Tracking high needs kids: out of sight, out of mind, and out of home care. Centacare Broken Bay ACWA Conference 2008 Dr Stephen MondyJean Murray Senior Manager Program Development and Research Senior Manager Out of Home Care

Purpose of this talk: Funding Incumbent on providers to detail the programs they offer Need for continued (longitudinal) research Need for collaboration

Centacare Broken Bay Professional welfare service delivery to Northern Sydney, Northern Beaches and Central Coast 12 Funding streams, 30 funding agreements and > 50 funded programs Disability, Aged Care, Family relationships, Counselling, Mediation, DV support, Childcare, Respite, Employment, Housing support, SAAP, and OOHC

Adapted from AIHW Child Welfare Series and Bath (2007)

12,712 Children in OOHC NSW (June 2007) 30.4% of children in OOHC are Indigenous (Aboriginal/TSI) yet only 3.4% of NSW children are Indigenous Residential care Foster care Kinship care

$1.2 billion of additional NSW Government funding to strengthen child protection and care Over $600 million for consolidating and extending OOHC services An early component of this funding rollout was provision for residential care for young people with high and complex needs (‘High Needs Kids’)

Despite increasing resources the number of Children in OOHC in NSW continues to rise YearRate per thousand population

Secure units were closed in NSW in 1998 A small number of young people in care exhibit extremely challenging and risky behaviours to themselves and to others Known as ‘High Needs Kids’ - acute, crisis- level of disturbance through self-harming and suicidal, violent or anti-social behaviour Represent about 2% of children in care, but accounted for 26% of DoCS OOHC budget (in )

NSW DoCS contracted four NGOs to work with High Needs Kids 224 placements across NSW Centacare Broken Bay Broken Bay – 12 residential placements in 4 homes 6 foster care placements Case management retained by NSW DoCS – placement service only provided by NGOs

Mostly adolescents with a history of residential and foster care placement disruption Seriously challenging behaviours to self and others Common diagnoses – ADHD, Conduct Disorder, Oppositional Defiant Disorder, Mood Disorders Often fail to meet thresholds for intensive long term intervention by service systems - disability, mental health and criminal justice systems - yet still have complex child protection needs

Challenging behaviours - social/emotional difficulties: poor impulse control and/or stress intolerance high risk-taking behaviours alcohol and other substance abuse poor self image self-harming behaviours social isolation/limited capacity to form relationships with peers/adults sexually inappropriate behaviour anti-social behaviours including aggression/violence towards people In some instances: criminal behaviour mental health issues physical health issues intellectual disability educational difficulties

Percentages of all Children in OOHC in NSW by number of placements (June 2007; n=12,712) Number of Placements

Centacare Broken Bay HNKs December 2005 – present Foster Care n=8 Residential Care n=23 Average # prior placements211 Average age on entry (years) Males (%)6343 Indigenous (%)043 CALD (%)508 Sibling in care (%)6325 Cost per child (today’s $ p.a.)100,344274,894 Educational/Employment Placement (%) 6331 Median Length of Placement (days)432408

Centacare Broken Bay HNKs Exit Points # n=13 Restoration home2 Kinship care7 Disability placement1 Detention1 Self placed2

Small units (<3): tailored programs < iatrogenic effects

Staff Recreation Psychological Assessment Training Supervision Small units (<3): tailored programs < iatrogenic effects

Staff Recreation Psychological Assessment Training Supervision Small units (<3): tailored programs < iatrogenic effects Centacare Broken Bay Integrated Services Disability Aged Care Family relationships Counselling Mediation DV support Childcare Respite Employment Housing support SAAP

Key features of Continuum of Care approach Staged entry and transitional arrangements A comprehensive individualised therapeutic intervention plan Staff move with the young person Recreational activities familiarise children with staff from future placements Risk minimisation approach to co-placement

Key challenges Reducing placement disruption in community settings Site Behaviour management Neighbours Attracting and retaining staff Recruiting suitable staff Vicarious trauma Engaging with the education system

Key success factors Sufficient funding to meet each child’s needs Flexibility to redeploy staff to maintain attachments Close relationship with statutory case management agency (DoCS) Comprehensive individualised care plan Flexibility in young people’s participation in care planning Reconnecting young people with educational success

Implications for Practice continuum of care approach leads to enhanced placement stability offers the possibility of consistent, targeted therapeutic interventions that: address trauma lead to the establishment of better attachments and social functioning stabilise behaviours contributing to placement breakdowns

For more information please contact: Jean Murray Senior Manager Out of Home Care Dr. Stephen Mondy Senior Manager Program Development and Research