On the difference between traditional and contemporary residential care

Sometimes people ask about the differences in residential care between the “old days” and now. At the risk of getting myself in serious trouble, I offer the following brief summary. Now, don’t go thinking this is necessarily true – after all, its just the perception of a guy who has been around since those old days. Someone else could probably do a much better job, and maybe they will. As a matter of fact, why not just think of this as a stimulus for your own brief summary. Why not write yours up and send it along.

A more traditional model
Residential Care was traditionally isolated from the community it was designed to serve. The boundaries which surrounded and contained the system were rigid – they allowed little flow of information, except in a very controlled manner, between the residential care program and the other systems with which it was in contact. Family involvement, for example, was not encouraged and family's attempts to become involved were typically rejected. Residential care programs themselves were usually located outside of the mainstream community. Other professionals gave the observations, comments and suggestions of the youth care staff little validity.

Contact between residents and the community was controlled and monitored by the bureaucracy of the system, usually occurring in a neutral zone, such as an office, or in the community under close supervision. The involvement of others in residential life was strictly limited.

Staff interventions were directed primarily towards the behaviour of the resident and goals for young people were determined by the institution in isolation from the family. The primary focus was control and simple behavioural change. Youth care staff were seen as the extensions of the real treatment staff, working in a manner dictated by others. Family was seen as a major source of the problem, contact with them was controlled and severely restricted when it was permitted.

In the traditional model, with the isolation, lack of contact between residents and the rest of the community, the rejection of family, and the focus on behavioural control, the potential for abuse was high, opportunities for lasting change were few and institutionalization was the norm.

A more contemporary model
Contemporary residential care is typically situated within the community and the boundaries around it are clear, allowing for the free flow of information between the residential care program and the other systems of which it is a part. Residential care is more frequently thought of as a “passing phase" in a family's life, a helping support system which a family “passes through" as it requires support. Family involvement is encouraged and supported.

Contact between residents and the community occurs freely, in schools, in the community and in the residence itself. Others, such as family members, advocates, community members and other professionals are intensely involved in life in the residence.

Interventions are focussed not only on behaviour but on the conditions which give rise to the need for the behaviour, which is frequently seen as the solution to a problem. The goals, determined jointly with the youth and family, focus on the resolution of the underlying issues which gave rise to the need for placement. Family is seen as a major source of support for change. Youth care workers are frequently involved with families in the family home and community helping them to change their patterns of living, in the world in which they pass their days. Youth care workers are seen as treatment staff, central to the change process. The focus is on needs, daily life events, being in relationship, developmentally appropriate approaches, and “doing with”, not “doing to”.

In a contemporary residential care program, located in the community, with the frequent contact between the residents and the rest of the community, the involvement of family members in the process, and the focus on treatment rather than control, the potential risk for abuse is reduced, change tends to be more enduring, and normal is the norm.

Thom