child safety interagency therapeutic and behaviour support services

Child Safety Interagency Therapeutic

and Behaviour Support Services

Outline of Presentations

Overview of the model Yvonne D’Occhio

Interagency collaborationhow we did and continue to do itlessons learnt and implications for practice

Successes and challengeson the Sunshine Coast Colin Smith

Outcomes for children Stephen Bell

Case scenario Bronwyn Hartnett

Crime and Misconduct Commission Report “Protecting Children: An Inquiry Into Abuse of Children in Foster Care”

110 Recommendations

Recommendation 7.5

The CMC report recommends….”that more therapeutic treatment programs be made available for the children with severe psychological and behavioural problems. Successful programs should be identified, implemented and evaluated”.

Target Group

Children and young people in care with severe psychological and behavioural problems, targeting those with the most extreme and complex needs

DSQ: for children/young people with a disability, need to be eligible to receive services under the Queensland Disability Services Act, 2006

Education and

the Arts

Hea

lthDisability

ServicesChild Safety Interagency Therapeutic and Behaviour Support Services

Interagency response between Department of Child Safety, Queensland Health, Disability Services Queensland, Department of Education and the Arts

Child Safe

ty

Objective

To increase mental health, behaviour support and participation in education for children and young people in the care of the Department of Child Safety.

Role of Dept Child Safety

Sole source of referrals Case management Support integrated model of service

delivery through linking therapeutic & behaviour support planning with Case Planning processes

Chair of local and state-wide steering committees & local Panels

Role of Dept Education & the Arts

Core member of State-wide and Local Interagency Steering Committees and Interagency Panel

Support integrated model of service delivery through linking therapeutic & behaviour support planning with Education Support Planning processes

Role of Queensland Health

Mental Health-Child Safety Therapeutic Support Teams (9) Assessment Crisis response Short term intervention Medium to long term therapy Carer support Consultation – liaison Specialist professional development and

training

Role of Disability Services Qld

Child Safety Behaviour Support Teams (6) Assessment ServicesBehaviour Support (med – long term)

InformationEducation and trainingConsultation

Intent of the Interagency Initiative

Promoting partnerships

Capacity to do more of what is already done

Capacity to provide new services

Increased knowledge and understanding of unique needs of target group

Principles

Culture of shared responsibility and ‘owning’ solutions

Integrated approach

Child focused and family centred practice

Professionalism

Principles Cont…

Information sharing and service provision

Timeliness

Accountability

InteragencySteering Committees

Local

State-wide

Child Safety Interagency Therapeutic and Behaviour Support Services Panel

Membership

Core members (required to attend all meetings)

Department of Child Safety – Manager or Senior Practitioner

Queensland Health –Team Leader, Mental Health-Child Safety Therapeutic Support Team

Disability Services Queensland - Team Leader, Child Safety Behaviour Support Team

Department of Education and the Arts – Senior Guidance Officer

Child Safety Interagency Therapeutic and Behaviour Support Panel

Invited members may include: Indigenous Representation – Recognised

Indigenous Entity

Department of Communities, Youth Justice Service Centre - Case Worker

Non-Government Organisation, Youth Worker Coordinator

Private Practitioner, e.g. Psychologist, Psychiatrist, Counsellor

Panel Functions

Referrals from DChS

Intake and prioritisation

Interagency care planning

Monitoring and review

Case closure

Evaluation Model function: How well is the model as

described in the manual working?

Model difference: How is this model different from and ‘better’ than current practice?

Model scaling-up: What needs to be done to implement the model across Queensland?

Child & Carer experience: What are the perceived experiences of the referred children/young people and their carers?

Collaboration is……….

A process where parties see different aspects of a problem and can explore their differences while searching for a solution that is beyond the vision of the individual parties

(Darlington, Feeney, & Rixon, 2004)

Interagency collaboration is…

Multidimensional

Interactional

Developmental…and a lot of planning and continued hard work isneeded for it to be successful!

(Johnson, Zorn, Ram, Lamontagne & Johnson, 2003)

We know there are barriers… Departmental service boundaries Philosophical barriers Individual and Differing theoretical organisational

backgrounds barriers Perceived threats to

professional integrity/value Interagency competition Presence of “us and them” attitude

(McCartney 1999; Bolland & Wilson 1994; Foster-Fishman, Salem, Allen & Fahrbach 2001; Darlington, Feeney & Rixon, 2004)

We know there are barriers…

Lack of understanding Unrealistic expectations about other

agencies Prioritisation

Consent Differing Confidentiality processes Information sharing

We know there are barriers…

Lack of coordination

Lack of policies and procedures

Lack of resources

“Collaboration costs!!”

Implications for Practice

Mutual awareness and understanding One of 4 key intents Serious pre-planning Implementation support Interagency manual Interagency orientation training Do not expect miracles Be comfortable with robust conversations Professional learning can be challenging

Implications for Practice

Coordination and accountability Funding from Department of Child Safety Strong leadership from key decision makers

Local Interagency Steering Committees State-wide Interagency Steering

Committee Child Safety Directors Network Directors-General

Memorandum of Understanding Implementation support Adequate resources - $$, knowledge, skills

Implications for PracticeShared goals and outcomes

Promote shared care not ‘ownership’ of the child

Structured processes – communication and documentation; interagency care plan

Shared trouble shooting – steering committee, panel and stakeholder team

Always keeping each other informed about decisions that have a major impact on the child

Shared Goals and Outcomes

Getting the Picture

Sharpening our perspective from good systems to starting with the empowerment of marginalised children and young people

Shared Goals and Outcomes

The Child or Young Person who is experiencing trauma, extreme disadvantage, devaluation, alienation & marginalisation in their everyday lives is the central focus of this project.

The values of inclusivity, shared responsibility, professional co-operation, balancing supportive care and self determination are central

Shared Goals and Outcomes

The intention of the Sunshine Coast Steering Committee and the Interagency Panel is to support the co-operative processes between departments, professionals & clients to best serve the complex needs of the child & young person in care

An Emerging Art…

BRAND NEW TERRITORY Catching a glimpse of new way of

doing things Plans taking shape … learning to make

them real so they do change things Can become impatient … change

comes slowly Nothing is really happening until life is

better for these most disadvantaged young people

Still learning

It all starts happening!

Stepping through the process – client teams, assessments, interagency care plans

Workloads growing – stretching resources Raising the bar on referrals Challenge of engagement with clients Looking for, and seeing tangible changes Child Safety Officer’s lives becoming different

– specialist support, part of a wider team GETTING IT! This is a Child Protection

Service. Part of us!

Shared Goals and OutcomesWhat has worked!

The way we work together (a developing art)

Promoting: One Combined Service

Not left alone any more … shared responsibility

Approaching as a Team as far as possible and avoiding demarcations

Shared Goals and OutcomesWhat has worked!

Focus on contributing varied frameworks, holistic assessment, coming up with solutions

Honouring of difference vs competing for primacy

Encouraging staff in Child Safety Service Centres to shift our ways of working

Shared Goals and OutcomesWhat has worked!

Best Possible Knowledge….Good information

Assessments – new span of knowledge, expanded scope in planning

Able to regulate across complex themes and environments

Integrated assessment and response drawing on 4 departments and more

Each agency is able to focus on maximising their specialist skills and knowledge

Mutual Awareness & UnderstandingWhat has worked!

Talking through our varied perspectives

Learning each other’s language and frameworks

Openness to seeing through other’s eyes

Honest dialogue within the team

Mutual Awareness & UnderstandingWhat has worked!

Mixing with our partners within Child Safety Service Centres

Working through criteria, ensuring we hit the mark

Clarifying roles – between teams, within teams, panel, steering committee

Challenges / Learnings

Quality referral information Getting sharper so we waste less time All accepting that change for these

young people is a slow process, but still needs to be marked by real markers

Still learning how to be clear about outcomes

How do we plan for long term therapeutic outcomes?

Challenges / Learnings

Getting the idea of a fully collaborative service

Keeping on working on breaking down demarcations across departments and within each of our teams

What’s worked from my perspective

Learning heaps (unchartered territory)

Value what I see the other agencies bringing to our children and young people’s lives

Access to new ideas and possibilities

Learning what we didn’t realise we lacked

Agents of Healing and Bringing Together

These kids are the MOST marginalised, disenfranchised, invisible except as problems

New program … able to stamp a focus on bringing hope to excluded and marginalised children and young people

No longer falling between the gaps (mostly) Need fresh chances only possible through

creative rethinking of paradigms More sustainable model Ramifications for wider community Challenge to keep it alive and fresh as it can

become calcified

Outcomes of working together

Outcomes for children and young people are enhanced when we work together better

Holistic assessment and response

No one person / department has to hold everything or coordinate everything

Getting the best out of each other

TANGIBLE OUTCOMESLearning to articulate them

Changes across environments Carers less reactive – reduced stress,

greater coping Engagement Attendance in therapeutic environment Emotions more regulated Relationships enhanced Placements stabilised Increased school attendance

Harry

9 years old

Diagnoses Reactive Attachment Disorder Mixed disorder of conduct and emotions

8 placement changes in past 2 years

5 different schools attended in local area. Expelled from school early this year

Harry

7 stakeholder meetings to develop and maintain the interagency care plan

Multidisciplinary / multi-agency assessment Speech and language assessment by

Education Queensland Psychiatrist reviews re medication Functional OT assessment WISC

Harry

Goals Engagement in therapeutic process to

address anxiety, social skills and anger management

Support the maintenance of a stable placement

Graduated exposure to support transition into school

Harry

Interventions (Mental Health team identified as primary service provider)

Graduated exposure to support interaction with peers

Life story work to assist development of identity

To address significant traumatic events when Harry ready to disclose

Harry

Outcomes Now attending School ½ day 4 days

week No suspensions or exclusions for

3/12 Stable placement for 6/12 Despite acting out support network

can cope

Michael

11 year old

Diagnoses ASD ADHD Intellectual Impairment

Physical aggression at home and school

Michael

Multiple school suspensions

6 Foster placements in 6 months

Currently “self placed” with biological family.

Michael

2 stakeholder meetings to develop and maintain the interagency care plan

Multidisciplinary / Multi-agency assessment Speech and Language and Occupational

Therapy Assessment – Disability Services

Michael

Full-time teacher aide funded by Education Queensland

Family therapy provided by Family Therapy Team in local Child & Youth Mental Health Service

Mental Health team visiting Michael weekly at home for individual therapy and family support

NGO support for mother and children

Michael

Clinical Outcomes Reduction from clinical to non-clinical

range (HoNOSCA) Disruptive, anti-social, or aggressive

behaviour Problems with peer relationships Problems with self-care and

independence Poor school attendance

Michael

Clinical Outcomes Self-report (SDQ) improvement in conduct

problems, hyperactivity, and peer problems

Parent-report (SDQ) improvement in conduct problems

Improvement in overall functioning (CGAS) from moderate degree of interference in most social areas to variable functioning with sporadic difficulties in several areas

Michael

Functional Outcomes No school suspensions for 4/12 Remained in current placement for

9/12 No substantiated notifications in this

placement with biological mother

Case Study – Sam

A 13 year old

One of the first referrals through Sunshine Coast Panel - end 2005

Diagnoses:

Autistic Spectrum Disorder (ASD)

Obsessive Compulsive Disorder (OCD)

Non Verbal Learning Disorder (NVLD)

Attachment Disorder (AD)

Intellectual Impairment (II)

Communication Disorder

Background

Entered into care February 2005

Currently living in residential setting with other children in care

10 placement changes in last 5 months

Heavily medicated

Strengths

Great sense of humour

Very engaging with most adults

Personal care

Interests

Pattern of challenging behaviour

History of aggression to people and property across settings- Mother- School- Respite- Placements

Interagency Therapeutic and Behaviour Support Services

1. Initial assessment

2. Ongoing one to one support to Sam, his carers, school and mother

3. Client team: Behaviour Support Team (Psychologist and Speech and Language Pathologist) and Mental Health Team Psychologist

4. Stakeholder team: Client Team together with Child Safety Officer, Head of Special Education, Teacher, Carers, Carers supporters, Mother and Sam

5. Functional Assessment

6. Behaviour Support Plan

7. Therapeutic intervention

Engagement with Sam

Child Focussed

Inclusive decision making e.g. Stakeholder meetings

Working with Sam in his social and emotional context

Positive Behaviour Support model

Positive lifestyle changes that enhance quality of life, and

reduce the intensity, frequency and duration of the behaviour of concern.

Engagement with Sam

Sam’s Perceptions

“Before - I had nothing to do because I couldn’t tell anyone and I always got into trouble and I never got treated fairly”

“At the meetings I get to talk about anything that I’ve got worries about”

“I don’t like it when people don’t come to the meetings”

“Since I started doing Aikido I’ve lost 8 kgs.”

“All the bad people haven’t been picking on me because I know Aikido. They aren’t bothering me anymore”

Sam’s perceptions

“Everything’s good now – I think my behaviours have been better since I’ve been with [the program] I haven't had as many behaviour issues. I’ve had a couple, but not as many as before”

Sam’s perceptions

Stakeholder’s Perceptions – The School

Reduction in isolation

Short circuits the systemic problems

One avenue for communicating across stakeholders

Changes observed by Child Safety Officer

Mother more engaged

Sam willing to participate in community activities

Decrease in challenging behaviour

Sam is making friends at school

Hope for the future – for Sam, his mother and all concerned

Sam’s mother

Prior to involvement in the Interagency Service Sam’s mother would not take him out into the community.

She is now taking responsibility for taking Sam to the doctor and spending time with him in public.

What’s made the difference?

“Bron’s helped me, but I think it was my choice as well”