Following the 2022 publication of the Independent Review of Children’s Social Care, Chaired by Josh MacAlister, many UK newspapers led with stark headlines about the ‘urgent’, ‘unavoidable’, and ‘fundamental’ need to ‘reform’ and ‘overhaul’ children’s social care. Some of the key recommendations from the report relate to the need for safe and loving relationships, which can be essential anchors for young people through the turmoil of the care system. The report states, “it is loving relationships that hold the solutions for children and families overcoming adversity”. For young people in children’s homes, these loving relationships often come from people within their home staff team. However, practitioners working in residential children’s homes can face significant systemic challenges in forging and maintaining these relationships.

The number of children’s homes and residential placements increases year on year, with 2,462 homes currently providing care for 9,699 children and young people. These young people have often experienced multiple placement breakdowns, school and peer-group transitions, and relational trauma prior to entering residential care, which can increase their vulnerability to further social losses and re-traumatisation (Parry & Weatherhead, 2014; Bryson et al., 2017). Due to the often traumatic nature of a young person’s entry to residential care, it is essential for residential care services to provide comprehensive trauma-informed care and therapeutic relationships to support the healing process (Parry, Williams & Burbidge, 2021; Parry, Williams & Oldfield, 2021). However, residential children’s homes can be hostile environments for vulnerable young people and under-supported staff.

Training and support for staff varies enormously across the sector. The frontline workforce in residential children’s homes have no specific professional representation or mandatory supervisory standards, despite the therapeutic nature of their work (Parry, Williams & Oldfield, 2021). The therapeutic relationships staff provide can be essential to the healing and recovery of children in care. Research into the psychosocial impact of being looked-after is extremely limited (Richardson & Lelliott, 2003; Mullan et al., 2007), although it is widely recognised that looked-after children are amongst the most vulnerable in society (Morrison & Shepherd, 2015), in childhood and adulthood (Felitti et al., 1998; Committee on the Rights of the Child, 2016; Villodas et al., 2016; Teyhan, Wijedasa & Macleod, 2018). This incredibly vulnerable and growing group of young people are disadvantaged across their developmental trajectories, which has an impact upon health, social care, and educational systems. A key protective factor for these children is to have at least one supportive and loving relationship, with someone who can help them navigate the system (Parry & Weatherhead, 2014) and support the development of positive self-representations (Mikolajczak, Gross & Roskham, 2019).  The independent review calls for “No young person should leave care without at least two loving relationships, by 2027.” In summary, there is a clear need for loving therapeutic relationships between children in care and children’s home staff, to reduce the impact of childhood adversities and future re-victimisation.

Vulnerable children and young people who have experienced multiple traumas and relational losses are at further risk of instability and re-traumatisation through a system in need of theoretically robust evidence-based trauma-informed models of care that recognise the needs of staff to create the loving and secure relationships that can give children a sense of safety, security and hope for their future, alongside practical guidance, and support.

However, our research conducted during the pandemic has shown how staff can struggle to prioritise and protect their own mental health due to workplace stressors, which can impact therapeutic outcomes for children (Parry, Williams & Burbidge, 2021; Parry, Williams & Oldfield, 2021). The impact of burnout for parents and those in loco parentis roles as key workers in children’s homes, sometimes referred to as therapeutic/restorative parents, has been linked with neglectful and harmful parenting practices, and increased staff absences or retention challenges (Ackerman, 2005). Two protective factors for care staff have been found to be self-efficacy and access to supervisor social support, which are key factors that need to be carefully considered in service reform: to care for the carers who are pivotal in the care and recovery of care experienced young people (Klaver et al., 2021).

Consequently, with funding from the National Institute for Health and Care Research, we conducted individual semi-structured consultations with care leavers to explore the essential ingredients for loving relationships with staff in children’s homes. Young people aged 16-25-years-old with direct experience of out-of-home placements were invited to partake in the consultations via Social Media and renumerated with an e-shopping voucher for their time. Consultations took place via Microsoft Teams. With greater understanding of what works and what is most valued by care experienced young people, we will have a better sense of how to support staff to forge and maintain these essential relationships. Consultations took place with care leavers, online via video consultation, between October 2021 and February 2022, asking care leavers what therapeutic relationships meant to them. Overall, we found three key themes: 1) the importance of therapeutic relationships for positive outcomes and life skills, 2) therapeutic relationships facilitating opportunities, and 3) barriers to forming therapeutic relationships.

Therapeutic Relationships and Positive Outcomes

Care leavers told us how relationships with staff helped nurture their resilience and guided them through processing their trauma. Staff who listened and validated care leavers’ feelings were vital to developing a sense of freedom and belonging; whereas when trust and understanding were lacking, care leavers described feeling ignored and isolated. Therapeutic relationships with staff were also important for role modelling and to learn life skills. Care leavers discussed that when staff set boundaries, and provided structure and routines, they felt more secure and understanding of morality.

Some care leavers were still in contact with key workers years after leaving care, emphasising the importance of long-term therapeutic relationships. It is not uncommon for care leavers to contact former carers, especially during times of crisis. However, there is currently little guidance available for carers and former staff as to how to manage and negotiate later-life contact requests. In such cases, situation specific guidance can be sought from employers and line managers. There are also a number of reflexive articles in professional network publications that discuss the challenges these requests can pose for all concerned.

The therapeutic relationships between peers were also reported as important for resilience. Those who took part in the consultations explained that the parallel experiences of trauma and residential placements with peers could create empathy, shared points of reference, and a ‘deeper level’ of connection, suggesting therapeutic relationships between young people, as well as with staff, also nurture belonging.

Therapeutic Relationships Facilitating Opportunities

In addition to nurturing positive outcomes, therapeutic relationships were seen as important in laying foundations for young people to gain additional support and funding whilst in care. Staff and professionals working with care leavers, through existing therapeutic relationships, were able to champion for, signpost and inform young people of their rights to additional services, funding, and benefits. Having a ‘link person’ between the young person and service at large was important to care leavers; enabling access to services, encouraging their interests and hobbies, and fuelling aspirations and hopefulness. Consequently, care leavers were able to access funding that could alleviate financial burden, further facilitating opportunities for study and employment.

Barriers to Therapeutic Relationships in Residential Care

Care leavers who partook in the consultations referred to the challenges of maintaining relationships during care transitions and pathway plans, often experiencing relationship breakdowns during key moments in care. Therefore, key staff should have the flexibility to work across services, rather than only for one employer at a time, prioritising the positioning of the young person within the system and their developmental stage. Care leavers also discussed the detriment of risk-adverse residential care, compromising the quality of relationships through excessive surveillance, hindering therapeutic relationships within and outside of the home. Unregulated placements were also a significant barrier for developing therapeutic relationships due to care leavers’ fears for their own safety. Care leavers were often moved far away for residential placements, making it difficult to maintain relationships and connections with friends and family from their hometown.

Concluding Thoughts

In summary, care experienced young people needed safety, trust and structure to develop therapeutic relationships with children’s home practitioners. There were a number of threats to developing and maintaining therapeutic relationships, although when present, therapeutic relationships could have a huge impact upon development, healing and future opportunities. Findings and recommendations from the independent review of children’s social care have highlighted how much reform is needed, why urgent change is essential, and how children are being let down. However, for real change to happen, we also need to reform the working conditions and practices for many children’s homes workers, to support them in their essential role with these vulnerable young people: to create a system that promotes emotional availability, reduces burnout, and ultimately recognises the need for love.