Search

This qualitative study examines the emerging field of therapeutic residential care for young people in Out of Home Care. Inconsistent service quality and outcomes are persistent concerns in residential care. Consequently, it is increasingly used as a last resort for children removed from parents in Australia and internationally. Therapeutic residential care intends to reverse this trend by improving practice and outcomes. International efforts in developing therapeutic care principles and models have begun in earnest. However, very little is known about how this knowledge is being translated into practice. This study addresses this knowledge gap, embarking on a new line of inquiry into the implementation of therapeutic residential care in the state of New South Wales, Australia. It draws on the first-hand experiences of those directly involved including young people, residential care managers, clinicians, caseworkers, team leaders and direct care practitioners across three residential care organisations. This study provides a comprehensive analysis of the needs, challenges and opportunities young people and practitioners face in therapeutic residential care and contributes invaluable insights into the development of this nascent service initiative. Findings showed that young people in therapeutic residential care are impacted by peer victimisation, ambiguous loss and placement instability, pointing to their need for safety and relational permanency with practitioners and families. Practitioners, to a large extent, recognise these needs, framing therapeutic residential care from a trauma-informed care perspective. However, different interpretations exist on what this entails in practice, leading to conceptual ambiguity and inconsistency. Frontline practice of therapeutic care is further affected by frequent critical incidents, causing a paradox in which practitioners attempt to provide trauma-informed care in a potentially re-traumatising environment. Restoring safety becomes a primary practice component, along with program-oriented routines, boundary-driven relationship-based practice and family support. Implementing these practices in therapeutic residential care is constrained by time and financial pressures, and insufficient clinical support, leading to inadequate placement assessment and matching. Strategies to mitigate these implementation barriers are identified. This study concludes that therapeutic residential care needs to be underpinned by an ecological framework, enabling it to be designed as a whole-of-system approach to care.