New Pathways Residential Treatment Services

1. New Pathways Residential Treatment Services Working with High & Complex needs young males who have sexually problematic behaviour: Providing a Sanctuary for Change Leah Berry (Clinical Coordinator) Cass Herring (Program Manager)

2. Located in the Southern Highlands (Sutton Forest NSW)

3. New pathways staff • Program Manager: Cass Herring • Intern Psychologist: Liz Bennett • F/T Case Worker: Lauren Spinks • P/T Case Worker: Vacant • Admin Support: Sarah Sells • Full Time Specialist Youth Workers: x 7 • Part Time Specialist Youth Workers: x 5 • Casual Specialist Youth Workers: x9 • Night Workers: x 5 • Life Skills Mentor: Louis De Marco

4. Overview of new Pathways • Purpose: To provide Out of Home Care for adolescent males aged between 13 and 17 years of age who have sexually abused and who have High and Complex Needs.

5. Overview of new Pathways • 3 Houses on approximately 100 acres. • Mark David House • Mirvac House • Pif House

6. Unique to Australia; only OOHC provider to this client group • Treatment Milieu- 24 hour roster; focus on “life space” intervention not just individual counselling. Specialist Youth Staff are vital to process significant issues & behaviours immediately whilst it is still relevant to the young person. • CSOCAS accredited staff • Staff Training includes: • TCI, RAP, LSCI, Trauma Sensitive, Sex Offender Specific, Adolescent Mental Health, Good Way, “In-house” induction • All staff are provided with all training modules • Consistency provides safety and security • Anglin (2002)

7. High & complex needs • Multiple &/or traumatic placement breakdowns • Poor impulse control &/or stress intolerance • Educational difficulties including inability to attend mainstream schools • Attention Seeking Behaviours • Poor self image • Self harming behaviours

8. High & complex needs • History of Inappropriate Sexual Behaviours • Verbal & Physical Aggression (that may result in property damage) • Low level criminal behaviours (eg property damage, theft etc) • Intellectual Disabilities (mild-moderate) • Poor communication & social skills

9. Mark david house • Houses a maximum of 3 young people. • Solid Dwelling: Great for yp with destructive behaviours. • Has an in-ground swimming pool; a “gym”, a library, permanent campsite & bike jumps in immediate vicinity.

10. Mirvac house • Can have a maximum of 5 young people (although this is very unlikely due to dynamics of young people). • Has an in-ground trampoline, football field, versatile cement sporting area in immediate vicinity.

11. Pif house • Used for Admin purposes. • Can house a maximum of 3 yp. • Houses a “school room” for yp who can not cope in mainstream schooling.

12. Underlying therapeutic models of new pathways! Responding to pain-based behaviour

13. The Good Way Model • Originally developed for the Well Stop Program in New Zealand, by Ayland & West (2006). • Based on Narrative therapy, positive psychology, trauma theory and special education - helping our young people externalise their behaviours • The Islands of progress • The Gang of Three and Wise Men • Incorporating relapse prevention planning

14. The Gang of 3

16. Dice activity

17. The evolution of new pathways • Began as PPC (Positive Peer Culture) which focused on young people learning from their peers rather than adults. • Due to the increasingly complex needs of young people (who were unable to function as part of a peer group) the program evolved to a more individualised approach however maintained many of the PPC underlying values • Primary Goal of making Hurting Behaviours Unfashionable and Caring “Cool”

18. Strength-based interventions • Underlying value “All young people in Service are GOOD people who have made BAD choices.” • Focus on catching the yp being good & immediately acknowledging this • Approach Goals rather than Avoidance Goals: Setting goals that are challenging but also achievable for the yp. • Bringing about behavioural change is used through the raising of a young person’s anxiety’s (making the negative behaviour uncomfortable). However this is only possible by balancing the positives to combat perceived negative self-image (so the yp does not become their behaviours)

19. Translating into oohc • Demanding GREATNESS! (Not Obedience) • NO punishment (Natural & Logical Consequences) • Crisis = Opportunity • Reversing Responsibility: Troubled youth will attempt to put their problems onto those around them. They are NOT responsible for creating their problems but for how they respond to them.

20. Trauma Sensitive Approach • Adolescents who sexually abuse almost universally have some form of trauma in their histories ( McMackin et al, 2002). • Neurological Impact – structural and functional differences (Teicher et al, 2002) • Responding to a young person’s needs not reacting to their problems. • Understanding Vicarious Trauma of the staff team.

21. The Sanctuary Model • Bloom, 1997 • A residential care model integrating a variety of treatment approaches and is a trauma based system of care. • Structuring for safety and security to create a living-learning environment. • Therapeutic focus • S afety and security • E motional regulation • L oss • F uture

22. Circle of courage (Brendtro, Bockern & Brokenleg)

23. Bob

24. Bob at the Beginning • 15 years old & the middle of 3 siblings • History of ongoing neglect, verbal abuse, lack of supervision, and boundaries, exposure to alcoholism, aggressive behaviour, and pornography. • Mild intellectual delay, with a diagnosis of ADHD • Strong relationship with mother and minimal contact from Bob’s Father

25. Long standing sexually abusive behaviour (reported on numerous occasions) toward a younger sibling – JIRT investigated, but no charges. • Attempts at intervention whilst Bob continued to reside at home, however it was eventually evident that Bob required an OOHC placement to address these behaviours as the sexually bullying was increasing.

26. Reported problem behaviours include: • Sexual bullying, touching, & penetration • Cruelty to animals. • Urinating in public • Possession of weapons to harm himself • Suicidal threats and gestures • Risk taking behaviours • Poor self esteem • Anger management difficulties • Oppositional • Non compliance • Aggression – verbal and physical

27. Bob’s Intervention • Ensuring his environment was safe and secure, also encouraging him to express his personality in how he decorated his room and house. (Belonging) • Working with Bob to develop short & long-term personal goals to help change his abusive behaviour. (Mastery) • Bob was given the opportunity to contribute to his daily schedule and community activities that he is interested in. (Independence)

28. Bob Now • When Bob had been in the program for 14 months he was on Blue Island • He had improved in the following areas: • Decreased physical and verbal aggression • Acceptance of sexually abusive behaviour and development of Wise Men • positive communication • ability to follow structure and responds well to this • empathy skills • Had begun family restoration through positive and structured contact with his victim • Was still working through some attitudinal and value shifting processes.

29. trevor

30. Trevor at the Beginning • 14 year old, ATSI young person. • History of ongoing sexual, physical and emotional abuse, witness to violence and sexual abuse of family, neglect and abandonment. • Mild intellectual delay, diagnosis of PTSD, Learning delay, ODD, and some suggestion of ADHD. • Trevor has six older siblings and at least four younger siblings. • Trevor was rejected & abused by his mother and father and abused by his step father.

31. Trevor had a very strong positive relationship with an extended family member who is a constant positive and often therapeutic support. • Trevor sexually abused his younger cousin on several occasions within a short period of time and was charged for these encounters. • Trevor was abandoned, scheduled at an adult facility and homeless prior to entering New Pathways, but had specifically requested to have help to change his behaviour.

32. Trevor’s Problematic behaviours : • Suicidal Ideation and gestures • Petrol Sniffing behaviour • High risk of absconding • Violent and aggressive behaviour • Physical and verbal abuse • Non compliant and defiant • Pushing boundaries & manipulation • Poor peer interaction • Poor academic achievement. • Threats of harm toward self and others • Lack of impulse control & Easily misled • Poor communication • Poor anger management & Low tolerance for frustration

33. Trevor’s Intervention • Ensuring his environment was safe and secure, by placing him by himself and structuring for safety particularly of an evening. (Trauma Sensitive) • Working with Trevor to develop short & long-term personal goals to help change his abusive behaviour. (Mastery & Trauma Sensitive) • Trevor was given opportunities to engage in life skills development & cultural development. (Belonging, Mastery, Independence & Trauma Sensitive)

34. Trevor Now • When he had been in the program for eight months he was on Purple Island • He had improved in: • Positive communication • Decreased aggressive outbursts • Some impulse control • Victim empathy • decrease in suicidal gestures and ideations. • Building relationships • Ability to follow structures and guidelines

35. Outwitted He drew a circle to shut me out. Heretic, rebel, a thing to flout. But love and I had the wit to win. We drew a circle that took him in Edwin Markham

36. Questions?