What Happens When We Invest in Human Potential?
The Cotswold Community stands as a pioneering example of therapeutic residential care for deeply troubled young people, showcasing how thoughtful, systemic approaches to trauma can transform lives across generations. In my conversation with Graeme Kerridge, who worked at the Cotswold Community in the late 1970s before developing a career in international health management, we explored the profound and lasting impact of this revolutionary approach to caring for emotionally damaged children.
The Cotswold Community was established under the leadership of Richard Balbirnie, who undertook the monumental task of transforming an old-style approved school (essentially a reformatory) into a therapeutic community. What made this transformation remarkable was Balbirnie’s commitment to working with existing staff and residents rather than starting from scratch. This change management process speaks volumes about how institutional change can occur even in the most challenging environments when guided by clear therapeutic principles and strong leadership.
At the heart of the Cotswold approach was a therapeutic model based on the work of Donald Winnicott and Barbara Dockar-Drysdale, focusing on creating an environment where severely damaged children could begin to heal. The community operated without locks, bars, or restraints—remarkable for working with young people who were often one step away from secure facilities. This open approach was coupled with careful assessment: could they help the boy? Could they contain him in an open setting? And importantly, was the boy so damaged that attempting to help would drain and destroy staff?
What particularly stands out about the Cotswold Community was its commitment to being a learning institution. Staff regularly participated in reading groups, analyzed their work, and openly discussed what was working and what wasn’t. Both Balbirnie and Dockar-Drysdale published annual “realizations papers” documenting their learnings and needed changes. This culture of reflection and growth extended to both staff and residents, creating parallel developmental journeys that reinforced the therapeutic environment.
Perhaps the most powerful testament to the Cotswold approach came through Graeme’s story of reconnecting with a former resident 39 years after leaving the community. This young man, who had stolen soft toys from a childcare center (revealing his profound emotional deprivation), had managed to break his family’s intergenerational cycle of dysfunction. Despite a rough start after leaving the community, he developed marketable skills, maintained a stable 20-year partnership, and had two sons attending university—an extraordinary outcome for someone from his background.
The systems approach that guided the Cotswold Community had far-reaching implications beyond residential care. Graeme applied these principles throughout his career in healthcare management and international health development, recognizing that effective intervention requires looking at the entire system rather than isolated components. Whether managing hospital quality or national disease programs, this holistic perspective proved invaluable.
The conversation raises important questions about Australia’s current approach to troubled young people. While residential care has evolved toward smaller community houses, we lack the equivalent of the comprehensive therapeutic communities like Cotswold or the Mulberry Bush schools that continue to operate in the UK. This represents a significant gap in our care landscape, especially for our most damaged young people who may not thrive in foster care or conventional residential settings.
The economic argument for therapeutic intervention is compelling. As Graeme noted from his international health experience, preventive programs show remarkable returns on investment—$42 back for every dollar spent on TB programs, for example. Similar calculations would likely show the tremendous cost-effectiveness of proper therapeutic care for troubled children compared to the long-term costs of incarceration, intergenerational trauma, and lost human potential.
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About Graeme
Graeme is an international health development consultant who has worked in over 25 countries throughout Africa, Asia and the Pacific, and in the countries of the former Soviet Union. He has particularly focused on assignments supporting grants from the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM). In addition to working as a consultant and technical team leader on assignments funded by USAID, AusAID (DFAT), GIZ and other donors, for several years he was a technical manager on a major USAID project based in Washington DC where he managed and oversaw multiple teams of consultants supporting Global Fund grants around the world.
Prior to his international development career, Graeme worked for 18 years in health care management in several states of Australia. He started his professional career, however, working for several years in the late 1970s at The Cotswold Community, an experimental therapeutic community for maladjusted children in Wiltshire, UK. While he did not continue working in that field after returning to Australia, he often reflects on his learnings from that period in pursuing a career in the management of caring organisations.
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Transcript:
Colby: 0:00
Welcome to the Secure Start podcast.
Graeme: 0:03
And so the systems approach that was adopted at the Cotswold community very much influenced the way that I took work into healthcare management, and the probation officer that I was shadowing on a voluntary basis said look, Graeme, if you want to understand how people get to be like this in prison and coming out often very institutionalised and struggling, then it would be worth my while learning about children.
Graeme: 0:47
I saw an advertisement for the Cotswold community and I applied and was invited to go and meet with them and, yeah, that was how I came to work at the Cotswolds. Richard and his team had a very, very strong commitment to the Cotswold community being a learning institution and, you know, with a preparedness to examine what was working, what was not working and talk about it very openly, without, you know, ego getting in the way at all. The community was seeking to, and bearing in mind that a lot of the work that Winnicott had done and that Barbara Dr Drysdale had done was looking at the damage that was done by removing children during the blitz yeah and so there was a very, very um strong belief that, look, you do not remove the child unless you know it is is really very, very serious.
Graeme: 2:04
And then you look at how to do it in a way that causes the least damage.
Colby: 2:10
Welcome to the Secure Start podcast. I’m Colby Pearce, and joining me for this episode is a highly experienced executive and consultant in international health development who, at the beginning of his professional career, worked in the Cotswold residential care community for deeply troubled young people. Before I introduce my guests, I’d just like to acknowledge the traditional custodians of the land I’m meeting on the Kaurna people of the Adelaide Plains and also the Jagera and Tirribul people, who are the traditional custodians of the lands that our guest is coming to us from, and I’d like to acknowledge the continuing connection that Aboriginal people feel to land, culture, community and pay my respects to their elders, past, present and emerging. My guest for this episode is Graeme Kerridge.
Colby: 3:11
Graeme is an international health development consultant who has worked in over 25 countries throughout Africa, asia and the Pacific and in the countries of the former Soviet Union. He is particularly focused on assignments supporting grants from the Global Fund to Fight AIDS, tuberculosis and Malaria. In addition to working as a consultant and technical team leader on assignments funded by USAID, ausaid and other donors, for several years he was a technical manager on a major USAID project based in Washington DC, where he managed and oversaw multiple teams of consultants supporting global fund grants around the world. Prior to his international development career, Graeme worked for 18 years in healthcare management in several states of Australia. He started his professional community, however, working for several years in the late 1970s at the Cotswold Community, an experimental therapeutic community for maladjusted children in Wiltshire, the United Kingdom. While he did not continue working in that field after returning to Australia, he often reflects on his learnings from that period in pursuing a career in the management of caring organisations. Welcome, graeme.
Graeme: 4:40
Well, it’s very good to meet you at last, Colby.
Colby: 4:44
Yes, it’s been. I should tell the little bit of the story if you don’t mind that you got in contact with me after episode two of the podcast. Yes, yeah, with John Whitwell, who was the principal of the Cotswold community for a fair amount of time. I’m not sure if he was the principal while you were there, but he was there.
Graeme: 5:11
He was the deputy principal while I was there.
Colby: 5:14
Yeah, yeah and yeah. You got in touch with me and you’d just been in Adelaide as it happened, and discovered that this was where I was.
Graeme: 5:26
Yes, yes, I had no idea that there was interest in this field in Australia. So I saw that John had done a podcast. I listened to it and I was astonished to hear that it was hosted by yourself, based in Adelaide.
Colby: 5:44
Yes, so yeah, as we were talking about before we started, it is a community that fascinates me because it is an example, I think, of a really good a program with really good outcomes for children in a in a therapeutic residential care setting. And you’re right, there’s not a lot of that here in australia. And um, I will mention, uh, another podcast, uh, guest, adela holmes. I don’t know if you’ve ever heard of adela. She established the therapeutic model and was the initial director of a facility facility is a horrible way of putting it but a therapeutic residential care community in Victoria called Hurstbridge Farm, and so there is a little bit of that and it’s been quite successful and the podcast I recorded with her will probably have immediately preceded this one. If people are listening to this one and want to check that one out, to want to check that one out.
Graeme: 7:11
So, Graeme, tell me about how you first got involved in the Cotswold community. Well, it started off when I was at university. I studied economics as an undergraduate and during that time I became very interested in, I guess, what is known these days as human capital. That is how, and, more to the point, how we waste so much human capital in all sorts of ways, but particularly by, you know, the people that are incarcerated or the people who are in long-term institutions. And I’m not talking about wasting in a strictly economic sense of them not being in the workforce, but more in terms of them not leading full lives. You know it could be grandparents not being able to, you know, enjoy guiding their grandkids, that sort of thing. People just not being able to join the family in major gatherings at Christmastime and other times, all those sorts of ways where society and the lives of individuals are enriched. And while I was another graduate and thinking about all this, I saw a notice asking for volunteers at I think it was the Redfern Community Health Centre, because at that stage they were just dealing with an influx of people who were discharged from the long-term psychiatric hospitals which were in the process of emptying out as many as they could at that point. And I would go along and I became a volunteer with them, working with the staff to support weekly activities programs for the people who were newly out of the long-term institutions, and I found that a very interesting area.
Graeme: 9:22
When I finished my studies I travelled and went to, ended up in London and there I started exploring opportunities in the field of care and rehabilitation of people released from prisons and I volunteered with the London Probation Service, again with activity programs for men who had often been in prison for many, many years and had lost a lot of you know, social skills and daily living skills, and we would run a weekly activity center there and I would also shadow one of the probation officers as he would accompany some of the people along to court hearings, to meetings, to work out their next steps, to help them fill out forms.
Graeme: 10:27
And that was very interesting and the probation officer that I was shadowing on a voluntary basis said look, Graeme, if you want to understand how people get to be like this in prison and coming out often very institutionalised and struggling, then it would be worth my while learning about children. I saw an advertisement for the Cotswold community and I applied and was invited to go and meet with them. I applied and was invited to go and meet with them, and, yeah, that was how I came to work at the Cotswolds.
Colby: 11:14
So yeah, it’s interesting, isn’t it? You’re working with people who had served terms of imprisonment and had come out from it. But yeah, that sparked an interest or you were encouraged to follow an interest in how all of this came about. That’s right, and there was that recognition that people have kind of.
Colby: 11:40
I remember when I was training it was almost people could almost be a bit flippant about it all goes back to childhood. I think that reflects the particular time where I was doing my training, where the dominant I’m a trained clinical psychologist the dominant therapeutic approaches didn’t require an analysis of childhood experience and the enduring impacts that that has on life into adulthood. I’m a bit older and wiser now. In fact I’d never really fully embraced that, and you can see over here one of the books that I wrote about. I’ve written books about children and particularly have led a career with a strong focus and interest on child to adult relationships. Yeah, so you went back, I guess, went into the Cotswold community with an expectation of seeing where things go awry and perhaps how to change the course of history for young people.
Graeme: 12:57
Well, obviously that was my interest, but when I went to meet Richard Balbirnie, who was the principal there, and the senior staff to get to know them and to decide as to whether it was my thing, I must say you know, several things really made a big impression on me.
Graeme: 13:20
Firstly, the very clear therapeutic model that they had guided which was very much modelled on the work of Donald Winnicott and also coloured by Barbara Dockerdrysdale, who was the consultant psychotherapist for the Cotswold community, and so it was a very, very clear model that they were working to. Secondly and this actually became, I guess, over time, my particular interest I was struck by a very strong commitment to a systems approach for the way that they looked at care and the way that they looked at management of the care there. They worked very closely with the Tavistock Institute. They provided a consultancy, virtually a management consultancy for the community, and, as I can discuss later, I guess that was one of the things that really interested me, of the things that really interested me.
Graeme: 14:50
Thirdly, I picked up right at that initial meeting that Richard and his team had a very, very strong commitment to the Cotswold community being a learning institution and, you know, with a preparedness to examine what was working, what was not working and talk about it very openly without, you know, ego getting in the way at all. That was very impressive. You know, these were just the things I was picking up on at the initial meeting. And then I guess the fourth thing that really struck me during that initial meeting was the task that Richard was taking on, whereby he had been taking an old-style approved school, which you know all the dreadful things that everyone listening to this podcast will be very aware of, I’m sure.
Colby: 15:51
Reformatory in our parlance, I think in Australia yeah.
Graeme: 15:55
He was taking that and converting it into a therapeutic community and he wasn’t able to have the luxury of, uh, you know, clearing all the the uh, the boys from that approved school out and clearing all the staff that had been there out. He had to go through a process of working with what he had and then gradually, over a period of years, converting the whole style of that. And that type of change process was an extraordinary undertaking and so obviously you know that was very impressive.
Colby: 16:39
And at what point did you come into it? Because it would have been just. I remember when John speaking to John Whitwell about it, it would have been a massive undertaking. Yes, and as I recall the conversation with John, it started really from, obviously, I think it was 1969 that Richard Balburnie took it over. And at what point did you start there?
Graeme: 17:06
I started the very beginning of 77.
Colby: 17:10
Yeah.
Graeme: 17:11
So and I think John and Richard saw that look, the first five or four years or so, we’re really just slugging it out in terms of the change process and gradually, you know, moving on staff for whom it was not going to fit. Yeah, additionally, after a few years Richard moved on about half the boys that were in there as well.
Graeme: 17:46
Okay, because he recognised that, or there was a broad recognition that many of the boys there were, I guess, low-level delinquents and were not seriously disturbed boys that he wanted to really focus the community on and he recognised that, in fact, those boys that were essentially delinquents but not seriously disturbed, they actually deteriorated if they were in that type of environment you know of the institutional environment and it was much better for them to be out in the community and being kept an eye on at the community level by, you know, the local social services and the local police.
Colby: 18:41
Yeah, yeah, yeah, I mean, and that and that, yeah, and that’s right and that’s what we do see that um, there is that kind of effect where um people, when you’re the environment in which you are in, can can either um can expose you to um influences that that may not be in your best interest, I guess going forwards and um, but I, I’m really also this is a little bit of a question without notice, because I’m really um, I’m turning my mind to the really the, the magnitude of that, that process of change that richard undertook to um my and and my observation would be from my own work over the last 30 years. It is very difficult, even motivated people of the need to vary their approach to caregiving and relating with our deeply hurt and troubled young people, let alone what I think John well, in my conversation with him, described as almost prison guards really, and with that being the role and perhaps that being the mentality of the way in which they approached the work.
Graeme: 20:19
Yeah, yeah.
Colby: 20:21
So, no question without notice there it was more just me thinking and reflecting on on that um. So you, these were, that was your kind of initial impressions. They were, they were really favorable, um, and how did that, those impressions play out, I guess, at over the time that you were at the Cotswold community, and what additional things perhaps did you notice about it that both made it work and or needed further work?
Graeme: 20:58
Yeah, well, look, I can say that the portrayal that Richard provided and that I absorbed in that very first day that I spent with him, that was very accurate. But obviously I developed a lot more insights as to you know, more insights as to you know the way in which the place sought to function over time. One of the really things that struck me very, very strongly was the very clear triaging system that Richard had set up there, guided by Barbara Dockerdrysdale, obviously, in that there was a very clear process of asking, you know, firstly, can we help this boy? Secondly, can we contain the boy? Because it was an open community.
Graeme: 22:18
There were no locks, you know, no bars, no closed rooms, no bars, no closed rooms, no restraints. That, unfortunately, is still quite common in youth detention facilities and so on. It was an open facility. So it was really a question can we contain the boy? And thirdly, is the boy so damaged that trying to help drain and destroy staff? Because working with very damaged children, as you would know, is probably challenging for the carer. So the community was seeking to, and bearing in mind that a lot of the work that Winnicott had done and that Barbara Dr Drysdale had done was looking at the damage that was done by removing children during the Blitz, yeah.
Graeme: 23:42
We have got some dreadful experience here in Australia but that was the basis of their work at looking at the danger, that was, the damage that was done.
Colby: 23:53
Yeah.
Graeme: 23:54
And so there was a very, very strong belief that, look, you do not remove the child from unless you know it is very, very serious, and then you look at how to do it in a way that causes the least damage.
Graeme: 24:13
So there was a very strong belief in not taking in those boys who, while they may be damaged, they’re not so damaged that they would not be best staying with their family, however inadequate that might be, being supported by the county social services and by the police and other authorities at working through that out of a residential situation, but also not taking in those who were just so damaged that they would not be reasonably treated, without draining all the resources of the team.
Colby: 25:09
Yeah.
Graeme: 25:10
So getting an understanding of that triaging approach was, you know well, I found that that was a very valuable lesson to apply, you know, right throughout my career actually.
Colby: 25:29
Yeah, yeah, it almost sounds like you know, being very aware of what resources you have, to achieve the best outcomes with those with whom you think you can deliver the best outcomes for.
Graeme: 25:51
Yep.
Colby: 25:51
Yeah, that’s right. Yeah, and go ahead.
Graeme: 26:01
There are many other things that were really major lessons as well were really major lessons as well. Really, you know, understanding how their commitment to it being a learning institution played out was really an important and valuable lesson, you know, in that we would have frequently reading groups whereby, you know, we all studied different papers that were put together. We would, as a group and I’m talking about a small house group analyse what was working, what was not working and how to address those and the possible reasons for that. Again, in a way that was very open and Barbara Drasdell and Richard both often brought out about every year, brought out annual realisations papers, their learnings from the year where they had observed things that possibly needed to be changed or things that they need to stop doing and things they need to start doing. Being in that learning environment was really quite extraordinary.
Colby: 27:37
It does sound extraordinary and what it has me thinking about is that it was a very that staff growth and development, you know, had an important place alongside the boys’ growth and development.
Graeme: 27:55
Very much so.
Colby: 27:56
Yes.Graeme:
\27:58
And that was an important part of Barbara Dr Dresdell’s role.
Colby: 28:05
Aye.
Graeme: 28:06
Yeah, to guide staff as well.
Colby: 28:10
And it sounds like it was a reflective environment and from the point of view that and you referred to the annual insights paper but it sounds like it was an environment where people were encouraged to think about what they were doing not just approach the role, uh, in a very um, routine, ritualized um, I’m trying to think of a better word for automaton, but you know what I routine ritualised I’m trying to think of a better word for automaton, but you know what I mean but to actually approach the role with a healthy reflective capacity, which is very much one of the foundations for what we refer to generally now as trauma-informed practice, whereby you are encouraged to very much adopt a reflective stance, be aware of yourself, be aware of the person with whom you’re interacting, the young person with whom you’re interacting, and what is their experience that led up to this interaction in the here and now. And it sounds like that was very healthily encouraged and supported at the Cotswold community.
Graeme: 29:42
Very much so and, look, I must say that observing and working with Richard Balbirnie was an extraordinary experience. You know, richard was a very well courageous person in terms of what he was prepared to set up there and the changes that he was prepared to work through. He was very single-minded and with a very clear vision of what he wanted to do. I have heard him being referred to as a very charismatic person, but that was something that Richard really argued very much against, you know, because so many of the types of communities that were set up were often set up by a charismatic person and everyone followed the leader. But then, as soon as that person went or often before that person went, you know, the whole thing would crumble and what Richard was seeking to establish was something quite different from that. It was very much a decentralised organisation.
Colby: 31:12
Follow your instinct.
Graeme: 31:14
And not a hierarchical organisation at all. It wasn’t so much following your instinct. You were very much following very much the treatment and the care philosophies and so on. But it was very much that recognising that it must be the people who are the primary carers who are making decisions and that they be supported to do that. And certainly if they stumble then you pick them up and work through.
Colby: 31:53
But rather than looking for approval from on high from some charismatic leader, he was seeking to have a very, very different organisation, seeking to have a very, very different organisation and entrusting the people that worked in the organisation with that capacity to think and reflect and instinct was not the right word, I think I was more thinking, following your reflections, I guess, following your understandings, following your understandings, following your learnings and teachings again, an extension of thinking about what you’re doing, I think, sounds very much like that was very healthy there. Yeah, now my um, my understanding of the Cotswold community is that relationships were. The relationships that were cultivated with the young men were very influential and important, and I think part of us kind of connecting with each other was not just hearing the podcast and recognising John, but also you told me about an experience that you had of a resident at the Cotswold community who contacted you many or decades later.
Graeme: 33:33
Yeah. Yeah, yes that was quite extraordinary really, in that some 39 years after I had left and 39 years after I had left, I got a contact, through LinkedIn actually, from a chap who had been a resident and who had been one of the boys that I worked particularly with in that each of the house staff would have about four boys that they would work with.
Graeme: 34:20
Yeah, and this chap. I had started working with him when he came to the community at about age 13. He had been a young thug in his local area and was in a lot of trouble with the law, and this was well. For any of the boys coming to the community, it was really the last stop before going into closed institutions, before going into closed institutions, and I worked with him for several years while I was there and just to give you an idea of the sorts of damaged kids, we used to work in terms of about eight weeks and then the boys would go home for about eight to ten days to keep in touch with their family, because that was considered very important, even if their families were often, you know, fairly dysfunctional.
Graeme: 35:54
And often, unfortunately, you know, they did break down a bit and get into trouble. And so I went along. This chap had got into trouble one break home and I went along to the court hearing with him and what he’d done? He’d broken into a childcare centre near where he’d been and stolen soft toys and this is a 13-, 14-year-old thug and so that shouted out the sort of severely emotionally deprived boys, boys that we were working with who had really had a very inadequate you know, early life that they were still trying to come to terms with.
Graeme: 37:14
And so you know that was the sort of chat that this boy was. And anyway, he made some progress while I was there, but obviously, once I left the community and came back to Australia I didn’t have any contact with them. And it was quite extraordinary receiving this, this letter. He initially just sought to make sure that that he got the right and then said he would write a longer note. You know when he could, and it took about another year before he actually did, but when he did it he had lived an extraordinary life, you know.
Graeme: 38:00
He explained how, when he left the community community he actually absconded from the community and he then sought to return but it was decided that no, look, it was best that he just leave at that point. And he went through several rough years, thankfully managing to stay out of prison. But then he managed to gradually start using some of the manual skills that he picked up in the community because there was a very, very good educational program that was undertaken at the community Poor Boys to help them develop manual skills, and he actually managed to hold down jobs in various fields, becoming very much a jack-of-all-trades.
Graeme: 39:04
He’d actually got married and had a stable partner for 20 years, or over 20 years, and had two sons that were going through university.
Graeme: 39:37
This chap, who came from an absolutely appallingly dysfunctional family background of intergenerational poverty, had actually broken the cycle. It was extraordinary. He said that he still struggles a bit and he had at that time when he reached out to me, he said he’d recently become involved with a group who was seeking to raise the level of public awareness of the sorts of experiences that he and his siblings had gone through very early in their life. For him, before he had got to the Cotswold community, because he’d gone in and out of foster homes and some dreadful situations that did not work, and he said that that was a very difficult process, you know, reflecting back on that whole very early time. But he said that he was being supported a bit through that process and he was feeling that he was coming up a better person through it. And he was feeling that he was coming up a better person through it.
Graeme: 40:58
But, as I said, I was absolutely thrilled that you know this chap, who had come from a totally, totally dysfunctional family and the family had been dysfunctional for generations had actually broken the cycle and was living, you know, a healthy life where he was enjoying a stable partnership. A stable partnership, he was enjoying being a father and caring for his sons and and he’d developed various hobbies outside of work that were giving him a lot of joy. You know that was very much that. I guess that fitted in while I’m thinking about it, that fitted in with my initial interest in the whole thing of how one builds up human capital.
Colby: 42:00
Yeah, how one builds up human capital. Yeah, it’s a really. It’s a beautiful story of growth potential, even amongst our most disadvantaged, in many ways, young people, that they still have tremendous growth potential. And I think you’ve had the benefit as well, through this experience, of being able to make the connection with work that you did and work that was done in the community and what comes after in the community and what comes after and this is one of the things that I similarly have a lot of experience of care-experienced young people that I worked with during their time in care making contact with me, and it really provides, I think, a really valuable perspective on the work that was done and, in particular, the importance, I think, of relational connection, the fact that he sought you out and made the contact with you, which would have been a fantastic experience for you, but reflected very well on his experience of you when he was in those formative years.
Graeme: 43:33
I’d obviously love to know a lot more of his story, but I’m very conscious that and I’m sure that you would have had the same experience that you need to be conscious that they need to pace the contact. It’s very much up to them as to when they’re ready to disclose parts of their story parts of their story.
Colby: 44:07
But yeah, I think, um, I think, when um john whitwell was was paraphrasing winnicott, um, and he talked about this in the podcast about winnicott and the idea of the, of the, you know, the, the children being like a bulb and we, and the growth was in the bulb John referred to, and I think that’s a very interesting perspective that everyone has, in the right circumstances, in the right containing environment, has the potential to grow. Yeah, when you said you moved, after being at the Cotswold community, you moved back to Australia and you worked in healthcare management and your career developed onwards into international health management and consultancy and you’ve worked across a great number of countries. But I’m curious as to whether there were elements of your experience at the Cotswold community that you took into that work and continue to reflect on.
Graeme: 45:18
Yes, look, as I said, one of the things that struck me when I first met Richard and the team at the Cosmo was their commitment to seeing the work very much in a systems approach.
Graeme: 45:38
The work very much in a systems approach, and I know that that very much affected the way that I viewed my work in healthcare management, whereby rather than looking at each individual work area separately, one looks at the whole system, the whole organisation, because in any system the different parts impact upon each other.
Graeme: 46:16
And during my time in healthcare management I became very interested and active in the quality management area and for a while there I was an accreditation surveyor for the Australian healthcare quality process. And when one looks at the quality in a complex organisation like a hospital, one really needs to look at the whole organisation. Because you know you may have a world-leading you know you may have a world-leading you know cardiothoracic surgeon and an extraordinary you know interventional radiology unit. But if you actually don’t have the connections between them, which may be as simple, as you don’t have the porters and the wheeling the person to and fro, you don’t have the medical records system, you don’t have the porters and the wheeling the person to and fro, you don’t have the medical records system, you don’t have the nursing system, they’re all working together in a harmonious way Then your quality can be very compromised. And so the systems approach that was adopted at the Cotswold community very much influenced the way that I took work into healthcare management.
Colby: 47:53
Yeah.Graeme:
47:55
And to some extent in international health as well, in that I worked very much on national disease programs around the world and one needed to. You knew that for a country to be effective in, for instance, their program for HIV or TB or whatever, needed to not just look at the delivery process of drugs. You need to look at the supply system all the way through. You need to look at the legal system that they’re operating in in the country. You need to look at the uh, the messages that um, the elders, the community thought leaders, like the religious leaders, that they are sending in the community. So you need to take a total systems approach. So I think that that initial grounding that I experienced in the Cotswolds to a systems approach was, for me, extremely valuable.
Colby: 49:13
Yeah, and my understanding of how that looked in the Cotswold community is that everyone, all the staff, were trained in the model. All the staff were responsible for the delivery of the model. Yes yes, that’s true.Colby: 49:31
Yeah, and as an example of where that can break down, I remember John Whitwell talking about once he’d moved from the Cotswold to the first therapeutic foster care service within the UK. He made a similar point in relation to the drivers that they relied upon to transport young people to school and so on and that the observation that when the drivers were not were out of sync or asynchronous with other endeavour, that that has an observable impact on your capacity to achieve the outcomes of your endeavours.
Graeme: 50:21
Yes, yes.
Colby: 50:24
And you moved into international healthcare management and consultancy. What kind of motivated you to go there?
Graeme: 50:31
Well, I guess it was that original interest of mine in the concept of human capital, but very much on a macro scale.
Colby: 50:41
Yeah.
Graeme: 50:43
You know I was looking at what was happening in whole countries, not just in local communities or individuals. And also the knowledge and this is what we see in this field of treatment for disturbed children the knowledge that many of these interventions are massively, massively, massively cost effective. When I hear politicians drumming on about, oh, we’ve got to increase productivity, you know there is just so much that we can do as a society. That is massively cost effective. You know, rather than well, you would know, in dealing with disturbed children, you know, rather than locking them up in very, very costly and very destructive warehousing facilities where they are not going to really gain anything at all, you know. But if we do invest in them, hopefully very early in the piece, well before they become, you know, disturbed adolescents, but very early in the piece, you know the paybacks are enormous.
Colby: 52:11
Even so, if they’re disturbed adolescents, because the example you gave of the young person now not a young person anymore who contacted you, I mean think of the savings to society in the way and the breaking of that cycle and the way in which his family life and his children being at university, where the alternative would be to repeat the troubles that that family had, and there is a massive cost to society.
Graeme: 52:45
Indeed. So, the cost will. In those fields that I was working in, like in TB, I’ve seen various studies that suggest that for each dollar that’s put into a TB program, society gets $42 back. A similar in malaria and HIV, not at that level. I’ve seen figures of around $20 to the one. You know phenomenal payback, and you know, I’m sure, that there are similar studies in the area of treatment of young children.
Colby: 53:29
Yeah, I can’t say that I’m aware of them it’s not an area of professional reading that I do but I think it’s a point very well made in a number of ways, not least of which the description of the person who got in contact with you all these decades later, that if we, there is a tremendous benefit to our society by intervening in a therapeutic rather than a punitive way. In a therapeutic way with our troubled young people.
Graeme: 54:17
Yes.
Colby: 54:18
And the forward-thinking governments and administrators who hold the funding. Forward-thinking ones would do well to invest well in that area for the sake of. I found myself saying to a guest yesterday that the work we do is not only of benefit to the young people who are in front of us, but to their children and grandchildren as well.
Graeme: 54:55
Indeed.
Colby: 54:56
And it’s a very salutary reflection. I think yes, so, yeah. So do you have any kind of, all these years later, any ongoing or final reflections about your time at the Cotswold?
Graeme: 55:15
community. Oh well, look, it was obviously an astonishing privilege to have worked there during that time because it was very much leading edge, both from a clinical therapy point of view but also leading edge from that management approach as well, in that Richard and the team at the Tavistock who would consult with the community were very much, you know, studying how do we manage caring organisations, that they work most effectively, and that was an extraordinary experience. And, you know, obviously it was astonishing working in very much that learning environment where, you know, we were always studying the papers by Winnicott or Dr Drysdale or Bruno Bettelheim or others, and that was an extraordinary, very demanding experience. You know, I’d normally be reading between 10pm and 1am every night, so it was an extraordinary experience extraordinary is a good word, because, um, uh, they they’re not.
Colby: 56:50
It’s not the kind of reading that that someone who has a degree in economics, I guess, would necessarily. Or, you know, and people depending on what background drew people to that work. You know what was their formative or prior education. It’s not the sort of reading that I guess that they would necessarily have ever expected to be reading, ever expected to be reading. Um, it does make me, um, yeah, it does. It does make me wonder what, what people who work in a similar field are reading these days, what the what, the expectations around the growth in their potentials is. Um, look, it’s been fantastic having you answer a number of questions.
Colby: 57:43
I always, at the well, I’ve I’m developing a habit with these podcasts of uh, offering for the guests to ask me a question at the end because I’ve asked so many. I do. I do often. Um, I don’t often ask young people a lot of questions, but if it’s, if the circumstances are that I have to ask them more than just a small number of questions about something or other, I do the same for them. I say well, you know, I’ve asked you a lot of questions. Here you go, you can ask me a question. I’m pleased to say most of them are relatively safe in the sense that they generally ask me what my age is and I give them the answer. I used to give the answer in months, but someone worked that out how to do so I now give them my age in dog and cat years and they do they. Some of them have kind of cottoned on to that a bit now. But yeah, I pride myself on being able to answer questions without notice. I’m happy to answer a question if you have one of me.
Graeme: 58:49
Well, look, I would be fascinated to know whether you’re aware of therapeutic residential settings in Australia that are working with the highly damaged children, similar to what we’re working with in the Cotswolds, in that obviously I’m aware of individual or family-based therapy here. I get the impression that some of the residential ones are not dealing so much with the very troubled, damaged children, similar to what we were working with in the consulates. But I welcome you enlightening me as to what’s going on here.
Colby: 59:45
Well, if I speak for South Australia first, and based on my experience and an observation, residential care has gone through a lot of changes here in south australia in the last few years in terms of the structure and delivery of residential care. But certainly, um, our most troubled young people are in, um, they can, they can potentially be in each of the three main types of out-of-home care, which is foster care, residential foster care, kinship care. So, with with kin, usually family or residential care. I would say there was a, there was, there was a devolution from several years ago, from having congregate facilities, where there was eight or more or so in a facility, they’ve been devolved into smaller community houses where there would be one or more, really, depending on the complexity of the young person. And again, I don’t work in the residential care sector in our local departments. I may have omitted some of the things that they’re doing, but that would be my observation. I am aware, though, though, and as I said early on in this podcast, I interviewed, uh, someone whose podcast is likely to come out immediately before yours, who who was involved, um in the development of a facility in Victoria called Hurstbridge Farm, which I think is probably the closest thing that I’m aware of in Australia to what you describe as having been in place there at the Cotswold community.
Colby: 1:01:56
There are a few things that we don’t have that they had and or have maintained in the UK. So you know, barbara Docker, drysdale was equally perhaps more famous for establishing the therapeutic school, the Mulberry Bush. Yes, and there are the Mulberry Bush schools and those. There are several of those schools that continue to exist and in the United Kingdom where the kind of you know the Cotswold community and other therapeutic residential communities like that no longer exist and I think that they would be a good addition to our care landscape in Australia. In Australia, I think that I think it is. It is our loss to not have those kinds of. I know that there’s been scandals about them. I’m hoping to get a guest on who has looked into some of the myths and the factual or non-factual basis for some of the beliefs that exist about residential care.
Graeme: 1:03:08
Yes, Well, I guess that emphasises, I guess, how courageous Richard Balbirnie was in establishing the Cotswolds and taking it through that very, very difficult transition from an old-style facility.
Colby: 1:03:30
Yeah, so yeah, and then, yeah, I’m not au fait with other jurisdictions. Just, you know what’s happening in Victoria I’m aware of through connections and through a very recent podcast interview, but I would be pleased to know. I’ve worked overseas in Ireland as well, and they do have secure care facilities for their most at-risk young people, and that’s something that they’ve, as I understand it, has, been grappled with the implications of having a secure facility for our most at-risk young people. I think, here in Australia and here in South Australia, that we had a recent Royal Commission relatively recent that grappled with that issue, but probably that fell on the side of having a secure facility for our young people in such desperate straits is probably, you know, doesn’t necessarily doesn’t meet our human rights obligations, I guess, amongst other things. So I think, though, what I would say about the Cotswold community is is I would highlight some of the things that you’ve talked about that commitment to continuous growth, to parallel growth, you know, with the staff and the young people, that systemic approach, making sure that everyone is aligned and pulling in the same direction and pulling in the same direction, the implementation, maintenance of a therapeutic model, and I’m not aware of outcome study.
Colby: 1:05:35
There’s, you know data is key here, or king. I’m not aware of outcome studies, but I’m aware of, you know, a long career in an area of endeavour is kind of like research in and of itself. It doesn’t hold the same status as data collected within an academic institution same status as data collected within an academic institution, but across a long career, as I’ve had you can, I can reflect on the good outcomes that were developed with good practices and I can reflect on the you know, the problematic outcomes longer-term outcomes, adult people now, where things were not so great in terms of our care and management when they were growing up. They call that anecdotal. Sure, yeah, it was an enormous privilege, graeme, to speak to you and I really thank you for your preparedness to be on my fledgling podcast and share your experience and wisdom.
Graeme: 1:06:55
Well, thank you for reaching out and asking me to reflect back on what was an extraordinary um experience and very much a growing experience for myself yeah, well, thank you.
Colby: 1:07:09
I hope it was a good experience reflecting back, yeah.
