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Evolve: working with children and young people with severe and complex psychological and behavioural problems Protect All Children Today 26 March 2009 Outline • Evolve Interagency Services overview • The use of collaborative practice in the Evolve model • Learning’s, outcomes of this approach • Future challenges • Client outcomes • The model in action – a case study Background and Rationale • CMC • Collaborative model • Unique service – new model of service, no precedents, ongoing learning. • Changing and growing cohort Underpinnings of the Evolve model • Collaborative approach • Multidisciplinary approach • Child centred and Inclusive approach to ensure child, family and carers involved in planning and implementing intervention goals • Capacity building to support sustained change for both the child and their support network • Evidence based practice Evolve Locations Far Nth Qld North Qld Central Qld Sunshine Coast North Brisbane Logan Gold Coast Evolve Interagency Services Model Department of Child Safety CHILD or YOUNG PERSON Queensland Health Disability Services Queensland State-wide Steering Committee Local Steering Committees Evolve Panels Stakeholder Mtgs Department of Education, Training & the Arts Evolve Program • Goal of Evolve • Multiple agencies • Therapeutic & Behavioural Support Services, intensive and long term intervention • Holistic and consistent approach in support and intervention Developmental effects of abuse and neglect inform intervention approach Child protection intervention, breakdown of core relationships Trauma and neglect Sub-optimal neural pathway development Poor self concept & social skills inability to relate to others Behaviours challenge care environment Strain on care environment Placement breakdown Principles of therapeutic mental health services Safe environments at home, school and community High trust relationship with therapy team/ alliance Supportive, nonoffending family members included in the treatment Child’s resilience is increased long term Meaning-making about past traumatic events Skills development emotion regulation & interpersonal functioning Strong family relationships & child is integrated in positive social networks Long term functioning and welfare of the child Child see themselves as different from who they were at time of traumatic events and see hope for the future [Saunders, B.E., Berliner, L., & Hanson, R.F., 2004 & Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B., 2003]. Positive behaviour support model Comprehensive functional behaviour assessment and ongoing monitoring Peers and school Internalising behaviour Multi-component behaviour support plans incl. teaching new skills, ecological changes & direct strategies for behavioural change Current care of placement environment Externalising behaviour PROBLEM BEHAVIOUR Reinforcement of positive behaviours. Teaching of new adaptive behaviours and skills Past trauma Adaptive or asocial behaviour Functional ability and disability Positive lifestyle changes and reduction in the intensity, frequency and duration of problem behaviour Evolve Program Learning’s & Outcomes Benefits Shared Governance Shared ownership Time, energy & and responsibility resource MOU Endorsement at DG level Lengthy process – Need for support change slow at all levels of organisation Branding Common banner – owned by all partners Approval across all agencies & Whole of Govt restrictions Common Language & understanding language/ understanding of approaches Challenges Learning’s Issue Allow for longer timeframes Political/ agency impacts on process Professionals and Ongoing process agencies have as activities variable terms develop and understandings Evolve Program Learning’s & Outcomes Issue Benefits Challenges Learning’s Shared Responsibility Reduced blaming and responsibility shifting Agency specific requirements / policy and legislation Need processes and education to develop and support Myths Challenge myths Staff changes, across agencies vested interests Ongoing info flow to all parties Service delivery Stronger interagency relationships Capacity Increased demand Broad cooperation across agencies Resistance and barriers Barriers btw agencies reduced – flow on to other work and clients Changing staff Increasing stakeholder groups – new players Community shift re hope of closing service gap and availability of support Future Challenges • • • • • Capacity of Evolve and increased demand Recruitment of specialist staff Information sharing Educating and engaging stakeholders Links with other elements of the service system • Managing expectations • Research and Evaluation Evolve client outcomes Issues Intervention Outcomes Ben 13yr •Neglect & physical abuse • Anxiety & depression •Bullying, family & peer rejection •Challenging behaviours – impact at school and placement • Therapy re: past abuse and neglect • Primary Service Provider worked collaboratively with carer & school re: best support approaches for home school • Increased self-esteem • Nurturing relationship with carer • Developed friendships • School band • Writing & art competitions Pam 16yr • PTSD, epilepsy, intellectual disability • Frequent & severe self harming •High level outburst behaviours • 2:1 worker support • Therapeutic Services • Significant decrease in & Behaviour Support joint assessment • Token Economy system • Intensive training & support to carers stakeholders self harming & outburst behaviours • 1:1 worker support • Employment & community engagement • Positive family contact Evolve client outcomes Issues Intervention Outcomes Joe 11yr • History of physical & emotional abuse • Suspensions & truancy at school • Multiple placements • Violent behaviours • Stealing • Self-harming • Intensive therapy support with Joe • Support with specialist foster carer • Work with child safety, school & carer re: understanding Joe’s behaviours and ways to respond • Stabilised accommodation • Significant decrease in violence, selfharming & stealing • Improved academically • Increased self-esteem & engaging with peers Sue 8yr • History of neglect • Reactive attachment disorder & autism • Sexualised behaviours - self & others • Aggressive outbursts •Rejection by peers • Therapy with Sue •Intensive support & education with carer • Training teachers, NGO’s re: sexualised & aggressive beh. • Regular psychiatric & medical reviews • Reduced aggression & sexualised behaviour • Engaged in school • Positive interaction & acceptance with peers • Decreased risk of placement breakdown Evolve Program Client Outcomes Client Benefits • Review of Evolve – Significant decrease in challenging behaviours – Reduction of self harm and harm to others – Greater placement stability – Increased participation and engagement in educational programs Achieving outcomes for children through collaboration A Case Study “Jack” Referral • • • • • • • • • • • Referred to EIS 2007. 13 year old male Multiple placements Aggressive/violent outbursts Absconding from home and school Limited school attendance Dysfunctional sleeping and eating patterns Impaired activities of daily living No peer relationships Forensic History – theft, wilful damage, assault Emotional dysregulation Referral cont. • • • • • Significant learning difficulties Illiterate Diagnoses of ASD, ADHD Significant trauma and attachment issues Medication (Ritalin, risperidone, endep) Family and child protection history • Parental drug and alcohol misuse, domestic violence, homelessness • Complex blended family - multiple fathers/ partners/siblings • Family known to Department of Child Safety/multiple levels of intervention • Significant history of neglect, trauma and abuse including sexual abuse of children • Family has history of non engagement, litigiousness, and sabotage of interventions. Evolve Interagency Services program • Allocated to Primary Service Provider – Allocation of roles • Assessment process – How to, responsibilities, formulation and development of treatment plan • Treatment process – Identification of and establishment of stakeholder team, frequency of meetings, roles, and responsibilities: • Maintain open communication • Establish and set group cohesiveness • Demonstrate commitment to young person and stakeholder process Stakeholders Educatio n Family /Other Evolve Therapeuti c Service Young Perso n Residentia l Evolve Behaviou r Support Child safety Planning and Goal Setting • Stakeholders identified goals – linked to Jack’s treatment plan – Jack’s involvement /engagement sought • Goals set initially task focused – with each stakeholder identifying tasks that they were responsible for • Establishment of sub (micro) teams – to work on specific goals together for completion between stakeholder meetings Micro Teams in Action Stakeholder Group DChS EVOLVE HEALTH & DSQ •1:1 sessions with Jack •Connect with biological family •Advocacy for family contact •Training & education to School & NGO staff. FAMILY RESIDENTIAL & DETA •Attend SH meetings •Participate in training •Implement strategies •Flexible resourcing •Liaise, engage, support and value. Include in SH process & treatment plan •Education: re medication Financial support 1:1 placement •Open communication •Include SH in decisions •Attend SH meetings Outcomes for Jack • • • • • • • • • • Aggressive behaviour has reduced No further involvement with criminal justice system Attending school regularly/engaged in community Beginning to read Improved ability to manage activities of daily living Insight into behaviour, including empathy and remorse Medication free Peer relationships Family relationships Placement Medium to long term goals for Jack • Continuing development, peers, literacy, mainstreaming • Development of emotional regulation, empathy and social skills • Pre-employment skills with view to part time work • Transition to supported/independent living Outcomes for stakeholders • Improved skill base, particularly for direct staff. • Increased understanding of other professionals. • Enhanced relationships between government and non government departments. Key factors to successful collaboration amongst stakeholders • Willingness of all parties to engage in process • Open, effective communication with ALL stakeholders • Continued involvement of family - backing up behaviour support strategies. • Involvement of direct care workers (residential and school) - specific tasks to give them ownership of process. • Respecting the roles of others - honoring the person. • Keep young person at the centre – active participation at stakeholder meetings Our Key Learnings • Communication is the key - needs to be effective, open, and with ALL stakeholders • Each person needs their own ‘work’ to do so that they feel and become a key member of the team • Never underestimate the power of a united team • A collaborative team is characterised by equal partnership and shared responsibility • Keep the young person as focus – the goal of Evolve is to support the young person Collaborative Partnerships Ongoing Challenges • Interagency collaboration is – Multidimensional – Interactional – Developmental … and a lot of planning and continued hard work is needed for it to be successful! (Johnson, Zorn, Tam, Lamontagne & Johnson, 2003) Evolve Program Management Team • Melissa Yim, Department of Child Safety [email protected] • Jackie Bartlett, Queensland Health [email protected] • Morag Gilchrist, Disability Services Qld [email protected] • Brett O’Connor, Department of Education Training and the Arts [email protected] • Erica Russ, Department of Child Safety [email protected]