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”