The Mulberry Bush Approach | goodenoughcaring.co.uk

By John Turberville

The paper below describes The Mulberry Bush Approach. It sets out the way the practitioners understand the work with, and alongside, children and families in crisis.

The paper describes in section one: the Three Core Principles that underpin the work. It goes on the set out in section two: the Five Ingredients of the therapeutic culture using a model devised by psychiatrist Rex Haigh. These set a context for the developmental way in which the work is thought about and the ingredients are underpinned by the psychodynamic theoretical framework that has been central to the work of the school since it was established in 1948.

Then introduced in section three are the Eleven Key Elements. These elements are the aims of the school and represent those areas in which we aim for the children to make outstanding progress in. We measure children’s progress in relation to these.

The next section of the paper – section four describes The Mulberry Bush Provision. It sets out the chronological stages from: the Referral and Pre-treatment Phase, to the Assessment Treatment Phase, to the Mid Treatment Phase and finally to the Transition Phase.

Introduction

The school has, since its founding in 1948, used psychodynamic theory to underpin its policy and practice. The school has remained flexible to the different demands of Government direction and policy, adapting the organisation’s policies and its practice whilst maintaining and reflecting the value it places on its psychodynamic culture.

At the Mulberry Bush Organisation we believe that to effectively understand, educate and treat children who display challenging and disturbing behaviours, we need to be reflective practitioners, highly attuned to the communication and needs of children. Through our understanding of their verbal and non-verbal communication we can adapt our work and the environment to better meet their needs. Through meeting the needs of children we provide an environment in which they feel safe, understood and able to engage in learning, socially, emotionally and academically.

The organisation plays an important role in structuring the environment to enable this to happen.

This paper provides a policy statement which sets out how this is demonstrated through the day to day work and practice of the organisational structures and its staff.

The Three Core Principles

The organisation has three core principles that underpin its therapeutic work:

Staff need a good psychodynamic understanding to provide an informed psychodynamic approach
The development of a reflective culture at all levels and in all disciplines is paramount
Collaborative working is central to a high quality treatment environment

Psychodynamic Approach:

The key value that underscores all our work is the use of Psychodynamic Theory. The term psychodynamic comes from Freud’s work on understanding the unconscious; it is used to try and describe the internal psychic conflict that goes on inside all of us that sometimes results in unwanted behaviours. The work of psychotherapists and those who work in a psychodynamic way is to try and change the person from within, that is to see the behaviours as symptoms of the inner conflicts and to try and address the causes of the symptoms rather than to rectify the behaviours.

“Symptoms…could be viewed afresh as meaningful communications about inner states of conflict.”

(Bateman. A et al, 2000: 9)

This approach is used to understand children’s behaviours as communications of unmet needs.

The Mulberry Bush School was founded by Barbara Dockar-Drysdale in 1948). She later qualified as a psychotherapist. She worked closely with the influential paediatrician and psychoanalyst Donald Winnicott who in his work highlighted the importance of the early relationship that develops between a child and its mother. Much of the work of the school is based on Winnicott’s idea that the failure of some infants to fully integrate (when this relationship does not or cannot develop successfully) is at the root of many of the children’s problems. The school also uses the Attachment Theory that Bowlby developed which looks at attachment behaviour patterns in children that result from early attachment experiences with their primary carer. These patterns in turn are linked closely to Winnicott’s concepts of the importance of early primary experiences.

It is through the examination of the communication that children present through their behaviour that themes begin to emerge and their underlying needs can be identified. The school then works to meet those needs as part of the treatment through the children having individual treatment plans that are reviewed and adjusted on a regular basis.

Reflective culture:

The effect of working with very disturbed children is pronounced following the psychodynamic approach. The staff group is subjected to projections and transference on a daily basis and on occasion they may also experience projective-identification. The emotional impact is considerable, and it is only through a high level of mutual support acknowledging and understanding these processes that staff are able to continue working effectively. It is through meeting regularly in teams and identified groups (for group supervision and consultation) that the impact of the work can be shared and thought about. These meetings (with teams and individual staff members) form the heart of the school’s reflective practice. Reflective practice within the school enables staff to question their own reactions and behaviours and also that of their colleagues with the aim of improving practice leading to a greater understanding of the children’s behaviour. It is through being reflective that the projections and transference can be recognised and made sense of.

This reflective culture at the heart of the staff group is replicated in the life of staff with and alongside the children. This encourages children to develop reflective skills enabling them to explore and understand the impact for them of living and learning alongside one another.

All staff are part of a regular, facilitated reflective group to support and facilitate the integration of this culture into all aspects of the work of the school.

Collaborative working:

The sharing of the impact of the work leads to collaborative working, but further to this the school is conscious of the potential splits between departments and teams and so tries to combat this by actively engaging in collaborative work. This takes the form of bringing to together different departments to again think about the impact of working together with difficult children. Therapeutic communities are well-known for their inclusive meetings. The school has regular whole school meetings and open forums in which all staff either have to attend or are encouraged to attend. The aim of this is to help the school be more open and the work more shared. One of the keys to a successful organisation is communication and often the failure to communicate effectively is at the root of poor performance. The Mulberry Bush encourages open communications at all times, paying due care to the sensitivity of those present. In practice this means being clear about the emotional state of children when handing over to different people, e.g. from the teacher to the care worker. Staff are also encouraged to openly comment on their emotional state with each other so that they can be supported and offer support. Difficult subjects are encouraged to be talked about with parents and other professionals.

These three core principles are closely interlinked, and directly look after the wellbeing of staff and children; it is by paying careful attention to staff needs (through support structures, training and individual, team and departmental relationships) that the children’s needs can best be met.

The core principles are translated into these four underlying concepts:

All children use behaviour as a form of communication, especially when what they are communicating is an expression of an unconscious, unmet need and when they do not have the comprehension or words to say what they want to say.
Children communicate the same thing in different ways to different people, and also different things to different people.
There is an emotional impact on those experiencing these behaviours and those trying to understand them.
When people who are trying to understand or who have experienced the impact of these communications come together to openly share and process their feelings about this, there is a better chance of a fuller understanding being reached, of developing effective responses, and of supporting individuals and teams with their particular struggles in working with these communications.

Our Vision – Do We Achieve It?

We have developed self – evaluation systems to quality assure all elements of our practice and use the data we collect to identify areas for development across the school.

The Mulberry Bush Organisation vision statement is:

‘Changing Lives Together; working with you to provide excellent outcomes through outstanding therapeutic practice’.

The School vision statement is;

‘Changing lives together; working with you to provide excellent outcomes through outstanding therapeutic care, treatment and education for severely troubled children’.

We substantiate these aims in our outcomes data set. To ensure that the above statement translates directly into improving outcomes for children we have clearly defined the areas of progress that we are looking to see in the children. These we call our ‘11 Key Elements’ (See Appendix 1). We measure progress against these 11 areas.

They are:

We aim for the child to make progress in their ability to;

use and apply learnt skill and knowledge
be a successful learner
make a contribution and become involved in the immediate and wider community
improve self- awareness and value achievement
involve themselves appropriately in their care and the care of the environment
function appropriately in a group
reflect on and communicate feelings rather than act them out
ask for help and make use of it
keep themselves and others safe
build healthy and mutually trusting relationships
be able to play

These key elements form the basis of our treatment planning and are arranged developmentally to support this process (see the Mulberry Bush Developmental Schema). The treatment planning process is at the heart of the work for all staff and the development of the treatment plan by staff together across all disciplines provides the consistency and continuity of our approach which is so central to achieving good outcomes for the children.

The Five Ingredients of the Therapeutic Culture

All staff at the Mulberry Bush are supported to work together to translate the above principles into practice with high quality training. The training program is grounded using psychodynamic theory, but making good use of attachment theory, systemic theory and ensuring staff are up to date with the developing importance that neuroscience has to play in our understanding of child development.

We use the five ingredients of a therapeutic culture model devised by Rex Haigh to structure our understanding of our work. This model states :

’the five ingredients of a therapeutic culture and are seen as a developmental sequence: from the earliest experience of attachment to maternal and paternal aspects of containment, and the task to make contact with others in a way which allows intimate and mutative communication to happen. Then on to the adolescent struggle of involvement and finding one’s mutual responsibilities amongst others, and finally to an adult empowered position of agency – finding the self which is the seat of action and from which true personal power and effectiveness must come’.

(Haigh, Rex The Quintessence of the Therapeutic Environment )

These five ingredients provide a developmental model that helps in understanding the steps that we are working towards for each child placed at the school. It is not necessarily a simple linear progression in which children make step changes in their emotional and social development. It is expected that all children will develop aspects of the different ingredients at different rates, but that as they develop, the levels reached will become more solidly established and their emotional and social growth more secure.

Primary Experience – Attachment:

The importance of relationships in the work of the Mulberry Bush cannot be overstated.

It is believed to be essential for mental health that the infant and young child should experience a warm, intimate and continuous relationship with his mother, or mother substitute, in which both find satisfaction and enjoyment.

(John Bowlby, 1953, Child Care and the Growth of Love)

Providing children with new opportunities to develop meaningful relationships in a safe, secure, nurturing but task focussed environment is the foundation stone of the schools work. It is through these meaningful relationships that the child develops their capacity to learn and grow.

Research has also shown a strong positive correlation between the security of the children’s attachments and their capacity to co-operate with adults, to concentrate on play, to persist at problem solving and to be popular with peers.

(Juliet Hopkins, 1991)

From the point of first contact with the school, working relationships are believed to be key to the successful outcomes for the child. The Referrals and Partnerships Manager and House Manager’s work with the referral process which is designed to engage all stakeholders; family /carers, social services, health, education in working together to support the placement of the child. This engagement is vital in giving the child licence to engage emotionally with the staff and in the work.

The Director visits the child at home prior to their start date to establish a working bond between the family and the school.

The twelve week assessment period is spent introducing the child to the structures, rules and boundaries of the school. The assessment staff house has a higher staffing ratio to enable high levels of individual preoccupation to the individual needs of each child. This level of attentive attunement and the relationship established is used to consciously inform how the treatment plan is individually adapted for each child; a plan overseen throughout the child’s stay by their treatment team (key worker, teacher, psychotherapist, family worker, team manager). All transitions are carefully thought about for each child and so the child, before the end of the assessment period, will be introduced to the staff member who will be their key worker in their new parallel house. This move takes place at around 12 weeks into the child stay.

The key worker’s role is very important in maintaining high levels of pre-occupation with and for that child, ensuring that at no point are their needs overlooked. However, it is not expected that their relationship is a ‘special’ one, although this is often the case because of the child’s experience of being held so closely in mind. The most important/formative relationships may develop with any staff member. Our experience is that children often develop strong attachments to a number of staff members.

The children placed at the school have usually found the intensity of the relationship in a small family unit overwhelming, leading to birth family and foster/adoptive family breakdown. The larger staff team seems to dilute the intense experience of finding a place in a small family dynamic and give the opportunity for both; initially the attachment to a larger number of staff members, followed by the more intense attachment to one or two as the experience of more appropriate and satisfying relationships are survived and even enjoyed by the child. We are clear that these relationships should be, on the adult’s part, consciously thought about and planned. This avoids the staff engaging in relationships with children that may lead to a repeat of previous confusing or unhelpful attachment patterns.

The importance of attachments is seen throughout the child’s placement and powerfully felt during their last year at the school when plans are made for the child’s transition to a secondary school and home.

The opportunity for a carefully planned ending to the child’s time at the MBS is very important. It is often a new experience for the children placed, whose previous experience of ending has been unplanned, chaotic and confusing.

We use two key elements to measure the child’s progress in attachment. These are: their ability to;

build healthy and mutually trusting relationships
be able to play

Culture of Safety and Understanding: Containment

The children arriving at the MBS have demonstrated being uncontained in a variety of settings, often in dangerous and anxiety provoking ways and have shown themselves through these behaviours to be un-containable/un-liveable with. Consequently the task of the MBS is to help the children experience that they are containable and that they can be kept safe. This experience of being containable will be one of physical and emotional safety which can then give space for thought, communication and understanding.

‘Basic to all treatment is the issue of safety. Unless an individual feels safe, it will be difficult to overcome defences and resistance to change. Unless he feels safe there will be little energy available for continued growth and change. Therefore, basic to the creation of a therapeutic Milieu is the necessity of creating an environment in which children feel both physically and psychologically safe.’ (Fahlberg, V, 1990:p143)

It is within the containment of the environment, its predictable rules, structures and boundaries, that the depth of the relationships can develop. It is then within the security of these relationships that space is found to explore the children’s inner turmoil and confusing thoughts and feelings.

The day to day work of the MBS is therefore ensuring that; the physical environment is safe, appropriately secure, resilient and respectable; that staff and children understand and agree with the rules, structures and boundaries; and that we share knowledge about what is going on day to day so that as much as possible is predictable. This makes it more possible to think about that which we have not predicted.

The clearly defined spaces created within the daily structure provide opportunities to come together to think and reflect, exploring how we understand the rules, structures and boundaries and perhaps how we should respond to those who challenge them or are not respecting them.

This process takes place in households and the class groups, but also is replicated in staff teams and management meetings, at all levels of the organisation

We measure the children’s progress in containment through their;

Ability to be keep themselves and others safe, and
Their ability to ask for help and make use of it.

Culture of Openness: Communication

The meeting structures described above give the opportunities to develop a culture of openness, to develop skills in communication.

It is important that all members of the Mulberry Bush community are supported to communicate in appropriate ways, to find their voice, and for each and every one to feel that they can voice their thoughts and feelings safely and respectfully and that they are valued for this.

The therapeutic importance of communications can be undervalued and the chance to build on them lost unless both individual worker and the staff team as a whole are able to locate such interventions within a theoretical framework which will help them understand what is happening and offer some guidance about what to do next. We need to listen to our intuition, reflect on it before we use it and use it in context by attaching it into our repertoire of conscious responses.

Linnet McMahon and Adrian Ward, 1998

Community meetings, circle time, daily meetings, reflective spaces, group supervision, team meetings, morning meetings, training – are all examples of spaces in which valuable communication takes place about the task and the relationships that surround it. All this communication is in service to the work with and alongside the children. It is our experience that when we are not communicating well at any level of the organisation, there is a tangible difference in the child group. When we are dysfunctional as a staff team, it is often then that the children will do something that brings us together to think about what they have done and through this to recognise our dysfunction. Consequently it is important that staff teams and managers attend to any dysfunction so that the children are not put in the position of acting it out for us.

Our openness and communication with external agencies, stakeholders and families/carers is very important to us and vital in our joint work with the children. We consequently have one document – the Integrated Treatment Plan that we use for each child in the school. This document is used as a working document by staff in the treatment planning and monitoring process day to day and used with all agencies and stakeholders and the family/carers at six monthly placement reviews. This openness is also replicated in our contact with all parties through the work of our Therapies and Networks Team and the household staff.

We measure the children’s progress in communication through:

Their ability to function appropriately in a group, and
Their ability to reflect on and keep themselves and others safe.

Culture of Participation and Citizenship

It is through the child’s ability to play and their development of trusting relationships that each child dares to make forays into the wider world, beginning with taking up their role as a participant in the school community. This is the move towards interdependency where children grow via a take up in responsibilities rather than a demand for rights.

The creation of a therapeutic community calls for learning of a peculiarly immediate and personal kind on the part of all involved……….everyone is subject to scrutiny and while the process may be painful it cannot fail to increase individual awareness, provided of course that the group has the skill, motivation and shared ego strength to work through the problem rather than resort to escape devices or over hasty and false solutions.

Maxwell, Jones, 1968, Social Psychiatry in Practice

Opportunities grow from the new found confidence children find in dependable relationships and clear rules and boundaries. In groups in the households and classes, children begin to see that they can have a positive influence on the social and physical environment in which they live. They notice that their voice is being heard and their communications understood. Their increasing ability to consciously recognise these facts help them to make deliberate use of the developing skills they have.

Children are supported in this journey using the Social / Emotional APP (Assessing Pupils Progress) tool. This is a visual aid which through answering questions, helps children to recognise and see plotted on a diagram their social and emotional progress. They take pride in this progress and it is reflected in changes to the rights and responsibilities they experience in their groups and groupings in the houses and classes.

Much of the day to day living alongside activity between adults and children is the work of developing participation and citizenship.

The children see the pinnacle of this progress as election to the school council. This follows a hustings type event in which children canvas opinion, advertise what they feel they have to contribute and speak in front of the community, looking to ‘convince wavering voters’. They are voted for by their peers. The council takes an active role in the running of the organisation.

We measure children’s progress in culture of participation and citizenship through:

Their ability to make a contribution and become involved in the immediate and wider community.
How they have improved their self – awareness and value achievement.
Their ability to involve themselves appropriately in their care and the care of the environment.

Culture of Empowerment: Agency

As children develop their interdependency, they also develop a shared authority over their lives at a level appropriate to their age and stage of emotional development. This is agency.

The Mulberry Bush looks to nurture this in children, not to create false adult selves but to support the development of personal responsibility, also the ability to share responsibility rather than impose authority, the qualities of empathy and consideration for others. It is important that these qualities are nurtured at a level appropriate to the age and stage of the child. It does not deny that children need adults to look after them, but recognises the transition towards adulthood and importance of moving towards independence.

It is not enough to give emotionally deprived children good experiences, we must also help them to keep good things inside them, or they will lose them once more.

Barbara Dockar-Drysdale, 1990

Children at the Mulberry Bush are given appropriate levels of responsibility as they grow emotionally; they may be a buddy to a new child, show visitors round the school, attend a club or society outside the school, be a member of the school council or help present one of our sharing assemblies.

We measure the children’s progress of achieving agency through:

Whether they are a successful learner, and
Their ability to use and apply learnt skill and knowledge

The Mulberry Bush Provision

In the table below the Provision of the Mulberry Bush is described step by step, week by week, taking you through the phases of treatment.

Referral and Pre Treatment Phase
Enquiry(week 1)	The enquiry form is completed on line or following a phone request. Information is sent to the person enquiring together with the Referral Form. The enquiry form should be returned as soon as possible.Information about referred children are discussed at the weekly referrals meeting in which managers make decisions about offering places and timescales for admission.
Referral(week 4)	The referral form covers all information about the child, the family and the network: a chronology of the child’s history / education / early life experience / family history / child’s health. It also collects general administrative information.It collects the data for the Contextual Data spreadsheet (MBS Outcomes Project)This form will also collect academic achievement and attainment data as well as the views of carers and professionals about the child in relation to the school’s ‘Eleven Key Elements’.This enables the school to measure and communicate progress data from the beginning of the child’s placement.The referral process involves the Partnerships Manager working closely with the Therapies and Networks Team to identify areas of work with the child or with their family that may be required. These areas of work can then be explored with the network.
	The contextual data is entered by the family network practitioners into the database for the MBS Outcomes Project. Information is used to formulate the child’s Induction plan Other Base Line data is used to populate the child’s first Integrated Treatment Plan (ITP)
Pre professionals Meeting(week 5)	This is an opportunity, having read all the enquiry and referral paperwork received, to agree the additional information required in relation to the child, their family and / or the professional network from the professionals meeting. This need can be for factual information or developing a better understanding of working relationships or dynamics in the network.
Professionals meeting(week 5)	This meeting is called by the Mulberry Bush and brings together the relevant professionals to discuss the placement. A ‘Pen Picture’ case summary and risk assessment are prepared. The meeting for exploring: How integrated the network are in thinking about the child’s needs and the placement at the MBS. Further information about the child and their family that can inform the understanding of the child’s needs and those of their family. Placement objectives are agreed and written on the referral formThe contract should be signed at or by this point and the various required permission forms signed by the family or person holding parental responsibility for the child.
Parents / Carer’s visit to the school(week 7)	It is essential that the child’s family / carer’s visit the school prior to the child and reassure themselves that they believe the MBS is the right school for their child. This is the first essential step to them engaging with and becoming a part of the treatment process.The family / carers are given a copy of the Welcome Book.
Home visit(week 6)	This is usually the first opportunity to meet the child. This is an informal meeting, usually at home, talking with the child and their family about the school, the work it does and how it does it. It is an opportunity to develop an initial understanding of the way the child and their family will respond to the structures, routines and processes of the Bush. It is an important first opportunity to build a therapeutic alliance / working relationship with the child from which the work can be developed. In this way the meeting informs the development of the Induction Plan, the ITP and the Cultural Toolkit. This visit is not to decide whether the school can work with the child and their family but how.This meeting is carried out by the Director or the Partnerships Manager.
Child’s visit to the school(week 8)	The child must also visit to experience for themselves the culture value and ethos of the school. The child spends time in the Assessment House and in the Foundation Stage class and is supported by a buddy identified by the school council. The child may then be in a position to say whether or not they feel the school is somewhere that can help them.The child chooses a duvet cover which will be on their bed when they arrive and is given a personalised copy of the Child’s Welcome Booklet.
Preparation for the child’s arrival	In preparation for the child’s arrival, the treatment team (multi-disciplinary group) is formed and ‘email group’ created for them. The logging and reporting systems are set up and staff team fully briefed with the information received from the previous steps.An induction plan is created for the child. This plan shows day by day the graduated programme adapted for the needs of each child and the level of support planned for each step of the way. The plan demonstrates the ways in which provision is individually adapted depending on the diagnosis and individual needs of each child. Any diagnosis the child has is identified on the child’s ITP and the appropriate adaptations are then built into the plan.The child’s medical file is set up detailing any specific medical needs and their MAR sheet created.
Arrival(week 9)	The child will arrive about a week after their visit. They arrive into a ‘getting to know you meeting’. This meeting is an opportunity to pass on any last minute information. It is designed to provide an emotional handover of the child by the family to the school. It is therefore not usually about sharing new information but more about the process, ensuring the family feel heard and understood and that they know and have confidence in the staff that will be looking after their child.Formal minutes of this meeting are not taken. The house and class should ensure their staff, note and pass on any essential new information to those staff working the evening. All other information should already be known from the referral forms and the professionals’ meeting. The child then goes over to their household to settle in with staff from the house. This gives an opportunity to complete with the family any other more sensitive matters in the meeting before they join the child in the house to say goodbye. The goodbye can be a painful time and so is usually kept fairly short.
Assessment Treatment Phase
Summative Assessment Measures – used to measure children’s progress annually(also used for the MBS Outcomes Project)(week 1 – 12)	The assessment period starts and last for up to 12 weeks. This time is spent getting to know the child and supporting the child to get to know the staff at the schools and the structures and routines. Part of this process is undertaking various Summative Assessments. These Summative Assessment Measures are used to better understand each child’s needs and provide the second step in measuring the child’s progress on their care, treatment and education journey in the school. (the Pre Treatment information provides the base line data) Some are Standardised Assessment Tools whilst others are questionnaires designed to measure progress against the school’s ‘Eleven Key Elements’ (see assessment Model for details).They are used to inform the development of the ways we work with each child and are documented in the first ITP.
	The class teacher completes an initial assessment. This assessment may lead to a more in depth assessment by the school’s Educational Psychologist for some children. Each child also has a Speech and Language Assessment and Occupational Therapy Assessment. These are done at the start of the child’s stay and will only be repeated if required. They are intended to identify specific areas of work that may require specialist input and inform the child’s ITP and IEP (Individual Education Plan).
Formative Tracking Tools(week 1 – end of placement)	These tools are used on a more regular, weekly, monthly or termly basis to track progress. They are intended to show clearly to practitioners, networks and families what we have achieved and areas that require more focus. Staff use them to identify patterns in learning or behaviour and to intervene or change the way the child is being worked with to maximise the opportunities to improve outcomes. In this way they directly affect the areas of focus for the staff teams in their work with each child. They are tracked on each child’s ‘Tracking Record’ and by the end of week 12 the child’s ITP is completed.These tools cover all key areas of potential development for the child; aggression/ antisocial behaviour, academic achievement/attainment, social/emotional growth, health and family work. Incidents of Aggression and Antisocial Behaviour – Staff record incidents of aggression, self – harm, sexualised, damage to property, bullying and where a physical intervention has been necessary. These are all entered on an Excel data base and reviewed weekly by the Head of Group Living. Patterns and concerns are noted and the Treatment team Informed requesting action be taken to address the identified issue. Progress against these areas is monitored in a monthly meeting with managers and displayed on the child’s ‘Tracking Record’ Target Tracker – Teachers use this system to monitor academic progress and identify areas in which the child may be making less progress. Although teachers use these forms as live documents and so they inform the week to week planning for each child, they are reviewed formally each term. Social and Emotional APP _ The households use this system to monitor social and emotional progress against the ‘Eleven Key Elements’. The documents are live and used day to day to guide and inform work and treatment planning. They are reviewed more formally each month in Treatment Team Meetings. The results are displayed on the child’s ‘Tracking Record’ Health – Each child has a termly health check with the school nurse. This opportunity is used to ensure the child is fit and healthy and that any necessary actions are being taken to maximise their health whilst in treatment at the school. The child’s BMI (weight and height) and resting heart rates are tracked in the ‘Tracking Record’. Partnership Plan _ As described below this plan is used to monitor and plan work with those in the network including the family and / or carers.
Working with Professional Networks	We know that children make the most progress when all stakeholders are working closely in support of the work undertaken in the placement. The Therapies and Networks Team strives to develop good partnership working with all professionals in the network team. A written plan of this work and progress in relation to it is kept in the Integrated Treatment Plan.
Working with Families	The assigned family and network practitioner will look to engage with the child’s carers and other family members as appropriate. In order to return the child to a stable home base, engaging with families to better understand the difficult position they find themselves in is an essential component of the work. Twice yearly, targets are written and reviewed in relation to work with parents, carers and networks. This enables us to monitor and track the work, assess whether the approach is working or whether something different is needed. This is linked into each child’s treatment team meetings and internal case conferences.
Treatment Planning and Reporting Systems	The Integrated Treatment Plan (ITP) is completed initially using information from the Referral form and the intensive 12 week assessment process. It is the document that records our work and progress with each child. It is the document that is used as a live document internally by all members of the Treatment Team in the school and prepared for use at reviews with professionals and families. It includes placement objectives, base line data, graphs that track progress, risk assessment data, and a comprehensive description of the process of our work with our observations and practice guidance.It is reviewed formally every six months for the child’s Looked After Child Review and Annual Educational Review.
Assessment Summary Report	The first ITP and Tracking Record comprise the Assessment Report. This report summarises outcomes of the Assessment Phase. It documents our observations of the child and practice guidance. The results of the assessment and tracking or base lining processes are included against which progress is measured during the placement. The report will also provide guidance detailing our view of achievable progress for the child and their family.
Mid-Treatment Phase
Internal Case Conferencing (ICC) System	At the end of the assessment period the child’s first ICC is held. This is then repeated twice yearly during the child’s stay. Its function is a review of the child’s progress by managers making use of the data collected from both the Annual Assessment Measures and the Tracking Tools. The result is guidance to the treatment team on areas that require more focus as well as any unhelpful patterns that have been identified. It is also of course important to praise where progress has been made.
Additional mid – treatment Therapeutic Interventions(optional)	Stemming from the Integrated Treatment Plan and the ICC, various additional tools are used to support and develop the core therapeutic milieu work of the school. These are individualised and adapted to meet each child’s needs and incorporated into the treatment with the knowledge and support of referring authorities and families. Individual work – Although working with the children individually and in groups is a central part of the day to day provision of the Bush, it is sometimes decided to set up an individual time with a staff member. This 1:1 time is at a set time and place each week and usually has a set format and location. It can be in recognition of a specific attachment that a child is developing with a staff member that through nurture and protection can develop to form a key part of the therapy of relationship building for the child. In other circumstances it can be put in place to assist a child in developing a relationship or exploring certain issues that staff may feel the child is trying to communicate but struggling to do within the milieu setting. The staff member will use supervision to maintain a conscious use of themselves in the developing relationship and to best understand the communication taking place in the session. Individual or Group Psychotherapy – All children receive a story stem psychotherapy assessment in their first twelve weeks. The results of this, together with information from the assessment period, are used to develop the treatment plan for each child. For some children it may be felt that psychotherapy, individual / group drama therapy or music therapy would be supportive of their treatment. Sometimes a therapist may join a staff member for a regular ‘individual time’ as a way of facilitating the development of relationships, or to help bring out the emotional content of sessions. Decisions about individual therapy are made between the therapists and the child’s treatment team. Life story work – Some children benefit from an additional time each week with one or two staff members to develop their understanding of their life. These sessions are carefully planned and prepared with a great deal of thought being given to sharing difficult information with the child. Referrals to CAMHS – Once a term a psychiatrist from Witney CAMHS visits the school. The purpose is to review children’s medication and to consult about other mental health issues. We routinely liaise with other camhs teams that might have worked with a child and family. Group work – All children take part in a weekly formal group. These groups, facilitated by staff trained in group work, help the children explore issues of being in a group, something that all referred children find very challenging.
Family Work	During the mid-treatment phase the hope is that relationships have been developed with the family enabling a more rigorous phase of challenge and engagement. The aim of this phase is to support change in the family so that there is a shared context to understand the changes the child has made. The intention is to support the family to create a stable home base for the transition of the child home at the end of the placement if this is appropriate. In other situations it may be supporting the family to understand that the child may need a provision away from home at the end of their time at the Bush and why this may be so. Family weekends are arranged where this work can start to take place and where parents and carers can gain first hand experience of the school. Various activities are arranged for families together in groups and also for parents and carers to talk together.
Transition Phase
Transition Planning	The school’s treatment team will be discussing the transition plans for each child at least a year before their expected leaving date. These discussions in Treatment Team meetings will inform treatment planning with the child, their family and network. It will therefore be documented in the ITP. Discussion with the network will begin early in this process to try and ensure joined up thinking and a carefully planned and managed transition for the child and their family.
Final ICC	This final ICC brings together information from our Formative and Summative Assessments to summarise the progress the child has made and be clear about their current level of functioning. This information presented in the Final ITP is used in Partnership meetings to identify an appropriate next placement and plan the transition.

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