superhumans and silver bullets
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Superhumans and Silver Bullets. Lloyd Owen Barwon Youth Accommodation Service & La Trobe University-Retired Senior Lecturer-PhD Candidate ACWA Conference – Darling Harbour August 2006. Superhumans and Silver Bullets. - PowerPoint PPT PresentationTRANSCRIPT
Superhumans and Silver Bullets
Lloyd OwenBarwon Youth Accommodation Service
&
La Trobe University-Retired Senior Lecturer-PhD Candidate
ACWA Conference – Darling Harbour August 2006
Superhumans and Silver Bullets
• Just what sort of people can we find and develop to work effectively with challenging youth at minimum cost? When we have them what will they do?
• Are there “magic bullets” (big bang for the buck) programs or “silver bullets” (precise projectiles for surgical strikes) for tightly targeted “specific problems” or “greatest needs” to help do “best practice” within “available resources”?
Sobering Stats
• Approx. 30% of young people in Victorian Juvenile Justice System have come through protective services.
• Approx. 37% of young people in Victorian residential care have involvement with the Juvenile Justice System.
• Approx 11.7% spent some time in detention in the 12 months after exiting State Care in Victoria (excluding community based orders).
(JSS 2006).
Sobering Encounters
• Foster Care, Residential Care and Institutional Care for Adolescents in Child protection and Juvenile Justice.
• Assertive Outreach in the Innovations program and one to one care and placement support for High Risk Adolescents.
• Public Apologies to Forgotten Australians.
More Sobering Encounters
• Violence between adolescents and adolescents and parents– Parentline – Encounters in Innovations
• Alcohol and Drugs– Getting wasted as a rite of passage– Chroming etc. and complex needs– Offenders with ABI
The Research Problem*
Some young people present behavioural challenges to the degree that they are either excluded by programs or allocated to stronger more intrusive responses: – assertive outreach, sometimes family work,– intensive case management or supervision
programs, – therapeutic programs or settings, or– placed in secure welfare or other custodial
settings
The Research Problem
• These tend to be costly and intrusive (sometimes coercive) services which leads to limitation through targeting, rationing, restrictions on access etc. for both economic and political reasons.
• Practitioners are often faced with dilemmas in balancing autonomy for the young person and limit setting – empowerment vs control and in achieving access to opportunities the youth will accept.
One Starting Point Robyn Clark’s Work -two key directions
• Unconditional Care – the exceptional practitioner, it has to be more than a job (Clark 2000).
• Therapeutic services – When care is not enough (Morton, Clark and Pead 1999).
These reports were full of useful insights including the significance of attachment and trauma issues for the care population.
Other Insights included
• Individualised wraparound “unconditional care.”
• Careful holistic, comprehensive assessment.
• Individualised therapeutic input delivered flexibly through a care team approach.
• A multidisciplinary and multi systemic capacity to respond.
Balancing power in the “between” years
“Services for young people in the 14-18 age group need to be responsive and flexible enough to vary their role in decision-making according to judgments about the young person’s maturity and day to day capacity for making life decisions. At times a service for young people will make decisions for the young person, at times make decisions jointly with them and at times have them make decisions quite independently” (Morton, Clark & Pead 1999).
A useful treatment of the balancing act required of adolescents and their adult
carers.Reminds me of Parad and Caplan’s (1965)
developmental needs for mental health.1. Love for one’s own sake.2. A balance between freedom and control
of instinctual expression.3. A balance between autonomy and
dependency in making decisions with respect to tasks.
4. Adequate role models.
Duty of Care
• Duty within a relationship to care for and not harm the other
• Standard what a reasonable person would do or not do in the same situation
• Proof of physical, psychological or economic damage
• Proof of cause through action or omission
Balance between empowerment and limit settingfrom “When care is not enough” (Morton etal 1999)
Empowerment• Engagement
• Respect
• Validation
• Support
Limit setting• Expectations
• Consequences
• Challenge
• Compulsion
TAKING RESPONSIBILITY FOR ONE’S OWN CHOICES AND BEHAVIOUR
IN
DEVELOPMENTALLY
APPROPRIATE BALANCE
IMPORTANT FACTORS FOR JUDGING CAPACITY FOR MAKING IMPORTANT LIFE DECISIONS
• Gravity of consequences that may follow• Accurate and unbiased info to inform the
decision making• Comprehension of the information• Capacity to balance the risks & benefits• Capacity to make judgments about own
ability to carry through actions• Capacity to ask questions and seek more
info and support
Features affecting young person at the time which might make a difference
• AGE and maturity closer to 14 or 18
• The presence of supportive relationships with peers and adults who can help weigh the pros and cons of the decision
• Their mental and physical state at the time-intoxication, severe distress including anger or depression
Applying power positively – Graded Options for empowerment and limit setting (Morton et al 1999)
INSIDE
• Relationships with treatment and care staff. Staff are expert, warm, firm, authoritative, fair and admit mistakes. Limits are relationship based and consistently maintained. Skills are taught to assist young person in staying within limits.
• Practice instructions, practice precedents, staff supervision, consultation and training. Staff are supported in setting and maintaining reasonable limits. Staff are supported in considering the developmental stage of the young person and both short term and long term risk when deciding if compulsion is appropriate.
• Creating a shared culture of safety. Development of positive peer culture in services and norms about harm to self and others that are jointly endorsed by staff and the young people.
• Using Rewards Not Punishments. Avoiding playing the role of punitive, retaliatory or unfair authority figure.
Applying power positively – Graded Options for empowerment and limit setting (Morton et al 1999)
OUTSIDE Developing cooperative relationships with police to ensure an
appropriate police response when needed. Developing a cooperative relationship with mental health in-patient
and crisis services to ensure an appropriate response when needed.
Juvenile Justice Community based orders to undergo high quality, well resourced intensive therapeutic interventions.
Treatment or therapeutic home based care as an alternative to a custodial sentence.
Secure crisis care for up to 21 days, in exceptional circumstance for a further 21 days.
Mental Health in-patient unit stay. Juvenile Justice sentence with incentives to participate in offence
specific treatment.
Another Starting Point HRA SQIIHIGH RISK ADOLESCENT SERVICE QUALITY IMPROVEMENT INITIATIVE
• INTENSIVE CASE MANAGEMENT• ONE TO ONE CARE• BROKERAGE• Established 1997 (228 youth 28% of the
adolescent care population)• Evaluated over two and a half years by
SuccessWorks. Report in March 2001.• Action Research design with inputs from
youth, families, carers and workers.
The Victorian Service Quality Improvement Initiative for High Risk Adolescents saw those young people of concern as presenting with multiple and complex behavioural and emotional difficulties including
combinations of:
• Challenging behaviour at home, in placement and at school.• Significant substance abuse.• Suicidal tendencies• Aggression.• Chronic running away.• Prostitution.• Association with paedophiles.• Emerging or diagnosed psychiatric or psychological disorder.• Consistent, escalating offending.• Sexual offending.• Estranged or non-existent relationships with their family. (DHS
1997; Success Works 2001)• About two hundred across the State, resources and targets strongly
contained.
How is it doing
• A view that it is mostly doing quite well.
• But it is not the answer for all.
• It is a strictly limited option.
• There are exit issues, getting from high cost to low cost to no cost.
• Still a need for longer term outcome evaluation.
Another Starting Point - Complex Needs in the SAAP System
• Young People are being diverted, discharged or abandoned to SAAP.
• Conflict of opinion. Appropriate use of supported accommodation for youth, inappropriate end point of care to be a service for homeless youth.
• SAAP workers are being challenged by complex needs and challenging behaviour also. Resourced for low levels of support.
• Notification, abandonment or exit to Juvenile Justice appear to be likely outcomes.
The Present Study
• Drawing on the views of experienced practitioners – people with 5 years or more (mostly 20+) sustained involvement with challenging youth, and
• Significant breadth or depth of program experience, to
• Explore ideas about good practice, and• What is an optimal service system to
support it.
The young people of interest are described as -
• Youth facing homelessness with complex care needs associated with
• high risk or challenging behaviour
• which threatens their stay – at home, – in crisis accommodation or – in out of home care.
Program concerns include
• Containing or otherwise responding safely to acting out behaviour and
• Facilitating recovery, psychosocial growth, and quality of life for them and
• Acceptance and belonging in a kith, kin and community network
Four Broad Research Questions
• How do experienced practitioners “construct” good practice?
• What factors enable good practice ?
• What factors impede good practice?
• What do experienced practitioners believe an optimally effective service system would look like?
First Wave Findings
• Based on analysis of 6 interviews influenced by a Glaserian grounded theory approach, thematic analysis with some assistance from NVivo computer software for qualitative data analysis and
• My practice encounters, and • The Literature,• Some tentative pointers and additional
questions are emerging.
Summary of Key Themes
• Have come up with a summary of key themes which have emerged in response to these questions.
• Will share them conditionally at this stage, as the research is not finished, send me an email and we can correspond. Your views might help.
• For now, a focus on the consistent theme that good practice comes from good workers in a good workplace.
Superhumans
There is a substantial literature now detailing characteristics and competencies of exceptional practitioners, expert professionals, good home-based carers and competent residential workers.e.g labyrinth of competencies attached to the 15 core competencies in the Cert IV Community Services (Protective Care), or 7 essential and 5 desirable Resi Care Worker characteristics all with an array of subcategories developed in Meredith Kiraly’s work on recruitment and selection which has contributed also to the “Choose with Care” Program. Now in a Haworth Press Book Residential Child Care Staff Selection 2003.
Superhumans in this Research
Participants gave emphasis to• Being there when needed, which could be at any
hour of the day – appointments often don’t work.• Being able to engage and develop a functional
relationship or supporting someone else to do this.• Understanding the unique person in context (what
has happened to them and how they see it) with ability to constructively interpret events and consequences for the young person.
• Having emotional intelligence, self-awareness and emotional regulation. Validating feelings and nurturing emotional regulation in the young person.
Superhumans in this research (contd.)
• Being able to negotiate behavioural boundaries and limit setting.
• Being able to generate or find developmental opportunities and motivate the young person’s participation in them.
• Being in there for the long haul and finishing well (with constructive disengagement).
A summarising proposition is “being there, with intentional relationships and purposeful intervention”.
Being there
“Part of it is having the time to give to the young person so that you can actually engage. It's no good having a caseload of 50 and saying I am working with high-risk kids. Look I can see you in three weeks time at four o'clock on Thursday afternoon for half an hour. Part of the relationship building is the availability and being able to talk in person or on the phone” (Participant 4).
Being there – critical mass
• Participants pointed to the critical importance of supervision and support to sustain the effort of these people even on a single case basis.
• Sustainable programs had ‘critical mass’. The aggregation of resources into optimal blocks or teams, permitted flexibility, continuity of cover and capacity for relief, support and shared specialist resources.
• Some participants suggested that Home based programs and one to one need outreach capacity and residential back up to survive.
Intentional relationships
“the most important thing is relationships and it doesn't have to be the case manager. I don't appoint key workers I never have, I let the kids choose, I'm talking now about resi, I let the kids choose among the resi staff the ones that they feel closest to and then watch that so that they don't put all their eggs in one basket, as one of the things I think they have to learn as adults even though they have had terribly abused backgrounds that you get different things from different people. And if you can trust one you can trust more than one. But without having a trusting relationship between the kid and a significant adult, there is no way you can do any of the reparenting that is necessary” (Participant 1).
Connecting to Carer
“All those placements are based on relationships, they contrive a connection one way or another, the really damaged kids before they move in and one of the things that I still do is get the carers to ask the kid would they like to live with them. Because these kids, nobody has ever wanted themSo if you contrive the relationship through being a support worker or volunteer or something, you are manipulating like mad in the background and then you get them to pop the question” (Participant 1).
Purposeful Intervention
Participants had much to say about what workers should do After relationships, listening and modelling
“Fundamentally I think it's a worker’s job to put things in a kids head. It's the kids job to decide when and if they use it” (Participant 2).
Their observations have drawn me strongly to the principles and processes outlined by
Chris Trotter’s Principles for Working with Involuntary Clients.James Anglin’s Framework matrix for understanding group home life
and work.And the strategies of Therapeutic Crisis Intervention for deescalating
stress related crisis.
Managing risk, incidents and allegations- Dilemmas
• The present climate of risk aversion, super-accountability and a somewhat blaming culture runs the risk of destroying people and programs, even superhumans.
• Removing too much risk, may involve removing, too much opportunity for growth, development and the achievement of a normal enough identity. By default it may produce greater risk.
Impact on workers
“We've had people almost suicidal, volunteer carers, and we find now when we explain that process they back out of volunteer caregiving and we can't blame them and we have to explain it honestly” (Participant 5).
Impact on opportunities for youth
“I think that to take them away into another environment is also a way that you can settle them down. I'm even talking about offending kids. Get one of your nice tattooed blokes to take them down the river bank fishing. But there are all sorts of regulations if you're taking somebody's surf fishing. They have to have surf rescue qualifications in case they come off the rocks now, God help us” (Participant 1).
It has to be more than a job!Robyn Clark summed up a report on exceptional practice with the following quote from
one of the subjects
“It has to be more than a job. What you do with kids and families you do with workers-you support, value, build a culture that respects individuals and encourages people to be different; and you encourage them never to give up. You teach them to never accept “no” if they think a kid really needs something. And not to accept that a service will not be provided for a kid. Protocols with other services can be helpful, but in my experience, the most effective way of getting what you want for the kid is to wear the other system down until they deliver. After all that’s what parents do, isn’t it?” (Clark 2000:62).
Are we pushing it over the top?
Superior recruits
Up to date training
Able to withstand abuse from kids and the wider world
They need a superior work environment as well.
Homegrown youth worker• “I think the other fundamental is to work effectively with young
people you actually have got to enjoy working with them and I think good practice and it doesn't exist any more or it rarely exists any more -- a good homegrown youth worker is somebody who has some of the characteristics that adolescents have in and of themselves, prepared to take a risk, a bit creative, a bit out there, bugger all the obstacles were going to get through this no matter what. That adolescent resilience notion and I think good workers used to have those sorts of things but I think now that has been battered out of good workers”.
• “I think good workers need to have a good philosophical base rather than ones driven by only policies and procedures, I don't think that's good practice I think that's what good practice or best practice is defined as today but I think that's code for we have good policies we have good procedures I don't think it's got anything to do with face-to-face work with kids” (Participant 2).
The Kaleidoscope of care for challenging youth
• Magic bullets (The big bang for the buck).
• Silver bullets (Surgical strikes)
Past Magic Bullets
Comprehensive economical solutions in Victoria’s past-
• Boarding out• Institutions – Disciplined dormitories• Institutions – Campus Cottage• Congregate Care Children’s Homes• Scattered Unit Residential Care• Some Foster Care and Adoption• Hostels, Home release and Private Board
Means to Manage Troublesome Behaviour
• De-escalation, persuasion, negotiation, coercion. There were many good staff and some bad. Much effort went also into trying to generate opportunities for young people.
• Exclusion – discharge or transfer to stronger, more controlling options.
• Controlled Environments – staff secure or physically secure, rules, routines, carrots and sticks and treatment (psychiatry, I-level (interpersonal maturity), guided group interaction (positive peer culture), triad training).
• Restraint physical or chemical. Seclusion/ isolation, solitary confinement or high dependency beds.
A period of emphasis on social justice and structural concerns.
• The “community” becomes a magic bullet.
• De-carceration, radical non-intervention and the least restrictive alternative grow in popularity.
• Treatment becomes a dirty word.
• Rights take hold and lawyers move in to bring adult due process to the affairs of troubled youth.
With Deinstitutionalisation and Regionalisation more magic Bullets emerge and some specificity
(Silver bullets).• Resi care: Short term units, medium term units,
transitional care units, early adolescent units as well as generic family group homes and hostels.
• Foster Care –Emergency, Short term, Long term• Permanent Care, Kith and Kin Care, Shared Family Care • Family Support Services (family counselling, family aid,
financial counselling)• Specialist Child and Family Services• Family Preservation Services (placement prevention and
family reunification)• Youth Welfare Services, ICRASS, PACT• Adolescent Community Placements• Adolescent Protective Teams
After Carney 1984 and CYPA 1989
Silver bullets emerging for specific targets • Separate systems for offenders, protection
cases, homeless, substance users, mental illness and disability grew in strength. But not very much in their capacity to deal productively with challenging youth.
• 1993 Mandatory reporting leads to colonisation of many programs by forensic child protection.
• Mid to later nineties saw a structural shift to a market approach and mass devolution of resi care from the statutory system to CSOs. More expensive programs jettisoned or squeezed. Much emphasis on targets and throughput.
Protection and care magic bullets today with a silver lining
• Kith and Kin Care
• Foster Care
• Shared Family Care
• Adolescent community placement
• High Risk Adolescent One to One Care
• Residential Care with sleepover or stand up cover at night
Increasingly complex service system with many silos, specialties and competing services
• Coordination, collaboration and working together become magic bullets. Ways of doing this at all levels remains a challenge.
• HRASQII emerges as a silver bullet, Take Two emerges as a silver bullet, Multiple and Complex Needs Program emerges as a silver bullet targeting challenging youth. All are resource intensive and very rationed.
• Other very specific silver bullets are to be found within the different service systems eg sex offender programs in juvenile justice, early psychosis intervention in mental health, the notification reduction innovations program, the placement prevention finding solutions program. They appear to be minimally resourced and often hard to access prior to problems becoming acute.
In 2006 we have new legislation and a mass of required competencies, procedures, and accountability requirements
• The new legislation has largely sidestepped issues to do with more challenging adolescents outside of juvenile justice.
• Faith is largely pinned on Take Two and MACNP as silver bullets for the very few.
• We have carefully rolled out some additional resi support for HRA programs.
• We are wrestling with service models for therapeutic foster care, resi care in general and integrated intake for bifurcated regional child protection systems.
• We are starting to digest the implications of recent research on the maturing brain for adolescents.
• There is promise in the interpretation of “best interests”, concern for well being and extended support.
What is emerging from this research about the optimal service system to support good practice?
• More integrated• More flexible• More options within it• More expensive• More congruent• More creative• More therapeutic but in a normalising way• More localised
Some possible fruitful directions
• Outreach work to build more on the examples of Reconnect, Innovations and Finding Solutions.
• Family work could draw more on packages like The Meridian Approach, Triple P, ABCD Parenting, Parenting with Love and Limits, Parenting Wisely and Rick Barth’s pointers.
• There could be much more integrated agency based and locally based use of resi care, home based care, family support, supported accommodation and support for leaving care and independent living.
Wondering about Staff secure and secure accommodation optionsThis nettle needs a firmer grasp.
Is it sufficient to rely on juvenile justice and mental health options for this function and the consequential stigma?
Are we propelling challenging young people into greater criminal exposure and careers?
Are the present secure welfare arrangements ethical, equitable and sufficient?
Observations from the research in respect to secure welfare
• Secure welfare can be helpful because it provides the kid with a sort of, the eye of the hurricane in a way, where they can calm down and have some responsible adults around them to say, let's give this some thought, and many of the kids who go in there do relax and let themselves just stop and think and be kids again rather than tough guys and hooligans or whatever. I've seen girls go in there and play with soft toys like they are five years old again and boys play with cars on the floor, when on the outside they are stabbing people on trains. So in some ways it's good in terms of holding them emotionally and psychologically at some stage, but that's got to do with the environment, the staff, all sorts of variables. It's not just the building and the fact that they are locked up. (Participant 3)
Containment
“And I learnt from that moment that that kid needed to be in physical containment in order for her to be able to reach some emotional containment. And we've lost that and were not fair to those kids. That we put them through trying to struggle in the community, in a unit with other feral kids when they have totally lost the ability to manage themselves and I think we are very wrong, because it's applying adult principles around containment and rights and so forth to adolescence in that period of turmoil anyway. And I didn't like RDOing, I didn't do it a whole lot and I didn't do it for long periods of time” (Participant1).
Relationship and the caring challenge
• I think a good practice, if you've got a good relationship with a kid, what piggybacks on that -- is the capacity to challenge. To challenge behaviours, to challenge values, to challenge lifestyles and a challenge it with some credibility. I mean having a relationship with the young person in the context of worker client has to be intentional. There has to be a purpose behind it rather than just, let's feel good about ourselves. And one of the purposes is going to be that capacity to challenge (Participant 2).
Riding through the risky situation but being there at the end
• “saying no occasionally, absolutely also being able to say I can sort of a little bit predict where this kids going with this I can jump in there and stop it now or I can let it go a bit further and see what happens. There are two options one is that the kid will get through it fine or alternatively I'm going to be there at the other end anyway. Which again is probably a good parenting skill.”
• with a learning component• “Absolutely. There is that old saying that you
can't subtract experience you can only add to it” (Participant 2)
Boundaries and bottom lines from the honest broker
• One of the other qualities and characteristics is good negotiation skills, so you are communicating and negotiating all the time about-- look we discussed this and you said you would and if you keep doing this, these are the likely consequences. The reality is our staff do have to say to kids, look I am really concerned about what you're doing at the moment and for example, today I will be contacting the Department and making a request for secure welfare. I am concerned that you are at risk out there, but still the honesty, it's not saying I'm worried about the kid then grabbing hold of the kid and whisk them away. It's being upfront and consistent about it Participant 4)
Metaphors might matter
• Not too sure about superhumans, magic bullets and silver bullets. Also have some disquiet about the dominance of “risk management”. The research still has a way to go.
• Am also very uncertain about the metaphors of seeing young people as targets and the placement and support system working like an airline booking system