Transcript Residential care in Australia

Working with High Risk
Young People
Interventions, Models and Significant
Issues
Lisa Hillan
Save the Children Qld
Key Issues
• Increase in drug use by households –
leads to lack of appropriate boundaries
for young people
• Immense trauma of young people both
within their family home and through
failed multiple placements
• Key policy directives that are leaving
children in challenging and dangerous
environments for longer periods of time
Current behaviours that cause concern
• Chronic absconding to unsafe places
• Prostitution
• Physical aggression and acting out
towards staff and other young people
• Property damage
• Inability to be calmed – inability to self
soothe
• Abusive and bullying behaviour
Key responses
• Restraint
• Model Development
- Secure Care
- Mental Health Treatment Centres
- Therapeutic Residential Care
Restraint
Discuss in Pairs key issues from
your point of view in the use of
restraint within residential
care?
Key Issues on Restraint from Research
• When should restraint be used?
• The types of restraint
• Injuries to young people – asphyxia, broken
bones, bruising, carpet burns, death
• The frequency of restraint
• Monitoring of restraint
• Children and young people’s opinions on
restraint
• Criminalistion of Children and Young
Peoples’ Trauma
Key issues in Restraint continued
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Union responses to staff safety
Staffing levels
Training of staff
Lack of policy directives from Govt
Legal liability for staff
Young People’s views of restraint
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Commission for social care inspection UK 2004
• Staff not recognising triggers for yp
• Staff not problem solving smaller incidents that build up
• Staff undertaking inappropriate responses to behaviour
that include shouting or saying things such as “don’t
mess with me.”
• Being restrained feels always feels like punishment
• Restraint should be used if you are going to hurt
someone or do major property damage
• Where young people had suffered past
abuse (physical/sexual) – created
distress – riled them made them lose
control.
• Makes you more worked up
• “It makes you feel like you are nothing.
People holding you down brings bade
memories. Its horrible. Makes you want
to head butt them”
• Other young people watching causes
distress
What young people wanted
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Trained staff
No physical pain as a result
Restraint as a last resort
Restraint never as punishment
Staff better at defusing incidents
Staff debriefing young people post restraint
Staff having consulted young people about the
ways to calm them when out of control –
developing a plan together
Policy and Practice Development
• Extreme risks evident in providing a safe
environment for young people and staff
• Milligan (2006) what needs to be present for
restraint to be practised appropriately and
well – Scottish Institute for Residential Care
• Key factors include
• A high skilled staff group
• A philosophical and theoretical framework of care that
looks at restraint within a therapeutic context
• Significant training and policy development
• A low restraint culture
Policy continued
• Lack of empirical evidence – little research
about the impact or capacity to create
change?
• Interaction between police and mental health
systems and residential care
• All states in Australia should have clear
policy development about restraint and its
place in caring for children and young people
– this should include parameters and
approved restraint practice within an overall
framework of therapeutic care.
Policy cont.
• Significant training of residential carers and
restraint practised within a context of
therapeutic care with a well developed
therapeutic intervention model that ensures
restraint is a last resort
• All residential care providers need identified
policy provision about restraint and a
demonstrated capacity to monitor its use and
develop alternatives that honour young
people’s experiences.
Secure Care
When you hear about secure care for
young people outside of juvenille justice
context what are your immediate
reactions?
Discuss with a person next to you
Overseas experience.
Scotland
- Used for young people who are a harm to
themselves or others – drug use, physical
aggression, self harm, prostitution
- 3 months – reviewed by children’s panel
- If no longer displaying concerns at 3
months released
- Placed with jj young people
Overseas exp cont
• Comprehensive assessment undertaken –
medical, educational, psychological, social
care and possibly psychiatric.
Canada
• Sexually exploited young people only
• Can place in protective care for up to 47
days
• Other states currently considering options
Outcomes
• Young people desisting behaviour
whilst in secure
• Comprehensive assessment
• Young people having a period of health
and safety
Concerns
• Young people cycling through secure units
• Lack of voluntary services for young people to treat
drug and alcohol issues, appropriate mental health
services, housing, jobs – basing service provision on
risk not absence of other appropriate service
provision
• Lack of focus on the system that the young person
belongs – lack of interventin to support change
• Lack of follow up after secure to ensure gains are
maintained
Key factors to consider
• Young people who are exposing themselves to
significant danger – lack of intervention abandons them
to the street
• Failure to provide systemic models of care that work
with family, peers, and community and provide long
term follow up
• High correlations in one unit between entering secure
and the following family history
• Exposure to domestic violence
• Being a victim of domestic violence
• Parents who abuse alcohol or drugs
• Recent study by the in UK by office of
National statistics children aged 5-15 –
mental health – 8.5% of children in
general population displayed mental
health issues – 45% in the looked after
population – 4 out of 10 young people
had considered suicide in the last month.
Hopefulness and Creative Responses
• Scotland
- Looked after children mental health
team for foster care and residential
care – multi-disciplinary team – not
diagnostically driven – psychiatrist
involved
• Canada
- Maples Treatment Centre
• Residential and Outreach
• 3 months in length
• Attachment and family systems
framework
• Multi-disciplinary team – psychiatrists,
psychologists, nursing staff, social
workers and residential care staff and a
recreation team.
• Care plan consultants
• Residential programs provide:
- psychiatric assessment
- multi-disciplinary assessment
- plans of care
- family therapy
- education and support
- vocational and recreational
opportunities
- ongoing outreach and respite
Chicago
• Institute of Juvenille Research – Illinois
University in Chicago
– Short term stay to develop treatment plan
– Returned to residential where the team
provide ongoing consultancy to assist staff
in constructing care environments that
meet young people’s needs
New York
• Sanctuary Model – Andrus Children’s
Centre
– Trauma training for staff
– Trauma training for young people
– Social worker in each residential
– Safety plans
– Community meetings