HCN Forum: Services Co-ordinators Maladaptive Behaviour

1. HCN Forum:Services Co-ordinatorsMaladaptive Behaviour Mel Bleach Psychologist Nov 2010

2. Presentation Overview • Our Client Population • The Needs of this Population • Goals, Interventions and Outcomes • Barriers and ‘Getting Stuck’

3. Our Client Population • Common Features of Clients with Maladaptive Behaviour (anecdotal) (separate handout) • Links with the Literature (separate handout) • A closer look ……..

4. Our Client Population - A closer look….. • Hyperarousal and Hypervigilence • Proactive vs. Reactive Aggression • Relational Aggression • Ineffective Parenting Style • Distorted Core Beliefs • Developmental stage of Adolescence

5. The Needs of this Population • Maslow’s Hierarchy of Needs • What Doesn’t Work • What Works – What does the literature say

6. Maslow’s Hierarchy of Needs

7. Intensive, long-term intervention Target the individuals needs An over-arching treatment plan based on assessment Clear goals Praise and tangible rewards Logical consequences not punishment Adults who are ‘firm but fair’ Environments which provide: - Stability - Structure - Predictability - Consistency - Routine - Boundaries What Works – Meet the Basic Needs

8. What Doesn’t Work • Ad hoc, piecemeal interventions • Vague and unfocused interventions • Interventions addressing needs which aren’t linked to problem behaviours/offending • Interventions which involve the ‘wrong’ kind of adults • Institutionalisation

9. What Works – The Literature • Best overseas models are currently: - Multi-systemic Therapy - Multidimensional Treatment Foster Care - Teaching Family Homes They share common features………..

10. What Works – The Literature contd Shared Features of the most effective Models: • An integrated, organized treatment approach • Specifically targets the risk factors linked to ongoing difficulties • Based on Cognitive-Behavioural Principles • Individualised assessment and treatment plans • Those providing direct-care are the key change agents, they are delivering treatment • Targets all areas – home, school, peer, community. • Strong focus on behaviour modification and skills development • Programme quality / integrity

11. What Works - Behavioural Intervention • Behaviour Change vs. Behaviour Management • Adults as Change Agents: the behaviour, practice and interpersonal style of those providing ‘direct-care’ • Understanding the Functions of Behaviour • Decrease negative behaviours and increase/develop positive replacement behaviours and skills.

12. Goals, Interventions and Outcomes - Questions • Where are we pitching our interventions? • Are we attending to critical, ‘lower order’ needs first? • Are we focusing on the basics, or getting caught up in more sophisticated goals and interventions?

13. Goals, Interventions and Outcomes – Basic Principles • At the very least, do no harm • Be realistic about the level of change to be expected • Avoid quick fixes • Acknowledge that there will be setbacks

14. Goals, Interventions and Outcomes – Basic Principles • Intervention for the ‘high risk’ group needs to be intensive – half hearted attempts are likely to be a waste of time and resources (and may do harm). • This will be expensive, and long-term, but will be minimal in comparison with the social and economic cost of ‘life course persistent offending’.

15. Goals, Interventions and Outcomes – Basic Principles • Meet the clients most basic needs first, then work your way down the list (or up Maslow’s triangle) • Stay true to the chosen priorities, and don’t let the focus become diluted. • If stable and safe placement is the top priority, everything the Team does should reflect this.

16. Barriers and ‘Getting Stuck’ What will get in the way of you, as a Services Co-ordinator, developing and implementing an HCN Plan based on the above notions of ‘best practice’ for clients with maladaptive behaviour?