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Working with High Risk Young People


Key policy directives that are leaving children in challenging and dangerous ... Makes you want to head butt them' Other young people watching causes distress ... – PowerPoint PPT presentation

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Title: Working with High Risk Young People

Working with High Risk Young People
  • Interventions, Models and Significant Issues
  • Lisa Hillan
  • Save the Children Qld

Key Issues
  • Increase in drug use by households leads to
    lack of appropriate boundaries for young people
  • Immense trauma of young people both within their
    family home and through failed multiple
  • Key policy directives that are leaving children
    in challenging and dangerous environments for
    longer periods of time

Current behaviours that cause concern
  • Chronic absconding to unsafe places
  • Prostitution
  • Physical aggression and acting out towards staff
    and other young people
  • Property damage
  • Inability to be calmed inability to self soothe
  • Abusive and bullying behaviour

  • Key responses
  • Restraint
  • Model Development
  • - Secure Care
  • - Mental Health Treatment Centres
  • - Therapeutic Residential Care

  • Discuss in Pairs key issues from your point of
    view in the use of restraint within residential

Key Issues on Restraint from Research
  • When should restraint be used?
  • The types of restraint
  • Injuries to young people asphyxia, broken
    bones, bruising, carpet burns, death
  • The frequency of restraint
  • Monitoring of restraint
  • Children and young peoples opinions on restraint
  • Criminalistion of Children and Young Peoples

Key issues in Restraint continued
  • Union responses to staff safety
  • Staffing levels
  • Training of staff
  • Lack of policy directives from Govt
  • Legal liability for staff

Young Peoples views of restraint
  • Commission for social care inspection UK 2004
  • Staff not recognising triggers for yp
  • Staff not problem solving smaller incidents that
    build up
  • Staff undertaking inappropriate responses to
    behaviour that include shouting or saying things
    such as dont mess with me.
  • Being restrained feels always feels like
  • Restraint should be used if you are going to hurt
    someone or do major property damage

  • Where young people had suffered past abuse
    (physical/sexual) created distress riled them
    made them lose control.
  • Makes you more worked up
  • It makes you feel like you are nothing. People
    holding you down brings bade memories. Its
    horrible. Makes you want to head butt them
  • Other young people watching causes distress

What young people wanted
  • Trained staff
  • No physical pain as a result
  • Restraint as a last resort
  • Restraint never as punishment
  • Staff better at defusing incidents
  • Staff debriefing young people post restraint
  • Staff having consulted young people about the
    ways to calm them when out of control
    developing a plan together

Policy and Practice Development
  • Extreme risks evident in providing a safe
    environment for young people and staff
  • Milligan (2006) what needs to be present for
    restraint to be practised appropriately and well
    Scottish Institute for Residential Care
  • Key factors include
  • A high skilled staff group
  • A philosophical and theoretical framework of care
    that looks at restraint within a therapeutic
  • Significant training and policy development
  • A low restraint culture

Policy continued
  • Lack of empirical evidence little research
    about the impact or capacity to create change?
  • Interaction between police and mental health
    systems and residential care
  • All states in Australia should have clear policy
    development about restraint and its place in
    caring for children and young people this
    should include parameters and approved restraint
    practice within an overall framework of
    therapeutic care.

Policy cont.
  • Significant training of residential carers and
    restraint practised within a context of
    therapeutic care with a well developed
    therapeutic intervention model that ensures
    restraint is a last resort
  • All residential care providers need identified
    policy provision about restraint and a
    demonstrated capacity to monitor its use and
    develop alternatives that honour young peoples

Secure Care
  • When you hear about secure care for young people
    outside of juvenille justice context what are
    your immediate reactions?
  • Discuss with a person next to you

Overseas experience.
  • Scotland
  • Used for young people who are a harm to
    themselves or others drug use, physical
    aggression, self harm, prostitution
  • 3 months reviewed by childrens panel
  • If no longer displaying concerns at 3 months
  • Placed with jj young people

Overseas exp cont
  • Comprehensive assessment undertaken medical,
    educational, psychological, social care and
    possibly psychiatric.
  • Canada
  • Sexually exploited young people only
  • Can place in protective care for up to 47 days
  • Other states currently considering options

  • Young people desisting behaviour whilst in secure
  • Comprehensive assessment
  • Young people having a period of health and safety

  • Young people cycling through secure units
  • Lack of voluntary services for young people to
    treat drug and alcohol issues, appropriate mental
    health services, housing, jobs basing service
    provision on risk not absence of other
    appropriate service provision
  • Lack of focus on the system that the young person
    belongs lack of interventin to support change
  • Lack of follow up after secure to ensure gains
    are maintained

Key factors to consider
  • Young people who are exposing themselves to
    significant danger lack of intervention
    abandons them to the street
  • Failure to provide systemic models of care that
    work with family, peers, and community and
    provide long term follow up
  • High correlations in one unit between entering
    secure and the following family history
  • Exposure to domestic violence
  • Being a victim of domestic violence
  • Parents who abuse alcohol or drugs

  • Recent study by the in UK by office of National
    statistics children aged 5-15 mental health
    8.5 of children in general population displayed
    mental health issues 45 in the looked after
    population 4 out of 10 young people had
    considered suicide in the last month.

Hopefulness and Creative Responses
  • Scotland
  • Looked after children mental health team for
    foster care and residential care
    multi-disciplinary team not diagnostically
    driven psychiatrist involved
  • Canada
  • - Maples Treatment Centre

  • Residential and Outreach
  • 3 months in length
  • Attachment and family systems framework
  • Multi-disciplinary team psychiatrists,
    psychologists, nursing staff, social workers and
    residential care staff and a recreation team.
  • Care plan consultants

  • Residential programs provide
  • - psychiatric assessment
  • - multi-disciplinary assessment
  • - plans of care
  • - family therapy
  • - education and support
  • - vocational and recreational opportunities
  • - ongoing outreach and respite

  • Institute of Juvenille Research Illinois
    University in Chicago
  • Short term stay to develop treatment plan
  • Returned to residential where the team provide
    ongoing consultancy to assist staff in
    constructing care environments that meet young
    peoples needs

New York
  • Sanctuary Model Andrus Childrens Centre
  • Trauma training for staff
  • Trauma training for young people
  • Social worker in each residential
  • Safety plans
  • Community meetings