Intensive Therapeutic Service A joint initiative by: Berry Street Victoria & the Austin CAMHS In partnership with La Trobe University Faculty of Health Science & Mindful

This target group has been characterised in the report “When Care is Not Enough” (Morton, Clark & Pead 1999) in the following way: “… there are a number of children and adolescents in care, who have suffered traumatic early environments, for whom care is not enough to effectively address the aftermath. It is argued that these young people need consistent and high quality care, which offers continuity of positive relationships. However, they also need systemic therapeutic interventions, to assist them to rebuild their lives and address post traumatic states and developmental disturbance associated with the severe abuse and neglect they have suffered”.

Service Components The submission brief required that the ITS deliver four service components: –Regional Intensive Therapeutic Services (85% budget) – 9 teams –Training component –Research component –Management component

Service Components…Cont’d The submission brief also specified that the Target Group will all be: –Referred by the regional Child Protection Manager –Clients of Child Protection who exhibit, or are at risk of developing, severe emotional or behavioural disturbance caused by abuse and/or neglect. –Clients of Child Protection who are subjects of substantiated significant and/or very severe harm because of physical or sexual abuse. –Aged 0-18 –May be living at home, with relatives, or in out of home care. –Expected to work with 710 clients.

Service Model There are 4 key aspects of the Service Model: –A treatment approach that utilises attachment based, outreach and multi- systemic interventions that have been shown to be particularly effective with the target group –A commitment to wrap around treatment planning models that emphasise the appropriate use of carers and others in day- to-day contact with the child or young person in order to provide treatment and therapeutic care that supports the healing process

Service Model…..Cont’d –An awareness of key service linkages and service system issues and a commitment to addressing the needs of target group clients through relevant service system development –A model that builds on and complements existing Child & Adolescent Mental Health Services (CAMHS) and builds bridges between Child Protection, CAMHS and other relevant service providers, continuing, and further developing, linkages established under the Working Together Strategy

Key Principles The client’s experience of disrupted attachment will be addressed through a primary one to one relationship between therapist and child or young person The effects of abuse will be understood within both developmental and systemic frameworks Interventions will be “whole of person” addressing both the current behaviour and its underlying causes ITS intervention will never be seen as “stand alone”, but always delivered through the building of collaborative alliances and integrated service planning with other services and professionals that can help the child or young person

Key Principles… Cont’d Given the complexity of understanding required and the potential complexity of service systems to be accessed, simplicity and consistency will govern the ITS service to any given client A wrap around approach, including work with school, family, and/or carers, will complement any individual work done with the child or young person Each client will be taught new social skills to increase their future resourcefulness Intervention effectiveness needs to be continually evaluated from the perspectives of the client, families and carers and other service providers

TAKE TWO Structure

Research Component There are 2 research questions: –What is the service framework and model which delivers effective assessment and therapeutic interventions to at risk children and young people and which effectively engages the elements of the service system to support those interventions and contribute to more positive outcomes for the child or the young person? –What are the important elements in the effective implementation of the service framework and model?

Research Component… Cont’d These questions are addressed through: –The development of the assessment instruments and the provision of information to assist the development of service models. –The undertaking of process and outcomes evaluations. The process evaluation will identify the processes of the ITS and the factors which impact on the effective implementation of the service. The outcome evaluation will identify if the project meets the ITS aims and the identified outcomes of the service.

Training Component Training Manager based at Mindful. Co-location enables drawing upon their well-established links and resources. Training calendar developed in two components: introductory and advanced across a three year training cycle. Incorporates induction for new staff within TAKE TWO and training for workers from Child Protection, CSOs, Education, CAMHS and Drug and Alcohol Koori workers. By the third year a training calendar will incorporate university accredited subjects, within existing Graduate Diploma in Mental Health Sciences (Child, Adolescent and Family Mental Health). Capacity for two junior staff from TAKE TWO per year to access the Developmental Psychiatry Course.

Timelines Minister launched TAKE TWO – 1/5/03 Director commenced on 21/7/03 Area Managers and Training & Research Managers commence on 11/8/03 Advertised for Senior Clinicians on 2/8/03 Advertise for Clinicians on 16/8/03 Expect to have most staff on board by early November Fully operational from January 2004

Issues for Discussion Implementation issues in your region Key stakeholders and relationships – for consultation and Regional Advisory Group Location of service