Rupture, repair and building resilience in residential care

Residential care is not somewhere kids should have to live.

All children deserve a safe home with adults who care about them. Unfortunately, there are lots of kids who end up living in residential care with paid carers rostered to come into the unit and look after them.

However, for one 11-year-old that we’ve been working with, it’s been a positive place for him to live… temporarily.

Axel*, his mum and his little sister moved every couple of months when he was little. His mum struggled to look after them. When Axel started school, teachers immediately became worried about him. Child Protection services placed both kids in a foster home.

His little sister quickly formed a strong attachment to the carer. Axel didn’t. His fear increased and he started having meltdowns. They started off being a few hours long. Soon they lasted all day. The foster carer reluctantly said she couldn’t keep caring for Axel. Successive foster carers also struggled to cope with his violent and self-harming behaviour during the meltdowns. Several times ambulance officers came and forcibly sedated him.

Axel was diagnosed with Reactive Attachment Disorder and Post-Traumatic Stress Disorder. A foster care placement became impossible. At 9 years old he moved into a therapeutic residential care unit on his own.

When Axel arrived at the residential care unit his meltdowns continued. Some of the carers in the house would try to comfort him. Others would give him consequences. Neither worked. Axel and the residential unit carers were referred to Berry Street’s Take Two service for specialist trauma-informed help.

The Take Two clinician Emma started working with the carers rostered in the unit. Everyone wanted to improve life for Axel. She started facilitating regular reflective practice and psychoeducation sessions to support them to better look after Axel. Emma needed to help the carers to understand that Axel had never had a safe and caring relationship with an adult. He was pushing everyone away because he was terrified of relying on anyone other than himself. His meltdowns were his way of trying to survive.

Axel’s mum hadn’t been able to look after him or his sister. Instead of helping his mum, grownups had arrived, put some of their things in a bag and taken him to live in a stranger’s house. Since then he’d been taken away from his sister. Adults had made him live with new rules that he didn’t understand, and ‘rejected’ him when he tried to protect himself. Grownups in uniforms had held him down and sedated him when he didn’t know what they were doing.

It didn’t matter what the intentions of these people were, Axel saw all adults as dangerous. He thought he could only rely on himself to stay safe.

Emma explained Reactive Attachment Disorder and encouraged the carers to deliberately use a trauma-informed relationship-building approach with Axel. Together they practised and role-played ways they could communicate to Axel that some of his reactive behaviours were unwanted, without making him feel unwanted as a person.

Rather than being angry at him when he had a meltdown or lashed out, Emma taught the carers to be curious and try and understand why he reacted that way. She helped them learn to be more empathetic with him, to give him time and space to explain things himself rather than them making assumptions. She encouraged them to try and imagine what his fear felt like – and understand that disciplining him would make it feel worse. She suggested ways for them to use a more playful tone of voice with Axel when he could tolerate it.

Emma has also spent time helping the carers find ways to regulate themselves so they can remain calm when Axel isn’t. Using her clinical understanding of complex childhood trauma, Emma has helped the carers understand Axel’s trigger points so they can give him space when the relationship starts feeling too much for him.

The way residential carers are rostered in the house has worked for Axel. He’s been exposed to several adults predictably coming and going from the house, creating tolerable ‘doses’ of safe relationships. After a morning and lunchtime spent with one carer, a different – but familiar – carer would come into the unit for the afternoon and evening. This has been allowing him to build trust in his carers through a technique called ‘rupture and repair’.

When a child feels angry or upset (a rupture) the adult helps them repair by being calm and reassuring. It’s up to the carer to repair any ruptures that have occurred in the relationship, and to understand the child’s behaviour. There are still consequences for Axel’s behaviours but they are about repairing the relationship, not punishing Axel. Importantly for Axel, the carer would come back for their next shift.

The carers can only do this because they accept Axel unconditionally and have separated him as a person from the way he reacts to something. It allows Axel to build trust in his carers, but also in the world around him.

Several of Alex’s meltdowns started with him banging and screaming on the locked office door in the residential care unit. The office is usually off-limits to the children and young people who live in residential care. Staff were scared he was going to try and steal something or try to access medication kept in the office.

Emma saw that Axel was just curious about what was inside. She suggested that Axel watch them putting the medication in a locked box in the cupboard and they explain it was so he didn’t hurt himself. The carers then started leaving the office door open. Axel poked around in the office a few times but soon became bored. He had no desire to steal anything, he just wanted to see inside.

The carers started doing their handovers (ordinarily done in the office behind a locked door) at the kitchen table. On Emma’s advice they’ve started the handover as an opportunity to reflect on how the day had gone so far, knowing that Axel will often listen in. They now use language Axel can understand and are careful to talk about things in a way that avoids him feeling shamed.

The trauma-informed way the carers are looking after Axel is working. In the 18 months he’s been living there, he’s gone from being a closed-off kid, to one that smiles and laughs often. He likes learning card tricks on YouTube and his cheekiness is shining through. His meltdowns still happen but now they are only occasional, and much shorter.

With Emma’s support his carers have been helping Axel learn how to describe how he’s feeling. He’s also been increasingly showing empathy for others. Recently he got angry and kicked a carer in the knee. She came to the unit the next day wearing a knee brace. When Axel saw it, he went silent and walked to his bedroom and wrote her an apology letter.

The carers looking after Axel have needed a lot of guidance and debriefing from Emma to be able to stay the course with Axel, but the rewards are really becoming evident.

Emma says Axel has been going to school and is doing well.

“He’s also been speaking to his sister on FaceTime. She’s still living with the foster carer who cared for them both when they were first placed in out of home care,” she said. “The foster carer is keen to have Axel come to visit after COVID restrictions have eased more. Presuming that goes well, we can start slowly transitioning Axel out of the residential care unit and back into her home.”

*Names have been changed and models are used in our photos to protect the identity of the children and families we work with.

Berry Street’s Take Two program is a Victoria-wide therapeutic service helping to address the impact on children of the trauma they have experienced from abuse, neglect or adverse experiences. Take Two can also provide specialist clinical consultancy services to other organisations. Learn more about our Take Two service.