1. Compulsory Treatment Client Pathways Project (2014) Author: Danielle McLeod Masters of Social Policy University of Melbourne Reporting to The Senior Practitioner- Disability Office of Professional Practice

2. Compulsory Treatment Part 8 of the Disability Act outlines provisions for Compulsory treatment – which is the detention of a person for the purpose of Treatment and to manage their risk of harm to others; Supervised Treatment Orders: Civil order made by Victorian Civil and Administrative Tribunal (VCAT) Residential Treatment Orders: The person has been charged and is subject to an order allowing compulsory treatment in a Residential Treatment Facility

3. Compulsory Treatment Supervised Treatment Orders ID, residential service, Treatment Plan approved by Senior Practitioner Violent and dangerous behaviour causing significant harm Can’t be reduced in less restrictive ways Treatment is considered to be of benefit to the person Person can not consent nor demonstrates compliance with the treatment plan Determined necessary to detain to manage risk Full supervision Supervised by Senior Practitioner, Approved by VCAT Residential Treatment Orders Sentencing, Corrections, Crimes (MIUT) Act 1997, Serious Sex Offenders Monitoring Acts, Transfer from prison ID, serious risk of violence, less restrictive, facility can provide services, Senior Practitioner notified Treatment Plan approved & supervised by Senior Practitioner Reviewed and confirmed by VCAT

4. Compulsory Treatment Client Pathways Project Purpose: to understand the socio-demographic characteristics within the compulsory treatment group and targeted support needs Scope: Analysis of 45 people with intellectual disability who had completed a term of compulsory treatment between 1 July 2007 and 1 March 2014 Findings: overall trends of needs in group & two sub-groups identified These characteristics have also been found in other forensic disability studies, particularly the pathways research in the UK.

5. Compulsory Treatment Client Pathways Characteristics across the whole sample included: The average age was 32 years (ranging from 18 yrs to, 4% of the group were women, and 6.6% identified as Aboriginal 60% of sample had a mild intellectual disability Physical & sexual harm accounted for 96% of the BOC being treated Overall low, unstable and sporadic employment histories in both supported and unsupported situations (60% of the CT group had no employment or minimal work experience) 20% had lived in institutional settings, 24 % experienced transient foster care placements, and 13% experienced transience or homelessness under 18 years

6. Compulsory Treatment Client Pathways Characteristics across the whole sample continued: 82% had evidence of childhood abuse, whether physical, sexual or some other form of deprivation or neglect 31% had other additional significant trauma or loss reported Over 70% engaged in substance misuse and/or gambling, unclear the degree of problematic within these behaviours. (58% were considered ‘possibly problematic’ and 31% confirmed problematic) 62% had more than two diagnoses (including physical disorders) The average length of compulsory treatment was 28 months; period of detention varied from 1 month up to 5 years. Early intervention pathways evident in these populations but little diversion from the CJS actually happened

7. Compulsory Treatment Client Pathways

8. Key characteristic differences between the CT sub-groups: Group (1) –mainstream disability profile More likely to have a diagnosis of autism and higher support needs Had an average of 4 months longer in treatment More likely to have demonstrated behaviour that was physically harmful to others. Were less likely to have any criminal convictions, and if they did were less likely to be sentenced to prison.

9. Compulsory Treatment Client Pathways Key characteristic differences between the two CT sub-groups : Group (2) –mainstream offender characteristics More likely to have been diagnosed with a behavioural disorder, personality disorder and to have experiences of suicidal ideation More likely to have been convicted of sexual assault Versatile offending behaviour (including theft, property damage, etc) Much higher rates of abuse and neglect experienced More likely to have mental illness 95% had been sentenced to a correctional facility at some point

10. Compulsory Treatment Client Pathways Group (2) –mainstream offender characteristics continued This group was further divided into two sub groups: »Younger, unstable presentation, more active offending cycle leading to higher likelihood of future imprisonment. »Older, residing in shared supported accommodation, whose offending cycle is more historical and (risk) presentation stable. These different presentations reflect significant differences in need & require very different responses within our disability workforce.

11. Compulsory Treatment Client Pathways Discussion: Useful information for practitioners to consider in assessment, preparing treatment plans and when providing targeted training to our disability support workers. This group requires thorough, individualised and regular re-assessments (i.e. risk, treatment gains, changes in needs) Complex presentations require substantial resources, time to reshape / address behaviours and appropriately trained staff A major point of difference between the CT model is the unique legislative charter which allows treatment to be provided without consent, to skill development and behaviour change while managing community safety. This could be used as diversion from justice or an appropriate rehabilitation model for community reintegration, notwithstanding the above points.

12. Compulsory Treatment Client Pathways Practice Implications: Findings reveal that compulsory treatment clients interface across different government sectors at different times in their life, therefore making this research everyone’s business. We need to consider the following: Flexible & integrated responses across all government service provisions Prevention (address skills, individual needs & QOL across life span) Appropriate pathways for forensic disability clients (diversion, sentencing, community reintegration)

13. Compulsory Treatment Client Pathways Practice Implications continued: Workforce capacity to respond to the complex needs of this group Treatment strategies that can be implemented by disability support models across environments. How this group is managed under NDIS

14. Compulsory Treatment Client Pathways Updates from Compulsory Treatment team- Electronic Treatment Plan on RIDS with specific fields added in response this project’s findings Series of resources have been developed including- practice advice in relation to CT clients, risk management plans, and flowcharts about compulsory treatment A Compulsory Treatment Practice Guide is currently in development The findings of this project will be put into a practice resource for the department and sector

15. QUESTIONS ? Chelsea Troutman Principal Practice Leader- Compulsory Treatment Team Senior Practitioner-Disability, Office of Professional Practice (DHHS) Ph: 9096 3010, M: 0427953874 Chelsea.troutman@dhhs.vic.gov.au References: McLeod, D. (2014). Accommodation changes and characteristics of people with an intellectual disability under compulsory treatment in Victoria 1997-2014 (Unpublished Masters Thesis). University of Melbourne: Victoria.