In this first stage it is important to make the child and young person feel welcome in either Hill House or Blossom House (the residential homes) and to allow them to feel safe and secure.  Without safety as a cornerstone of the milieu nothing is possible, only the perpetuation of harm.

We make it very clear from the beginning that our efforts are firstly to invite, and then to engage the young person in a collaborative endeavor where we work with rather than do something to them.

Once the young person has developed a secure base the focus is to develop with them a Master Treatment Plan which is essentially a map of what the programme may offer

them.  The construction and ongoing refinement of the Master Treatment Plan is central to providing safety as it is the basis of a contract between the Galtee Clinic and the young person and removes ambiguity and confusion.

Much violence and disruptive behaviour in residential childcare emanates from this lack of informed consent and a treatment contract.

Strategies used in Stage 1

• Introduce the young person to the structures and routines of life in Hill House, Blossom House and the farm.  These structures and routines allow for a sense of predictability and order which reduces anticipatory anxiety relating to a lack of knowing
• The young person will have their own Weekly Planner which outlines daily routines and the various activities that they will be involved in
• Weekly Community Meeting provide opportunities for young people to identify activities they have an interest in, and allows for a collective responsibility of being part of the farm, Hill House and Blossom House thereby developing an all important sense of belonging
• The installation of hope through stories and allegory

In the second stage opportunities are provided for the young person to learn the basic skills that are necessary for success in adolescence and in life, therefore forming the basis of any necessary therapeutic work.  This step is extremely important as engaging in any more formal psychotherapeutic work without these skills can be overwhelming and, therefore, re-traumatising.

The basic skills that we focus on are cognitive-behavioural in nature and most often include Emotion Awareness and Management, Interpersonal Skills, Tolerating Distress and Mindfulness.

Strategies used in Stage 2

• It is widely known that many young people are hesitant about being involved in certain processes, such as social, educational, relational, as previous experiences have often reinforced a sense of ineptitude and failure.  Correspondingly, the staff in the Galtee Clinic will teach and model these skills during the course of daily activities
• Psychosocial Skills Building occurs as part of the routines and activities of daily life, rather than this learning being provided in a formal didactic environment
• This is achieved in manner that reinforces that this is a collaborative process rather than something being done to someone

Many of the children with whom we work have suffered significant disruptions in attachment and have suffered traumatic experience throughout their lives. This combination creates the development of complex and wide ranging psychosocial difficulties, which often include disruptions in identity, significant struggles with relationships, difficulties in affect regulation and behavioural control.  These difficulties often result in the young person continuing to recreate the trauma through their behavior, thoughts and feelings.

The goal of treatment is, therefore, to provide the right opportunities to address these concerns.

Strategies used in Stage 3

Use of evidence based approaches that have been identified in the clinical literature as being effective in working with identified issues, including:

• Cognitive-Behavioural Therapy (CBT)
• Eye Movement and Desensitization and Reprocessing (EMDR)
• Exposure Based Treatment
• Mentalisation Based Treatment (MBT)
• Systemic Family Therapy.

All of these specific treatment modalities are provided by appropriately trained, qualified and experienced individuals within the Galtee Clinic staff team.

The focus of this fourth stage is to practice the real and everyday life skills that are necessary to eventually succeed as an adult and be an active contributor to one’s community.

The particular skills required are idiosyncratic, depending on the child’s level of exposure and competence in various areas, but should include commonplace things such as using grocery shopping, domestic chores, being involved in afterschool activities and attending to one’s physical and mental health through balance and fun.

Strategies used in Stage 4

• The development and practice of essential daily life skills
• Experience a sense of accomplishment and security within the Galtee Clinic
• Feeling ready to be an active member of the local community around the Clinic.  It is our responsibility to support this involvement by identifying and developing  interests and seeking out social prospects for young people to engage with others
• The provision of work experience and apprenticeships where appropriate

The focus of the fifth stage is on the transition out of the Galtee Clinic into living in the community.  As evidence has clearly shown, the move out of care for many young people may be better described as a ‘tumble’ rather than a ‘step down.’  Therefore, the Galtee Clinic makes a long-term commitment to the young person, and understands that a successful transition out of care needs to be planned and executed with thoughtfulness and precision. Any transition needs to be experienced in a manner that allows for coming and going rather than an abrupt end.

Strategies

• The goal of “independence” for young people is fundamentally flawed.  No-one lives an independent life.  Our goal is for young people to live successful interdependent lives.
• We help young people move out of the Galtee Clinic and into the community as part of a gradual and planned process.
• Identify and secure lodgings for young people well ahead of any planned move
• Allow for an incremental move to the community that decreases the likelihood of significant difficulties and disruptions

The sixth stage happens after the young person leaves the Galtee Clinic and, in most cases, reaches the age of majority and leaves the formal care system.  In a manner similar to regular family life, it is imperative that young people experience a continuation of relationships and support from those who provided it before they reached 18 years old.  The Galtee Clinic recognizes that there needs to be a commitment that lasts well into adulthood, with a range of contact and engagement opportunities dependant on the needs and life circumstances of individuals. We are positioned in such a way that we have the adaptable facilities to provide this much needed service.

Strategies

• Longstanding commitment to the young person
• Designed to be flexible to the needs and requirements of individual young people.  This may range from some individuals stating that they neither want nor need any further contact to others that will need some form of regular check in and support for years to come

Young people know and believe that the Galtee Clinic, both as a service and its individuals, is something that can be called upon as a resource when need arises, thereby providing continuity the essential component of effective aftercare.