Careers: Working in residential care

We are both assistant psychologists currently working for Fresh Start residential care services for looked after young people (YPs). We had been looking for relevant experience in order to progress towards clinical psychology training, and being part of a multidisciplinary team working within residential care has fitted perfectly with our development in the area.

Fresh Start and other residential care services comprise homes for the YPs where 24-hour care is provided by expert professionals. Looked after YPs need a home and a nurturing family; residential care facilities can offer them this stability. In essence, care workers are 'in loco parentis' for looked after YPs and should meet their needs for caring and nurturing attachments as well as providing positive experiences in the home environment. The residential care home is the YP's home and is treated that way.

The professionals working in care range from residential childcare staff, who work with and support the YPs every day, to managers and clinical professionals, who provide and oversee therapeutic input for the YPs on an ongoing basis. Residential care services endeavour to meet the YPs' needs from basic physical needs, such as clothing and food, to deep emotional needs, such as issues with attachment, experiences of abuse, and reactionary behaviour. Residential care, therefore, offers a variety of ideal clinical opportunities for assistant psychologists such as group work with looked after YPs, psychological assessments, and report and research work evaluating programmes for the YPs.

As a young child, being told (and in some cases not being told) that you are going to be living in 'residential care' can be a very fearful and traumatic experience. Not only do you have to cope with the impact of being removed from your biological family, you are also required to live with strangers who you are expected to trust and believe that they know what is best for you. Growing up and developing a healthy lifestyle with one's biological family is considered the best model for all YPs, so being enforced into residential care is usually a last-ditch option. To be placed in care, therefore, a YP must be in desperate need of support for their development. In most cases, they are victims of abuse (physical, psychological, verbal or neglect) and have no significant or responsible adult to rely on.

Although these services are available to YPs once placed in care, trusting relationships with individual YPs need to be built before any good-quality work can be done. One must, therefore, have a background knowledge of developmental psychology, such as the stages of cognitive development and attachment theory, in order to gain any understanding of much of what is happening for looked after YPs. Furthermore, the biggest hurdle with looked after YPs is engagement and motivation. YPs tend to struggle with their sense of self and the complexities of the world around them, so it is very much a case of trying to find common ground to develop an understanding relationship. This may seem difficult, and at times impossible, given the complex backgrounds of any individual YP, but the art of clinical work in residential care requires such psychological expertise and innovation. The ideal residential care service will have a multidisciplinary team made available to the YPs, to include psychological, psychiatry, occupational, speech and language, and fitness therapies. Fresh Start has these services readily available but it is not always enough – there can still be a reluctance among YPs to engage with the service.

Working with looked after YPs can be extremely stressful and challenging: many have disturbed views of others, and at times struggle to understand that the service has their best interests at heart. A calm and patient persona is required from professionals in this area, as looked after YPs need people who are consistent, flexible and understanding in their approach regardless of the situation they are faced with. Antisocial behaviours are common, as YPs can act out against the residential care establishment and other points of authority as a way of communicating their needs. Therapeutic psychology requires empathic listening skills and an ability to engage clients; residential care units test these skills in  a highly pressurised environment. For example, two of our YPs recently trashed the care home the night before a going-away party for another resident, causing thousands of pounds worth of damage. There are multiple and unique reasons for each individual's involvement in such incidents that can range from fear to frustration to stimulation.

Understanding the motives behind extreme antisocial behaviour, and the need it conveys for each child, requires significant clinical insight and years of psychological experience in the field. A common philosophy when dealing with looked after YPs is 'unconditional positive regard'. Any form of acting out should be understood in relation to the previous traumas experienced by the YP or a need they currently have. This approach can prove difficult, as the line between misbehaviour that is a reaction to inner conflicts and just being plain deviant is often ambiguous. Many YPs in care have criminal records upon entering the care system, which also needs to be dealt with accordingly by the service.

The most rewarding aspect of working in residential care is when there is progress or positive elements of the YPs' development. When working with looked after YPs, it is important to take solace in ensuring that the YP is getting the best possible structured and consistent support. Every effort can be made to love and nurture the YP and develop a healthy relationship with them; sometimes it will be reciprocated and sometimes it will not. YPs can make remarkable developmental progress when given the proper support. Despite sometimes coming into care having had no educational background and seemingly very little potential, many YPs blossom in the environment and learn to live healthy, independent lives through adulthood. The downside of course is that, despite our best efforts, some YPs will still run into trouble one way or another, with the law, with their peers or with themselves. Such transgressions can be seen as major setbacks in residential care systems, and it can be heart-breaking to see YPs flounder in the public domain. One of the most important aspects of unconditional positive regard, however, is to always be there for the YP, no matter what the occurrence, and to make sure they have the necessary supports and therapeutic input when facing hospitalisations, unauthorised absences or court hearings.

An example of a YP who exemplifies the highs and lows experienced in working in residential care is that of a boy in our care who experienced extreme sexual abuse and neglect in the family home and who arrived in care without familiarity with normal society. This boy entered care with vast psychological, educational, occupational and speech needs, and his potential was seen as minimal from the beginning. Through the regular care from residential staff and therapeutic input from the clinical team, this YP has defied all odds by maintaining an educational placement, learning to relate to his peers, and developing his coordination and fitness to a high standard. This has been seen as a marvel in the care system and provides huge satisfaction for the professionals involved. Attachments have clearly developed between the YP and staff, and his story is an example of the rewarding nature of residential care. On the other hand, this particular YP has also suffered many setbacks. Due to the nature of his past experiences, he can become outwardly sexualised, physically aggressive and even self-harming. On a number of occasions, emergency services have been called in for fear of his and the staff's safety. Such incidents are obstacles and can be painful for staff to deal with, but they are understood as part of the developmental process of adolescence. YPs need affection and support, but they also need to learn that there are consequences to their actions and that they need
to take responsibility for these.

One of the major challenges facing modern-day residential child care is a lack of funding due to little scientific evidence that the residential care system actually works. Outcome measures have been poorly recognised in Ireland and the UK for scientifically tracking the progress of YPs in care. While it is a prerequisite for care systems to have daily logs, the majority of clinicians will track changes in assessment and anecdotal evidence is plentiful, the everyday progress of YPs' well-being is not being analysed. Psychology is a science, and evidence-based services are the requirement in modern professional psychology organisations; residential childcare is currently adapting its research methods in this way. Residential childcare systems in Australia and the States have incorporated electronic databases whereby YPs' data can be input via psychology questionnaires (on well-being, depression, anxiety, etc.), and care professionals are then given contextualised feedback for the YPs' care programmes moving forward. This system would be ideal for tracking YPs' progression in residential care and giving professionals feedback on what path may work best for future treatment. Fresh Start is currently importing such a system from the University of Vanderbilt in America, whereby we hope to be pioneers in the field of evidence-based residential care practice in Ireland in the coming years.

Working in residential care offers huge variety of experience for psychology professionals. There are chances for group and individual work with YPs on a daily basis, each case is as complex and challenging as the next, and there is regular support available from other staff and members of the multidisciplinary team. There are opportunities for important systems or research and a wide community of care organisations to liaise with and disseminate to. Residential care also benefits from the number of psychology areas involved; Fresh Start, for example, employs clinical, forensic, psychotherapeutic and educational psychologists as well as occupational, speech and language, and fitness therapists. Furthermore, the fact that residential care is progressing as a science and developing more evidence-based approaches to its work is encouraging for its future. The experience of residential care, for us as assistant psychologists, has been extremely positive and has been essential in helping us reach the level of expertise required to begin clinical psychology training.

Public relations – a branch of applied psychology?

Ian Florance talks to Jon White about working in the communications industry

Public relations (PR) affects most people that train or work in psychology. Many graduates in the discipline follow careers in marketing, advertising and market research. More generally, the misrepresentation of scientific findings in the media, often seen as the result of PR spin, is a hot topic. Interviews in the 'Careers' section over the years with psychologists from all corners of the discipline reflect two basic positions: deep suspicion of the motives of people involved in the 'communications industry', sometimes based on past bad experiences, or a real commitment to communicating psychological ideas to a wider public.

Dr Jon White contacted The Psychologist intending to kick start a discussion on the psychological basis of public relations. He has practised PR internationally for years, taught and trained on the topic at university and executive development levels, and written books and articles on public relations and related topics such as public affairs and internal communication. He's also a Chartered Psychologist.

Fundamental laws of human behaviour                                           

'I left school after O-levels, worked in the police and really took to studying at the police training centre. Then I left the police intending to study law and return, but I soon became interested in psychology – it seemed to uncover fundamental laws of human behaviour, ones which illuminated what other people did but which I could also apply in my own work. I often think when I meet ex-psychology students in organisations that they need to be reminded of the incredibly valuable body of knowledge they've acquired so that they can apply it more frequently.'

After his degree, Jon worked at IPC Newspapers – 'essentially as a "glorified messenger" working between editorial, production and advertising departments' – to learn about the workings of the media. 'I hoped that I could link journalism and my interest in social sciences; at the time IPC published the weekly magazine of the social sciences and social commentary, New Society. I also worked in social research and as a freelance writer.'

Two years after his degree in psychology from the University of Nottingham, Jon emigrated to Canada where he took a position in communications and public affairs with the government of Alberta in Western Canada. He held a number of positions with the government, learning how organisations relate to the wider society of which they are part. While working in a central communication research and consultancy role he developed training programmes for the government's communications staff on topics such as crisis management and persuasive campaigning.

Jon came back to the UK on study leave for a one-year master's in social psychology at the London School of Economics, looking at communications and attitude change, organisational behaviour and the psychology of conflict, topics directly related to his practical experience. 'When I went back Canada I became more interested in teaching the subject. In addition to my government role, I taught part-time at the University of Alberta and then moved to a full-time position in Halifax, Nova Scotia, to a university offering the first degree programme in public relations in Canada.

I helped to establish this programme, which was rooted in the study of the social sciences, business and management, and communication.' During a second study leave, Jon came back to the UK to start the first year of his doctorate at the LSE. This examined contributions to high-level decision-making by people who work across organisational boundaries within organisations and between organisations and their environments. This is, again, a particularly important topic at the moment as organisational structures become less rigid, many teams work 'virtually' through digital channels and consultants are used more frequently to provide an outside view of a culture and to break down internal barriers.

'I took my viva in 1986. I was recruited to establish an MBA programme specialising in public relations at what is now the Cranfield University School of Management. I had combined consultancy in PR practice with university teaching, and when the programme at Cranfield did not attract sufficient interest, I began to work independently, combining consultancy with university teaching and training. My clients have included organisations such as Shell, British Airways and Siemens. Over recent years, working through the Chartered Institute of Public Relations, I worked with the UK's Foreign and Commonwealth Office, training diplomats and other staff in more effective use of communication and influencing skills. I maintain a strong interest in research, and have used my knowledge of research methodology in addressing questions of evaluation in public relations practice, and specifically on projects to examine communication management in multinational companies and government departments.'

What is PR?

Jon had given a number of examples of where he worked and the sorts of disciplines he applied, but it seemed the right time to ask him how he'd define public relations and why he sees psychology as so central to it. 'Public relations is called different names in different organisations but, put simply, it's a branch of applied psychology. It looks at the management of relationships, whether they involve groups or individuals. It addresses the use of communication to influence behaviour, both strategically and tactically. Public relations is often viewed with suspicion since outsiders frequently see it as the way large companies try to cover up their problems. In the public mind, events as diverse as RBS's near implosion, suspicious deaths at a number of hospitals and the BP oil spill implicate PR in attempts to cover up wrongdoing. But this is similar to typifying all sport by the actions of drug cheats. When events like an oil spill or a scandal within a school happen, public relations is essential in effective communication to ensure people stay safe or have the appropriate facts. Developing awareness of healthy lifestyles in relation to smoking or over-eating, for instance, involves public relations and social marketing techniques . And the practice of public relations is being transformed by social media. Just look at the huge growth in internet dating, an example of individual relationship management. '

Jon slightly contradicts my earlier comments on the number of psychologically trained people in related professions. I meet very few psychologists who work in PR and I wonder why that is. The area rests, as much as anything else, on detailed understanding of group dynamics. Of course there are seemingly new applications, such as consumer psychology, which overlap.'

Routes into public relations

As one route into this area, Jon feels that there is good scope for psychologists to work in business and management school settings. A key question they could address is how to manage relationships between organisations and groups inside and outside the organisation. Jon is a visiting fellow at the John Madejski Centre for Reputation within Henley Business School, which looks at this issue. 'Business schools offer opportunities for dialogue with other specialists and for teaching, applied work and focused research.'

People tend to think of public relations as an area that is about messaging rather than about research. 'But, again, that's a misunderstanding. Research, whether it's into methodology or the subject that's being communicated, underpins all good public relations. You can't decide what you should say then communicate persuasively unless you know what you're talking about. One of the reasons I contacted The Psychologist was the excellent work Christian Jarrett is doing on the BPS Research Digest. This makes new research findings available, some of which we can translate into public relations practice. Interestingly the Chartered Institute of Public Relation has set up a research and development unit specifically to develop knowledge to underpin practice – a major element in that is psychology.

'You can see that some topics and skills covered in psychology are directly relevant to PR – they make it easier for graduates and postgraduates to communicate effectively; to translate numbers into words; to understand good research design and the limits of findings. Psychology graduates and postgraduates should be aware of how different groups have different ways of looking at the world and be well-suited to what's a truly international discipline. Psychologists have a greater understanding of decision making and its impact on behaviour. It would be good to see more psychological input into business courses and to see more opportunities for psychology students to get more practical business experience.'

Don't believe the public image

How should someone prepare if they want  to go into the area? 'Don't believe the public image of PR. It's about attending to, understanding and enabling relationships. Communication is key in developing, sustaining and influencing participation in relationships, but that is a part, not the whole of public relations practice. Study recent cases, such as the BP accident, to see the problems that can be compounded by a failure to manage public relations. Finally, despite everything I've said, psychologists don't have all the answers. Working in PR means working in a multidisciplinary environment to the same extent as working in a specialist acute unit, and a lot can be learned from fellow professionals.'