tracking high needs kids: out of sight, out of mind, and out of home care. centacare broken bay acwa...

Tracking high needs kids: out of sight, out of mind, and out of

home care.

Centacare Broken BayACWA Conference 2008

Dr Stephen Mondy Jean Murray

Senior ManagerProgram Development and Research

Senior ManagerOut of Home Care

Purpose of this talk:

Funding

Incumbent on providers to detail the programs they offer

Need for continued (longitudinal) research

Need for collaboration

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

AUSTRALIAN OOHC TRENDS, 1983-2006

17,000

12,273

14,67715,674

16,92318,038

18,880

20,29721795

23,695

25,454

9,860

9,898

12,85914,323

15,701

16,861

17,82319,234

20758

22,601

24,199

7,140

2,4551,818 1,351

1,2221,177

1,0571,063

1037 1,0941,255

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

26,000

Nu

mb

ers

in C

are

Total in Care

Foster Care

Group Care

Adapted from AIHW Child Welfare Series and Bath (2007)

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 careFoster careKinship care

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’)

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

Year Rate per thousand population

2003-04 6.2

2004-05 6.3

2005-06 6.7

2006-07 8.7

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)

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

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

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

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

Number of Placements

Centacare Broken Bay HNKsDecember 2005 – present

Foster Caren=8

Residential Caren=23

Average # prior placements 2 11

Average age on entry (years) 13.4 14.7

Males (%) 63 43

Indigenous (%) 0 43

CALD (%) 50 8

Sibling in care (%) 63 25

Cost per child (today’s $ p.a.) 100,344 274,894

Educational/EmploymentPlacement (%)

63 31

Median Length of Placement (days) 432 408

Centacare Broken Bay HNKsExit Points

#n=13

Restoration home 2

Kinship care 7

Disability placement 1

Detention 1

Self placed 2

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

Staff

Recreation

PsychologicalAssessment

Training

Supervision

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

Staff

Recreation

PsychologicalAssessment

Training

Supervision

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

Centacare Broken Bay Integrated Services

DisabilityAged Care Family relationships Counselling Mediation DV support Childcare Respite Employment Housing support SAAP

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

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

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

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

For more information please contact:

Jean Murray Senior Manager Out of Home Carejmurray@brokenbay.catholic.org.au

Dr. Stephen MondySenior Manager Program Development and Researchsmondy@brokenbay.catholic.org.au

centacare@brokenbay.catholic.org.au