Looking for Good Practice and Optimal Services for Youth Facing Homelessness with Complex Care Needs.

1
Looking for Good Practice and Optimal Services
for Youth Facing Homelessness with Complex Care
Needs.

• PhD Research completed 2007
• Lloyd Owen - La Trobe University. Australia
• lloydsowen_at_bigpond.com

2
The Research Concerns

• Youth abandoned, excluded, running away or
  removed from home or care
• Complex care needs
• High risk or challenging behaviour
• Driven by past experience in institutions and
  care system and some discomfort with recent
  experience

3
The Past

• Notwithstanding many shortcomings
• All comers were accommodated
• Atmospheres (with much care and work) could be
  warm, caring, friendly and safe
• Much specialised assistance was on tap
• There was generally capacity to contain extremes
  and respond individually
• There were many positive outcomes

4
The Past

• And many negative outcomes
• Bringing them Home
• Forgotten Australians
• Etc.

5
The Present

• There is much to be proud of in Victoria
• Some innovative outreach service models
• New Legislation
• Best interests principles
• Strategies to revitalise out of home care
• New models of therapeutic home based and
  residential care.
• But, for young people, many negatives are still
  evident on the ground,

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The Present

• Frequent parent blaming family exclusion
• Low expectations
• Young people often prematurely left to their own
  devices
• Gaps in timeliness and responsiveness
• Frequent struggle for resources
• Risk aversion and procedural complexity

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Case planned to homelessness or accelerated
criminal justice careers

• In spite of much good work, and recognising the
  need for
• sound risk management,
• adherence to important human rights and
• sound resource management,
• there appears to be an overemphasis on
• (1) personal risk to staff and youth in a
  somewhat disparate way
• (2) rights at the expense of responsibility and
• (3) restriction of resources
• to the extent that in many instances, it
  compromises the ability of the service system and
  the family, to deliver, through relationships
  with skilled supported people in a variety of
  roles,
• adequate nurture, healing, personal growth and
  development and opportunity to thrive, and
• appropriate, safe, humane control with or without
  physical security.

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The research sought

• The perspectives of fourteen experienced
  practitioners about
• Good practice with these young people
• Optimal services to support good practice

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The research method

• Was informed by Glaserian grounded theory
  tradition
• Used in depth interviews for narrative data
• Analysis of transcripts was assisted by
• NVivo computer program and a
• Summary aided approach.
• There were three waves of collection and analysis

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Methodological aim to achieve

• Propositions grounded in practice
• Theoretical redundancy on at least some of the
  story
• In grounded theory terms core categories

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Findings about good practice

• Good practice entails
• Accessible and assertive presence of
• Appropriate adults to be there
• Fostering intentional relationships
• Providing skilled purposive intervention.

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Good Practice Intervention provides

• Active unconditional care
• Clarks definition of unconditional care,
  as bad as it gets, we will still care for you
  you might run but we will still be here for you
• Active means calm, assertive and respectful
  follow up of absence, significant risk taking or
  self sabotage and disrespect of self or others
  and
• Non colluding, non colliding messages of value
  and concern for wellbeing and safety.

13
Good Practice Intervention should be

• Planned
• Holistic
• Sensitive
• Responsive to particular individual needs
• Attends to attachment and trauma issues
• Has short run goals and long term view
• Sustained till constructive disengagement is
  possible

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Good Practice Intervention should also

• Accommodate developmental readiness
• Tap resilience
• Enhance coping and problem solving skills
• Obtain necessary specialist help
• Be delivered with a sense of normality
• Address family issues
• Address education issues

15
Good Practice is enabled by

• Investing in the work force
• Achieving a congruent positive workplace
• These factors also underpin optimal services

16
Findings about optimal services

• Helping hurt and acting out youth is not for the
  faint hearted
• Needs often the support, strength and guidance of
  a multi-skilled team
• Should promote a sense of normality

17
Optimal Services are

• Timely
• Congruent
• Seamless
• Robust in their capacity to
• Nurture
• Establish behavioural boundaries
• Meet developmental needs
• Deliver necessary therapeutic help

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Optimal Services should also

• Be connected to a community
• Have ready access to suitable accommodation for
  the young person
• Have purchasing power (quick access to sufficient
  brokerage)
• Have flexibility of operation
• Ideally be able to deliver on the spot
• Be committed till personal capacity and natural
  networks take over.

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Implications for policy

• Challenge the tendency for services to be
  episodic, short term and tightly rationed.
• Support the development of
• Robust
• Local
• Flexible
• intervention teams

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For professionals

• Interdisciplinary and multi-skilled orientation,
  collaborative and reflective
• Strong emphasis on intentional relationships and
  purposeful intervention

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For Research

• We need to do it and evaluate it
• Includes topping up those programs already close
  to the ideal
• More grounded theory work on behaviour management
  and limit setting which avoids more coercive and
  stigmatising options would be useful

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Postscript

• Some items to take away for further digestion and
  dialogue
• Some participant inputs
• Fifteen propositions from first and second wave
  analysis.
• Some additional references

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Participant Vision

• I would codify in some way that it is a human
  right to have somewhere to live. I would codify
  in some way that adolescents have the absolute
  right to have caring adults who will look after
  them until they are ready to move out on their
  own. (Participant 2)

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Participant Vision

• I would create a place where they could go,
  houses where they could live that were well
  supervised, where the kids were safe, where their
  possessions were safe, where they didn't have to
  be every night if they couldn't be there, but
  their bed was not taken away (Participant 3).

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Participant Vision

• The things that enable it, the best resource
  that any organisation or agency has are its
  workers. I'm not talking about money or cars or
  mobile phones, it's the people who do the face to
  face work with the kids. Investing in their
  skills, investing in their support and investing
  in their mental health, they are all appropriate
  use of resources. (Participant 2)

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Participant Vision

• When we are thinking of an optimal system, it
  would cost more than it costs now, because it
  would have a greater mixture of options if we are
  talking about the out-of-home care system. Even
  with a focus on intensive case management
  services there is still a concern about having
  different types of accommodation available for
  different kids and for different lengths of time.
  The optimal system would need to be much more
  flexible to enable them to receive the right
  service at the right time. (Participant 1)