Integration of Dyadic Developmental Psychotherapy and Theraplay approaches in residential child care in South Eastern Health and Social Care Trust
A Florence Nightingale Foundation travel scholarship trip was undertaken, funded by the Department of Health Social Services and Personal Safety Northern Ireland to explore experiences of other services utilising a combination of Theraplay and Dyadic Developmental Psychotherapy (DDP) with teenagers, particularly in residential care.
Sarah Lewis is employed as the Therapeutic LAC Nurse in SET Connects, a multidisciplinary therapeutic service for Looked After and Adopted Children who live in the care of the South Eastern HSC Trust (SET) in Northern Ireland.
SET Connects was developed to improve the emotional wellbeing of children who live in the care of the Trust and post-adoption, by increasing resilience in the care givers and promoting stability in placement. This is achieved through consultative support and training to the professional system around the child, therapeutic involvement with carers, and using a dyadic approach with child and carer. In some cases, individual work is offered to the child. The therapeutic team comprises clinical psychologists, social workers and a mental health nurse.
The Therapeutic LAC Nurse completes a mental health screen with young people on their admission to residential care, offers therapeutic support to young people, their keyworkers and the professional system around the looked after child. The nurse maintains close links with the local Child and Adolescent Mental Health Service and supports discharge from the mental health inpatient unit into the care of SET. Training on issues related to emotional health and wellbeing is offered to residential staff, social work teams and foster carers.
The Children’s homes in SET currently implement the Sanctuary Model. Care givers in fostering, post-adoption and in residential care are helped to think about the young person, their experiences and behaviours using the DDP approach. The SET Connects team use elements of Theraplay in therapeutic sessions with young people and their care givers.
A review of available information indicated that a combination of DDP and Theraplay could lead to more positive outcomes for young people. DDP and Theraplay fit in well with principals of the Sanctuary Model.
A benchmarking exercise was carried out to establish the current level of implementation of the combined DDP and Theraplay models in the UK and Ireland. It seemed that few practitioners were using the combined approach and less using it in residential care.
Contact was made with services locally, those identified within the UK, and in other countries following an Internet search.
Travel
The aims of the Travel Scholarship were to:
- establish how SET could best integrate DDP and Theraplay into daily practice in children’s homes
- identify how DDP and Theraplay is introduced to and accepted by adolescents and staff members.
- inform a plan of integration of learning into practice
Group Theraplay South Shields
The nurse attended Group Theraplay training in South Shields, hosted by the local LAAC service, and linked in with professionals working with looked after and adopted children.
Learning:
- Preparation is key prior to travelling for the longer trip.
- LAAC service provision is not standardised throughout the UK
- An education support service provides a high level of support input into the children’s homes.
- There is a specialist education school for LAAC.
- Some children’s homes comprise of several independence flats for adolescents over 16 years. These homes also comprise some staffed residential beds.
Chaddock, Quincy, Illinois
During benchmarking, a visit to Chaddock was recommended. Chaddock “offers a full range of community, educational and highly specialized treatment services for children, infant to age 21, and their families” (Robinson et al 2009). The program combines principles from: Trust based Relational Intervention (TBRI); DDP; Theraplay; Attachment, Self-Regulation, and Competency (ARC) and other evidence based trauma therapy techniques. The nurse met with staff from different professional backgrounds/ levels of expertise and learned about their service model, experiences of introducing an integrated model and staff recruitment and retention in the context of organisational change. She also attended Theraplay group sessions with some of the young people who are currently living in Chaddock.
Learning:
- The Chaddock cottages have similar numbers of young people and staff ratios to those in SET children’ homes.
- Structure and routine is essential.
iii. All team members (including support staff) must be trained in and on board with the therapeutic models chosen for the service.
- Staff are encouraged to rethink their involvement in the team if the therapeutic model continues to contradict their understanding or beliefs about how the children should be cared for.
- Assessment is similar to that used in the children’s homes in SET
- Planned moves are key to the success of placements
Theraplay Institute and International Theraplay Conference
The nurse volunteered at the Theraplay Institute while they prepared for their International Conference. Opportunities arose to meet with the professionals who are based there, and to observe internet and Institute based supervision. The Level 2 Theraplay course was also completed.
The nurse volunteered at the conference, recording individual therapists who spoke about the impact of Theraplay on their personal and professional lives. This generated an opportunity to meet individually with many attendees at the conference.
Other services
At the conference, information was shared about residential services from Denmark, the Netherlands and Chicago.
Impact of the experience:
The nurse has led a Theraplay group in one of SET children’s homes, provided information sharing and awareness raising sessions about the Theraplay approach and learning from the trip. The nurse contributes as part of a team to a whole service review of residential care.
Service-specific recommendations have been made to share learning from the project, including recommendations for staff training, therapeutic support and residential care environments.
Plans regarding implementation in residential care, participation in the whole service review and training for SET staff have been made.
The nurse has considered how to share learning from this project to a wider audience.