A systemic approach to working with children and young people in OOHC and their carers

1. A C C The Alternate Care Clinic Therapeutic support for kids in care A systemic approach to working with children and young people in OOHC and their carers Romina Tucker & Dr Brendan New

2. A C C The Alternate Care Clinic Therapeutic support for kids in care

3. Alternate Care Clinic Who are we? • Joint project between Community Services and Health. • Provides services to children and young people aged 0-18 years old who are living in out of home care and have high level complex needs.

4. Alternate Care Clinic Services • Psychiatric review • Individual and group based therapy for children and carers • Neuropsychological assessment • Support with case management, coordination and care planning • Systemic work with the key players in the child’s life

5. Alternate Care ClinicReferral base • Referrals received from the Community Services. • We only accept clients living in the Sydney West Area Health Service area.

6. Alternate Care ClinicSystemic approach A system can be thought of as a set of elements that interact with each other.

7. Alternate Care ClinicSystem diagram Mentor CS Caseworker CS Manager Biological Father Carers Class Teacher Biological Mother Teacher’s Aid PANOC Counsellor School Principal ADHC Programmer

8. Alternate Care ClinicTherapeutic model

9. Alternate Care ClinicWe establish safety by: • Training carers • Advocating for stable long term relationships • Increasing coherence by clarifying roles • Actively working against cliques and alliances • Increasing communication and neutrality • Managing the therapists own anxiety through supervision • Providing medication where useful.

10. Alternate Care ClinicWe increase reflection by: • Building a sense of self and developing a coherent narrative of their life experience • Facilitating group discussions and experimental exercises • Encouraging regular residential care worker team meetings • Assisting stakeholders to develop a coherent management plan.

11. Alternate Care ClinicWe improving functioning by: • Teaching skills • Managing arousal • Using parent-child special time • Encouraging access to additional community and educational supports • Modelling systemic thinking in our communication.

12. Alternate Care ClinicSystemic approach • Thinking about the three hierarchical levels of need is valuable. • Only thinking about one level of functioning results in less effective outcomes. • Whether you think systemically or not, systems exist.

13. Systemic considerations within OOHC Some of us work with children, some with carers, some with families Regardless of our role we suggest there is benefit in considering: What elements make up the wider OOHC system? What level of need (safety, reflection, functioning_ do these elements function at? How might different parts of the system and their needs shape the way we work and the outcomes we are working towards?

14. Systemic considerations

15. The Child Who is ‘the Child’? Foster children Foster siblings Biological children of carers Children in care of birth family What might influence safety, reflection or functioning? Age Culture Trauma history Age of entry into OOHC Number and type of previous placements Who do they share the placement with Siblings in care or still with birth family Child’s understanding of why they were removed Contact with birth family Type of placement; kinship, foster or residential

16. The Carer Who is ‘the Carer’? Kinship carers Foster carers Residential workers Birth family What might influence safety, reflection or functioning? Reasons for becoming a carer Experience at being a carer Biological children of their own Level of familiarity with children before placement; kinship often more, foster often less Caring on own or with partner Support carer receives, or doesn’t receive, in their care role Grandparent carers; assuming a care role later in life

17. The Education system: An example Who is ‘the Education system’? Teachers, teacher aides, relief teachers Principals, deputy/assistant principals School counsellors Department of Education and Training, school boards, trustees What might influence safety, reflection or functioning? Responsibility to children as individuals as well as a group Ensure the safety and retention of school staff Long term involvement Contribute to multiple domains of child functioning; academic, personal, creative, sport, social, cultural May have limited understanding of child’s life outside the school setting External benchmarks and expectations

18. The Wider System Extends beyond the single child and family group: Peer groups Cultural groups Neighbourhood and community groups Sporting groups Religious groups Almost always includes service providers: Education Community Services Therapeutic services Residential services Medical (e.g., GP, paediatric, dental) Allied health (e.g., occupational therapy, speech and language, vision and hearing, developmental) Legal

19. Thinking systemically: The nuts and bolts Who is out there? Where in the hierarchy of safety, reflection and functioning are they functioning? What level are we functioning at? What level of hierarchy are we working towards for children, carers and the wider system? How do we influence other parts of the system? How are we influenced by others? What do others know about us? What do they believe they know about us?

20. Acting systemically: The nuts and bolts Target actions to address level of need Is consensus possible? Reflect on the way we work and reasons we work this way Reflect on beliefs we have regarding the way other people work Meet with people whose actions affect us now, or may do so in the future Try to incorporate systemic thinking into the way we work now

21. Challenges to working systemically Systemic practice can take: Time Energy Support Change Changes in how we understand the impact we have on children, families and the wider system Changes in the way we work with different parts of this system How do we fit these changes into our current work roles? How do we work systemically if others don’t or won’t?

22. Benefits of systemic practice Foster children and families exist within systems made up of multiple, complex and interrelated elements Systemic practice seeks to recognise the presence and interdependence of these systems By acknowledging different parts of the OOHC system and reflecting on their need for safety, reflection and functioning we may: Gain a better idea of what children and families need Target our support more effectively Improve children and families access to the wider system Provide opportunity for services to build consensus and explore differences Reduce redundancy of effort Change in one part of the system can effect change in other parts

23. Where to from here Alternate Care Clinic, Redbank House, Westmead, Sydney, NSW Romina Tucker, phone: (02) 9845 9087, Romina.Tucker@swahs.health.nsw.gov.au Dr Brendan New, phone: (02) 9845 9086, Brendan.New@swahs.health.nsw.gov.au