How children’s home consigned restraint to history

 Art therapist Catherine Lennox (left) and Colombo Road children’s home manager Sharon Willis have called time on restraint of young people at the Sunderland establishment through a programme called Holding the Space

Aggressive behaviour in Sunderland’s children’s homes has been reduced as staff take a more therapeutic approach and avoid using restraint, reports Gordon Carson

PROJECT DETAILS

● Project name: Holding the Space

● Aims and objectives: An accredited training programme to encourage staff in residential children’s services to think more psychologically about children in their care, and to reduce the use of physical interventions, including restraint, when children behave aggressively

● Run by: The Kite, Sunderland, an Action for Children project providing therapy for children who have been abused

● Clients: Sunderland Council and Action for Children residential children’s services in Scotland

● Timescale: Two years

Sunderland’s children’s homes accommodate some very troubled young people, many of whom have been sexual abused and neglected. Aggressive behaviour used to be commonplace and staff would sometimes deploy restraint to tackle it. This has changed since the authority started sending staff on a training programme run by a local Action for Children project, The Kite, which provides therapy for traumatised children.

Sharon Willis, manager of Sunderland’s Colombo Road children’s home, says physical restraint by staff has ended since they started the Holding the Space programme, while looked-after children now refer to Colombo Road as “their home” rather than “the home” due to the change in culture, atmosphere and relationships.

Key to this transformation has been the use of a technique at the heart of the Holding the Space model: the Way of Council, where everyone living and working in the home sits in a circle to share their thoughts and feelings. Participants take turns to speak, and young people have equal power to staff. In understanding what young people are thinking and feeling, staff can deal with problems before they escalate into situations that may require physical intervention.

Holding the Space started in 2004 as a pilot project to help Colombo Road staff think more therapeutically about children in their care (the home now houses six young people, aged 12 to 18). The Kite had already been working with children in Sunderland’s care since the early 1990s. But, according to art therapist Catherine Lennox, they had found it difficult to encourage young people in residential care to access therapy, while workers were often “fire fighting” and had little time to think about their charges’ therapeutic needs.

To counter this, Lennox and Simone Silverpath, a colleague at The Kite, started working with staff “to try to get them to think more psychologically” and to change the culture at the home from one of reaction to earlier intervention. The pilot lasted three years and in 2007 the programme was rolled out as Holding the Space to staff in Sunderland’s six children’s homes as a two-year, level 4 course, accredited by NCFE.

The first 12 students completed the accredited course last year, and have been followed by a second group of 14 who will finish next year. The course comprises 42 days of training over the two years and, because it is designed to be experiential, is assessed mainly on practical exercises. The cost of the training in Sunderland is included in Action for Children’s service level agreement with the local authority. As well as the Sunderland trainees, staff from four Action for Children children’s homes in Scotland will complete their two-year programme at the end of October (see case study).

The Way of Council is at the core of the Holding the Space model because, as Lennox says, “in therapeutic terms we are creating a space we can then hold and people can dip in and out of, and it is always available”. There are, however, three more components of the training: creative arts therapy, including poetry and writing as well as artwork; the Carl Rogers Core Conditions of empathy, congruence and unconditional positive regard; and “transpersonal” therapy, which looks at personality and its fragmentation in traumatised young people.

Follow-up training has included a “wilderness therapy” project involving five staff in the first batch of Sunderland trainees. They take young people in care into the Northumberland countryside four times a year for one-to-one sessions where they talk about nature and the seasons, and what these can show about their own lives.

Holding the Space has benefited residential workers and young people alike, says Willis. “It’s hard to quantify what it has done for the young people but to an extent it has changed everything. Staff have also been able to talk about the most volatile challenges of residential care without being judged.” The stability of placements has improved and one boy has just left Colombo Road after six years to go to college.

The benefits of Holding the Space have also been highlighted in an evaluation by the Scottish Institute for Residential Child Care. After staff had completed the programme there was a huge reduction in the number of incidents – including physical aggression, verbal abuse and failure to return to the home – attributed to each of six residents of one home, while researchers observed “a house where staff and young people relate well to each other”.

One member of staff provides perhaps the clearest statement on why the training has improved behaviour and relationships in the home: “You’ve got to make it clear that behaviour doesn’t define them [young people]you get underneath to the real person.”

Case study

‘We now look at things more psychologically’ – Barbara Keenan, Action for Children

Barbara Keenan, a residential project worker at Action for Children’s ISSC (Intensive Supervised Structured Care) unit in Ayr, in west Scotland, is nearing the end of her two-year Holding the Space training and says it has given her a “totally different way of looking at things”.

“We look at things more psychologically, and at what’s behind the behaviour,” says Keenan, who has worked at ISSC for four years. “We also look at activities like creative art to support young people to express themselves when perhaps they can’t find the words. I didn’t use any of that previously and wouldn’t have had the confidence either.”

Keenan says the training has definitely improved her management of challenging behaviour. “We didn’t use an awful lot of restraint anyway, but before doing Holding the Space, challenging behaviour probably escalated more quickly,” she says.

The training has also been particularly helpful in her work with one young person.

“Early on, when she would get upset, she would break things and cause disruption,” Keenan says. “But now when she’s about to escalate I give her art materials and she puts down what she’s feeling on paper. I’ve seen my relationships with young people improve massively.”

How to minimise the need for restraint

● Take a child-centred approach: Recognise the worth of each child, no matter their behaviour. Being child-centred can be challenging in the face of violence and aggression.

● Understand high-risk or violent behaviour: When young people with a range of difficulties are forced together through group living, the individual stressors are exaggerated. You must learn about child development, the effects of negative experiences, and about group processes.

● Develop and maintain self-awareness: Not only young people bring their history to residential care – you will have your own fears and impulses. You should develop strategies for working with those likely to “wind you up”.

● Promote self-mastery in children: You can reduce the need for restraint by helping young people to learn self-mastery. Do this by showing self-control yourself, and by controlling young people’s behaviour in ways that do not involve punishment.

● Use authority appropriately: Not intervening when young people may need to be restrained or otherwise stopped can confirm that intimidation and violence are acceptable ways to achieve what they want. A strong adult presence, using authority appropriately, will reduce the need for restraint.

● Develop a policy to manage behaviour: This will ensure young people and staff know where they stand. A clear policy may reduce the need for physical restraint, but is unlikely to make it completely redundant.

● Promote positive relationships: You cannot do any of the other tasks in residential child care effectively without constructive relationships with young people.

From Holding Safely: A Guide for Residential Child Care Practitioners and Managers about Physically Restraining Children and Young People, Scottish Institute for Residential Child Care, Scottish Executive and Social Work Inspection Agency, 2005 

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This article is published in the 30 September 2010 edition of Community Care under the headline “Restraint put on hold”