The use of NVR in residential care.

As I was reminded recently while reading a report about the use of residential care for adolescents on the edge of care, we have a rather different model of residential provision in Britain to that in other European countries, where a placement in a therapeutic establishment with highly trained and qualified staff may be the norm rather than the exception for a young person unable to stay at home. Lesser professional qualifications required, residential care as last resort – the sector in Britain has suffered from a period of neglect itself, despite the fact that some of the most troubled young people will be placed in such homes, whether for lack of alternative or as a positive choice. It is sadly to be expected that staff in residential homes will experience levels of abuse and violence from children and teenagers struggling to come to terms with trauma in similar ways to families coping in the community, perhaps to an even greater extent, yet this receives less coverage still.

The Anderida organisation was brought to my attention for its use of Non Violent Resistance (NVR) as a model of working with young people in its establishments. NVR was introduced when Peter Jakob began working with the organisation as clinical consultant, and all staff are now trained in this technique and way of thinking. Young people coming to the homes may have long care histories, with multiple placements, perhaps on their return from secure accommodation, but certainly where there is a need for a high level of supervision. Many of those who are persistently aggressive have been found to have histories of witnessing domestic violence as children. Violence and abuse to parents, certainly trashing the house, may feature in their “habituated aggression”, but it is part of a mix alongside substance misuse, other risk taking behaviours, and sexual exploitation.

I am aware that NVR is met with a certain amount of scepticism by some, not least for the focus on changing the way the adults think and behave, with little apparent direct involvement with the young person’s thinking, attitude or behaviour. Yet those who use it in their work report it to be “powerful” and “transforming”, precisely because of the emphasis on empowering the adults; and it is asserted that by not accepting violent or abusive behaviour, but rather resisting it, you are in effect challenging it. Through this it is possible to secure an environment in which risk-taking behaviour is reduced and further therapeutic work can then take place. Within the Anderida community, the use of CBT has been developed as the therapeutic response, but this would not be possible until a more appropriate authority and power structure has been established. As the young people respond to NVR they are now more willing to accept this other help.

While remaining a way of thinking for staff, the actual elements of NVR may not come in to play very often as far as young people are concerned. The “basket exercise” requires a prioritising of concerns, and this is as helpful in residential care as in the family home. Only when there is extreme behaviour, causing harm to the young person themselves or to others, might an “ announcement” be made.

The use of NVR in residential care is not widespread in this country, and Anderida are described as pioneers in this respect. The individual elements might seem like common sense, but take immense planning, thought and care. Staff training and supervision is crucial in order to achieve such success. With a reputation for an excellent service significantly enhanced by the use of NVR, the Anderida community is overwhelmed with referrals, from local councils but also from around the country.

We are perhaps a long way from seeing NVR rolled out in a more organised way – not least because the infrequency of its use means that some still need to be convinced of its effectiveness. But the final thought is the most telling. “In the end we do it for ourselves; not because we think it will change the child either immediately, or in the long term, but because it is about us empowering ourselves – and it is so powerful.”

Peter Jakob has kindly offered the following comment in relation to the evidence base for NVR:

NVR does have an evidence base, with 4 randomised controlled trials, and in addition to that numerous other outcome studies that take pre/post measures, but without control groups. One such pilot study is a UK study.  There is no RCT of NVR in residential care.  That would be methodologically extremely difficult to undertake, because there are so many factors that go into your outcomes. You would have to have a sufficient number of residential services working with NVR and a sufficient number of comparable other residential services working without NVR so that you could establish any validity. However, another way of looking into it is to look at outcomes from NVR for young people with similar difficulties and backgrounds, and there is indeed such a study, which evidences the efficacy of NVR with young people in foster care in Belgium, i.e. with similar histories of attachment insecurity and developmental trauma. 

For those interested in further reading, the references to the research and other documents supporting NVR can be found here.

Many thanks to Kerry Shoesmith, Director of Care and Training at Anderida Care, for making the time to be interviewed for this piece, and also to Peter Jakob for his helpful comments and contribution.

 

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