1. New Pathways Residential Treatment Services
Working with High & Complex needs young males who have sexually problematic behaviour:
Providing a Sanctuary for Change
Leah Berry (Clinical Coordinator)
Cass Herring (Program Manager)

2. Located in the Southern Highlands (Sutton Forest NSW)

3. New pathways staff Program Manager: Cass Herring
Intern Psychologist: Liz Bennett
F/T Case Worker: Lauren Spinks
P/T Case Worker: Vacant
Admin Support: Sarah Sells
Full Time Specialist Youth Workers: x 7
Part Time Specialist Youth Workers: x 5
Casual Specialist Youth Workers: x9
Night Workers: x 5
Life Skills Mentor: Louis De Marco

4. Overview of new Pathways
Purpose: To provide Out of Home Care for adolescent males aged between 13 and 17 years of age who have sexually abused and who have High and Complex Needs.
In April 2007 DoCS signed an agreement with New Pathways to provide residential treatment for high and complex needs adolescent males who also had sex offending behaviours.

5. Overview of new Pathways
3 Houses on approximately 100 acres.
Mark David House
Mirvac House
Pif House

6. Unique to Australia; only OOHC provider to this client group
Treatment Milieu- 24 hour roster; focus on “life space” intervention not just individual counselling. Specialist Youth Staff are vital to process significant issues & behaviours immediately whilst it is still relevant to the young person.
CSOCAS accredited staff
Staff Training includes:
TCI, RAP, LSCI, Trauma Sensitive, Sex Offender Specific, Adolescent Mental Health, Good Way, “In-house” induction
All staff are provided with all training modules
Consistency provides safety and security
Anglin (2002)
New Pathways is currently the only service provider in Australia who caters to this specialised client group. All staff who work with the young people in the service are provided with intense training prior to commencing work; this includes all of the Specialist Youth Workers, the dedicated Night Youth Workers, the Case Workers, the Intern Psychologist, Admin Support, the Program Manager; even the regular maintenance worker. Importance is placed on all staff receiving the same training in accordance with Anglin’s research into what makes an effective residential program. Anglin found that when all staff had the same level of training that this provided a sense of safety and security for the young people in the service as they would receive the same messages consistently from all staff. (Young person stated that when they got a new staff member they would attempt to push a boundary and if the new staff member did not respond the way they were supposed to- by enforcing the boundary- they immediately became an unsafe person for the young person as they didn’t know how to do their job adequately).
Having the same level of training also feeds into the Milieu model that New Pathways utilises. Treatment occurs in the young person’s life space; not just during scheduled individual counselling times, staff are able to process significant events as they occur whilst they are still pertinent to the young person and captures the greatest opportunity for change and growth.
New Pathways is also lucky enough to have some staff accredited through CSOCAS which is a voluntary scheme in NSW (Child Sex Offender Counsellor Accreditation Scheme)

7. High & complex needs Multiple &/or traumatic placement breakdowns
Poor impulse control &/or stress intolerance
Educational difficulties including inability to attend mainstream schools
Attention Seeking Behaviours
Poor self image
Self harming behaviours
The following are definitions of what makes a “High & Complex” need. All young people referred to New Pathways present with a number of these behaviours.

8. High & complex needs History of Inappropriate Sexual Behaviours
Verbal & Physical Aggression (that may result in property damage)
Low level criminal behaviours (eg property damage, theft etc)
Intellectual Disabilities (mild-moderate)
Poor communication & social skills

9. Mark david house Houses a maximum of 3 young people.
Solid Dwelling: Great for yp with destructive behaviours.
Has an in-ground swimming pool; a “gym”, a library, permanent campsite & bike jumps in immediate vicinity.
Mark David House was donated by the McIntosh family in memory of their son; it is located towards the top of the property and currently houses two young people. This house is often utilised for the more destructive young people at New Pathways due to it’s strength and durability.

10. Mirvac house
Can have a maximum of 5 young people (although this is very unlikely due to dynamics of young people).
Has an in-ground trampoline, football field, versatile cement sporting area in immediate vicinity.
Mirvac house was donated by the Mirvac building company and the house was originally used in the Olympic Village in Sydney. At New Pathways, although the main goal is treatment, it is important that the time the young people spend at New Pathways is enjoyable. A lot of time is spent providing sporting & recreational resources to encourage the young people to learn & practice new skills and strategies amongst each other and within the community.

11. Pif house Used for Admin purposes. Can house a maximum of 3 yp.
Houses a “school room” for yp who can not cope in mainstream schooling.
Pif house was donated by the Property Industry Fund and is located approximately 400 meters from Mirvac house. Pif is used primarily for administration purposes however we currently have a young person residing there who is unable to reside safely with other residents. Pif also houses a school room for the young people who cannot attend school; we are currently utilising this room for a life skills program.

12. Responding to pain-based behaviour
Underlying therapeutic models of new pathways!
Responding to pain-based behaviour

13. The Good Way Model
Originally developed for the Well Stop Program in New Zealand, by Ayland & West (2006).
Based on Narrative therapy, positive psychology, trauma theory and special education - helping our young people externalise their behaviours
The Islands of progress
The Gang of Three and Wise Men
Incorporating relapse prevention planning
The Good Way Model was developed in New Zealand by the Well Stop Program (Ayland & West, 2006). The model was designed for treatment of adolescents with sexually problematic behaviours. The model is based on a narrative therapy approach, which essentially allows the young person to externalise their behaviours. For example the young person is not seen as the problem, but the behaviour is seen as the problem. The model was also found to work well with young people with intellectual delays. (Ayland & West, 2006). The Good Way Model is essentially comprised of 7 stages of therapeutic interventions, or as the young people have coined as ‘the islands’. The islands are representative of each stage of treatment and address specific therapeutic goals.

14. The Gang of 3

16. Dice activity

17. The evolution of new pathways
Began as PPC (Positive Peer Culture) which focused on young people learning from their peers rather than adults.
Due to the increasingly complex needs of young people (who were unable to function as part of a peer group) the program evolved to a more individualised approach however maintained many of the PPC underlying values
Primary Goal of making Hurting Behaviours Unfashionable and Caring “Cool”
New Pathways opened in 2002 and began with a Positive Peer Culture model focusing on adolescents being more open to learning from each other rather than from feeling as though adults are forcing change upon them. It soon became apparent that PPC would not be effective as the young people who were being referred were unable to function within a group setting. In response to this New Pathways began to evolve to more individualised approaches.

18. Strength-based interventions
Underlying value “All young people in Service are GOOD people who have made BAD choices.”
Focus on catching the yp being good & immediately acknowledging this
Approach Goals rather than Avoidance Goals: Setting goals that are challenging but also achievable for the yp.
Bringing about behavioural change is used through the raising of a young person’s anxiety’s (making the negative behaviour uncomfortable). However this is only possible by balancing the positives to combat perceived negative self-image (so the yp does not become their behaviours)
Underlying PPC and the evolution of New Pathways is strength-based practice.

19. Translating into oohc Demanding GREATNESS! (Not Obedience)
NO punishment (Natural & Logical Consequences)
Crisis = Opportunity
Reversing Responsibility: Troubled youth will attempt to put their problems onto those around them. They are NOT responsible for creating their problems but for how they respond to them.

20. Trauma Sensitive Approach
Adolescents who sexually abuse almost universally have some form of trauma in their histories ( McMackin et al, 2002).
Neurological Impact – structural and functional differences (Teicher et al, 2002)
Responding to a young person’s needs not reacting to their problems.
Understanding Vicarious Trauma of the staff team.
Research into the area of trauma has indicated that it is almost universal in the histories of young people with sexual behavior problems to have experienced some form of abuse. This of course is not restricted to sexual abuse, but a traumatic experience can be witnessing physical abuse or sexual abuse, emotional abuse or neglect, general neglect or abandonment, physical abuse, sexual abuse, long standing verbal abuse, etc. So many of our young people have endured such pain in their lives with many serious consequences. It has been shown through neurological research that people who are exposed to early childhood trauma show significant alterations in both the structural make up of the brain, particularly the amygdale, hypothalamus and limbic system, and the function of these structures resulting in many common manifestations such as hyper vigilance, interpretation of environmental cues as being threatening and therefore have a stronger tendency to show a fight-flight response. This also affects the ability for individuals to take on environmental stimuli and process it cognitively to problem solve and learn from it.
Stabilization and Safety – as mentioned many of our young people presents with traumatic histories, it is imperative that we ensure a safe and secure environment, both physically and psychologically before any traumatic experiences can be decoded and processes. This is also our first step in addressing sexual behavior problems, if a young person has a history of significant trauma they will not necessarily be ready to take on the understanding of the choices they have made.
Vicarious Trauma – As an high and complex needs placement for young people we have a highly skilled and competent staff team that we need to ensure have a good level of self awareness and understand the impact of a young persons story on the psychologically and also the impact of the intense and often abusive behaviors that they face on a regular basis. We ensure that our team is well supported with education regarding trauma based behavior and well trained in managing these behaviors, but we also ensure that they have the capacity to debrief with senior staff and external counselors to ensure that they an not becoming traumatize

21. The Sanctuary Model Bloom, 1997
A residential care model integrating a variety of treatment approaches and is a trauma based system of care.
Structuring for safety and security to create a living-learning environment.
Therapeutic focus
S afety and security
E motional regulation
L oss
F uture
The Sanctuary model was originally developed in a short-term, acute in-patient psychiatric setting for adults who were traumatized children. However it has evolved to become a significant model to consider when addressing residential care for young people. The model was developed by integrating numerous treatment modes, with two dominant approaches psychoanalytically – oriented intensive individual treatment and a therapeutic community or Milieu. The model helps us to look at young people that have been traumatized as being exposed to significant psychological pain and have had developmental injuries that we are able to help them through to simulaneousy work on the injuries inflicted on the body, mind and soul.

22. Circle of courage (Brendtro, Bockern & Brokenleg)
Asks the question “how do children develop courage and resilience?”
The answer is they need to Belong; they need Mastery; they need to become Independent; they need to be able to contribute to others in the spirit of Generosity.
When a young person enters New Pathways we look at where their circle is broken (which can be in more than one place) and begin to look at how to provide opportunities and approach goals that will allow the young person to heal their circle.
When growth needs are met; Youth have positive outcomes.
When growth needs are frustrated; Youth show problems.

23. Bob

24. Bob at the Beginning 15 years old & the middle of 3 siblings
History of ongoing neglect, verbal abuse, lack of supervision, and boundaries, exposure to alcoholism, aggressive behaviour, and pornography.
Mild intellectual delay, with a diagnosis of ADHD
Strong relationship with mother and minimal contact from Bob’s Father

25. Long standing sexually abusive behaviour (reported on numerous occasions) toward a younger sibling – JIRT investigated, but no charges.
Attempts at intervention whilst Bob continued to reside at home, however it was eventually evident that Bob required an OOHC placement to address these behaviours as the sexually bullying was increasing.

26. Reported problem behaviours include:
Sexual bullying, touching, & penetration
Cruelty to animals.
Urinating in public
Possession of weapons to harm himself
Suicidal threats and gestures
Risk taking behaviours
Poor self esteem
Anger management difficulties
Oppositional
Non compliance
Aggression – verbal and physical

27. Bob’s Intervention
Ensuring his environment was safe and secure, also encouraging him to express his personality in how he decorated his room and house. (Belonging)
Working with Bob to develop short & long-term personal goals to help change his abusive behaviour. (Mastery)
Bob was given the opportunity to contribute to his daily schedule and community activities that he is interested in. (Independence)

28. Bob Now
When Bob had been in the program for 14 months he was on Blue Island
He had improved in the following areas:
Decreased physical and verbal aggression
Acceptance of sexually abusive behaviour and development of Wise Men
positive communication
ability to follow structure and responds well to this
empathy skills
Had begun family restoration through positive and structured contact with his victim
Was still working through some attitudinal and value shifting processes.

29. trevor

30. Trevor at the Beginning
14 year old, ATSI young person.
History of ongoing sexual, physical and emotional abuse, witness to violence and sexual abuse of family, neglect and abandonment.
Mild intellectual delay, diagnosis of PTSD, Learning delay, ODD, and some suggestion of ADHD.
Trevor has six older siblings and at least four younger siblings.
Trevor was rejected & abused by his mother and father and abused by his step father.

31. Trevor had a very strong positive relationship with an extended family member who is a constant positive and often therapeutic support.
Trevor sexually abused his younger cousin on several occasions within a short period of time and was charged for these encounters.
Trevor was abandoned, scheduled at an adult facility and homeless prior to entering New Pathways, but had specifically requested to have help to change his behaviour.

32. Trevor’s Problematic behaviours :
Suicidal Ideation and gestures
Petrol Sniffing behaviour
High risk of absconding
Violent and aggressive behaviour
Physical and verbal abuse
Non compliant and defiant
Pushing boundaries & manipulation
Poor peer interaction
Poor academic achievement.
Threats of harm toward self and others
Lack of impulse control & Easily misled
Poor communication
Poor anger management & Low tolerance for frustration

33. Trevor’s Intervention
Ensuring his environment was safe and secure, by placing him by himself and structuring for safety particularly of an evening. (Trauma Sensitive)
Working with Trevor to develop short & long-term personal goals to help change his abusive behaviour. (Mastery & Trauma Sensitive)
Trevor was given opportunities to engage in life skills development & cultural development. (Belonging, Mastery, Independence & Trauma Sensitive)

34. Trevor Now
When he had been in the program for eight months he was on Purple Island
He had improved in:
Positive communication
Decreased aggressive outbursts
Some impulse control
Victim empathy
decrease in suicidal gestures and ideations.
Building relationships
Ability to follow structures and guidelines

35. Outwitted He drew a circle to shut me out.
Heretic, rebel, a thing to flout.
But love and I had the wit to win.
We drew a circle that took him in
Edwin Markham

36. Questions?