Milieu or packages of care – culture eats strategy for breakfast
At a recent event NCERCC was supporting there was a discussion on a table that turned out to be multilayered (Of course! This is residential child care!) about needs of children, models of care, and fees.
One home provides a therapeutic milieu, they have a long standing evidenced therapeutic community model providing a planned (meaning thoroughly thought through) environment. Its theory and practice care rigorous. The whole environment, everything, is carefully, attentively, considered and provided. It provides a developmental opportunity, appropriate relationships, boundaries, reparation. It understands transference and counter-transference, holding and containment, symbolic communication, inner world, and behaviour as communication.
Such a milieu needs to be constantly available and used in whatever way a young person requires. Continuity, consistency, is paramount. With this understanding it does not decrease fees during placement.
It is understood that in the first days, months, the young person will draw more from the provision, and differently, not necessarily less later. Everything is paid for in a single known agreed fee.
This is an example of good child-centred care and financial planning for both provider and local authority.
It anticipates the ups and downs of care, but does not get anxious. The planning of care and finance is proactive. Scenarios often seen repeatedly are met with organised fluidity. The provider knows what to do, they have the knowledge and experience and practice to make the unpredictable predictable, they understand the panic, rage, chaos, a young person can experience when communication breaks down. Seen it thousands of times.
Creativity is high in their work. It is this responsiveness, not riskiness, that underpins their work, not compliance.
The therapeutic culture is deep and able to hold challenges. It understands challenging behaviour as a young person being placed in a challenging situation. Behaviour is context specific, as is attachment. The grown ups understanding their responsibility for the situation, change it. Boundaries are flexible and resilient. As a result the provider does not call on the local authority for more fees, more staff, at times of pressure.
This is the difference between a milieu and packages of care.
In football terms the milieu is constructing space rather than close marking.
That is not to say that some providers provide for some children exactly what they need. In footballing terms, Manchester City’s assistant coach Pep Lijnders, formerly of Jurgen Klopp’s Liverpool, acknowledges, “where [teams] play man to man, there are no lines, there are no pockets, there are no free spaces. It’s all about how to play [through] that movement of high pressure.”
It is about matching needs to provision.
Both approaches might be deploying principled practice to reduce the tightly guarded defences of the young person developed over years of neglect, trauma, abuse, exploitation.
Importantly, there is a need for an acceptance that things won’t always go perfectly. It is a question of when this happens. It is always because the grown ups have allowed it to happen, letting preoccupation slip.
As Pep Guardiola attested when discussing why he prefers passing in the centre of the pitch than out wide, “Of course, if you lose the ball in the middle, it’s a risk and you screwed up. But it’s a decision. The coach has to make a decision. Because it’s going to happen to you. You’ll lose balls in the middle and the rival will score on the counter-attack.”
He goes on, “You will come home and question your idea. But in front of your players, you will ask yourself two questions: change the style or insist on my idea?”
Contrast control, a strategy, with confidence, a culture, and care is given a different meaning.
It is a different leadership from a different culture.
It comes with psychological assurance based in knowledge, experience, together they make expertise.
It is one thing to have a model of care and another to carry it through and on into the decades. As Arsene Wenger observed, “It’s not as easy as it looks.’”
