Protect All Children Today 26 March 2009

1. Evolve: working with children and young people with severe and complex psychological and behavioural problems Protect All Children Today 26 March 2009

2. Outline • Evolve Interagency Services overview • The use of collaborative practice in the Evolve model • Learning’s, outcomes of this approach • Future challenges • Client outcomes • The model in action – a case study

3. Background and Rationale • CMC • Collaborative model • Unique service – new model of service, no precedents, ongoing learning. • Changing and growing cohort

4. Underpinnings of the Evolve model • Collaborative approach • Multidisciplinary approach • Child centred and Inclusive approach to ensure child, family and carers involved in planning and implementing intervention goals • Capacity building to support sustained change for both the child and their support network • Evidence based practice

5. Evolve Locations Far Nth Qld North Qld Central Qld Sunshine Coast North Brisbane Logan Gold Coast

6. Evolve Interagency Services Model

7. Evolve Program • Goal of Evolve • Multiple agencies • Therapeutic & Behavioural Support Services, intensive and long term intervention • Holistic and consistent approach in support and intervention

8. Developmental effects of abuse and neglect inform intervention approach

9. Principles of therapeutic mental health services [Saunders, B.E., Berliner, L., & Hanson, R.F., 2004 &Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B., 2003].

10. Positive behaviour support model

11. Evolve Program Learning’s & Outcomes

12. Evolve Program Learning’s & Outcomes

13. Future Challenges • Capacity of Evolve and increased demand • Recruitment of specialist staff • Information sharing • Educating and engaging stakeholders • Links with other elements of the service system • Managing expectations • Research and Evaluation

14. Evolve client outcomes

15. Evolve client outcomes

16. Evolve Program Client Outcomes Client Benefits • Review of Evolve • Significant decrease in challenging behaviours • Reduction of self harm and harm to others • Greater placement stability • Increased participation and engagement in educational programs

17. Achieving outcomes for childrenthrough collaboration A Case Study “Jack”

18. Referral • Referred to EIS 2007. • 13 year old male • Multiple placements • Aggressive/violent outbursts • Absconding from home and school • Limited school attendance • Dysfunctional sleeping and eating patterns • Impaired activities of daily living • No peer relationships • Forensic History – theft, wilful damage, assault • Emotional dysregulation

19. Referral cont. • Significant learning difficulties • Illiterate • Diagnoses of ASD, ADHD • Significant trauma and attachment issues • Medication (Ritalin, risperidone, endep)

20. Family and child protection history • Parental drug and alcohol misuse, domestic violence, homelessness • Complex blended family - multiple fathers/ partners/siblings • Family known to Department of Child Safety/multiple levels of intervention • Significant history of neglect, trauma and abuse including sexual abuse of children • Family has history of non engagement, litigiousness, and sabotage of interventions.

21. Evolve Interagency Services program • Allocated to Primary Service Provider • Allocation of roles • Assessment process • How to, responsibilities, formulation and development of treatment plan • Treatment process • Identification of and establishment of stakeholder team, frequency of meetings, roles, and responsibilities: • Maintain open communication • Establish and set group cohesiveness • Demonstrate commitment to young person and stakeholder process

22. Stakeholders Evolve Therapeutic Service Education Evolve Behaviour Support Young Person Family/Other Child safety Residential

23. Planning and Goal Setting • Stakeholders identified goals • linked to Jack’s treatment plan • Jack’s involvement /engagement sought • Goals set initially task focused • with each stakeholder identifying tasks that they were responsible for • Establishment of sub (micro) teams • to work on specific goals together for completion between stakeholder meetings

24. Stakeholder Group EVOLVE HEALTH & DSQ DChS • 1:1 sessions with Jack • Connect with biological family • Advocacy for family contact • Training & education to School & NGO staff. • Financial support 1:1 placement • Open communication • Include SH in decisions • Attend SH meetings FAMILY • Liaise, engage, support and value. Include in SH process & treatment plan • Education: re medication RESIDENTIAL & DETA • Attend SH meetings • Participate in training • Implement strategies • Flexible resourcing Micro Teams in Action

25. Outcomes for Jack • Aggressive behaviour has reduced • No further involvement with criminal justice system • Attending school regularly/engaged in community • Beginning to read • Improved ability to manage activities of daily living • Insight into behaviour, including empathy and remorse • Medication free • Peer relationships • Family relationships • Placement

26. Medium to long term goals for Jack • Continuing development, peers, literacy, mainstreaming • Development of emotional regulation, empathy and social skills • Pre-employment skills with view to part time work • Transition to supported/independent living

27. Outcomes for stakeholders • Improved skill base, particularly for direct staff. • Increased understanding of other professionals. • Enhanced relationships between government and non government departments.

28. Key factors to successful collaboration amongst stakeholders • Willingness of all parties to engage in process • Open, effective communication with ALL stakeholders • Continued involvement of family - backing up behaviour support strategies. • Involvement of direct care workers (residential and school) - specific tasks to give them ownership of process. • Respecting the roles of others - honoring the person. • Keep young person at the centre – active participation at stakeholder meetings

29. Our Key Learnings • Communication is the key - needs to be effective, open, and with ALL stakeholders • Each person needs their own ‘work’ to do so that they feel and become a key member of the team • Never underestimate the power of a united team • A collaborative team is characterised by equal partnership and shared responsibility • Keep the young person as focus – the goal of Evolve is to support the young person

30. Collaborative PartnershipsOngoing Challenges • Interagency collaboration is • Multidimensional • Interactional • Developmental … and a lot of planning and continued hard work is needed for it to be successful! (Johnson, Zorn, Tam, Lamontagne & Johnson, 2003)

31. Evolve Program Management Team • Melissa Yim, Department of Child Safety melissa.yim@childsafety.qld.gov.au • Jackie Bartlett, Queensland Health jackie.bartlett@health.qld.gov.au • Morag Gilchrist, Disability Services Qld morag.gilchrist@disability.qld.gov.au • Brett O’Connor, Department of Education Training and the Arts brett.oconnor@deta.qld.gov.au • Erica Russ, Department of Child Safety erica.russ@childsafety.qld.gov.au