Berry Street Take Two is an accredited state-wide mental health service in Victoria, Australia, which provides therapeutic services to infants, children and young people who have experienced neglect, family violence and/or abuse. The services including assessment, intervention and consultation, are delivered within the context of several different programs within Take Two. One of these programs is supporting carer staff to provide therapeutic care to young people in therapeutic residential care (TRC) (Cox et al, 2021a).

TRC homes provide residential care to young people in the Child Protection service and have additional funding to support the provision of ‘therapeutic’ care within the homes. This funding allows for a part- time therapeutic specialist role for four children as well as other resources designed to support the provision of therapeutic care. One of the primary tasks of the therapeutic specialist is to facilitate fortnightly reflective practice to the care staff. The Berry Street Take Two program provides this role with Berry Street’s residential care services as well as for other organisations.

Children and adolescents in OOHC have typically experienced complex developmental trauma. This differs from an acute ‘one-off ’ trauma such as a car accident or natural disaster as it is multiple traumatic experiences of sexual, physical and/or emotional abuse over a prolonged period (Purvis et al, 2013; van der Kolk & Courtois, 2005). The context of this abuse is almost always relational, and the perpetrator is often the primary carer or attachment figure. It also happens during crucial developmental periods and thus disrupts development and affects developing neuro systems (Cox, Perry & Frederico, 2021b). The impact of complex developmental trauma is global, affecting attachment systems, dissociation, cognition, affect regulation and self-concept (Cox et al, 2021b & Purvis et al, 2013). These early experiences, and the subsequent impact on the child’s neurodevelopment, influences their perception of relational interactions and relationships, often resulting in misinterpretations that perpetuate maladaptive strategies.

In order to keep children safe, they are removed from the care of parents/carers who have abused them or been unable to keep them safe and placed into OOHC. This disruption in the child’s attachment further impacts the attachment system or relational templates. It is not uncommon for the child to move from placement to placement as the system attempts to find a stable home for them. Not surprisingly, children in the OOHC system find it hard to trust adults and can develop coping strategies that jeopardise their relationships with carers (Cox et al, 2021b). Interventions that support carers to provide stable and nurturing care are most effective (Purvis et al, 2013). Understanding the pushes and pulls experienced by the people in the child’s care network is the first step. The second step is finding a way to explain it to carers and others in a non-blaming or shaming way.

In the Australian state of Victoria there were 12,669 children in OOHC or on permanent care orders in 2021 (Australian Institute of Health and Welfare, 2022). Out of home care and other supported placements for example kinship placements (not including permanent care) in Victoria has been costed at $850 million for 2020-2021 according to government figures (Australian Productivity Commission, 2022). The number of children in OOHC and the financial costs highlight the need to develop appropriate and effective response to these vulnerable and complex children and young people.

A small number of Take Two staff have been trained in CAT and were utilising it in supervision and case presentations. Those that were exposed to this relational framework recognised its value in understanding the young person’s relational templates as well as the role of the people in the young person’s life inadvertently perpetuating. This was communicated to senior leadership and in 2019 Berry Street Take Two committed to a phased project to introduce relational consultation within the program.

The primary aim of this project was to support the development of skills and experience in relational formulation and consultation using the mapping tools of CAT. This practical and accessible reflective tool is particularly useful where professionals or the care system are challenged by the complex presentations of young people. Initially, an external CAT consultant and trainer was engaged to provide a series of consultations within the program as well as a training day for the whole program. In the second phase, in 2020, a CAT informed consultation group (subsequently referred to as relational consultation group) of 10-15 participants was established.

The relational consultation group comprised of senior management, team leaders and clinicians across the program who were interested in further developing skills in using a relational consultation model within the program. The external CAT consultant was engaged to facilitate monthly two-hour consultations with a focus on using mapping and relational formulation as a reflective tool. Due to COVID-19 restrictions associated with the 2020-21 pandemic these sessions took place online. A mentoring approach to enable those within the group to continue the consultation group in the next phase was an additional aim.

The relational consultation group continued in 2021 without the external consultant and was led by a senior manager, a CAT practitioner (who was also a senior clinician), and a team leader undertaking CAT training. Group membership was also opened to team leaders who had not been part of the group in 2020 as their role afforded opportunities to use the model within their teams. The group continued to meet monthly for two hours utilising the relational consultation model provided in 2020 by the external consultant. At each session one group member presented a case to be mapped together and the group members also practiced mapping with a partner. Once again, due to COVID restrictions, most of the sessions took place online.