a systemic approach to working with children and young people in oohc and their carers romina tucker...
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A systemic approach to working with children
and young people in OOHC and their carers
Romina Tucker &
Dr Brendan New
The Alternate Care ClinicTherapeutic support for kids in care
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
The Alternate Care ClinicTherapeutic support for kids in care
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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.
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
Alternate Care ClinicReferral base
• Referrals received from the Community Services.
• We only accept clients living in the Sydney West Area Health Service area.
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
Alternate Care ClinicSystemic approach
A system can be thought of as a set of elements that interact with each other.
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
Alternate Care ClinicSystem diagram
Carers
CS Caseworker
Biological Mother Teacher’s Aid
Class Teacher
School PrincipalPANOC CounsellorADHC
Programmer
Biological Father
CS ManagerMentor
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
Alternate Care ClinicTherapeutic model
Improve Safety
Improve Reflection
Improve Functioning
Child Medication to decrease arousal
Coherent narrative development
Problem Solving, Affect Regulation, Interpersonal skills
Carers Build empathy/ decrease misunderstanding
Putting things in developmental/ historical context
Training the carers to teach the skills.
Incl. skills of carers
Wider System
Decrease anxiety in the system
Long-term planning (not crisis driven)
More coherent system, clearer communication etc
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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.
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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.
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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.
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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.
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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?
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
Systemic considerations
Improve Safety
Improve Reflection
Improve Functioning
Child
Carers
Wider System
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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?
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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?
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
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
The Alternate Care ClinicTherapeutic support for kids in careRomina Tucker and Dr. Brendan New
Where to from here
• Alternate Care Clinic, Redbank House, Westmead, Sydney, NSW
• Romina Tucker, phone: (02) 9845 9087, [email protected]
• Dr Brendan New, phone: (02) 9845 9086, [email protected]