Purpose
The purpose of this evidence brief is to provide a description of ‘therapeutic care’ and outline essential aspects of the therapeutic care environment. Therapeutic care incorporates a range of interventions, or ‘ways of working’, usually stemming from a variety of therapeutic techniques or theories presented and employed in different ways.
This evidence brief does not attempt to gather all the available evidence on therapeutic interventions to assess their effectiveness. Rather, it starts with a fundamental question: what is common to good practice therapeutic care? This evidence brief should provide an adequate overview and depth of coverage to inform discussion and decision-making.
Methodology
This evidence brief supports the Ministry’s work developing an improved therapeutic care response that better meets the needs of our children and families/whānau. It aims to advance the Ministry’s understanding of therapeutic care and identify the approaches that best support children and families/whānau.
The evidence brief incorporated a comprehensive narrative review of the literature to identify key therapeutic care concepts, settings, models, and interventions. This type of approach gathers information about a subject from many sources and is considered appropriate for summarising and synthesising literature to draw conclusions on ‘what is known’ about a subject. The narrative review helps collate diverse and plural understandings.
The research design itself followed a standardised methodology. It was circumscribed given the limited time available for the evidence brief. The key steps in the research process included:
- Evidence brief scope document
- Evidence brief document outline and formatting
- Evidence brief literature search, including noting of key search words and terms
- Inclusion of identified documents into Nvivo for thematic analysis and coding
- Evidence brief analysis and writing
- Development of recommendations based on findings
The evidence brief insights support work detailing therapeutic care in Aotearoa New Zealand and overseas as well as those therapeutic care services specifically provided by Oranga Tamariki and our partners. This will enable need and services mapping and improved understanding of the respective challenges and opportunities involved in improving the delivery of therapeutic care.
This evidence brief offers a clearer idea of what good practice therapeutic care could look like for Oranga Tamariki and what the Ministry might do in the future to improve delivery of good practice services.
There are several primary and secondary research questions:
- Definition: What is the definition of therapeutic care?
- Need: What are the needs of our children and families/whānau?
- Therapeutic care: What does the therapeutic care and therapeutic care continuum look like?
- Te ao Māori: What is the te ao Māori perspective?
- Recommendations: What are the next steps in identifying and understanding therapeutic care and developing how Oranga Tamariki best utilises therapeutic care approaches?
The research design followed from the commissioning of the evidence brief by Care Services and was informed by subsequent discussions. A draft structure was developed and within that scope a set of search terms (strings) was used in select databases, repositories, and search engines. Terms included ‘therapy’, ‘therapeutic’, ‘care’, ‘intervention’, and ‘children’. Other search terms were used when particular insights were sought, or themes developed.
This evidence brief draws on a range of Aotearoa New Zealand and overseas literature and endeavours to provide a clear understanding of the varying facets of therapeutic care and good practice. This is an important step in supporting the improved provision of therapeutic care for tamariki and families/whānau by Oranga Tamariki.
The search was kept reasonably broad so as to not unnecessarily exclude relevant materials. Several hundred titles were scanned for relevance. Given the significant volume of results, where required, searches were delimited by date (2005-) and type (evidence, guidance, and policy-related). Given the higher-level focus on therapeutic frameworks and settings of care the research design also sought out more generalised literature and reports that provided innovative and insightful thinking on the subject area.
Key Results
- While there are distinctions between aspects of therapeutic care, what is common among definitions at different levels is the focus on healing and safe relationships with caregivers and workers at the centre of therapeutic care practice.
- Relationships are one among several ‘common factors’.
- Māori models of health and wellbeing are a way of conceptualising therapeutic focus. The foundations of Māori healing practices are based on interconnected relationships. The health and wellbeing of tamariki Māori is inseparable from that of their whānau.
- Research on therapeutic care interventions, including in residential care settings, demonstrates effectiveness if they are responsive to children’s needs.
- Most of the therapeutic interventions used in Aotearoa New Zealand originate in part or entirely from overseas. They do not adequately address Aotearoa New Zealand’s unique cultural context, specifically for Māori, and for other ethnic groups.
- The importance of cultural identity is found in the literature on good practice therapeutic approaches involving Indigenous populations, along with considerations of spirituality, understanding family dynamics, and crucial links to the surrounding environment.
- Similar themes, including a strong cultural identity for tamariki Māori and adults, are found in the Aotearoa New Zealand literature.
- Collaborative approaches are the best way to pursue change and develop a suitable therapeutic care framework.