“I’d lost trust and having to tell everyone the same story again and again and again…”: Bottlenecks and barriers to the application of therapeutic approaches within care services’ ecological systems

• The application of Bronfenbrenner’s Ecological Systems Theory has facilitated an exploration of the opportunities and barriers encountered in the provision of effective mental health support via a statutorily funded Therapeutic Intervention. • Needs are developed in the microsystem as children and young people in OOHC deal not only with the process of maturation, but the difficulties associated with poor relationships with professionals and the withdrawal of support. • The ecological systems, in therapeutic support, are split into two composite parts: microsystem primacy , in which young people and their immediate carers seek positive change, and macrosystem primacy, in which the exosystem actions the desires of the macrosystem. • Where the two systems meet, tensions arise as the mesosystem is unable to advocate for change due to a high turnover of staff and resource dependence, whilst the exosystem experiences challenges with regard to balancing the competing demands for resource provision. Children in out-of-home care (OOHC) who have been exposed to significant adversities such as neglect, abuse, family dysfunction, acute family stress, and/or revolving placements are at risk of experiencing poor outcomes. Each of these experiences can result in complex traumas for children, which creates cognitive and emotional difficulties. Although social care has the responsibility for supporting such children, there are certain pressures when it assumes responsibility for other statutory services, such as Public Health. These tensions can lead to missed opportunities in the effective support of children and young people with, for example, a focus on behavioural management rather than therapeutic approaches, with the latter being believed to be more effective in dealing with the underlying trauma. When partnerships are formed effectively, this creates space for innovative practices such as the approach examined in this paper. Semi-structured interviews were conducted with children, foster carers, and staff engaged in therapeutic interventions, delivered by an independent not-for-profit company in the United Kingdom, to investigate the effectiveness of services in improving outcomes for children. The services were designed to tackle health inequalities for those who experienced problems with their mental health during the COVID-19 pandemic. Drawing on Bronfenbrenner’s (1977) Ecological Systems Theory, the research presented here explores the benefits of early-help therapeutic projects for children and young people receiving support from social care. It seeks to understand the role of therapeutic support in improving outcomes for children in OOHC. The paper is the first of its kind in the UK to explore the impact of projects delivering therapeutic interviews, through a joined-up approach that combines with Public Health and Social Care, for care-experienced children and young people, as well as for foster carers. It concludes by identifying the range of bottlenecks and barriers that can hamper therapeutic interventions and offers recommendations for developing cohesive approaches to supporting children and young people through a therapeutic lens.