Therapeutic residential care

This page provides the applications, key considerations and critical questions of applying intentional practice in the design and implementation of therapeutic residential care programs for children with a context of instability and trauma. 

Applications from the 'system' to the 'moment'

Intentional practice offers a shared way of thinking and planning to strengthen the delivery of trauma-informed and therapeutic practices, social-emotional learning programs and clinical support for therapeutic residential care settings, from the ‘system’ to the ‘moment’. 

Check out the video for summary applications. 

Design and implementation of therapeutic program models (system')

Intentional practice offers a shared way of thinking and planning to design and implement therapeutic (or trauma-informed) program models. 

Best-practice features

Intentional practice supports the view that the ‘best-practice’ design and delivery of therapeutic residential care programs include:

  • A clear articulation of the individual components or active ingredients of therapeutic service delivery, the intent or purpose of each component and how they relate and integrate with one another (operationalised in a logic model). Raymond (2020) proposes that best-practice therapeutic program models should include the following five core components in their design: 
    1. Growth and risk focused procedures and systems – program specific policies and procedures (not relying solely upon general or agency specific policies).  
    2. Foundational therapeutic principles (setting conditions) – e.g., Sanctuary Model, contextualised therapeutic logic model, trauma-informed practice principles. 
    3. Moment-to-moment practice and growth planning – the inclusion of a component that actions moment-to-moment support and intentional caregiving. In other words, all caregivers are able to personalise their wellbeing and growth responses to a child’s individual needs and context (including trauma).
    4. Crisis management – e.g., Therapeutic Crisis Intervention, safety planning.
    5. Coaching and reflective practices – including being embedded within supervision and leadership support.
  • An uplifting of ‘growth’ as a practice approach, energy or intent (‘growth intent’), such that it is visible in practice and action across the care community.

Critical questions for leaders

Intentional practice asks critical questions of policy makers, programmers and leaders entrusted to design and deliver therapeutic residential care. This includes:

  • Do we have a service delivery model or therapeutic program, that integrates all of our current therapeutic program features into a logical whole (e.g, milieu based model, Therapeutic Crisis Intervention, clinical support, practice principles).
  • What is the intent of our therapeutic model or service delivery program?
  • Are we bringing high levels of mindful awareness to the needs and experiences of children, the intent or purpose of our work, the outcomes we are working towards, and how we are working towards those outcomes?
  • Do we have systems and methods to activate this awareness within our program and across our caregivers within moment-to-moment practice?
  • What are the active ingredients or core therapeutic or trauma-informed intervention components of our service delivery? Can all of our staff articulate the intent or purpose of each component, and how do individual therapeutic components relate and interface with each other?
  • Do we have a cohesive practice philosophy or intent that underpins our entire program or therapeutic components?
  • Are we bringing enough awareness and energy to ‘growth’ as an intent or practice philosophy within our service delivery? Or are we overly preoccupied with ‘managing’ child behaviour or risk within our service?
  • Do we have a method to operationalise or make practical our milieu-based model (e.g., Sanctuary Model) into moment-to-moment practice (or in a manner that staff can apply into the next moment-to-moment interaction with a child, as personalised to a child’s individual needs and context?

From this

To this

Personalised growth planning. Moment-to-moment trauma-responsive practice.

Intentional practice offers a shared way of thinking and planning to support caregivers to: (1) conduct personalised growth planning (or support or care plans) and (2) conduct moment-to-moment trauma-responsive practice. 

In action

Intentional practice asks caregivers to: 

  • Bring mindful awareness to everything they do, including the needs and contexts (e.g., trauma, developmental) of children, the intent of their support, and how they are actioning this through their communication and strategies.
  • ‘Respond to a child’s needs’, rather than react to a child’s surface behaviours.
  • Develop a ‘shared intent’ with child, fellow caregivers and care team. 
  • Support and grow children in a side-by-side manner.
  • Bring a ‘growth intent’ to each and every interaction with a child, and ensure this is visible and uplifted in their thinking and actions, even in crisis or when behaviour management or safety planning processes are required.
  • Intentionally deliver social-emotional learning, wellbeing and resilience content for children, drawing upon both implicit (e.g., reflective or restorative conversations, intentional coaching conversation) and explicit teaching (e.g., programming).
  • Develop personalised plans ‘for’ and ‘with’ children, and in a manner that can be actioned in moment-to-moment caregiving support.
  • Apply intentional caregiving and support processes.

Critical questions for caregivers

Intentional practice asks caregivers a range of critical questions (see video). 

Case example: Locally contextualised therapeutic framework

The following video is a case example of a ‘contextualised’ therapeutic program model, that draws upon intentional practice and the best-practice considerations identified on this page.

Deeper Reading

The foundational article that supports the content on this page is here:

The following articles provide additional supporting content.