Changing your practice to being trauma informed in therapeutic residential care

Whilst the following Arabian proverb takes a bit to get your head around it leads rather nicely into this blog and our brief introduction on the relevance of the conscious competence model  – or changing your practice to becoming a trauma informed therapeutic residential care worker.

“He who knows not,
and knows not that he knows not,
finds it difficult; (rewritten)
He who knows not,
and knows that he knows not,
is a student; Teach him.
He who knows,
and knows not that he knows,
is asleep; Wake him.
He who knows,
and knows that he knows,
is Wise; Follow him.”

 

Did you know?

Ever wondered why professional sports people continue to do repeated skills and drills as part of their training regime? Becoming good at something and staying good at it takes time, persistence, repetition, and focus.

 

Experience tells us that to change our previous ways of working with children and young people to working therapeutically in a trauma informed environment plus confidently using the language can take up to two years with training and supportive mentoring/coaching, supervision and reflective practice.

 

The journey of change

We understand that this journey can be quite different for every residential care worker. For some it will come easily matching their current philosophy; for some new to the industry, it will be the only way they know and for others it can be really difficult.

 

 

What are some of these changes?

1.      Moving from a points based, sometimes directive behavioural practice to searching for the real reasons for the behaviour and working on forming a trusting and lasting relationship

2.      Realising that every interaction with a young person/people is an opportunity for change

3.      Understanding that each child and young person is doing the very best they can at a point in time – they are surviving the best way they know how

4.      Focussing on “what has happened to you rather than what have you done”

5.      Responding with empathy whilst balancing this response with discussed agreed expectations and consequences that make sense to the young person/people

6.      Being able to understand, link and apply the concepts of attachment, child development and neurobiology to your practice and understanding why you are doing it

7.      Understanding how abuse and neglect impacts on children and young people’s psychological, emotional, physical and spiritual development

8.      The need to balance safety of staff and young people equally

9.      Being able to use the language of trauma informed care to explain what you see and feel

10.   Working relationally in an environment fraught with achievements and dangers

11.   Being allocated an experienced coach or mentor to reflect with, to watch them manage the seemingly unmanageable and to learn from it

12.   Realising that whatever you portray will be mirrored by the young person

13.   Being and staying strong enough to keep young people safe

14.   Ability to both work autonomously and as part of the staff team as well as the broader professional Care Team

15.   As you know the young person best, you need the confidence to speak up and share this information in a language others can understand

 

What is unconscious/conscious competence?

One of my favourite examples of unconscious/conscious competence is learning how to drive.

 

When you first learn how to drive a manual car, you very quickly learn that you don’t know how to do it (conscious incompetence). As you practice you can start to think your way through it (the conscious competence stage).  As driving the manual car becomes a habit for you, eventually you can drive without thinking, shifting gears effortlessly while you think about other things, hold conversations, or listen to the radio (unconscious competence.) The next stage of danger comes when you think you know it all and don’t bother to go on being aware of new knowledge and skills – thinking you are the best driver with nothing further to learn.

 

 

Let’s use the model of unconscious/conscious competence to understand the journey to becoming therapeutic residential care workers . . .

unconscious-conscious-competence-diagram

Applying This Theory in Practice

Managers and supervisors/team leaders commonly assume staff to be at stage 2, and focus effort towards achieving stage 3, when often staff are still at stage 1. Supervisors/team leaders frequently assume that the staff members are aware that the knowledge/skill exists, its nature and relevance, and their own lack of knowledge in that area. Unfortunately, staff at stage 1 – unconscious unknowing or incompetence – may have only some of these things in place and will not be able to move into conscious competence until they have become consciously and fully aware of their own lack of specific knowledge. This lack of congruence between supervisors/team leader’s assumptions, and the staff members actual stage of knowledge/skills has been identified as a basic reason for the failure of a lot of training to make a real difference in practice. Allocation of an experienced mentor or coach at this time is extremely useful.

Based on this model, if a supervisor/team leader expects the new staff member to employ new knowledge and skills when they seem to be reluctant or unsure how to move forward, the first step may be to start with a list of competencies required for therapeutic residential workers to identify new knowledge required to help them to identify what they don’t know in a safe and supportive supervisory relationship and environment.  Only then will they understand what they don’t know and can be guided through the subsequent steps and stages of knowledge and skill development.

This sound fairly simple, however, because it requires the new residential staff member to acknowledge to themselves as well as to others that they don’t know, the first change – from unconsciously incompetent to consciously incompetent – requires a very large emotional as well as cognitive effort. If it is to be achieved successfully the supervisors/team leader needs to expect and recognise seemingly small improvements over each staff members journey. Allocating a mentor – more experienced staff member to support newer staff members is also beneficial.

Note: A list of relevant personal attributes, capabilities and knowledge domains can be found at Minimum Qualification Requirements for Residential Care Workers in Victoria December 2018

 

Definitions for the purpose of this blog:

Incompetent: not yet having, showing or understanding the necessary knowledge and skills to work unsupported with high-risk young people in therapeutic residential care.

Competent: having the necessary ability, knowledge, or skill to do something successfully.

Conscious: having knowledge of something.

Unconscious: the part of the mind which is inaccessible to the conscious mind, but which affects behaviour and emotions. This is where working alongside an experienced and willing mentor really helps the newer staff member of their journey.