Closed institutions and their alternatives: What works?

1. Closed institutions and their alternatives: What works? Presentation Eusarf Conference 22th September, 2005 ,Paris

2. 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)

3. 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

4. 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

5. 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

6. “ 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

7. 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

8. Outcome 2000-2002 (%)

9. Outcome 2003 - 06/2004 (%)

10. 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

11. No perspective – “No Future” • School drop-outs • Illegal drug abuse • Verbal and physical aggression • vandalism • Antisocial peers • Staying out overnight

12. No perspectives - continued • The “coach” – “educator” • Fading away of boundaries and limits • Institutional context • “Procession of Echternach” • “Asking Parents”

13. 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

14. 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

15. 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

16. 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

17. 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.

18. 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.

19. Recent outcomes (%)

20. Evolution Outcome (%)

21. 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

22. 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’

23. Contact Vzw 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