Protect All Children TodayProtect All Children Today

26 March 200926 March 2009

Evolve: Evolve: working with children and young people with severe working with children and young people with severe and complex psychological and behavioural problemsand complex psychological and behavioural problems

Outline• Evolve Interagency Services overview

• The use of collaborative practice in the Evolve model

• Learning’s, outcomes of this approach

• Future challenges

• Client outcomes

• The model in action – a case study

Background and Rationale• CMC• Collaborative model• Unique service – new model of service, no

precedents, ongoing learning.• Changing and growing cohort

Underpinnings of the Evolve model

• Collaborative approach• Multidisciplinary approach• Child centred and Inclusive approach to ensure

child, family and carers involved in planning and implementing intervention goals

• Capacity building to support sustained change for both the child and their support network

• Evidence based practice

Far Nth QldFar Nth Qld

North QldNorth Qld

Central QldCentral Qld

Sunshine Coast

North BrisbaneNorth Brisbane

LoganLogan

Gold CoastGold Coast

Evolve Locations

Evolve Interagency Services Model

Department of Child Safety

CHILD orYOUNG

PERSON

Department of Education,

Training & the Arts

Disability Services

Queensland

Queensland Health

State-wide Steering Committee

Local Steering Committees

Evolve Panels

Stakeholder Mtgs

Evolve Program

• Goal of Evolve

• Multiple agencies

• Therapeutic & Behavioural Support Services, intensive and long term intervention

• Holistic and consistent approach in support and intervention

Developmental effects of abuse and neglect inform intervention approach

Sub-optimal neural pathway development

Strain on care environment

Behaviours challenge care environment

Poor self concept & social skills

inability to relate to others Trauma and

neglect

Child protection intervention,

breakdown of core relationships

Placement breakdown

Principles of therapeutic mental health services

Safe environments at home, school and community

High trust relationship with therapy team/

alliance

Supportive, non-offending family

members included in the treatment

Meaning-making about past

traumatic events

Skills development emotion regulation

& interpersonal functioning

Child’s resilience is increased long term

Strong family relationships & child is integrated in positive

social networks

Child see themselves as different from who they were at time of

traumatic events and see hope for the future

Long term functioning and

welfare of the child

[Saunders, B.E., Berliner, L., & Hanson, R.F., 2004 & Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B., 2003].

Positive behaviour support model

Peers and school

Current care of placement

environment

Past trauma

Functional ability and disability

Internalising behaviour

Externalising behaviour

Adaptive or a-social behaviour

PROBLEM BEHAVIOUR

Comprehensive functional behaviour assessment and

ongoing monitoring

Multi-component behaviour support plans incl. teaching new

skills, ecological changes & direct strategies for behavioural change

Reinforcement of positive behaviours. Teaching of new adaptive behaviours and skills

Positive lifestyle changes and reduction in the intensity,

frequency and duration of problem behaviour

Evolve Program Learning’s & Outcomes

Issue Benefits Challenges Learning’sShared Governance

Shared ownership and responsibility

Time, energy & resource

Allow for longer timeframes

MOU Endorsement at DG level

Lengthy process – change slow

Need for support at all levels of organisation

Branding Common banner – owned by all partners

Approval across all agencies & Whole of Govt restrictions

Political/ agency impacts on process

Language & understanding

Common language/ understanding of approaches

Professionals and agencies have variable terms and understandings

Ongoing process as activities develop

Evolve Program Learning’s & Outcomes

Issue Benefits Challenges Learning’sShared Responsibility

Reduced blaming and responsibility shifting

Agency specific requirements / policy and legislation

Need processes and education to develop and support

Myths Challenge myths across agencies

Staff changes, vested interests

Ongoing info flow to all parties

Service delivery

Stronger interagency relationships

Capacity

Increased demand

Broad cooperation across agencies

Resistance and barriers

Barriers btw agencies reduced – flow on to other work and clients

Changing staff

Increasing stakeholder groups – new players

Community shift re hope of closing service gap and availability of support

Future Challenges• Capacity of Evolve and increased demand

• Recruitment of specialist staff

• Information sharing

• Educating and engaging stakeholders

• Links with other elements of the service system

• Managing expectations

• Research and Evaluation

Evolve client outcomesIssues Intervention Outcomes

Ben

13yr

•Neglect & physical abuse• Anxiety & depression•Bullying, family & peer rejection•Challenging behaviours – impact at school and placement

• Therapy re: past abuse and neglect• Primary Service Provider worked collaboratively with carer & school re: best support approaches for home school

• Increased self-esteem • Nurturing relationship with carer • Developed friendships• School band• Writing & art competitions

Pam

16yr

• PTSD, epilepsy, intellectual disability• Frequent & severe self harming•High level outburst behaviours• 2:1 worker support

• Therapeutic Services & Behaviour Support joint assessment

• Token Economy system

• Intensive training & support to carers stakeholders

• Significant decrease in self harming & outburst behaviours

• 1:1 worker support

• Employment & community engagement

• Positive family contact

Evolve client outcomesIssues Intervention Outcomes

Joe

11yr

• History of physical & emotional abuse• Suspensions & truancy at school• Multiple placements• Violent behaviours • Stealing• Self-harming

• Intensive therapy support with Joe• Support with specialist foster carer • Work with child safety, school & carer re: understanding Joe’s behaviours and ways to respond

• Stabilised accommodation• Significant decrease in violence, self-harming & stealing• Improved academically• Increased self-esteem & engaging with peers

Sue

8yr

• History of neglect• Reactive attachment disorder & autism• Sexualised behaviours - self & others• Aggressive outbursts•Rejection by peers

• Therapy with Sue •Intensive support & education with carer• Training teachers, NGO’s re: sexualised & aggressive beh.• Regular psychiatric & medical reviews

• Reduced aggression & sexualised behaviour• Engaged in school• Positive interaction & acceptance with peers• Decreased risk of placement breakdown

Evolve Program Client Outcomes

Client Benefits• Review of Evolve

– Significant decrease in challenging behaviours

– Reduction of self harm and harm to others– Greater placement stability– Increased participation and engagement in

educational programs

Achieving outcomes for childrenthrough collaboration

A Case Study

“Jack”

Referral• Referred to EIS 2007.• 13 year old male• Multiple placements• Aggressive/violent outbursts • Absconding from home and school• Limited school attendance • Dysfunctional sleeping and eating patterns• Impaired activities of daily living• No peer relationships• Forensic History – theft, wilful damage, assault• Emotional dysregulation

Referral cont.

• Significant learning difficulties

• Illiterate

• Diagnoses of ASD, ADHD

• Significant trauma and attachment issues

• Medication (Ritalin, risperidone, endep)

Family and child protection history

• Parental drug and alcohol misuse, domestic violence, homelessness

• Complex blended family - multiple fathers/ partners/siblings

• Family known to Department of Child Safety/multiple levels of intervention

• Significant history of neglect, trauma and abuse including sexual abuse of children

• Family has history of non engagement, litigiousness, and sabotage of interventions.

Evolve Interagency Services program• Allocated to Primary Service Provider

– Allocation of roles• Assessment process

– How to, responsibilities, formulation and development of treatment plan

• Treatment process– Identification of and establishment of stakeholder team,

frequency of meetings, roles, and responsibilities:• Maintain open communication• Establish and set group cohesiveness• Demonstrate commitment to young person and

stakeholder process

Stakeholders

Education

Young Person

Evolve Therapeuti

cService Evolve

Behaviour Support

Child safety

Residential

Family/Other

Planning and Goal Setting

• Stakeholders identified goals – linked to Jack’s treatment plan – Jack’s involvement /engagement sought

• Goals set initially task focused– with each stakeholder identifying tasks that they were

responsible for

• Establishment of sub (micro) teams – to work on specific goals together for completion

between stakeholder meetings

Micro Teams in Action

EVOLVE HEALTH & DSQ

FAMILY

DChS

Stakeholder Group

•1:1 sessions with Jack•Connect with biological family•Advocacy for family contact•Training & education to School & NGO staff.

Financial support 1:1 placement•Open communication•Include SH in decisions•Attend SH meetings

•Liaise, engage, support and value. Include in SH process & treatment plan •Education: re medicationRESIDENTIAL & DETA

•Attend SH meetings•Participate in training•Implement strategies •Flexible resourcing

Outcomes for Jack• Aggressive behaviour has reduced • No further involvement with criminal justice system• Attending school regularly/engaged in community• Beginning to read• Improved ability to manage activities of daily living• Insight into behaviour, including empathy and remorse• Medication free• Peer relationships• Family relationships• Placement

Medium to long term goals for Jack

• Continuing development, peers, literacy, mainstreaming

• Development of emotional regulation, empathy and social skills

• Pre-employment skills with view to part time work

• Transition to supported/independent living

Outcomes for stakeholders

• Improved skill base, particularly for direct staff.

• Increased understanding of other professionals.

• Enhanced relationships between government and non government departments.

Key factors to successful collaboration amongst stakeholders

• Willingness of all parties to engage in process• Open, effective communication with ALL stakeholders• Continued involvement of family - backing up behaviour

support strategies.• Involvement of direct care workers (residential and

school) - specific tasks to give them ownership of process.

• Respecting the roles of others - honoring the person. • Keep young person at the centre – active participation at

stakeholder meetings

Our Key Learnings• Communication is the key - needs to be

effective, open, and with ALL stakeholders• Each person needs their own ‘work’ to do so that

they feel and become a key member of the team• Never underestimate the power of a united team• A collaborative team is characterised by equal

partnership and shared responsibility• Keep the young person as focus – the goal of

Evolve is to support the young person

Collaborative PartnershipsOngoing Challenges

• Interagency collaboration is– Multidimensional– Interactional– Developmental …

and a lot of planning and continued hard work is needed for it to be successful!

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

Evolve Program Management Team• Melissa Yim, Department of Child Safety

melissa.yim@childsafety.qld.gov.au• Jackie Bartlett, Queensland Health

jackie.bartlett@health.qld.gov.au • Morag Gilchrist, Disability Services Qld

morag.gilchrist@disability.qld.gov.au • Brett O’Connor, Department of Education Training

and the Arts brett.oconnor@deta.qld.gov.au • Erica Russ, Department of Child Safety

erica.russ@childsafety.qld.gov.au