Therapeutic Residential Interventions for Harmful Sexual Behaviour - A Theory of Change

Abstract

The numbers of children who are removed from their families and looked after by the state is rising in the UK. Whilst approximately 90% of these are eventually placed in foster care, the remainder are a very diverse population with complex needs that often require care delivered in a residential setting, usually with therapeutic input and purpose. Some of these young people will have extensive experiences of trauma and abuse and will have engaged in Harmful Sexual Behaviour (HSB). Therapeutic residential interventions to meet the needs of this group come at an especially high cost to the public purse, but despite this, outcomes for this group of looked after children are statistically poor. This is across primary and mental health, employment, education, housing and welfare, and offending measures. In this context identifying and promoting good practice is important but a challenge in this regard is assessing the effectiveness of residential interventions when there are so many confounding and competing variables in play. The individual pathway into residential care means that young people have very different starting points and needs; young people might receive a range of different therapies and interventions during their time in care; there are often ongoing and dynamic forces in the wider system around a young person; and continuation of resources or timing of moves might be driven by economic reasons rather than need or the precepts of good practice. Conversely, theory-based approaches offer a potential route to defining and evaluating practice by shifting the focus from ‘what works’ to required activities and how these are expected to work. In response, this study draws on the field of theory led evaluation, specifically Mayne’s (2001) Contribution Analysis (CA) to create a Theory of Change (ToC) to explain how capacity, opportunity and motivation to change behaviour can be promoted in therapeutic residential settings for children and young people who have engaged in HSB Drawing on interviews with service providers and adult males who received interventions, it providers an account of the activities and processes that are considered to have generative potential in terms of promoting good outcomes in therapeutic residential settings for boys who have engaged in HSB. Haigh’s (2013) ‘quintessences’ (attachment, containment, open communication, participation and agency) and Kennard’s (1998) ‘common features of a therapeutic community’ emerge as key theoretical frameworks to understand data from staff and former resident interviews. Within the ToC that is finally developed there is a focus on the role, relevance and contribution of relationships to better outcomes and how structures and processes can be used to underpin therapeutic change. This is the first time that a model like this has been created to describe and navigate a therapeutic residential journey. The model provides the foundation stage for theory-based evaluation of such services and for further iterations and adaptation for use in other complex relational systems and interventions.