Closed institutions and their alternatives: What works?

Presentation Eusarf Conference

22th September, 2005 ,Paris

Situation in Belgium

• Regional Juvenile Courts • Common answer to serious offences = forced

residential treatment• In the Flemish region (population 6 million

people): 3 closed institutions for boys run by the Flemish government (Cap.182) and one run by the federal government (Cap. 25)

Closed Institutions in Flanders

• Population characteristics– Boys from 12 -18 y

– Delinquent behaviour

– And/or serious conduct problems• Aggression

• Oppositional behaviour (acting-out)

• Limited Capacity– cap. 212 for boys

• Boys are isolated from participation in society

Our (open) organisation

• Vzw Sporen: different departments

• Department ‘De Pas’ : – focus on adolescent boys (14 y - max 21 y)

– goal = re-integration

– 3 treatment models available

• residential care

• intensive family preservation

• independent living of youngsters with intensive coaching from the service

History of ‘De Pas’

• Started in 1991 as a training group for boys to become independent of their families.

• Reasons for referrals by judges– assumption: residential care = safer than living in the

own environment

– Residential care used as a sanction

– assumption: independence = a good thing

“ a political problem”• Critical incidents• Public opinion: “youth protection” – “youth sanction”• Appeal of the juvenile court magistrates• European Convention on Children’s Rights• Overcrowded Community Institutions (terminal)• 1st Youth Detention Centre (Everberg)• Catg 1 B: alternative programs• Legally stated continuum from less to more intervening

measures

What did happen?• A little progress in practical skills (cooking, public

transportation, cleaning..)

• Therapists focused on their own relation with the individual boys and tried to teach them how to live without adult caretakers around them

• Massive negative impact of peers: reinforcement of anti-social behaviour in the institution (aggression, drug abuse, vandalism..) This overruled the impact of the therapists.

• Little involvement of family members

• Lots of incidents and poor outcomes

• Very high turnover staff members

Outcome 2000-2002 (%)

Outcome 2000-2002

20

3327

16

4

05

101520253035

Home andfamily

Independant closedinstitution

restrictiveresidential

care

other(neutral)

Outcome 2003 - 06/2004 (%)

Outcome 2003-06/2004

26 26

48

0 00

102030405060

Ho

me

an

dfa

mily

Ind

ep

en

da

nt

livin

g

clo

sed

inst

itutio

n

rest

rict

ive

resi

de

ntia

lca

re

oth

er

(ne

utr

al)

Why did we make a shift ?

• We had to!

• Traditional residential setting aiming for autonomy/independence of the adolescent boys

• Culture of aggression

• Priority to “personal relationship” – “negotiations”

• Attitude towards families: theoretical view/reality

No perspective – “No Future”

• School drop-outs

• Illegal drug abuse

• Verbal and physical aggression

• vandalism

• Antisocial peers

• Staying out overnight

No perspectives - continued

• The “coach” – “educator”

• Fading away of boundaries and limits

• Institutional context

• “Procession of Echternach”

• “Asking Parents”

New goals

• coach adults to reinforce responsible behaviour

• help restoring links with school, work, family..

• be very clear about society rules

• primary goal = reintegration in family

• Progress to be proven by facts

– ex: goes daily to school/negative on drugstest and so on...

• Period of living in residence = period used to re-engage family

• Goals of the adolescents should address concerns of family and/or court

Staff Issues

• Organisation of training and supervision is inspired by family treatment models like

• multi-systemic treatment

• Homebuilders /families first/Fam/Fim

• All workers must develop skills to engage family members and others meaningful persons

• Worker can no longer take over tasks and responsibilities of caregivers

The Gearbox of “De Pas”

• Vector 1: context-oriented

• Vector 2: group-oriented

• Vector 3: individual-oriented

• Vector 4: making sense of school/work

• Vector 5 & 6: drugs and aggression

• Vector 7: attitudes of the social worker

CANO-principles

• Reconnecting the youngster with his context• Positive belief in possibilities• Problem-solving attitude• Strengthening of the youngster’s natural

network• Sharing responsabilities = re-engaging

families• Integrated model

Principles MST (Henggeler, et. al.)

• Understand the Fit Between the Identified Problems and Their Broader Systemic Context• Emphasize the Positive and Use Systemic Strengths as Levers for Change• Promote Responsible Behavior and Decrease Irresponsible Behavior among Family

Members• Interventions should be Present-Focused and Action-Oriented, Targeting Specific and

Well-Defined Problems• Interventions should Target Sequences of Behavior within and between Multiple Systems

that Maintain Identified Problems• Interventions should be Developmentally Appropriate and Fit the Developmental Needs of

the Youth• Interventions should Require Daily or Weekly Effort by Family Members• Intervention Effectiveness is Evaluated Continuously from Multiple Perspectives, with

Providers Assuming Accountability for Overcoming Barriers to Successful Outcomes• Promote Treatment Generalization and Long-Term Maintenance of Therapeutic Change

by Empowering Care Givers to Address Family Members’ Needs across Multiple Systemic Contexts.

Beliefs Homebuilders -Families First

• Safety for children is our highest priority.

• The family is the focus of service.

• Children are better off with their own families whenever safely possible.

• Troubled families can change.

• Families are colleagues of the staff members.

• Families’ beliefs and values must be respected.

• It is the worker’s job to instil hope.

• A crisis is an opportunity for change.

• Inappropriate interventions can do harm.

Recent outcomes (%)

Outcome 07/2004-08/2005

65

10 155 5

010203040506070

Hom

e an

dfa

mily

Inde

pend

ant

livin

g

clos

edin

stitu

tion

rest

rictiv

ere

side

ntia

lca

re

othe

r(n

eutr

al)

Evolution Outcome (%)

20

33

27

16

4

26

26

48

00

65

10

15

55

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Period 1 Period 2 Period 3

other (neutral)

restrictive residentialcare

closed institution

Independant living

Home and family

Consequences for clinical practice

This change = culture shock• new goals for all levels in the organisation

• general agreement to work differently

• different skills needed for all practitioners• changes always imply discomfort

• other requirements, new job descriptions

• old patterns tend to last longer than expected• new image must be made known to judges and

referral agencies

Consequences for the Government Policy

• Policy based on results, not on populism or (manipulated) public opinion

• Recognition for changed needs of youth care organisations

• investment in research (what works) instead of investing money in ‘more of the same’

ContactVzw Sporen

Geldenaaksebaan 428

B-3001 Leuven

BELGIUM

Info: www.sporen.be

++32 16 387600

Gie Kiesekoms, clinical director

Jan Tibo, program supervisor

Gie Lambeir, family therapist