“We talk about relationship-based approaches but what do we actually mean by that?”
Service Manager, East Ayrshire
I was challenged four years ago by a colleague in our Corporate Parenting team to spend time in a Children’s House and live the life of a carer for a few shifts. I sensed some frustration from her that I didn’t full appreciate the scale of the challenges that care teams experience on a daily basis.
I felt an overwhelming sense of anxiety – I worried about how confidently and competently I would be able to pull this off without looking like some sort of fraud who was only able to offer advice rather than put the theory into practice.
I’ve since realised that carers themselves often feel like that too. In East Ayrshire, we’ve managed to put our doubts behind us and have nurtured strong, positive relationships between carers and psychologists by putting a new model of care into practice, resulting in improved relationships and outcomes for our children and young people in residential care.
When I first started working with Children’s Houses there were some differences in practice not only between the three local houses I supported, but between the individual shifts of care teams within those houses. I thought that this must be confusing for the children who live in the house and also for the carers themselves.
Around this time the Corporate Parenting team developed East Ayrshire-SNAP (Social Pedagogy, Nurturing approaches, Attachment Theory, Response Ability Pathway), a relationship-based model of care that integrates trauma-informed knowledge into practice. The house managers visited other residential care settings and providers that were able to evidence good outcomes for children and young people, and they took what worked best back to East Ayrshire Children’s Houses. EA-SNAP has now been piloted over the last three years in three separate Children’s Houses.
Combining these approaches has supported the ongoing development of relationship-focused practice. Inviting the carer to take time to explore attachment theory, brain development and individual chronologies through assessment has created a better understanding of behaviour and also renewed empathy. Our children now report that they also feel safer, happier and better supported.
Utilising Nurturing Principles has enabled us to provide the young people with the chance to develop their social and emotional skills to prepare them with the foundations to build positive, healthy relationships as they grow up. This has meant leaving behind traditional behaviour management techniques and has also led us to a readiness to embrace the use of PACE (Playfulness, Acceptance, Curiosity and Empathy) as part of the overall approach to trauma-informed practice.
We have identified several key factors for the successful implementation of SNAP:
• Readiness for change (carers and systems)
• Effective and consistent leadership (managers and care teams)
• Reducing staff changes and turnover
• Ensuring equity, participation, respect and consistency
• Whole house ethos and practice
The Corporate Parenting team has reported a number of positive improvements including:
• A reduction in the involvement of the police
• A reduction in children and young people picking up charges
• A reduction in safe holds
• An increase in the longevity of placements.
It’s not been without difficulty, but moving towards a learning culture has empowered us to be more confident to discuss, critically reflect and grow from our mistakes. These days when the educational psychologist walks into the Children’s House there is a warm welcome, an air of calm and the children and young people have a better idea of who we are: we’re known by our first names.
I now consider each visit as I would entering into someone’s family home, with a renewed empathy and respect for the family that live there.
As a direct result of training in Nurture, coaching and modelling sessions and peer reflection, carers are now more confident in recognising any anxiety or stress in one another, and when they have compassion fatigue – they’re full up – they are now better able to support each other by letting colleagues know when they are not feeling contained.
Carers are continuously inventing new ways to enable their colleagues to feel felt by allowing them to choose an out, an alternative to a situation escalating, much like we would with the children and young people. Connect and redirect, or the tap on the shoulder approach, generally works well: “That’s the phone for you…”; or “Could you make us a wee cup of tea?”.
Through coaching and modelling sessions, Nurture training, and being available to listen to carers we have developed a framework that complements the overarching model of practice (EA-SNAP). The more recent introduction of the use of Dyadic Developmental Psychotherapy (DDP)-informed practice, supported by trained educational psychologists and adopting PACE-full approaches, is enhancing the impact: as a service we have observed PACE in action on several occasions when we have been in the houses and in more formal settings such as meetings.
Carers now have permission to get creative in terms of playfulness and de-escalation, with some interesting interventions noticed by visitors. For instance, wearing layers and layers of odd clothes to make a young person feel less self-conscious about their school uniform more often than not result in a crisis averted but also lots of attuned laughter.
As someone who works alongside but is not within the carer team, I’m inspired by the people who choose to become carers. I have the upmost respect and admiration for the compassion, care and love that these professionals provide every day, more so when things are not going so well.
From my perspective as a psychologist, there’s a real value that the model of care we have adopted for the children and young people in our Children’s Houses is the same model of care we have developed for/with the carers. There is mutual respect, compassion, acceptance and understanding – truly relationship-based.