Residential care is changing. It is no longer enough to provide a house, meals and basic care for young people. We understand commissioners increasingly want to see measureable improvements to the outcomes for the children and young people that they place. We need to evidence that they are making progress in health, education and emotional well being whilst in our care.
We have some fantastic services and highly skilled staff within Keys and we want to make sure that our standards are consistent across the whole organisation. Keys provide therapeutic, quality care individualised to the needs of each child, which takes into account their story, identifies the issues that they are working on, and is informed by evidence about effective interventions. We will also demonstrate that we are making a difference through systematic use of outcome measurement. This is about delivery and not just appearances. Our primary aim is to improve the care we provide for the children.
Our Clinical Director, Dr Miriam Silver: BSc, MSc, ClinPsy D, C.Psychol, AFBPsS leads on clinical governance. Her team of psychologists and assistant psychologists work closely with the therapists who provide input to each home.
We have high aspirations both for the young people we look after and our staff – we want everyone to achieve their personal best.
Our model has two main components. There is a psychologically informed care pathway, with assessments and a system of outcome measurement (PICI), plus staff training to support applying this knowledge in the daily life of the residential homes (Safe and Sound Model).
Psychologically Informed Care-Planning and Intervention (PICI)
he PICI model has been developed in order to ensure that we complete a structured assessment of the needs of each child placed with us, and have an expanded care-plan document giving their story and a set of strategies to manage and support their presenting issues, as well as undertaking regular outcome measurement.
Keys – Psychologically Informed Care Planning and Intervention (PICI)
The Pathway Involves
The initial psychological assessment and process of gathering information will be undertaken by the Assistant Psychologist, under the supervision of the Clinical Psychologist for the area, with input from the Therapist and care team. Staff who know the child will be asked to complete questionnaires and help us to understand the child’s background.
This process will involve:
- Gathering all the relevant background information from the files about each young person.
- Completing a methodical psychological assessment of each young person, including assessing their cognitive ability, mental health and feelings.
- Gather information from the care team and school about the young people’s life skills, mental health, behaviour and functioning.
Completing a checklist about the child’s current functioning in terms of their Behaviour, Emotional wellbeing, Risk, Relationships and indicators of other concerns (BERRI).
- Triangulating information from paperwork, observation and psychometric measure completed by the young people and the care team, to explore any differences in view.
- Making a formulation for each young person, mapping out how their experiences lead to their current thoughts, feelings and behaviour.
- Ensuring evidence-based decision making about which children should receive therapy and what form is should take.
- Identifying the goals for keyworking sessions and therapy.
- Monitoring how the child is progressing by making frequent observations of the issues we are targeting with our interventions and using regular outcome measurement to track.
The BERRI checklist will be completed about each child every 3 months, by the keyworker and care team. This will help us to identify and monitor individual needs, but also to keep an overview of the cohort within the home and organisation.
Safe and Sound Care
Safe and Sound Care is a whole organisation approach to improving the quality of the care provided in our placements. The aim will ensure a minimum training and reflective learning programme for all staff that have direct input to the children and young people that we care for. The training consists of a modular work book with multi-media components like videos to watch, articles to read and activities to try out. each member of staff is to work through the programme under the guidance of their line manager and therapist who consults to the team. The staff handbook is full of practical guidance and tips, and the reflective journal is a record used by staff to help them look closely at the way they work and help them improve their personal practice. This can also be used as a supervision tool.
The content of the Safe and Sound training is consistent with the use of the PICI pathway, but is about ensuring that every day-to-day aspect of care is a continuation of the therapy that we provide. We want to ensure that all staff have knowledge and skills about the key issues. A further component of the Safe and Sound approach is that every member of staff receives two days of training from a Clinical Psychologist (normally the Clinical Director) about attachment, trauma and the impact of maltreatment. The training involves some activities, exercises and discussion as well as teaching based on
Dr Silver’s book, “Attachment in Common Sense and Doodles”. A copy of the book is available as part of the learning resources in each home.