Working with High Risk Young People

Interventions, Models and Significant Issues

Lisa HillanSave 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

• 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• 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• 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