Practitioners’ experience of implementing therapeutic residential care: A multi-perspective study

Abstract

Repeated inquiries into residential care for children and young people in out-of-home care have documented persistent service inadequacies. Calls for reforming residential care into therapeutic care have received growing attention in recent years. However, limited research exists to inform how therapeutic care can be optimally implemented in residential care settings. This research draws on the first-hand experience of residential care practitioners to examine the barriers they experienced when implementing therapeutic care. Twenty-six practitioners across five different service strata (senior managers, therapeutic specialists, caseworkers, team leaders and direct care workers) from three Australian residential care organizations participated in semi-structured interviews. Framework analysis of the interview data indicated, whilst there was a strong consensus that therapeutic residential care should be underpinned by trauma-informed knowledge, its implementation was constrained by six barriers: (1) inconsistent understandings of how therapeutic care should be operationalized; (2) crisis-driven referrals and assessments; (3) problematic placement configuration and client mix; (4) inadequate workforce development; (5) the emotional cost of care; and (6) atrophied clinical support. These barriers call into question the extent to which therapeutic residential care is implemented as intended. Findings indicate that, to actualize the full potential of therapeutic residential care, substantial work is needed to provide a more translatable practice framework, strengthen referral and assessment processes, revitalize the workforce and elevate implementation efforts to a systemic level, bringing closer alignment between different service systems to jointly avert re-traumatization and enhance consistency in service delivery.