Protect All Children Today 26 March 2009
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Transcript of Protect All Children Today 26 March 2009
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
[email protected]• Jackie Bartlett, Queensland Health
[email protected] • Morag Gilchrist, Disability Services Qld
[email protected] • Brett O’Connor, Department of Education Training
and the Arts [email protected] • Erica Russ, Department of Child Safety