Model of Care

Pathways Ireland's Model of Care - The Relationship and Competency Model

Objectives of our Model of Care

Objectives

1.To ensure continued operations and a stable home environment for young people.

2.To provide the highest quality care possible for young people including citizenship and belonging in the community.

3.To work together to always strive to find ways to improve through team work and a culture of opening challenging

4.To reduce staff turn-over, ensure longevity of employees,  through recognising the difficult task of caring for children with complex needs. This ensures continuity of care and stable care figures in young people’s lives throughout their stay with Pathways Ireland.

5.To promote positive healthy life choices and positive outcomes for young people in our care through acknowledging the research regarding past failures and working hard to ensure they are not repeated.

6.To promote positive healthy relationships in which young people can learn to trust and start to heal.

7.To help young people reach their potential through creating a nurturing  environment and trusting relationships in which they feel: empowered, listened to, valued, valuable, loved, loving and loveable.

8.To provide a place of safety and fun for young people so they can be afforded the same enjoyment of childhood as other children.

9.In 2013 Dutch children ranked as the happiest in the world according to UNICEF. The reason? They have Voices and Choices AND  Happy Parents = Happy Children, Happy Children = Happy Parents J

Please select the objectives below that are correct for our Model of Care

  • To ensure continued operations and a stable home environment for young people.
  • To provide the highest quality care possible for young people including citizenship and belonging in the community.
  • To ensure staff are capable of restraining young people in the first instance of behavior management
  • To promote positive healthy relationships in which young people can learn to trust and start to heal.
  • To deliver in-house education as a primary source of education to young people.
  • To help young people reach their potential through creating a nurturing environment and trusting relationships in which they feel: empowered, listened to, valued, valuable, loved, loving and loveable.
  • To ensure young people can move on as quickly as possible to other residential services
  • To reduce staff turn-over, ensure longevity of employees, through recognizing the difficult task of caring for children with complex needs. This ensures continuity of care and stable care figures in young people’s lives throughout their stay with Pathways Ireland.

Theoretical Framework to our Model of Care

Theoretical Framework

The frameworks that inform this model  and our practice include:

•Children First: National Guidelines for the Protection and Welfare of Children

•The National Standards  for children's residential centres (2001)

•An adaptation of the Focus Ireland Competency Framework. (Governing Professional Practice and Working Together).

•Cornell University Therapeutic Crisis Intervention (TCI) governing communicating and relationships with young people as well as planning for helping promote positive healthy  behaviour that will serve them into adulthood. 

•Guidelines on Recording in Children’s Residential Care (2009) Children Acts Advisory Board

•Various authors (found in further reading) regarding ‘mistakes from the past’ regarding relationships with young people.

•Winnicott, Ward et al: Regarding providing emotional availability and a nurturing environment. The personal difficulty that can be experienced in  “The Therapeutic Task”.

•Role modelling and mentoring & Resilience Theory:  Various theorists including : Ungar, Rutter & Walshe

•Ecological approach/ social supports approach/ systems theory: Various theorists including Bronfenbrenner, Whittaker & Bomar

What theories below are applicable?

  • Sigmund Freud - Psychoanalysis
  • Ecological approach/ social supports approach/ systems theory: Various theorists including Bronfenbrenner, Whittaker & Bomar
  • The Working Time Act
  • Role modelling and mentoring & Resilience Theory: Various theorists including : Ungar, Rutter & Walshe
  • Winnicott, Ward et al: Regarding providing emotional availability and a nurturing environment. The personal difficulty that can be experienced in “The Therapeutic Task”.

Section 1 - Effective Professional Practice

Effective Professional Practice

•Commitment to providing the highest levels of quality service: Always promoting the good name of the organisation; always abiding by company policies and procedures.

•Openness to change and contributing to an environment that encourages constructive challenging of both our colleagues and ourselves.

•Informed practice and on-going training and professional development.

•Effective communication both oral and aural & actively listening.

•Commitment to health & safety, and to the overall protection and well-being of individuals.

•Planning, Organising & Consistency.

•Analysis, Evaluation and Problem Solving.

•Initiative and Taking Responsibility.

High competency and knowledge in report writing, file keeping and overall pride in how the unit and care of children is presented through record keeping. 

Summary

•In simple language you must always strive to provide the best service capable whilst always looking to evaluate and improve on areas identified as lacking. You can do this through identifying it yourself, through client feedback, supervision, coaching sessions, peer feedback, internal audits and other agencies. The key is to remain open to change and development.

Importance of Change:

•Own Practice: You assess how well you carry out your work activities; you identify how your values, belief systems and experiences may affect your work with individuals and you identify any skills, knowledge and support that would help you to carry out your work practice more effectively.

•Always Behave in a Professional Manner: You must always work off plans (made collaboratively with the client). You should always try to be positive and solution focused. You must take responsibility for your own work and mistakes and remain self-motivated. A productive attitude does not convey… “It’s hopeless, or it’s the clients fault or another agency”. There is always a solution to every problem. And if at first you don’t succeed…..

Fill in the gaps

  • ​Look for
  •  
  • ​Effective  is important..
  •  
  • Openness to and contributing to an environment that encourages constructive challenging of both our colleagues and ourselves.
  •  
  • Commitment to providing the highest levels of quality service: Always promoting the good name of the always abiding by  

Section 2 - Working Together

Working together

• This relates to your day to day interactions and commitment to building and maintaining relationships between self, team members and external agencies, upon which we depend to help our clients achieve their goals. The attitudes of workers are of great importance in order to maintain a strong team and positive relationships with the community on behalf of the organisation. This is vital when advocating on behalf of your client.

The key points are:

•Respect for clients, each other, and other agency workers.

•Leadership: The ability to lead and be led.

•Influencing and negotiating in order to achieve solutions and positive outcomes.

•Resilience and positive outlook.

•Effective team working, providing and receiving support from each other.

•Developing and maintaining  good external relationships.

What are those key points again?

  • Informing service users when they are wrong
  • Doubting a young persons ability to change when they are persistently challenging and disruptive to their placements
  • Respect for clients, each other, and other agency workers.
  • Resilience and positive outlook.
  • Seeking a discharge where a young person is deemed by you to be unsafe
  • Developing and maintaining good external relationships.
  • Influencing and negotiating in order to achieve solutions and positive outcomes
  • Leadership: The ability to lead and be led

Section 3 - Client Centeredness and The Relationship

Section information

The expectation of Pathways Ireland is that employees will at all times show complete respect for their clients, and behave in ways that empower and encourage the client to become independent.

The key points are:

•1. Advocacy: Ensuring you are delivering a service that is meeting the needs of the client as well as empowering clients to effectively use community services available to them.

•2. Promoting choice, independence, health and well-being, and respecting the decisions of the client.

•3. Contributing to care planning and review for individuals

•4. Focusing on positive achievable time specific outcomes. . Plans should be SMART (Specific, Measurable, Achievable, Realistic, Time-specific)

•5. Contributing to the prevention and management of challenging behaviour.

•6. A focus on Collaboration

 

The very Beginning:

“The most valuable tool we have in therapeutic interventions with children and young people is ourselves”(Garfat,2004; Maier,1991; Trieschman, Whittaker & Brentro, 1969”) TCI Edition 6

Pathways Ireland employee are valued because they are rare, unique and inimitable. For this reason it is important to focus on the quality of your relationships with young people, and to strive to use the tools available to avoid ‘empathy fatigue’ or ‘burnout’.

 

Social care workers can often be personally hurt by the behaviours of their clients.

Cooper, F 2012 states:

“Many clients who are in the social care system suffer from a lack of boundaries… If they have had poor parenting they may not understand what  boundaried relationship is… People who have been hurt or abused will often act out their feelings and push or ignore boundaries pathologically”  pp34

The Question we need to ask ourselves is: Does Time heal all wounds, or do we carry them from one relationship to the next?  This same applies to Social Care Workers

Areile M, 1997 Outlines some of the hurtful events that can be experienced by Social Care Staff

“Claire: I asked a child to help me move some benches.  This is a boy I have known for 5 years, since he was six, and I am quite fond of him.  He said ‘get lost old woman!’.  I was devastated but I didn’t give up.  Then he said ‘Go do it yourself. That’s what you’re paid for isn’t it?’  I don’t know if he did it deliberately to hurt me or whether it was just an outburst in a moment of anger and frustration, but in any case I felt very humiliated.  Why would he talk like that to someone who is devoted to him?”

“Ephraim:  When I got angry they parroted my words, while the rest of the group served as their audience, laughing at me.  What I felt then could be described as utter humiliation: 10 and 11-year old children making me look like a fool”

 

Emotional Distance:

Sometimes social care workers can find ways to justify reasons to keep an emotional distance from a child in order to protect themselves from further hurt…

Shaver ,P (2008)

“A problem was that all too often residential care staff adopted an emotionally detached style to prevent children from becoming too distressed when a staff member had to leave”

Whittaker, J.( 1997) Stated:

“Institutions do little more than warehouse children”

 

Coping with young peoples fears and pain:

Deciding to work with a child and to be brave enough to develop a real trusting relationship requires patience and understanding.   We need to look beyond the behaviour and help the young person with the unmanageable feelings they are trying to convey. 

Winnicott 1965 focused on early parental relationships with infants where children are helped by their carers to move from a state of dependency towards independence.  He believed ‘the holding environment’ was a crucial aspect in this process.

The holding environment is usually provided by the mother, both physically and emotionally, where she holds her child’s powerful feelings until the child is gradually enabled to learn to do this for himself.

Bion 1962 spoke about “containment”.  Unmanageable feelings and deepest anxieties are “projected” onto the care giver who must feel them for him/her before handing them back in a manageable way.  This is the task of the Social Care Worker.

Opportunity-led-work is of utmost importance when caring for young people. If a young person begins to talk about difficult feelings or memories, allow them the attention, space and time to do this.  It may feel more comfortable to  distract or comfort a child rather than to hear or feel their pain. However, this may be the child’s final leap of faith in trusting a adult with their feelings, or could be a ‘test’ for further disclosures.

 

The importance of Emotional Availability:

“Children may somehow physically survive awful deprivation and cruelty, but be left with emotional scars which remain with them throughout their lives, even when the deprivation and cruelty have stopped... no child can grow up in a care vacuum...

Therapeutic settings concentrate on providing carefully adapted environments to nurture severely deprived children and to provide the specialised living environment that is required for some recovery to take place ” (Lanyado, in Ward et al 2003)

 

Children referred to us are complex, but have three things in common. 

One is that they are all victim in some way to the failures of the relationships with the key adults in their lives: relationships that have failed to meet their emotional and developing needs either at key points in their lives or throughout. 

The second is that they continue in some way to cope with the consequence of their earlier deprivation, loss, separation, trauma or abuse... They affect the young person’s capacities to learn or be taught, to be looked after, to join in normal social activities, make friends, or try to be hopeful about the future.

The third is that it can be assumed that they are at some stage of bereavement/grief/loss.

A crucial part of the care task will be to provide young people with the opportunities to form relationships that are positive: successful futures will depend upon this.  Moreover, these relationships will need to impact on them in a way that will challenge their pessimistic and incongruous assumptions about themselves and others, and to be experienced as loveable, creative and worthwhile” ( Worthington in Ward et al 2003)

 

The importance of Role Modelling:

Michael Ungar (2012) speaks of the importance of positive role models for building lasting resilience. “(Werner & Smith 2001) followed the lives of nearly 700 multicultural children of plantation workers living in poverty on the Hawaiian island of Kawai.  By the age of eighteen about two thirds had done poorly as predicted, with early pregnancy, need for mental health services, or trouble in school or with the law.

However, one third of those at-risk had developed into competent, caring and confident young adults with the capacity to “Work well, play well, love well, and expect well”…most often crediting supportive relationships or religious involvement (belonging and community).  These findings have important clinical implications, revealing the potential, despite troubled childhood or teen years for later developing resilience across the life course.

 

Role Modelling to Promote Resilience:

Definition of Resilience (Luthar et al., 2000; Masten & Reed, 2002; Rutter, 1999)

Resilience refers to a class of phenomena characterized by good outcomes in spite of serious threats to adaptation or development. Resilience has been characterized as the ability to:

“bounce back” and cope effectively in the face of difficulties”

“bend, but not break under extreme stress”

“rebound from adversities”

“handle setbacks, persevere and adapt even when things go awry”

“maintain equilibrium following highly aversive events”

In short, resilience turns victims into survivors and allows survivors to thrive.

The best documented asset of resilience is a strong bond to a competent and caring adult, which need not be a  parent. For children who do not have such an adult involved in their life, it is the first order of business …

Children also need opportunities to experience success at all ages (Masten & Reed, 2002). The

availability of close social support, better educational experience and a higher sense of self-worth. Good

relationships with pro-social adults and an ability to problem solve and make sense of what has

happened are critical factors in promoting resilience (Seden, 2002) There is a close relationship between developing resilience and opportunity for positive experiences

(Walsh, 1996) states that the crucial influence of significant relationships stands out across many studies.  Individual resilience was encouraged by bonds with kin, intimate partners and mentors such as coaches and teachers  who supported their efforts, believed in their potential and encouraged them to make the most of their lives” pp 174

Pathways Ireland works towards creating a culture whereby young people are dependent on the high level of care it provides.

  • True
  • False

Pathways Ireland focuses on the following as part of the relationship; advocacy, promoting choice, respecting decisions of clients, and empowering them to be able to go on and lead their own lives in the community.

  • True
  • False

The most valuable tool we have in therapeutic interventions with young people is ourselves.

  • True
  • False

Employees are replaceable and anyone can be easily trained by Pathways to replace another on the team.

  • True
  • False

People who have been hurt or abused will often act out and push or ignore boundaries.

  • True
  • False

Social Care Workers need to be able to let go of past bad experiences and not move them from one relationship to the next.

  • True
  • False

Social Care workers should remain emotionally detached to protect themselves and young people.

  • True
  • False

Challenging behavior is simply a young person acting aggressively either physically or verbally.

  • True
  • False

The 'holding environment' is crucial in helping a young person to move from dependency towards independence.

  • True
  • False

'Containment' is where a care member takes raw feelings and anxieties from a young person and makes sure they are not presented by them again.

  • True
  • False

If a young person is opening up to you and you feel uncomfortable with this you should use skills of distraction to avoid them verbalizing their pain at that time.

  • True
  • False

Care workers need to provide young people with the opportunities to form relationships that are positive as their future success will depend on this. They also need to use these relationships to challenge their pessimistic assumptions about themselves.

  • True
  • False

The best documented asset of resilience is a strong bond to a competent and caring adult, which need not be a parent. For children who do not have such an adult involved in their life, it is the first order of business

  • True
  • False

Section 4 - How We Deliver Our Model

How we deliver..

The Ecological Approach

Ecological refers to the way an organism and it’s immediate environment affect and respond to each other.

Bronfenbrenner’s ecological model (1979) provides a framework for understanding how critical factors in a child’s environment are inter-related. The ecological environment is conceived as a set of nested structures, each inside the next, like a set of Russian dolls. At the innermost level is the immediate setting containing the developing person.

... The next step, however, already leads us off the beaten track for it requires looking beyond single settings to the relations between them

Pathways Ireland believes that this is best achieved using an ecological approach.  This means the child is not viewed in isolation but rather it is acknowledged that he is part of many systems, each affecting him in different ways.  It is therefore important to deliver a service individual to each child, for no two children are the same.

“Since children in trouble do not come neatly packaged, neither should our approaches to helping them.  Much current wisdom holds that the need for specialised out-of-home-residential treatment for example- is minimal at best and that our energies should be directed at reaching troubled children earlier and in the context of their own families” Whittaker (1979) 

“Any intervention strategy – home based or residential- will succeed according to its ability to affect the total ecology of the child’s world: family; peer group; school; neighbourhood and community... Residential and day programs for troubled children should function as a family support system rather than treating the child in isolation from his family, home and community” Whittaker (1979)

In short ... it is essential to help young people and families identify natural helping networks in the community in which the child will reside. 


Social Support Networks:


Whittaker, Garbarino (1983)

A social Network is a set of interconnected relationships among a group of people that provides enduring patterns of nurturance (in any or all forms) and provides  contingent reinforcements for efforts to cope with life on a day to day basis.

•  we need a broad perspective on the relationships between the child/family and their various environmental systems

•  The environment shapes the child through reinforcement and modelling

•  Social riches are measured by: enduring, reciprocal, multi-faceted (having many aspects) relationships that emphasise playing working and loving.

This framework establishes the individual as a developing person who plays an acting role in an ever-widening world.

It is also important to afford young people the opportunity to explore life and peer relationships, with guidance, support and advice. 


How to assess the child's support network:

Bomar (2004)

1.  Identification of the network relationships with the use of an eco map (or other such tools)* see next slide

 2.Establishment of a partnership with the family network that are deemed appropriate.  3.Clear articulation of an understanding of the challenges/issues presented by the family network 

4.  Identification of how the social support network functions with other interacting systems (e.g. school).

5.  Clarification of the strengths of the social supports

6.  Identification of health promotion versus health hindering forces in the  relationships (e.g. use of alcohol).

8.  Engagement of the family support network in the intervention plan.



Child & Family Eco Map

Demonstrating the importance of social networks in supporting the development of children and families. 

Please select the phrases below that are in line with our model

  • Assessment, treatment and medication of clients is of the utmost importance
  • Ecological refers to the way an organism and it’s immediate environment affect and respond to each other
  • Any intervention strategy – home based or residential- will succeed according to its ability to affect the total ecology of the child’s world
  • It is not overly important to help a family identify supports in their locality or community
  • A Social Network is a set of interconnected relationships among a group of people that provides enduring patterns of nurturance (in any or all forms) and provides contingent reinforcements for efforts to cope with life on a day to day basis
  • The environment shapes the child through reinforcement and modelling
  • Avoidance of family contact is important in the healing process
  • We should engage family support networks in intervention plans