The language and terminology used in residential children’s services significantly impact practice and perceptions. Traditionally, distinctions have been made between “care” in children’s homes and “support” in supported accommodation. However, this binary classification often oversimplifies the reality of service delivery and fails to reflect the continuum of care needed by young people as they transition through different settings. Recent discussions have highlighted inconsistencies between the Supported Accommodation Regulations and the interpretations of professionals, more or less involved in the sector, leading to confusion and debate about whether services should be categorized as care or support and what kind of intervention can be provided in supported accommodation.
To address these issues, this document proposes a redefinition of terminology by introducing “controlled care” and “guided care.” These terms aim to clarify the nature of care in different settings, providing a more nuanced and accurate framework. Additionally, the document explores how staffing ratios intersect with these care models and the need for terminology that aligns with regulatory expectations and practical realities.
Addressing Inconsistencies in Terminology
Recent debates have emerged due to inconsistencies between the Supported Accommodation Regulations, the expectations set and the public interpretations. The regulations acknowledge that care is a continuum, recognizing that young people’s needs evolve over time and that care should adapt accordingly. However, in practice, many providers face challenges in reconciling this continuum with the often-rigid categorizations of “care” versus “support” used, for example, by Ofsted during inspections and registration visits.
Regulatory Confusion
The Supported Accommodation Regulations outline that care provided in supported accommodation should be seen as part of a continuum, meaning that support and care are not mutually exclusive but interconnected. This perspective aligns with the understanding that young people need different types of care at various stages of their development and transition.
Despite this, in recent communications, it appears that the stricter dichotomy between care and support is being enforced. Providers are often left grappling with whether their services are delivered the interventions that can be delivered, being classified as “care” or “support,” leading to unnecessary debates and inconsistencies in how services are evaluated and understood.
“Controlled Care” and “Guided Care”
To resolve these inconsistencies and better reflect the realities of residential services, this document proposes using the terms “controlled care” and “guided care.” These terms are designed to capture the different approaches used in children’s homes and supported accommodation while acknowledging that both types of services provide care in their own ways.
1. Controlled Care
Controlled care describes the approach typically used in children’s homes, where a high level of supervision, routine, and regulation is necessary. This approach is essential for creating a stable and secure environment for young people who have experienced significant trauma or instability. “Controlled care” emphasizes the role of structured environments, consistent boundaries, and oversight in ensuring safety and supporting the young person’s immediate needs.
The term “controlled” is intended to reflect the need for regulation and structure, not to imply authoritarianism or rigidity. It highlights that the care provided is designed to stabilize and support young people in a way that prepares them for future independence. Controlled care is characterized by its focus on keeping safety and stability through a carefully managed environment.
2. Guided Care
Guided care refers to the approach used in supported accommodation, where the focus is on promoting independence while providing necessary support. In this setting, care is less about direct oversight and more about guidance and mentorship. Staff members act as advisors and facilitators, helping young people develop life skills, make informed decisions, and navigate the transition to independent living.
“Guided care” emphasizes the supportive role of staff in fostering autonomy and personal growth. It reflects a flexible and responsive approach, adapting to the needs and progress of the young person. The goal is to empower young people to manage their own lives with the help of a supportive framework that encourages independence and self-confidence.
Staffing Ratios
Staffing ratios in residential children’s services play a crucial role in ensuring that young people’s needs are met effectively and safely. However, the notion that staffing ratios alone decide whether care is “controlled” or “guided” oversimplifies the situation. Instead, the essence of care is defined by the approach and intent behind staffing practices, not merely the number of staff members present. This section explores into how staffing ratios intersect with care models and the importance of practice over numbers.
Practice Over Numbers
Staffing Ratios and Care Models
Staffing ratios refer to the number of staff members compared to the number of young people in care. Higher staffing ratios can provide increased supervision, support, and safety, which is particularly important in environments requiring intensive care. However, the mere presence of a higher staff ratio does not automatically translate to “controlled care” or “guided care.” The key factor is how staff use their time and resources.
For example, a residential setting with a 1:1 or 2:1 staffing ratio might be thought of as indicative of “controlled care,” particularly if the focus is on constant supervision and behaviour management. However, this high ratio could also exist in “guided care” if the staff’s role is primarily to mentor, support decision-making, and encourage independence.
Conversely, a children’s home with a lower staffing ratio might still implement “controlled care” effectively if the staff are trained to manage behaviour and support structured routines within the available staffing framework. The emphasis in controlled care is on keeping a stable, safe environment through intentional practices, not just the number of staff on duty.
The Importance of Approach
The effectiveness of care is determined by the approach taken by staff members. In a controlled care setting, staff might use higher ratios to ensure safety and structure, but their practices are oriented towards maintaining order and stability. In a guided care setting, even with higher ratios, staff would focus on promoting independence, offering guidance, and facilitating personal development.
Therefore, a nuanced understanding of care requires examining how staff interact with young people, how they manage their responsibilities, and how they apply their training and skills in different settings. Staffing ratios are a tool that supports these practices but do not define them.
Flexibility and Adaptation
Dynamic Needs of Young People
The needs of young people in residential care are dynamic and can change over time. Staffing ratios alone do not account for the evolving nature of these needs. A young person may initially require a more structured approach with higher staff supervision but may later benefit from a more guided approach as they gain confidence and skills.
For instance, a young person with complex behavioural needs may start in a controlled care environment where staff ratios are high to provide consistent supervision and intervention. As the young person develops and their needs change, the care approach might shift to guided care, even if staffing ratios remain the same or change. This transition can involve staff focusing more on mentoring and less on direct supervision.
Integrating Care Approaches
A flexible care model integrates both controlled and guided elements based on the individual’s needs. In practice, this means that care providers need to be adept at adjusting their approach in response to the young person’s progress. Staff might use a structured environment to provide stability but also incorporate elements of guidance as the young person becomes more capable of managing their own behaviour and making decisions.
For example, in a children’s home, staff might initially use a controlled care approach to stabilize a young person’s situation. As the young person’s behaviour improves and they become more self-sufficient, staff can gradually introduce guided care practices to foster independence, while still maintaining necessary oversight.
Balancing Supervision and Autonomy
Ensuring Safety While Promoting Independence
In both controlled and guided care models, the balance between supervision and autonomy is crucial. High staffing ratios can provide the support necessary for young people who need a controlled environment, but they can also support guided care practices if staff use their time to encourage independence and self-management.
A well-designed care model ensures that young people receive the appropriate level of supervision to stay safe while also being given opportunities to develop autonomy. For instance, staff in a controlled care environment might use their higher ratios to establish routines and boundaries but also engage in activities that promote the young person’s growth and decision-making skills.
Examples of Effective Practice
Controlled Care with High Ratios: In a children’s home, a high staffing ratio can be used to implement consistent routines, manage behaviours, and ensure safety. For example, staff might work individually with young people on specific goals related to behaviour management while also creating a stable and structured environment.
Guided Care with High Ratios: In supported accommodation, a high staff ratio can be leveraged to provide extensive mentoring and support. Staff might use one-on-one time to help young people plan their daily activities, set goals, and navigate challenges, while still maintaining a focus on encouraging independence.
The Challenge of Defining Children with Complex Needs
The term “children with complex needs” is often used in residential and supported accommodation settings, yet it remains a difficult concept to define clearly. This ambiguity stems from the fact that “complex needs” is not a fixed category but rather a fluid and dynamic spectrum of physical, emotional, behavioural, and social challenges that vary greatly from one individual to another. The complexity lies not just in the presence of multiple needs but in how these needs interact and evolve over time, requiring a highly individualized approach to care and support.
For instance, a young person might be considered to have complex needs due to a combination of mental health issues, such as anxiety or depression, alongside learning disabilities, behavioural difficulties, or a history of trauma. However, another young person with entirely different challenges – such as chronic medical conditions combined with social isolation and emotional dysregulation – might also fall under this category. The broad range of factors that can contribute to a child’s complex needs makes it impossible to establish a single, clear-cut definition.
Moreover, the complexity of a young person’s needs can change over time, influenced by their environment, developmental stage, and the effectiveness of the support they receive. A young person who requires intensive support at one point may, with appropriate care, progress to needing less structured intervention, while another might require more support as their needs evolve. This fluidity further complicates efforts to categorize or define complex needs rigidly.
The recent position taken by Ofsted, suggesting that children with complex needs should not be placed in supported accommodation, reflects a fundamental misunderstanding of both the nature of complex needs and the capabilities of supported accommodation settings. This stance is not only overly simplistic but also counterproductive, as it fails to recognize the flexibility and adaptability that supported accommodation can offer. By assuming that these settings are inherently ill-equipped to handle complex needs, Ofsted overlooks the reality that many supported accommodations are specifically designed to provide the tailored, responsive care that these young people require. Such a blanket policy risks depriving children with complex needs of the opportunity to develop independence in a supportive environment, where their needs can be met with personalized care plans and skilled staff. This approach undermines the potential for supported accommodation to serve as a vital step in a continuum of care, where even those with significant challenges can thrive with the right support.
In supported accommodation, the challenge is to create care models that are adaptable and responsive to these varying and shifting needs. Rather than attempting to fit young people into predefined categories, the focus should be on understanding each individual’s unique circumstances and crafting personalized care plans that can adapt to their changing needs. This approach recognizes the impossibility of a one-size-fits-all definition and instead emphasizes the importance of flexibility, continuous assessment, and a holistic understanding of each young person’s situation.
By acknowledging the difficulty of defining complex needs, supported accommodation providers can avoid the pitfalls of rigid classification systems that may fail to capture the true nature of a young person’s experiences. Instead, they can develop more effective, individualized strategies that truly meet the diverse and dynamic needs of the children in their care.
When Guided Care Can be Used in Children’s Homes
Children’s homes are traditionally associated with a more structured, controlled environment designed to provide stability and safety for young people who have experienced significant trauma, instability, or complex behavioural challenges. However, even within these settings, the principles of “guided care” can be effectively integrated to promote the young person’s autonomy, personal growth, and eventual transition to more independent living.
Guided care in children’s homes focuses on blending the necessary structure with opportunities for young people to take more control over their daily lives and decision-making processes. It involves staff acting as mentors and role models, providing support that is responsive to the young person’s evolving needs while encouraging them to develop the skills and confidence needed for independence. This approach recognizes that, even within a controlled care environment, young people can benefit from guided support that prepares them for life beyond the children’s home.
Implementing Guided Care Practices
- Personalized Support Plans: In children’s homes, guided care can be implemented through individualized support plans that reflect the unique needs and aspirations of each young person. These plans should incorporate goals related to increasing independence, such as learning daily living skills, managing emotions, or navigating social relationships. Staff can work collaboratively with the young person to set achievable milestones and provide the guidance needed to reach them.
- Shared Decision-Making: A key element of guided care is involving young people in decisions about their care and daily routines. While maintaining necessary boundaries and oversight, staff can encourage young people to express their preferences, make choices, and take responsibility for certain aspects of their lives. For instance, they might be involved in planning meals, choosing activities, or setting personal goals. This shared decision-making fosters a sense of ownership and helps young people develop critical thinking and problem-solving skills.
- Mentorship and Emotional Support: Staff in children’s homes can adopt a mentoring role, offering not just supervision but also emotional support and guidance. By building trusting relationships, staff can help young people explore their interests, understand their emotions, and develop resilience. This mentorship approach aligns with guided care by focusing on the young person’s overall development, rather than just managing behaviour.
- Gradual Increase in Responsibility: Guided care in children’s homes can also involve a gradual increase in the young person’s responsibilities as they demonstrate readiness. This might include tasks like managing their own time, handling money, or participating in household chores. These opportunities to practice responsibility in a supported environment help prepare young people for the greater independence they will need when they transition out of the children’s home.
Balancing Structure and Flexibility
While children’s homes inherently provide a structured environment to ensure safety and stability, integrating guided care requires a balance between maintaining necessary controls and offering flexibility. The goal is to create a supportive environment where young people feel secure enough to take risks, learn from their experiences, and grow. Staff must be adept at adjusting the level of guidance based on the young person’s progress, ensuring that the care provided remains responsive and developmentally appropriate.
The Benefits of Guided Care in Children’s Homes
Integrating guided care within children’s homes offers numerous benefits. It helps young people develop a stronger sense of self, improves their decision-making abilities, and enhances their readiness for independence. Moreover, it can lead to more positive outcomes by reducing reliance on external controls and empowering young people to take charge of their own lives.
Guided care also promotes a more holistic approach to care, where the focus is on the young person’s long-term well-being and success, rather than just immediate behavioural management. By combining the stability of a controlled environment with the growth opportunities of guided care, children’s homes can better support the diverse needs of the young people they serve.
When Controlled Care May Be Necessary in Supported Accommodation
Crisis Situations
In cases where a young person experiences a significant crisis – such as severe emotional distress, a mental health episode, or a sudden behavioural escalation – immediate intervention is required to prevent harm. During such times, staff may need to implement more controlled care practices, such as increased supervision, stricter routines, or temporarily limiting certain freedoms to ensure the young person’s safety.
For example, if a young person exhibits self-harm behaviours or becomes a danger to others, it may be necessary to increase monitoring, reduce their autonomy temporarily, and create a more structured environment until the crisis is resolved. Once the situation stabilizes, staff can gradually return to the guided care approach.
Safeguarding Vulnerable Young People
There may be instances where a young person in supported accommodation is particularly vulnerable – whether due to external threats, exploitation risks, or personal challenges – that require a higher level of control and supervision. For instance, if a young person is at risk of being drawn into criminal activity or is facing external pressures that could lead to harm, staff might need to enforce stricter boundaries, curfews, or supervised activities to protect them.
In such cases, controlled care practices might be adopted temporarily, ensuring the young person is safe while longer-term solutions are developed. The focus remains on safeguarding while still aiming to return to guided care as soon as possible.
Behavioural Management
If a young person exhibits persistent behaviours that endanger themselves or others, it may be necessary to adopt more controlled practices temporarily. This could involve implementing stricter routines, reducing access to potentially harmful activities, or increasing staff presence to manage behaviours effectively. The goal remains to transition back to guided care once the young person demonstrates improved self-regulation and stability. If this will not be possible, consideration for another type of setting must be given.
Balancing Controlled Care and Guided Care in Supported Accommodation
The key to effectively integrating controlled care practices in a guided care setting is flexibility and a clear focus on the young person’s long-term development. Any shift toward controlled care should be:
- Temporary and Proportionate: Controlled care practices should be used only for as long as necessary and should be proportionate to the risks involved.
- Clear Communication: Young people should understand why controlled care practices are being implemented, with a clear plan for returning to a guided care approach.
- Collaborative: Whenever possible, involve the young person in decision-making, helping them see these measures as part of a supportive process rather than punitive.
- Review and Transition: Regularly review the need for controlled care practices and plan for a transition back to guided care as soon as the situation allows.
Conclusion
The debate over the classification of care and support in residential services, particularly the idea that children with complex needs should not be placed in supported accommodation, highlights a significant disconnect between regulatory expectations and the realities of care provision. This rigid approach fails to acknowledge the flexibility and adaptability inherent in supported accommodation settings, which are often well-equipped to meet the complex needs of young people through tailored, guided care. The insistence on separating care and support categories overlooks the potential for supported accommodation to offer both the structured support and the developmental opportunities necessary for young people with complex needs.
The real challenge lies not in the terminology or rigid categorizations, but in ensuring that care models are responsive and individualized. By recognizing that both “controlled care” and “guided care” can coexist and that supported accommodation can effectively address complex needs with the right approach, we can better serve the young people who rely on these vital services. It is crucial to move beyond simplistic regulatory classifications and focus on the quality and adaptability of care practices, ensuring that every young person receives the appropriate level of support they need to thrive. Only then can we create a more coherent and effective framework for residential care that truly meets the diverse and evolving needs of young people. Looking forward, there is a tremendous opportunity to enhance the effectiveness of residential care by embracing innovative practices and fostering a collaborative approach between regulators, providers, and young people. By building on the strengths of both care models and continuously adapting to the evolving needs of those we serve, we can create a more inclusive, supportive, and effective framework for residential care. This forward-thinking perspective holds the promise of delivering even better outcomes for young people, ensuring they have the tools and support they need to achieve their full potential and build a brighter future.
Miguel Valerio 