Seamab

Case Study

Seamab + University of Strathclyde

The development of a holding environment to reduce physical restraint at Seamab Residential Child Care and Education Service.

Awards and Achievements

KTP Final Grade: A ⭐⭐⭐⭐⭐

The project was awarded the grade of "Outstanding" by the KTP Grading Panel for its achievement in meeting KTP's objectives.

Seamab

Seamab is a charity based in Perth and Kinross, Scotland. It provides residential, therapeutic care and education for children who have experienced trauma and other adversities, including abuse and neglect. Maintaining a particular focus on inspiring the young people to experience adventures in learning and life while at Seamab, love, joy, care and nurture are central to the work.

The Challenge

The impacts of trauma and other adversities on some of the children can manifest in the form of behaviour that poses serious, imminent harm to themselves or others. On these occasions, when less restrictive interventions prove ineffective or are not possible, workers must physically restrain the child, meaning they must physically hold the child to prevent harm.

Physical restraints themselves can be traumatising or re-traumatising – for the child and for the adults. Physical restraints have caused injury to those involved and is associated with staff turnover and sickness. The use of physical restraint also raises questions about potential violations of children’s human rights. Further, in 2020, following an Independent Care Review, the Scottish Government established a policy known as 'The Promise', which pledged that ‘Scotland must strive to become a nation that does not restrain its children’.

Yet not physically restraining the child, in some circumstances, may result in even more significant harm.

The Solution

The KTP took a co-productive approach to build on existing good practice and expertise while integrating new ways of thinking and practicing. Using a human rights perspective and key theoretical frameworks of therapeutic containment and holding environments, key skills, knowledge, and capacities were developed or bolstered in Seamab’s members. Systems were created and trialled to maintain these developments and to support the ongoing growth of Seamab’s organisational culture.

The work coalesced around four areas of practice that embedded the knowledge transfer:

Establishing and developing reflective fora;
Establishing a crisis response approach for teams of workers when supporting a child going through a prolonged period of crisis – ‘The Team Around the Team’;
Developing reparative work, i.e., a model of restorative practice used after physical restraint occurred, and ways of repairing ruptures to relationships between adults;
Radically changing the focus and activity of the pre-existing Reducing Incidents Committee and identifying this group’s pivotal role in furthering the implementation of children’s rights.

These areas of work were essential to building a holding environment – an environment that ‘holds’ its members in a fabric of beneficial relationships supported by systems, processes and cultural norms – thereby allowing the transfer of academic knowledge. They also became core mechanisms through which we aimed to embed knowledge within Seamab, to provide frameworks which could remain post-project. A more detailed report of the processes and outcomes can be found here: Developing a Holding Environment

The Impacts and Benefits

Impacts for the Company

While the factors that influenced the changes below did not (and could not) all emanate solely from the KTP, evaluation data indicated the following impacts, all of which were reported as being strongly influenced by the KTP by those who took part:

Increases - sometimes substantial - in the percentage of workers who reported:

consistent reflective conversations with adults and with children after occurrences of physical restraint;
the presence of resources and support available at Seamab that helps to make things more manageable when the work is difficult;
feeling ‘okay’ to discuss ‘getting it wrong’ in escalating situations in which the potential for physical restraint increases;
a change in how they actively considered a range of children's rights.

Qualitative data indicated positive changes in workers’ thinking: from a functional orientation in responding to children’s distress to one that was more reflective. Willingness to discuss the impacts of the work on their practice grew. These changes point towards increased psychological safety and reflectiveness in Seamab’s culture - key components of a holding environment.

A majority of children who responded to the child survey indicated being happy or very happy with the support they receive in sorting out conflicts (related to reparative work). None expressed dissatisfaction.

Other impacts include:

an over 50% reduction in the number of physical restraints in the second year of the project as compared with the first, with fewer physical restraints in the final quarter than the same six-month period for each of the previous four years;
a 6% reduction in staff turnover (as compared with the same period the previous two years) during the project’s final 8 months; an over 50% reduction in staff injuries during incidents with children during the second half of the project.

Impacts for the Academic Team

The academic team gained capacity through the opportunity to integrate knowledge in social care, psychodynamics and systems theory, human rights law interpretation and practical implementation, and social pedagogy (the latter being the Associate’s primary field). As well as prompting new interdisciplinary thinking, the KTP generated new understandings within the Team members’ respective disciplines. For example, it yielded deeper insights in the field of social care about the requirements for front-line professionals to be able to respond effectively to children (or other clients) when in more extreme and prolonged periods of distress. Prior research has more narrowly considered physical restraint in terms of individual incidents and overall aggregate numbers. The KTP also afforded greater focus on adult relationships, expanding our understanding of some of the individual and organisational dynamics and, most importantly, the scaffolding necessary for adults to do reparative work on their professional relationships so that they could provide containing relationships to the children. Similarly, human rights research tends to focus on the ‘vertical’ relationship between workers, i.e. between representatives of governments and individual adults and children. The KTP’s additional focus on ‘horizontal’ relationships between adults, alongside new understandings of the role and experiences of containment in enabling progress in rights implementation, has opened up another new area for future research which will be pursued. The KTP is also being considered as part of an Impact Case Study for the University’s next Research Excellence Framework submission.

Impacts for the KTP Associate

The KTP Associate found a rare set of circumstances where it was possible to bring theory and practice together to develop residential child care practice. The set up of the KTP was such that both aspects of the work were held in tension, in a way that she has not found elsewhere. This enabled working in a value-led manner

Another benefit for the associate was found in working from a different theoretical starting point than during her PhD. Working with the psychodynamic ideas of emotional containment and holding environments allowed her to deepen her understanding of the conclusions her PhD: having used a critical and sociological lens to explore how residential child care workers think of the children and young people they work with, she was able to work relationally with residential care workers in a way that changed how they saw the children and young people they work with.

The experience of clinical supervision in addition to academic and site supervision provided a similar form of ‘holding’ that was required of the Associate in carrying out the project, sharpening her ability to attend to the parallel processes exerting influencing organisational change.

Meet the Team

Cecile Remy

KTP Assoicate

Dr Laura Steckley

Knowledge Base Supervisor

Robbie Henderson

Company Supervisor