of service
- Service accountability and responsibility
- Compliance with legislative framework
- Whole-of-organisation approach to therapeutic framework, including the training and development of the board members
- Comprehensive planning for leaving care or exiting the service, including post care support
- Safe Home for Life Principles
Evidence Based Therapies
CASPA use a range of Evidence Based Therapies inclusive of:
- Dyadic Developmental Psychotherapy (DDP)
- Attachment Self-regulation Competencies (ARC)
- Integrative Arts Psychotherapy
- Cognitive Behaviour Therapy (CBT)
- Applied Behaviour Analysis (ABA)
- Gestalt Psychotherapy
- Positive Parenting Program (PPP or Triple P)
Collective practices used at CASPA are:
- Dan Hughes – Attachment Theory
- Dan Hughes – PACE Model
- Bruce Perry’s - Six Core Strengths
- Richard Rose - Life Story Therapy
- Sanctuary Model
- Solution Focused Brief Therapy
- Therapeutic Crisis Intervention – Cornell University
CASPA offers clinical as well as relational modes of delivering therapeutic practices to the children and young people we support. Through ongoing training of care givers, who form key relationships in the children and young people’s lives, therapeutic strategies are applied on a moment-to-moment basis and throughout daily interactions and challenges. Offering safe, reliable, and responsive relationships gives children and young people with complex needs the opportunities to build skills and to develop a positive sense of self that is needed to further their connection to the community and to their futures.
Attachment theory, PACE model and Therapeutic Crisis Intervention practices are used extensively to acknowledge grief and trauma that underlie pain based behaviours, promote better integration of emotional states and to highlight adaptive coping mechanisms for change.
CASPA also recognises the importance of clinical supports in the lives of the children and young people in our care. In addition to clinical staff, our education officers and team leaders are also equipped with the resources to assess and develop the skills and needs of individuals. Life Story Therapy, Community Meetings (Sanctuary Model), and reporting tools relating to Bruce Perry’s Six Core Strengths are used as a means of recording and assessing qualitative data to assist the development of clinical practice and review
Evidence based practices influence positive long-term outcomes, and neurological repair of early adverse events. CASPA also offers intensive clinical support to children and young people in the form of mindfulness training and integration of somatosensory needs that underlie difficulties with self-regulation.
Internal Programs & Community Based Therapies
‘Fix It’ Program – ‘Work with Wozza’
Resulting from a history of trauma, neglect and abuse, children and young people often exhibit behaviours lacking in self-regulation and impulse control. They can display aggression and violence when not coping, which can lead to property damage.
A common method to deal with property damage is to involve Police which criminalises the behaviour of children and young people. Our experience is that children and young people just become further embedded in the criminal system which limits their opportunity to be supported in learning new ways to express their emotions.
The ‘Fix It’ Program operates from a positive and strengths basis which minimises punitive measures. It has been designed to engage children and young people in repairing damages to make their home environment safe and presentable again.
The aim is for the children and young people to:
- Experience a sense of redemption instead of embarrassment or shame after an incident where damages have occurred.
- Feel a sense of achievement when the job is completed.
- Learn skills during the program by gaining knowledge of tools, products and the necessary planning required.
- Increase pride in the presentation of the home environment.
- Evoke a sense of belonging in relation to their placement.
The children and young people will be supported by an experienced tradesperson who will:
- Contact the ‘apprentice’ to plan an approach to the repair i.e. purchase goods, organise tools and delegate each task.
- Adhere to WHS practices to ensure each person on the ‘work site’ remains safe.
The program will also be aimed at children and young people who repeatedly damage property, a specially tailored program will be developed, where they participate in the maintenance of their home, whether damages have recently occurred or not. The maintenance program may operate over several weeks.
Future vocational training opportunities may be available to children and young people who show keen interest in acquiring skills in the maintenance industry.
Equine Assisted Therapy
Horses simply respond to the energy of the moment, which offers us a chance to try something new if our current viewpoint isn’t working. When we get clear about what we are asking of the horse and follow through with congruency – which is the alignment of our thoughts, feelings and actions, the horse trusts what we are asking of them and responds accordingly.
Embodying this connectedness with the horse promotes change and personal growth. Because the process is experiential, it creates new neural pathways and a new frame through which we see and experience the world. This becomes a resource upon which we can draw from in future situations that are challenging.
Art Therapy has proven to be successful in various ways that differ from traditional therapy practice. There are various uses for art therapy in relation to healing. Art therapy sets itself apart as a means of therapy, by utilising the creative process of art. This is especially effective for children and young people who are usually less capable and less comfortable expressing themselves via words.
Art therapy can help children and young people process emotions and feelings so healing can begin. It can lead to a general sense of relief and overall improved emotional health following self-exploration, where insightful conclusions about themselves have occurred. Engagement with art therapy can help improve symptoms of pain, anxiety and tension. It can also benefit those who have mental health disorders, have suffered emotional abuse, post-traumatic stress disorder and a variety of other ailments.
Music therapy aides in the development of physical, sensory and cognitive skills i.e. listening, use of gross and fine motor movements, sequential memory and recall of information and self-management of behaviours.
Music invokes positive changes in mood and emotional states and improves concentration and attention span. Through music and associated skill development, an increase in self-confidence, self-esteem, personal insight and motivation can occur. Children and young people have experienced increased independence and confidence around decision making. It has proven to reduce tension, anxiety and stress.
Body Based – Rhythm and Music
Based on findings from the latest research in neurobiology, CASPA offers a yoga and meditation program incorporating repetitive, synchronised movement, along with mindfulness practices with children and young people who are willing to engage. This involves a dynamic blend of breathing exercises, physical postures, stretching, meditation, visualisation and relaxation to bring the child or young person into a greater awareness of their body. This increases their mindfulness and improves their ability to self-regulate when experiencing stress.
Patterned, repetitive, rhythmic, somatosensory activity is included in each child and young person’s programs. Our ancestors have known the healing power of music and movement for centuries, with almost all indigenous cultures having incorporated this into their traditional ceremonies. Neuroscientists now have scientific evidence for the way that rhythmic music impacts on key centres of the brain that are responsible for how we process trauma.
Research findings of Dr. Bruce Perry have shown that body sensing exercises help to regulate the primitive part of the brain, the brain stem and diencephalon cerebellum, which then makes the brain more accessible to relational (limbic brain) reward and cortical thinking.
He has found that by introducing “patterned, repetitive rhythmic activity” the brain’s neural networks are able to be rewired to elicit a sensation of safety, and help reduce anxiety, impulsivity and other trauma related symptoms.
Staff, carers and support workers are trained to develop specific trauma and attachment informed skills. Training is also linked to a practice framework within the organisation.
In recognition of their multi-faceted and highly challenging role staff, carers and support workers participate in on-going professional development training and are supervised by those who understand the complexity of their roles. Staff, carers and support workers have differing levels of confidence, resilience and learning needs and a supportive approach is extended through staff support processes.
Clinical Support – Neurological Psycho-Education
CASPA utilises the professional services of Clinicians with expertise and background in Out-of-Home Care. The clinicians specialise in the support of staff and carers who work closely with children and young people that have suffered the effects of trauma, abuse and neglect. The Clinicians also inform staff and carers about the children and young people’s psychological and emotional needs.
Psycho-Education and training equips children and young people with therapeutic interventions and strategies including the ability to maintain a mindfulness of the pain and suffering associated with their trauma experiences.
Each child and young person is discussed individually at case clinics. Presenting behaviours are explored and a plan is developed to enhance caregivers’ skills in order to support the placement and offer the child or young person alternative coping methods and opportunities for change.
Outcomes and Measures
CASPA utilises standardised measures which have been proven through exhaustive practice in therapeutic care services and international research, to assess outcomes. The following outcomes are assessed as part of the organisations commitment to progress healing:
- Placement Stability – average length of stay is a standard indicator used across services.
- Mental Health and other pathologies – a broad base of measures for assessing mental health is used, offering insight into issues relevant to child protection and placement.
- Quality of relationship with family, peers, and connection to the community – viewed as vital components in the recovery of trauma and the development of meaning and identity. Improvements in the quality of relationships is a critical factor in a therapeutic approach and an important indicator of positive change in an individual.
- Engagement with school and alternate forms of education.
- Sense-of-self and self-reports – improvement in self-worth, resiliency, and coping mechanisms are measured and are viewed as critical to sustained outcomes in individuals.
- Clinical Observation.
The following scales and assessment tools are used for their comprehensive measurement of outcomes in a therapeutic care framework:
- Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA): assesses mental health and social functioning within child protection and placement settings. It is an internationally validated measure that can be used in comparisons with normative data and against other studies.
- Child and Adolescent Functional Assessment Scale (CAFAS): a measure of indicators that are prevalent within child protection and placement services, including skills, development, connectivity, and dysfunction. Used widely in assessing and tracking day-to-day functioning of those within treatment services.
- Neuro-Sequential Model of Therapeutics (NMT): A comprehensive assessment tool for mapping the impact of early adverse experiences on the brain and for understanding current functioning based on neurological and developmental considerations. NMT offers clear guidelines for interventions that target underlying problems with current behaviours and also can identify key strengths and opportunities for enrichment.
- Trauma Symptom Checklist (TSCC): A self-reporting assessment of the scale and symptomology of trauma and trauma-related stress. It includes critical indicators and subscales of some clinically identified manifestations of trauma. The TSCC is a standardised measure that can be used with medical models and other data sets.
- Education Assessment Tool - ‘Compass’ is a computer based assessment of core literacy and numeracy skills specifically designed for disengaged and educationally marginalised young people and adults. The assessment uses realistic vibrant question prompts to actively engage test takers with disrupted exposure to formal education, testing and assessment. Compass provides an assessment of literacy and numeracy that can be delivered in a flexible, non-intimidating test environment. Testing does not have to take place in an educational setting. This assists with assessing those disengaged from education as traditional forms of testing can act as a barrier towards reengagement with formal learning.