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Protect All Children Today 26 March 2009 26 March 2009 Evolve: working with children and young people with severe and complex psychological and behavioural.

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Presentation on theme: "Protect All Children Today 26 March 2009 26 March 2009 Evolve: working with children and young people with severe and complex psychological and behavioural."— Presentation transcript:

1 Protect All Children Today 26 March 2009 26 March 2009 Evolve: working with children and young people with severe and complex psychological and behavioural problems

2 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

3 Background and Rationale CMC Collaborative model Unique service – new model of service, no precedents, ongoing learning. Changing and growing cohort

4 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

5 Far Nth Qld North Qld Central Qld Sunshine Coast North Brisbane Logan Gold Coast Evolve Locations

6 Evolve Interagency Services Model

7 Evolve Program Goal of Evolve Multiple agencies Therapeutic & Behavioural Support Services, intensive and long term intervention Holistic and consistent approach in support and intervention

8 Developmental effects of abuse and neglect inform intervention approach

9 Principles of therapeutic mental health services [Saunders, B.E., Berliner, L., & Hanson, R.F., 2004 & Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B., 2003].

10 Positive behaviour support model

11 Evolve Program Learning’s & Outcomes IssueBenefitsChallengesLearning’s Shared 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

12 Evolve Program Learning’s & Outcomes IssueBenefitsChallengesLearning’s Shared 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

13 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

14 Evolve client outcomes IssuesInterventionOutcomes 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

15 Evolve client outcomes IssuesInterventionOutcomes 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

16 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

17 Achieving outcomes for children through collaboration A Case Study “Jack”

18 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

19 Referral cont. Significant learning difficulties Illiterate Diagnoses of ASD, ADHD Significant trauma and attachment issues Medication (Ritalin, risperidone, endep)

20 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.

21 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

22 Stakeholders Educatio n Young Perso n Evolve Therapeuti c Service Evolve Behaviou r Support Child safety Residentia l Family /Other

23 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

24 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 medication RESIDENTIAL & DETA Attend SH meetings Participate in training Implement strategies Flexible resourcing

25 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

26 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

27 Outcomes for stakeholders Improved skill base, particularly for direct staff. Increased understanding of other professionals. Enhanced relationships between government and non government departments.

28 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

29 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

30 Collaborative Partnerships Ongoing 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)

31 Evolve Program Management Team Melissa Yim, Department of Child Safety Jackie Bartlett, Queensland Health Morag Gilchrist, Disability Services Qld Brett O’Connor, Department of Education Training and the Arts Erica Russ, Department of Child Safety

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