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Child Care in Practice
Vol. 10, No. 4, October 2004, pp. 345±357




Changing Residential Child Care: A
Systems Approach to Consultation
Training and Development
Johnnie Gibson, Marcella Leonard and Mena Wilson




In this article, the authors describe and illustrate their approach to consultancy,
development and training in residential child care. When working together the authors
form the MOSAIC Consortium and provide training and consultancy to residential child
care services. The article draws on systems theory, systems thinking and the politics of child
welfare to provide an analytic perspective that enables decision-making about the design
of training and development interventions that promote good practice in this service
setting. The theoretical perspective and intervention strategies are illustrated through case
material.

Introduction

This article illustrates and describes the authors' approach to consultancy, training
and development in the context of residential child care. Systems theory (Harrison,
1987), systems thinking (McCaughan & Palmer, 1994) and an understanding of the
politics of residential child care informs the approach (Frost, Mills, & Stein, 1999). We
do not claim that our experience is unique. However, we do argue that while systems
ideas and systems thinking are now long established in the social work literature
(Bruggen & O'Brian, 1987; Anderson & Carter, 1990; Greene & Holden, 1990;
Preston-Shoot & Agass, 1990; Dallos, 1991), the potential growth that could come
from the deliberate use of this approach is rarely realised; one such example is Nunno,
Holden, and Leidy (2003).
   The MOSAIC Consortium carried out the work outlined in the article. MOSAIC is a
Johnnie Gibson is an independent social work trainer consultant with Gibson±Cathcart Training Education &
Consultancy he represents the Residential Child Care Project, Cornell University, NY, in Ireland. Marcella
Leonard is an independent social work trainer consultant with specialist knowledge in therapeutic assessment,
childhood trauma and sexuality. Mena Wilson is Director of Unicorn Consultancy, Belfast which provides
training and consultancy to the Care Education and Justice Sectors. When working together these three form
MOSAIC Consortium and offer a systemic consultancy and training service to residential child care.

Correspondence to: Johnnie Gibson, Gibson-Cathcart Training Education & Consultancy, 5 Galloway Point,
Edgewater, Donaghadee BT21 OES, UK. Email: ajg@jongib.freeserve.co.uk

ISSN 1357±5279 print/1476±489X online/04/040345-13 ã 2004 The Child Care in Practice Group
DOI: 10.1080/1357527042000285529
346   J. Gibson et al.
group of three independent professional social workers that bring together their
collective expertise of working in and with residential settings with an aim to promote
quality child care and management practice. The case material in this article draws on
our work with several large and smaller organisations, all of which are providers of
residential childcare.
   The article begins with an example of work undertaken by the MOSAIC
Consortium. It then proceeds to outline the knowledge base that informs how we
work and concludes with a framework for mapping and analysing relationships of
in¯uence that can either impede or facilitate good practice in residential child care.
The example that follows con®rmed for us that systems theory, systems thinking and
understanding the politics of care are particularly relevant to understanding and
intervening in this context.
   A complex network of relationships that comprises parents, social workers, children
and young people, managers, policy-makers and sometimes the general public
in¯uence each interaction between any child in care and their care workers. Thus,
professional staff and others in the general sphere of residential care who may think
they are background factors are, in fact, very much in the foreground even though not
physically present all of the time. That well known family therapy sound bite that
claims that ``background is fore-ground'' may well be overused but that does not mean
that it is not true. We have found this to be so. We believe the Northern Ireland context
of residential child care serves as a practical example of this idea of ``back-ground and
fore-ground factors''. In the past few years, signi®cant progress regarding improve-
ments in the stock of local children's homes has become evident; the quality of living
environments is improving. This progress relates to the Children Matter plans (Social
Services Inspectorate N Ireland, 1998). Policy-makers and planners who do not
interact on a daily basis with children and young people in residential care deserve
credit for initiating these improvements and for planting the seeds of the differentiated
system of care envisioned in the Children Matter report. We are, however, very
concerned that the emphasis is entirely on ``bricks and mortar''. The total residential
child care service in Northern Ireland is small and would bene®t greatly from a centre
like the Scottish Institute on Residential Child Care. An initiative like this would
provide leadership on practice issues and on specialised training. Our view is that equal
and parallel emphasis needs to be given to practice as well as improvements in ``bricks
and mortar''. Leadership in the area of practice and training is not aspirational. It is
essential, for it is as recent as 2001 that the Northern Ireland Assembly described the
local residential child care service as being ``in a state of crisis'' (Committee for Health
Social Services and Public Safety, 2001). Our point is that the sector needs leadership to
develop a vision that builds on current good evidence-based practice that acknow-
ledges the complexities of service delivery needs more that a bricks and mortar strategy.


A Case Study: Anxiety, Disarray and Crisis
One of us was contacted by a ®eld social worker who said that she was concerned for
her 13-year-old client and for the team of residential childcare staff that looked after
Child Care in Practice   347

her. The young person had a history of aggression (i.e. threatening behaviour) and of
violence (i.e. hitting, kicking and otherwise physically attacking staff). The ®eld social
worker was concerned that the staff team were almost at the stage of walking out. This
would have effectively closed at least one of the homes in this agency. At a meeting
between the team and a consultant from MOSAIC that was organised, it was clear that
the whole team was in an acute state of crisis. The phrase ``traumatised and
disempowered'' ®gured heavily in this team's self-description and experience. In
summary, this meeting comprised tears and fears alongside a commitment to change
but without the power to achieve it. Walking out seemed like the only empowering
option left to them. The initial consultation meeting that took place on a weekend
morning prevented the walk-out from becoming reality. This meeting, initiated by the
®eld social worker, had the sanction of agency management; however, no management
representative attended the meeting. Management was in crisis as well and were not
sure about how to provide leadership at this time.
   Here is how the staff team summarised their experience.
d    Frequent (daily) aggressive outbursts from the children, which involved hitting and
    kicking staff as well as using implements such as knives.
d    No designated age band for each unit, therefore no proper assessment system for the
    appropriate unit for a child.
d    Lack of management support following assaults.
d    No of®cial method of recording the detail of the assaults, including the action taken
    by staff. As a result of this staff do not record the assaults unless they think they are
    serious.
d    Lack of acknowledgement by management of the impact of continuous
    physical, emotional and behavioural attacks on them as individuals and as a staff
    group.
d    Lack of external counselling available.
d    Sense of isolation and victimisation as a staff group.
d    Due to the continued crises in the units there is a resignation among staff of their
    inability to provide a continuum of care for the young people.
d    Some of the children are clearly afraid of being assaulted in the units where they have
    been placed for care and protection.
d    Structured care plans not carried out.
d    No consensus in how to deal with the assaults.
d    Staff have to continue working their shift after an assault, which requires continued
    contact with the young person.
d    Transference of anger, fear and anxiety to the young people, which therefore negates
    any therapeutic work being undertaken.
d    Individual supervision does not happen.
d    Staff feel undervalued in respect of their experience.

This staff team was clear about their needs. They listed these as follows.
d   Team buildingÐthey identi®ed this as a ®rst step.
348    J. Gibson et al.
d    Training in Therapeutic Crisis Intervention (Holden, Mooney, & Budlong, 2001)
    including safe holding/physical restraint.
d    Training in childhood trauma, emotional, physical and sexual abuse and neglect.
d    Report writing, recording, critical incident reporting.
d    Supervision.
d    Therapeutic skills.
d    Understanding and responding to self-harm.
d    Responding to disclosures of abuse.
d    Loss and bereavement.
d    Understanding Post Traumatic Stress Disorder.
d    Impact of living with trauma on staff.

In her debrief to her colleagues the consultant involved in the aforementioned meeting
reviewed the experience as follows:
       I felt frustrated for them, their emotional pain was palpable and so was their anxiety.
       There were tears. They care for vulnerable young people yet they are at risk from these
       young people, the young people exploit the vulnerabilities of the staff. These staff are
       emotionally ``frozen'' and because of their own work based trauma they cannot be alert to
       the trauma that the children bring with them. The current situation is that the
       traumatized are caring for the traumatized. They feel like they are ``banging their head
       against a brick wall'' with management and are about to resort to extreme measures like
       walking out, yet their value base of care keeps them there. My strongest feeling on leaving
       them was of impending tragedy in a situation that was unsafe for everyone if a
       coordinated response does not follow soon.

It would have been easy to be completely panicked by this experience both through
direct encounter and by hearing it described by the consultant during de-brief. The
systemic perspective shared by the MOSAIC consultants helped in three ways. First it
ensured that the consultants did not become overwhelmed by the raw emotion of the
situation. It also helped the consultants to remain ``neutral'' and not take sides and,
®nally, it provided a framework that enabled the design of a suitable intervention
strategy. The following section of the article outlines the consultants' shared
perspective that helped to make sense of these phenomena



Making Sense of Residential Childcare: The Politics of Care, Systems Theory
and Systems Thinking
Residential care in general and childcare in particular has a long and powerful history.
This backdrop casts long shadows and shapes perceptions and attitudes about the
service. Parker (1988) points out that residential child care is very much connected to
its poor-law roots and that there remains a ``persistent public image of institutional
care as `repugnant' '' (p. 8). In the same publication Parker refers to this long-standing
negative attitude that spans past and present as a ``historical continuity'' (1988, p. 8).
Frost et al. (1999) subject residential care to a rigorous historical and sociological
analysis and conclude that a number of key themes are woven into the fabric and
Child Care in Practice   349

history of residential care that make it a political activity. The themes that they identify
areas follows.
d   The operation of and exercise of power. For example, the power to remove children
    from their families and to regulate their behaviour within the system and setting.
d   The relationship between the care system and the wider social and political themes
    of the dayÐto understand the care system, it is essential to relate its functions,
    purpose and operations to wider societal issues such as social class, gender, disability
    and ethnicity.
d   Tensions between ``care'', ``control'' and ``resistance'' are always present within any
    care setting but how these are played out will vary uniquely to each setting.

Subtle and not so subtle comments and observations reveal perceptions and views of
``institutional'' child care. Norman Warner (1992) reports a senior manager who
commented in evidence to the Warner Committee that ``residential child care is a
necessary evil'', not that it is a ``positive choice'' (Wagner, 1990) selected by many
young people as a preference to living at home or in foster care (Frost et al., 1999). In a
similar vein, a now retired Chief Executive of one of Northern Ireland's Health and
Social Services Trusts said on viewing a soon to be opened new build residential
facility for troubled teenagers, ``It's far too good for them''! Ten years after Parker's
(1988) analysis, Frost et al. (1999, p. 1) suggested that the public image of residential
child care has changed little. They report a crisis of con®dence in residential childcare
and that the public view of children's homes is that they are places where children are
``¼ victims, being sexually or physically abused, or villains, who are beyond control,
involved in prostitution, crime or going missing'' (Frost et al., 1999, p. 1).
    With the exercise of power comes the risk of dis-empowerment. Children and
young people who enter the care system may be dis-empowered already. Typically,
they have been let down and neglected or abused emotionally and sexually by family
and community, they may have had multiple placements in foster care, and they may
have experienced societal intolerance about their unique characteristics such as
disability or their life circumstances such as being in care. They will certainly be young
people who are both ``innately and structurally vulnerable'' (Goldson, 2002, p. 153);
the former concept refers to characteristics of the individual and the speci®cs of their
immediate family and social environment, the latter refers to societal structures such
as unemployment and poverty. Thus, a pre-requisite to a real understanding of
residential child care is a broad perspective that sees this substitute to family care in the
context of a temporal, social, political and economic climate. And that, secondly,
frames the core tasks of care as being about achieving a balance between empowering
the dis-empowered alongside providing for them and, with them, ``good experiences
of comfort, care and control'' (Winnicott, 1971, p. 31). As we have already seen early in
this article, it is not just the ``looked after'' who know and experience dis-
empowerment, care staff and managers can equally end up not knowing what to do,
where to turn or contemplating extreme actions in order to exercise power and self-
control. At the conclusion of their sociological and historical analysis of residential
350   J. Gibson et al.
child care, Frost et al. (1999) rightly argue and illustrate that good practice in this
arena of social work practice requires a philosophical and practical orientation that
works toward empowering carers as well as the cared for. We agree.
    It is to systems theory and systems thinking that we turn now as the ®nal
component of the theory base that helps us as consultants specialising in residential
child care to make sense of what we sometimes observe and feel. The term ``system'' is
widely used in everyday language. When ®rst introduced into the social sciences it was
part of ``general systems theory''. The concept of system has been adopted by many
disciplines (e.g. engineering, psychology, anthropology and biology) (Richardson,
2003). In application, it conveys the idea of a ``complex of elements or components
directly or indirectly related ¼ each component is related to at least some others in a
more or less stable way within a particular period of time'' (Anderson & Carter, 1990,
p. 3). Thus systems theory holds that any organised human enterpriseÐfor example,
schools, businesses, leisure centres, families, and so onÐare comprised of a number of
parts or subsystem. Understanding any part of the system requires knowledge of the
whole as well as how the parts of the system interact, connect or, as the case may be,
fail to connect and exercise reciprocal in¯uence upon each other. Understanding any
subsystem requires knowledge of how the smaller parts ®t into the larger system. Every
system and subsystem has and needs to have boundaries that distinguish it as unique
and that help to make its tasks and processes clear, manageable and achievable.
    Systems theory provides a range of analytic concepts that can help to inform,
understand, map and diagnose function, dysfunction and inter-relationships in
organisations, groups (Harrison, 1987) as well as in families (Nichols & Schwartz,
1991). But systems thinking involves more than drafting informative and essential
diagrams and charts. Systems thinking has been described by Senge, Kleiner, Roberts,
Ross, and Smith (1999, p. 6) as ``a way of thinking about and a language for describing
and understanding the forces and interrelationships that shape the behaviour of
systems''. Central among the analytic concepts in systems theory is the concept of
``structure''. To some people structure equates with the organisational chart or the
agreed or required arrangements for carrying out work. In systems theory, and central
to systems thinking, is the idea that structure ``is the pattern of interrelationships
among key component of the system. That might include hierarchy and process ¯ows,
but it also includes attitudes and perceptions, the quality of products, the ways in
which decisions are made, and hundreds of other factors'' (Senge et al., 1999, p. 90).
Thus, ``structure'' has a major and reciprocal in¯uence on behaviour.
    Systems thinking requires the ability to see both the ``wood and the trees'' at the
same moment, or another way of saying this is that systems thinking requires the
ability to view system events through a close-up lens and through a wide-angle lens
simultaneously. In application, this means the ability to understand the aggressive
behaviour of the 13-year-old girl described earlier while at the same time,
understanding team dynamics. And at the same time understanding how the
``structure'' affects and is affected by the team and how the ``structure'' affects and is
affected by the wider organisation, and how all of these impact upon the 13-year-old
girl and how the 13-year-old girl impacts upon ¼ and so on.
Child Care in Practice   351

   In addition to the aforementioned we found Richardson's (2003, pp. 104±112)
framework of systemic biases helpful. These are now listed, and we expand them to
show how we understand these.

1. First bias. When people act, they are normally tying to do something good. This
   perspective is referred to as ``positive connotation''. Seeing the positive in another's
   actions is better than being critical and judgemental, and adds momentum rather
   than resistance to change efforts.
2. Second bias. The observer is in the observed. Richardson (2003, p. 106) points out
   that ``one of the effects of holding this bias is that it helps us not to assume that we
   can fully know another and to treat our perspectives as partial truths or stories
   which in turn leaves room for other truths and perspectives to emerge''. We take
   from her work that once we engage with a system, we become part of a new even if
   temporary system and that our own actions and inactions are part of this new and
   forming reality.
3. Third bias. The only person you can change is yourself. When we try too hard to
   change another person or system, our efforts can lead to resistance. Richardson
   (2003, p. 107) tantalisingly asserts that ``if you want to create change you have to
   sometimes stop being on the side of change''. As consultants we have learned not to
   push or persuade; rather, our mental posture is one of curiosity and helping the
   change process by helping people to think through the implications of the status
   quo, which, sometimes as the example at the start of this article illustrates, can be
   chaos and crisis.
4. Fourth bias. When working with one part of a system hold the other parts in mind.
   Our approach to this work has con®rmed for us that it is essential to expand
   continually the context beyond the initial point of entry into the system until there
   is a real sense that all signi®cant actors in the systems are within the frame of
   reference. It is not essential for them all to meet at the same timeÐbut as
   consultants it is essential that we have contact with all systems elements and that
   each in turn knows and understands that our work together is in this systems
   context.
5. Fifth bias. Be irreverent. Essentially, this is to do with challenging assumptions and
   beliefs, our own as much as others. It might mean with respectful curiosity asking
   another person, maybe a care worker or a manager, ``what would be the result if
   you stopped believing that a particular child is violent''. We have seen this several
   times in relation to children described as violent. Certainly, they can be
   intimidating and can behave with aggression but have never actually hit anyone.
6. Sixth bias. Every perspective has value. An example will provide illustration. While
   working with a staff team we asked them whether they believed that acting, as a role
   model for adolescents in group care was an important part of the job of a
   residential social worker. They agreed and all positioned themselves tightly around
   the answer ``yes'' that was written on the ¯oor and well away from the ``no'' answer.
   The next question was ``If the young people were here now and if we asked them
   about what sort of role models they see in the team on a day-by-day basis, what
352    J. Gibson et al.
   would they say?''. There was stunned silence followed by honest re¯ection of the
   fact that the team did not always display desirable role models at all. Adding the
   children's perspective even though they were not there enabled the formation of a
   systemic connection.
7. Seventh bias. Language is not neutral. We identify strongly with Richardson (2003)
   on this point. She rightly states that language conveys meaning; words are used to
   tell a story that de®nes and describes people and situations in certain ways. The
   question is ``why this particular way and with what effect?''. We agree with
   Richardson when she points out that in residential child care the most obvious
   example is the daily handover meeting between shifts. How information is ``handed
   over'', how meaning is construed, can have profound implications for all
   concernedÐnot least as Richardson reminds us (2003, p. 113) ``for the characters
   in the story'' (i.e. the children and their families).




Consequences of Systemic Dislocation
From our work with a range of organisations, we have observed attitudes and practice
that serve as examples of systems where there is disconnection between the parts. This
systems dislocation leads to dysfunction. Here are some examples.
d    Teambuilding opportunities, while supportive, were less effective when not linked to
    other factors impacting on the team.
d    Organisations were demanding more specialist training when the foundation skills
    were not in place.
d    The impossible task of one staff attending training and expected to feedback and
    share learningÐimplementation often requires a team approach best understood
    when teams are trained together.
d    Increased demand for training on physical restraint when early intervention/
    diffusing skills are not there and concerns about a lack of a policy framework to
    support and guide staff.
d    Once learning has taken place essential systems are not in place to facilitate
    integration of learning into practice (e.g. supervision, appraisal).
d    Increased expectation that training will solve all problems when what is required is a
    range of other responses (e.g. mentoring, coaching, team development, strategic
    planning).

The opposite of dislocation is systemic connectedness, which is referred to as
``coherence'' by Brown, Bullock, Hobson, and Little (1998). Their research indicates
the importance of ``coherence'' between the staff's, the unit manager's and senior
managers' de®nitions of what the home is about. Our re¯ections on work carried out
both within Northern Ireland and in the Republic of Ireland led us to identify a
number of core assumptions that would lead to a better connection between the parts
of the systems that ``contain'' children's homes.
Child Care in Practice   353

1. The need for commitment and leadership at a strategic level that holds and
   continually promotes the vision for the work.
2. An ongoing awareness of the external environment and its impact on the work.
3. Clarity of role and responsibilities within the internal environment and senior
   management mandate, and ownership that includes active involvement in the
   process. Residential child care teams often highlight gaps between themselves and
   managers that develop into a barrier when not addressed. When Berridge and
   Brodie (1998) carried out their follow-up study into a number of children's homes
   10 years after their initial study, they found evidence of a decline in managers'
   involvement in the homes.
4. The need for staff (and young people where possible) to be involved in decision-
   making and part of the change process. Communication is critical.
5. The need for sensitivity to the speci®c context for each piece of work and the issues
   to be addressed. One Health Board in the Republic of Ireland was able to respond
   to the very speci®c needs of a child through provision of a tailored ``wrap around''
   service while another unit was powerless in contributing to any decision regarding
   placement of young people in their care
6. Recognition that learning can happen through a range of methods (e.g. training,
   development, mentoring, coaching), but there must be opportunities for practice-
   based learning and individual and team re¯ection.
7. Staff must be provided with time to process the impact of the work on themselves,
   and the organisation needs to ®nd ways to review incidents regarding challenging
   behaviour, sexuality, managing change to ensure trauma is reduced and more
   effective responses developed.



Introducing a Systemic Framework
Building on what we have described thus far, our core approach de®nes a philosophy
that recognises that all parts of the system are inter-related and interdependent and
there needs to be recognition of this in order to effect and support change, whether
that is practice learning or team development or rede®ning the purpose of a unit. A
visual representation of this is shown in Figure 1.
   Our diagnostic and assessment work with all of the agencies that we work with
includes an open and transparent audit of work in these keys areas. We also try to
reach an understanding of how the structure of relationships in the agency and
between the different parts of the system both shape and are shaped by daily events in
and around the provision of care to troubled children. The next section is an
illustration of how the MOSAIC team along with one agency worked to provide a
multi-element solution to a situation of chronic disarray.


A Case Study: Anxiety, Disarray and Crisis
This article began with a descriptive case study of a residential unit in crisis. MOSAIC
354    J. Gibson et al.




                           Figure 1. A Systemic Framework.




was invited to undertake a further needs analysis and to offer solutions. On further
investigation, we found that the service was in crisis. We found caring people, direct
line staff, ancillary and support staff and managers desperate to do a good job for some
of the most seriously traumatised children and young people in our society. We found
young people who were angry, sad, and unhappy and who displayed moments of guilt
at some of their actions. We found young people who wanted adults to be in charge,
who wanted adults to show care and fairness but young people who, because of their
life experiences and distrust in adults and ``the system'', would resist the very aspects of
care that that they so desired. The MOSAIC consultants followed on from the initial
team meeting described earlier with visits of observation and interviews that sought
information from all parties on their views of critical system components. The result
was a programme of work that we outline in Table 1. The programme lasted 11
months and covered the following areas.
d   Senior management support.
d   Team building.
d   Therapeutic Crisis Intervention (managing challenging behaviour).
Child Care in Practice    355

            Table 1. Content of the Development and Training Programme

                       Aim                                        Content

Residential staff      To help equip residential childcare        Team development 5 Q 1 days
                       workers with the training and
                       development that will assist them in
                       providing quality care for children
                       and young people in residential care
                                                                  Therapeutic Crisis Intervention
                                                                  trainingÐ27 staff trained on 5-day
                                                                  programme
                                                                  Child and adolescent development
                                                                  Q 2 days
                                                                  Childhood trauma Q 1 day
                                                                  Managing sexual behaviour Q 1 day
                                                                  Recording skills 1 day
                                                                  Supervision skills 1 day
Senior                 To facilitate discussion, clarify issues   5 Q 0.5-day sessions providing an
management             and support senior managers in             opportunity to:
support                their planning and decision-making
                                                                  feedback issues/concerns/good
                                                                  practice
                                                                  facilitate discussion on strategic
                                                                  issues
                                                                  explore operational implications
                                                                  review and as appropriate adapt the
                                                                  programme



d   Child and adolescent development.
d   Childhood trauma.
d   Managing sexual behaviour/therapeutic skills.
d   Supervision and recording skills.
The programme content is presented in Table 1. A celebration event was held on
completion of the process with the presentation of certi®cates and feedback from all
those involved. Some staff comments included:
      All parts of the training have been signi®cantÐtraining which has given me a great
      knowledge base and teambuilding which has helped build better relationships with
      colleagues.
      TCI has been applied to my practice and has helped me deal with situations more
      effectively ¼ makes us work more consistently and provides an improved service for
      young people.
      Coming together and airing our views has helped staff to be more open. Discussing ways
      of dealing with the children has helped us deal more effectively as a team.


Conclusion
Residential child care is a complex activity and although it may appear contradictory
356   J. Gibson et al.
to say it, ``care'' alone is not enough' (Bath, 1998). When residential care works well,
and when it fails, the explanation is never down to one variable. In this article, we have
shown that multiple variables are involved and that the way they interact creates a
structure and pattern of relationships that will either promote and facilitate quality
care or will, at best, get in the way of quality or will, at worst, abuse the vulnerable.
We think that systems theory and systems thinking provide a road map that can
illuminate key variables and the relationships between them. Thus, when troubled
children and young people in a residential setting are settled for bed at night, as well as
when they get on the roof at three o'clock in the morning, residential social workers,
team-leaders, ®eld social workers and senior managers might all begin to de-construct
the event by asking ``what is my part in this?''. The follow-up is a response that should
seek systemic explanations and solutions. It is our experience that single solutions like
staff training or moving troubled young people to yet another placement are never
enough.


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Nunno, M. A., Holden, M. J., & Leidy, B. (2003). Evaluating and monitoring the impact of a crisis
       intervention system on a residential child care facility. Children and Youth Services Review,
       25, 295±315.
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Parker, R. A. (1988). Residential care for children. In I. Sinclair (Ed.), Residential care: The research
       reviewed. London: Her Majesty's Stationery Of®ce.
Preston-Shoot, M., & Agass, D. (1990). Making sense of socialwork. Pyschodynamics, systems and
       practice. London: MacMillan.
Richardson, C. (2003). The contribution of systemic thinking and practice. In A. Ward, K. Kasinski,
       J. Pooley & A. Worthington (Eds.), Therapeutic communities for children and young people.
       London: Jessica Kingsley.
Senge, P., Kleiner, A., Roberts, C., Ross, R. B., & Smith, B. J. (1999). The ®fth discipline ®eldbook.
       Nicholas Brealey Publishing: London.
Social Services Inspectorate N Ireland (1998). Children matter: A review of residential child care
       services in Northern Ireland. Belfast: Department of Health and Social Services.
Wagner, G. (1990). Residential care. A positive choice. London: National Institute of Social Work,
       HMSO.
Warner, N. (1992). Choosing with care. Report of the Committee of Inquiry into the selection
       development and management of staff in children's homes. London: HMSO.
Winnicott, C. (1971). Child care and social work. London: Bookstall Services.
Changing residential child care   johnnie gibson

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Changing residential child care johnnie gibson

  • 1. Child Care in Practice Vol. 10, No. 4, October 2004, pp. 345±357 Changing Residential Child Care: A Systems Approach to Consultation Training and Development Johnnie Gibson, Marcella Leonard and Mena Wilson In this article, the authors describe and illustrate their approach to consultancy, development and training in residential child care. When working together the authors form the MOSAIC Consortium and provide training and consultancy to residential child care services. The article draws on systems theory, systems thinking and the politics of child welfare to provide an analytic perspective that enables decision-making about the design of training and development interventions that promote good practice in this service setting. The theoretical perspective and intervention strategies are illustrated through case material. Introduction This article illustrates and describes the authors' approach to consultancy, training and development in the context of residential child care. Systems theory (Harrison, 1987), systems thinking (McCaughan & Palmer, 1994) and an understanding of the politics of residential child care informs the approach (Frost, Mills, & Stein, 1999). We do not claim that our experience is unique. However, we do argue that while systems ideas and systems thinking are now long established in the social work literature (Bruggen & O'Brian, 1987; Anderson & Carter, 1990; Greene & Holden, 1990; Preston-Shoot & Agass, 1990; Dallos, 1991), the potential growth that could come from the deliberate use of this approach is rarely realised; one such example is Nunno, Holden, and Leidy (2003). The MOSAIC Consortium carried out the work outlined in the article. MOSAIC is a Johnnie Gibson is an independent social work trainer consultant with Gibson±Cathcart Training Education & Consultancy he represents the Residential Child Care Project, Cornell University, NY, in Ireland. Marcella Leonard is an independent social work trainer consultant with specialist knowledge in therapeutic assessment, childhood trauma and sexuality. Mena Wilson is Director of Unicorn Consultancy, Belfast which provides training and consultancy to the Care Education and Justice Sectors. When working together these three form MOSAIC Consortium and offer a systemic consultancy and training service to residential child care. Correspondence to: Johnnie Gibson, Gibson-Cathcart Training Education & Consultancy, 5 Galloway Point, Edgewater, Donaghadee BT21 OES, UK. Email: ajg@jongib.freeserve.co.uk ISSN 1357±5279 print/1476±489X online/04/040345-13 ã 2004 The Child Care in Practice Group DOI: 10.1080/1357527042000285529
  • 2. 346 J. Gibson et al. group of three independent professional social workers that bring together their collective expertise of working in and with residential settings with an aim to promote quality child care and management practice. The case material in this article draws on our work with several large and smaller organisations, all of which are providers of residential childcare. The article begins with an example of work undertaken by the MOSAIC Consortium. It then proceeds to outline the knowledge base that informs how we work and concludes with a framework for mapping and analysing relationships of in¯uence that can either impede or facilitate good practice in residential child care. The example that follows con®rmed for us that systems theory, systems thinking and understanding the politics of care are particularly relevant to understanding and intervening in this context. A complex network of relationships that comprises parents, social workers, children and young people, managers, policy-makers and sometimes the general public in¯uence each interaction between any child in care and their care workers. Thus, professional staff and others in the general sphere of residential care who may think they are background factors are, in fact, very much in the foreground even though not physically present all of the time. That well known family therapy sound bite that claims that ``background is fore-ground'' may well be overused but that does not mean that it is not true. We have found this to be so. We believe the Northern Ireland context of residential child care serves as a practical example of this idea of ``back-ground and fore-ground factors''. In the past few years, signi®cant progress regarding improve- ments in the stock of local children's homes has become evident; the quality of living environments is improving. This progress relates to the Children Matter plans (Social Services Inspectorate N Ireland, 1998). Policy-makers and planners who do not interact on a daily basis with children and young people in residential care deserve credit for initiating these improvements and for planting the seeds of the differentiated system of care envisioned in the Children Matter report. We are, however, very concerned that the emphasis is entirely on ``bricks and mortar''. The total residential child care service in Northern Ireland is small and would bene®t greatly from a centre like the Scottish Institute on Residential Child Care. An initiative like this would provide leadership on practice issues and on specialised training. Our view is that equal and parallel emphasis needs to be given to practice as well as improvements in ``bricks and mortar''. Leadership in the area of practice and training is not aspirational. It is essential, for it is as recent as 2001 that the Northern Ireland Assembly described the local residential child care service as being ``in a state of crisis'' (Committee for Health Social Services and Public Safety, 2001). Our point is that the sector needs leadership to develop a vision that builds on current good evidence-based practice that acknow- ledges the complexities of service delivery needs more that a bricks and mortar strategy. A Case Study: Anxiety, Disarray and Crisis One of us was contacted by a ®eld social worker who said that she was concerned for her 13-year-old client and for the team of residential childcare staff that looked after
  • 3. Child Care in Practice 347 her. The young person had a history of aggression (i.e. threatening behaviour) and of violence (i.e. hitting, kicking and otherwise physically attacking staff). The ®eld social worker was concerned that the staff team were almost at the stage of walking out. This would have effectively closed at least one of the homes in this agency. At a meeting between the team and a consultant from MOSAIC that was organised, it was clear that the whole team was in an acute state of crisis. The phrase ``traumatised and disempowered'' ®gured heavily in this team's self-description and experience. In summary, this meeting comprised tears and fears alongside a commitment to change but without the power to achieve it. Walking out seemed like the only empowering option left to them. The initial consultation meeting that took place on a weekend morning prevented the walk-out from becoming reality. This meeting, initiated by the ®eld social worker, had the sanction of agency management; however, no management representative attended the meeting. Management was in crisis as well and were not sure about how to provide leadership at this time. Here is how the staff team summarised their experience. d Frequent (daily) aggressive outbursts from the children, which involved hitting and kicking staff as well as using implements such as knives. d No designated age band for each unit, therefore no proper assessment system for the appropriate unit for a child. d Lack of management support following assaults. d No of®cial method of recording the detail of the assaults, including the action taken by staff. As a result of this staff do not record the assaults unless they think they are serious. d Lack of acknowledgement by management of the impact of continuous physical, emotional and behavioural attacks on them as individuals and as a staff group. d Lack of external counselling available. d Sense of isolation and victimisation as a staff group. d Due to the continued crises in the units there is a resignation among staff of their inability to provide a continuum of care for the young people. d Some of the children are clearly afraid of being assaulted in the units where they have been placed for care and protection. d Structured care plans not carried out. d No consensus in how to deal with the assaults. d Staff have to continue working their shift after an assault, which requires continued contact with the young person. d Transference of anger, fear and anxiety to the young people, which therefore negates any therapeutic work being undertaken. d Individual supervision does not happen. d Staff feel undervalued in respect of their experience. This staff team was clear about their needs. They listed these as follows. d Team buildingÐthey identi®ed this as a ®rst step.
  • 4. 348 J. Gibson et al. d Training in Therapeutic Crisis Intervention (Holden, Mooney, & Budlong, 2001) including safe holding/physical restraint. d Training in childhood trauma, emotional, physical and sexual abuse and neglect. d Report writing, recording, critical incident reporting. d Supervision. d Therapeutic skills. d Understanding and responding to self-harm. d Responding to disclosures of abuse. d Loss and bereavement. d Understanding Post Traumatic Stress Disorder. d Impact of living with trauma on staff. In her debrief to her colleagues the consultant involved in the aforementioned meeting reviewed the experience as follows: I felt frustrated for them, their emotional pain was palpable and so was their anxiety. There were tears. They care for vulnerable young people yet they are at risk from these young people, the young people exploit the vulnerabilities of the staff. These staff are emotionally ``frozen'' and because of their own work based trauma they cannot be alert to the trauma that the children bring with them. The current situation is that the traumatized are caring for the traumatized. They feel like they are ``banging their head against a brick wall'' with management and are about to resort to extreme measures like walking out, yet their value base of care keeps them there. My strongest feeling on leaving them was of impending tragedy in a situation that was unsafe for everyone if a coordinated response does not follow soon. It would have been easy to be completely panicked by this experience both through direct encounter and by hearing it described by the consultant during de-brief. The systemic perspective shared by the MOSAIC consultants helped in three ways. First it ensured that the consultants did not become overwhelmed by the raw emotion of the situation. It also helped the consultants to remain ``neutral'' and not take sides and, ®nally, it provided a framework that enabled the design of a suitable intervention strategy. The following section of the article outlines the consultants' shared perspective that helped to make sense of these phenomena Making Sense of Residential Childcare: The Politics of Care, Systems Theory and Systems Thinking Residential care in general and childcare in particular has a long and powerful history. This backdrop casts long shadows and shapes perceptions and attitudes about the service. Parker (1988) points out that residential child care is very much connected to its poor-law roots and that there remains a ``persistent public image of institutional care as `repugnant' '' (p. 8). In the same publication Parker refers to this long-standing negative attitude that spans past and present as a ``historical continuity'' (1988, p. 8). Frost et al. (1999) subject residential care to a rigorous historical and sociological analysis and conclude that a number of key themes are woven into the fabric and
  • 5. Child Care in Practice 349 history of residential care that make it a political activity. The themes that they identify areas follows. d The operation of and exercise of power. For example, the power to remove children from their families and to regulate their behaviour within the system and setting. d The relationship between the care system and the wider social and political themes of the dayÐto understand the care system, it is essential to relate its functions, purpose and operations to wider societal issues such as social class, gender, disability and ethnicity. d Tensions between ``care'', ``control'' and ``resistance'' are always present within any care setting but how these are played out will vary uniquely to each setting. Subtle and not so subtle comments and observations reveal perceptions and views of ``institutional'' child care. Norman Warner (1992) reports a senior manager who commented in evidence to the Warner Committee that ``residential child care is a necessary evil'', not that it is a ``positive choice'' (Wagner, 1990) selected by many young people as a preference to living at home or in foster care (Frost et al., 1999). In a similar vein, a now retired Chief Executive of one of Northern Ireland's Health and Social Services Trusts said on viewing a soon to be opened new build residential facility for troubled teenagers, ``It's far too good for them''! Ten years after Parker's (1988) analysis, Frost et al. (1999, p. 1) suggested that the public image of residential child care has changed little. They report a crisis of con®dence in residential childcare and that the public view of children's homes is that they are places where children are ``¼ victims, being sexually or physically abused, or villains, who are beyond control, involved in prostitution, crime or going missing'' (Frost et al., 1999, p. 1). With the exercise of power comes the risk of dis-empowerment. Children and young people who enter the care system may be dis-empowered already. Typically, they have been let down and neglected or abused emotionally and sexually by family and community, they may have had multiple placements in foster care, and they may have experienced societal intolerance about their unique characteristics such as disability or their life circumstances such as being in care. They will certainly be young people who are both ``innately and structurally vulnerable'' (Goldson, 2002, p. 153); the former concept refers to characteristics of the individual and the speci®cs of their immediate family and social environment, the latter refers to societal structures such as unemployment and poverty. Thus, a pre-requisite to a real understanding of residential child care is a broad perspective that sees this substitute to family care in the context of a temporal, social, political and economic climate. And that, secondly, frames the core tasks of care as being about achieving a balance between empowering the dis-empowered alongside providing for them and, with them, ``good experiences of comfort, care and control'' (Winnicott, 1971, p. 31). As we have already seen early in this article, it is not just the ``looked after'' who know and experience dis- empowerment, care staff and managers can equally end up not knowing what to do, where to turn or contemplating extreme actions in order to exercise power and self- control. At the conclusion of their sociological and historical analysis of residential
  • 6. 350 J. Gibson et al. child care, Frost et al. (1999) rightly argue and illustrate that good practice in this arena of social work practice requires a philosophical and practical orientation that works toward empowering carers as well as the cared for. We agree. It is to systems theory and systems thinking that we turn now as the ®nal component of the theory base that helps us as consultants specialising in residential child care to make sense of what we sometimes observe and feel. The term ``system'' is widely used in everyday language. When ®rst introduced into the social sciences it was part of ``general systems theory''. The concept of system has been adopted by many disciplines (e.g. engineering, psychology, anthropology and biology) (Richardson, 2003). In application, it conveys the idea of a ``complex of elements or components directly or indirectly related ¼ each component is related to at least some others in a more or less stable way within a particular period of time'' (Anderson & Carter, 1990, p. 3). Thus systems theory holds that any organised human enterpriseÐfor example, schools, businesses, leisure centres, families, and so onÐare comprised of a number of parts or subsystem. Understanding any part of the system requires knowledge of the whole as well as how the parts of the system interact, connect or, as the case may be, fail to connect and exercise reciprocal in¯uence upon each other. Understanding any subsystem requires knowledge of how the smaller parts ®t into the larger system. Every system and subsystem has and needs to have boundaries that distinguish it as unique and that help to make its tasks and processes clear, manageable and achievable. Systems theory provides a range of analytic concepts that can help to inform, understand, map and diagnose function, dysfunction and inter-relationships in organisations, groups (Harrison, 1987) as well as in families (Nichols & Schwartz, 1991). But systems thinking involves more than drafting informative and essential diagrams and charts. Systems thinking has been described by Senge, Kleiner, Roberts, Ross, and Smith (1999, p. 6) as ``a way of thinking about and a language for describing and understanding the forces and interrelationships that shape the behaviour of systems''. Central among the analytic concepts in systems theory is the concept of ``structure''. To some people structure equates with the organisational chart or the agreed or required arrangements for carrying out work. In systems theory, and central to systems thinking, is the idea that structure ``is the pattern of interrelationships among key component of the system. That might include hierarchy and process ¯ows, but it also includes attitudes and perceptions, the quality of products, the ways in which decisions are made, and hundreds of other factors'' (Senge et al., 1999, p. 90). Thus, ``structure'' has a major and reciprocal in¯uence on behaviour. Systems thinking requires the ability to see both the ``wood and the trees'' at the same moment, or another way of saying this is that systems thinking requires the ability to view system events through a close-up lens and through a wide-angle lens simultaneously. In application, this means the ability to understand the aggressive behaviour of the 13-year-old girl described earlier while at the same time, understanding team dynamics. And at the same time understanding how the ``structure'' affects and is affected by the team and how the ``structure'' affects and is affected by the wider organisation, and how all of these impact upon the 13-year-old girl and how the 13-year-old girl impacts upon ¼ and so on.
  • 7. Child Care in Practice 351 In addition to the aforementioned we found Richardson's (2003, pp. 104±112) framework of systemic biases helpful. These are now listed, and we expand them to show how we understand these. 1. First bias. When people act, they are normally tying to do something good. This perspective is referred to as ``positive connotation''. Seeing the positive in another's actions is better than being critical and judgemental, and adds momentum rather than resistance to change efforts. 2. Second bias. The observer is in the observed. Richardson (2003, p. 106) points out that ``one of the effects of holding this bias is that it helps us not to assume that we can fully know another and to treat our perspectives as partial truths or stories which in turn leaves room for other truths and perspectives to emerge''. We take from her work that once we engage with a system, we become part of a new even if temporary system and that our own actions and inactions are part of this new and forming reality. 3. Third bias. The only person you can change is yourself. When we try too hard to change another person or system, our efforts can lead to resistance. Richardson (2003, p. 107) tantalisingly asserts that ``if you want to create change you have to sometimes stop being on the side of change''. As consultants we have learned not to push or persuade; rather, our mental posture is one of curiosity and helping the change process by helping people to think through the implications of the status quo, which, sometimes as the example at the start of this article illustrates, can be chaos and crisis. 4. Fourth bias. When working with one part of a system hold the other parts in mind. Our approach to this work has con®rmed for us that it is essential to expand continually the context beyond the initial point of entry into the system until there is a real sense that all signi®cant actors in the systems are within the frame of reference. It is not essential for them all to meet at the same timeÐbut as consultants it is essential that we have contact with all systems elements and that each in turn knows and understands that our work together is in this systems context. 5. Fifth bias. Be irreverent. Essentially, this is to do with challenging assumptions and beliefs, our own as much as others. It might mean with respectful curiosity asking another person, maybe a care worker or a manager, ``what would be the result if you stopped believing that a particular child is violent''. We have seen this several times in relation to children described as violent. Certainly, they can be intimidating and can behave with aggression but have never actually hit anyone. 6. Sixth bias. Every perspective has value. An example will provide illustration. While working with a staff team we asked them whether they believed that acting, as a role model for adolescents in group care was an important part of the job of a residential social worker. They agreed and all positioned themselves tightly around the answer ``yes'' that was written on the ¯oor and well away from the ``no'' answer. The next question was ``If the young people were here now and if we asked them about what sort of role models they see in the team on a day-by-day basis, what
  • 8. 352 J. Gibson et al. would they say?''. There was stunned silence followed by honest re¯ection of the fact that the team did not always display desirable role models at all. Adding the children's perspective even though they were not there enabled the formation of a systemic connection. 7. Seventh bias. Language is not neutral. We identify strongly with Richardson (2003) on this point. She rightly states that language conveys meaning; words are used to tell a story that de®nes and describes people and situations in certain ways. The question is ``why this particular way and with what effect?''. We agree with Richardson when she points out that in residential child care the most obvious example is the daily handover meeting between shifts. How information is ``handed over'', how meaning is construed, can have profound implications for all concernedÐnot least as Richardson reminds us (2003, p. 113) ``for the characters in the story'' (i.e. the children and their families). Consequences of Systemic Dislocation From our work with a range of organisations, we have observed attitudes and practice that serve as examples of systems where there is disconnection between the parts. This systems dislocation leads to dysfunction. Here are some examples. d Teambuilding opportunities, while supportive, were less effective when not linked to other factors impacting on the team. d Organisations were demanding more specialist training when the foundation skills were not in place. d The impossible task of one staff attending training and expected to feedback and share learningÐimplementation often requires a team approach best understood when teams are trained together. d Increased demand for training on physical restraint when early intervention/ diffusing skills are not there and concerns about a lack of a policy framework to support and guide staff. d Once learning has taken place essential systems are not in place to facilitate integration of learning into practice (e.g. supervision, appraisal). d Increased expectation that training will solve all problems when what is required is a range of other responses (e.g. mentoring, coaching, team development, strategic planning). The opposite of dislocation is systemic connectedness, which is referred to as ``coherence'' by Brown, Bullock, Hobson, and Little (1998). Their research indicates the importance of ``coherence'' between the staff's, the unit manager's and senior managers' de®nitions of what the home is about. Our re¯ections on work carried out both within Northern Ireland and in the Republic of Ireland led us to identify a number of core assumptions that would lead to a better connection between the parts of the systems that ``contain'' children's homes.
  • 9. Child Care in Practice 353 1. The need for commitment and leadership at a strategic level that holds and continually promotes the vision for the work. 2. An ongoing awareness of the external environment and its impact on the work. 3. Clarity of role and responsibilities within the internal environment and senior management mandate, and ownership that includes active involvement in the process. Residential child care teams often highlight gaps between themselves and managers that develop into a barrier when not addressed. When Berridge and Brodie (1998) carried out their follow-up study into a number of children's homes 10 years after their initial study, they found evidence of a decline in managers' involvement in the homes. 4. The need for staff (and young people where possible) to be involved in decision- making and part of the change process. Communication is critical. 5. The need for sensitivity to the speci®c context for each piece of work and the issues to be addressed. One Health Board in the Republic of Ireland was able to respond to the very speci®c needs of a child through provision of a tailored ``wrap around'' service while another unit was powerless in contributing to any decision regarding placement of young people in their care 6. Recognition that learning can happen through a range of methods (e.g. training, development, mentoring, coaching), but there must be opportunities for practice- based learning and individual and team re¯ection. 7. Staff must be provided with time to process the impact of the work on themselves, and the organisation needs to ®nd ways to review incidents regarding challenging behaviour, sexuality, managing change to ensure trauma is reduced and more effective responses developed. Introducing a Systemic Framework Building on what we have described thus far, our core approach de®nes a philosophy that recognises that all parts of the system are inter-related and interdependent and there needs to be recognition of this in order to effect and support change, whether that is practice learning or team development or rede®ning the purpose of a unit. A visual representation of this is shown in Figure 1. Our diagnostic and assessment work with all of the agencies that we work with includes an open and transparent audit of work in these keys areas. We also try to reach an understanding of how the structure of relationships in the agency and between the different parts of the system both shape and are shaped by daily events in and around the provision of care to troubled children. The next section is an illustration of how the MOSAIC team along with one agency worked to provide a multi-element solution to a situation of chronic disarray. A Case Study: Anxiety, Disarray and Crisis This article began with a descriptive case study of a residential unit in crisis. MOSAIC
  • 10. 354 J. Gibson et al. Figure 1. A Systemic Framework. was invited to undertake a further needs analysis and to offer solutions. On further investigation, we found that the service was in crisis. We found caring people, direct line staff, ancillary and support staff and managers desperate to do a good job for some of the most seriously traumatised children and young people in our society. We found young people who were angry, sad, and unhappy and who displayed moments of guilt at some of their actions. We found young people who wanted adults to be in charge, who wanted adults to show care and fairness but young people who, because of their life experiences and distrust in adults and ``the system'', would resist the very aspects of care that that they so desired. The MOSAIC consultants followed on from the initial team meeting described earlier with visits of observation and interviews that sought information from all parties on their views of critical system components. The result was a programme of work that we outline in Table 1. The programme lasted 11 months and covered the following areas. d Senior management support. d Team building. d Therapeutic Crisis Intervention (managing challenging behaviour).
  • 11. Child Care in Practice 355 Table 1. Content of the Development and Training Programme Aim Content Residential staff To help equip residential childcare Team development 5 Q 1 days workers with the training and development that will assist them in providing quality care for children and young people in residential care Therapeutic Crisis Intervention trainingÐ27 staff trained on 5-day programme Child and adolescent development Q 2 days Childhood trauma Q 1 day Managing sexual behaviour Q 1 day Recording skills 1 day Supervision skills 1 day Senior To facilitate discussion, clarify issues 5 Q 0.5-day sessions providing an management and support senior managers in opportunity to: support their planning and decision-making feedback issues/concerns/good practice facilitate discussion on strategic issues explore operational implications review and as appropriate adapt the programme d Child and adolescent development. d Childhood trauma. d Managing sexual behaviour/therapeutic skills. d Supervision and recording skills. The programme content is presented in Table 1. A celebration event was held on completion of the process with the presentation of certi®cates and feedback from all those involved. Some staff comments included: All parts of the training have been signi®cantÐtraining which has given me a great knowledge base and teambuilding which has helped build better relationships with colleagues. TCI has been applied to my practice and has helped me deal with situations more effectively ¼ makes us work more consistently and provides an improved service for young people. Coming together and airing our views has helped staff to be more open. Discussing ways of dealing with the children has helped us deal more effectively as a team. Conclusion Residential child care is a complex activity and although it may appear contradictory
  • 12. 356 J. Gibson et al. to say it, ``care'' alone is not enough' (Bath, 1998). When residential care works well, and when it fails, the explanation is never down to one variable. In this article, we have shown that multiple variables are involved and that the way they interact creates a structure and pattern of relationships that will either promote and facilitate quality care or will, at best, get in the way of quality or will, at worst, abuse the vulnerable. We think that systems theory and systems thinking provide a road map that can illuminate key variables and the relationships between them. Thus, when troubled children and young people in a residential setting are settled for bed at night, as well as when they get on the roof at three o'clock in the morning, residential social workers, team-leaders, ®eld social workers and senior managers might all begin to de-construct the event by asking ``what is my part in this?''. The follow-up is a response that should seek systemic explanations and solutions. It is our experience that single solutions like staff training or moving troubled young people to yet another placement are never enough. References Anderson, R. E., & Carter, I. (1990). Human behaviour in the social environmentÐA social systems approach. New York: Aldine De Gruyter. Bath, H. (1998). Missing the mark: Contemporary out of home care services for young people with intensive support needs. Association of Children's Welfare Agencies and the Child Welfare Association of Australia: Sydney. Berridge, D., & Brodie, I. (1998). Children's homes revisited. London: Jessica Kingsley. Brown, E., Bullock, R., Hobson, C., & Little, M. (1998). Making residential care workÐStructure and culture in children's homes. Dartington Social Research Unit, Ashgate: Aldershot. Bruggen, P., & O'Brian, C. (1987). Helping families. Systems, residential and agency responsibility. London: Faber and Faber. Committee for Health Social Services and Public Safety (2001). Inquiry into residential and secure accommodation for children in Northern Ireland (Vol. 1). Belfast: Northern Ireland Assembly. Dallos, R. (1991). Family belief systems, therapy and change. A constructional approach. Milton Keynes: Open University Press. Frost, N., Mills, S., & Stein, M. (1999). Understanding residential child care. Aldershot: Ashgate Publishing. Goldson, B. (2002). Vulnerable inside: Children in secure and penal settings. London: Children's Society. Greene, J. R., & Holden, M. M. (1990). A strategic-systemic family therapy model: rethinking residential treatment. Residential Treatment For Children & Youth, 7, 51±55. Harrison, M. I. (1987). Diagnosing organisations: Methods, models and processes. London: SAGE Publications. Holden, M., Mooney, A., & Budlong, M. (2001). National Residential Childcare ProjectÐtherapeutic crisis intervention (Version Five). Ithaca, NY: Cornell University. McCaughan, N., & Palmer, B. (1994). Systems thinking for harrassed managers. Karnac Books: London. Nichols, M. P., & Schwartz, R. C. (1991). Family therapy concepts and methods. Boston and London: Allyn and Bacon. Nunno, M. A., Holden, M. J., & Leidy, B. (2003). Evaluating and monitoring the impact of a crisis intervention system on a residential child care facility. Children and Youth Services Review, 25, 295±315.
  • 13. Child Care in Practice 357 Parker, R. A. (1988). Residential care for children. In I. Sinclair (Ed.), Residential care: The research reviewed. London: Her Majesty's Stationery Of®ce. Preston-Shoot, M., & Agass, D. (1990). Making sense of socialwork. Pyschodynamics, systems and practice. London: MacMillan. Richardson, C. (2003). The contribution of systemic thinking and practice. In A. Ward, K. Kasinski, J. Pooley & A. Worthington (Eds.), Therapeutic communities for children and young people. London: Jessica Kingsley. Senge, P., Kleiner, A., Roberts, C., Ross, R. B., & Smith, B. J. (1999). The ®fth discipline ®eldbook. Nicholas Brealey Publishing: London. Social Services Inspectorate N Ireland (1998). Children matter: A review of residential child care services in Northern Ireland. Belfast: Department of Health and Social Services. Wagner, G. (1990). Residential care. A positive choice. London: National Institute of Social Work, HMSO. Warner, N. (1992). Choosing with care. Report of the Committee of Inquiry into the selection development and management of staff in children's homes. London: HMSO. Winnicott, C. (1971). Child care and social work. London: Bookstall Services.