Tracking high needs kids: out of sight, out of mind, and out of home care.

1. Tracking high needs kids: out of sight, out of mind, and out of home care. Centacare Broken Bay ACWA Conference 2008

2. Purpose of this talk: Funding Incumbent on providers to detail the programs they offer Need for continued (longitudinal) research Need for collaboration

3. Centacare Broken Bay Professional welfare service delivery to Northern Sydney, Northern Beaches and Central Coast 12 Funding streams, 30 funding agreements and > 50 funded programs Disability, Aged Care, Family relationships, Counselling, Mediation, DV support, Childcare, Respite, Employment, Housing support, SAAP, and OOHC

4. Adapted from AIHW Child Welfare Series and Bath (2007)

5. 12,712 Children in OOHC NSW (June 2007) 30.4% of children in OOHC are Indigenous (Aboriginal/TSI) yet only 3.4% of NSW children are Indigenous Residential care Foster care Kinship care

6. 2002 - 2008 $1.2 billion of additional NSW Government funding to strengthen child protection and care Over $600 million for consolidating and extending OOHC services An early component of this funding rollout was provision for residential care for young people with high and complex needs (‘High Needs Kids’)

7. Despite increasing resources the number of Children in OOHC in NSW continues to rise

8. Secure units were closed in NSW in 1998 A small number of young people in care exhibit extremely challenging and risky behaviours to themselves and to others Known as ‘High Needs Kids’ - acute, crisis-level of disturbance through self-harming and suicidal, violent or anti-social behaviour Represent about 2% of children in care, but accounted for 26% of DoCS OOHC budget (in 2005-06)

9. NSW DoCS contracted four NGOs to work with High Needs Kids 224 placements across NSW Centacare Broken Bay Broken Bay – 12 residential placements in 4 homes 6 foster care placements Case management retained by NSW DoCS – placement service only provided by NGOs

10. Mostly adolescents with a history of residential and foster care placement disruption Seriously challenging behaviours to self and others Common diagnoses – ADHD, Conduct Disorder, Oppositional Defiant Disorder, Mood Disorders Often fail to meet thresholds for intensive long term intervention by service systems - disability, mental health and criminal justice systems - yet still have complex child protection needs

11. Challenging behaviours - social/emotional difficulties: • • poor impulse control and/or stress intolerance • • high risk-taking behaviours • • alcohol and other substance abuse • • poor self image • • self-harming behaviours • • social isolation/limited capacity to form relationships with peers/adults • • sexually inappropriate behaviour • • anti-social behaviours including aggression/violence towards people • In some instances: • criminal behaviour • mental health issues • physical health issues • intellectual disability • educational difficulties

12. Percentages of all Children in OOHC in NSW by number of placements (June 2007; n=12,712) Number of Placements

15. Small units (<3): • tailored programs • < iatrogenic effects

16. Small units (<3): • tailored programs • < iatrogenic effects Staff Recreation Psychological Assessment Training Supervision

17. Centacare Broken Bay Integrated Services Disability Aged Care Family relationships Counselling Mediation DV support Childcare Respite Employment Housing support SAAP • Small units (<3): • tailored programs • < iatrogenic effects Staff Recreation Psychological Assessment Training Supervision

18. Key features of Continuum of Care approach • Staged entry and transitional arrangements • A comprehensive individualised therapeutic intervention plan • Staff move with the young person • Recreational activities familiarise children with staff from future placements • Risk minimisation approach to co-placement

19. Key challenges • Reducing placement disruption in community settings • Site • Behaviour management • Neighbours • Attracting and retaining staff • Recruiting suitable staff • Vicarious trauma Engaging with the education system

20. Key success factors • Sufficient funding to meet each child’s needs • Flexibility to redeploy staff to maintain attachments • Close relationship with statutory case management agency (DoCS) • Comprehensive individualised care plan • Flexibility in young people’s participation in care planning • Reconnecting young people with educational success

21. Implications for Practice • continuum of care approach leads to enhanced placement stability • offers the possibility of consistent, targeted therapeutic interventions that: • address trauma • lead to the establishment of better attachments and social functioning • stabilise behaviours contributing to placement breakdowns

22. For more information please contact: Jean Murray Senior Manager Out of Home Care jmurray@brokenbay.catholic.org.au Dr. Stephen Mondy Senior Manager Program Development and Research smondy@brokenbay.catholic.org.au centacare@brokenbay.catholic.org.au