Looking for Good Practice and Optimal Services

for Youth Facing Homelessness with

Complex Care Needs. PhD Research completed 2007

Lloyd Owen - La Trobe University. Australia

lloydsowen@bigpond.com

The Research Concerns

• Youth abandoned, excluded, running away or removed from home or care

• Complex care needs

• High risk or challenging behaviour

• Driven by past experience in institutions and care system and some discomfort with recent experience

The Past

Notwithstanding many shortcomings

• All comers were accommodated

• Atmospheres (with much care and work) could be warm, caring, friendly and safe

• Much specialised assistance was on tap

• There was generally capacity to contain extremes and respond individually

• There were many positive outcomes

The Past

And many negative outcomes

Bringing them Home

Forgotten Australians

Etc.

The Present

There is much to be proud of in Victoria

Some innovative outreach service models

New Legislation

Best interests principles

Strategies to revitalise out of home care

New models of therapeutic home based and residential care.

But, for young people, many negatives are still evident on the ground,

The Present

• Frequent parent blaming family exclusion

• Low expectations

• Young people often prematurely left to their own devices

• Gaps in timeliness and responsiveness

• Frequent struggle for resources

• Risk aversion and procedural complexity

Case planned to homelessness or accelerated criminal justice careersIn spite of much good work, and recognising the need for • sound risk management, • adherence to important human rights and • sound resource management, there appears to be an overemphasis on • (1) personal risk to staff and youth in a somewhat disparate way • (2) rights at the expense of responsibility and • (3) restriction of resources

to the extent that in many instances, it compromises the ability of the service system and the family, to deliver, through relationships with skilled supported people in a variety of roles,

• adequate nurture, healing, personal growth and development and opportunity to thrive, and

• appropriate, safe, humane control with or without physical security.

The research sought

The perspectives of fourteen experienced practitioners about

• Good practice with these young people

• Optimal services to support good practice

The research method

• Was informed by Glaserian grounded theory tradition

• Used in depth interviews for narrative data

• Analysis of transcripts was assisted by

• NVivo computer program and a

• Summary aided approach.

• There were three waves of collection and analysis

Methodological aim to achieve

• Propositions grounded in practice

• Theoretical redundancy on at least some of the story

• In grounded theory terms – “core categories”

Findings about good practice

Good practice entails

• Accessible and assertive presence of

• Appropriate adults to “be there”

• Fostering intentional relationships

• Providing skilled purposive intervention.

Good Practice Intervention provides

• Active unconditional care– Clark’s definition of unconditional care,

“as bad as it gets, we will still care for you; you might run but we will still be here for you”

– Active means – calm, assertive and respectful follow up of absence, significant risk taking or self sabotage and disrespect of self or others and

– Non colluding, non colliding messages of value and concern for wellbeing and safety.

Good Practice Intervention should be

• Planned• Holistic• Sensitive• Responsive to particular individual needs• Attends to attachment and trauma issues• Has short run goals and long term view• Sustained till constructive disengagement

is possible

Good Practice Intervention should also

• Accommodate developmental readiness

• Tap resilience

• Enhance coping and problem solving skills

• Obtain necessary specialist help

• Be delivered with a sense of normality

• Address family issues

• Address education issues

Good Practice is enabled by

• Investing in the work force

• Achieving a congruent positive workplace

These factors also underpin optimal services

Findings about optimal services

• Helping hurt and acting out youth is not for the faint hearted

• Needs often the support, strength and guidance of a multi-skilled team

• Should promote a sense of normality

Optimal Services are

• Timely

• Congruent

• Seamless

• Robust in their capacity to– Nurture– Establish behavioural boundaries– Meet developmental needs– Deliver necessary therapeutic help

Optimal Services should also

• Be connected to a community• Have ready access to suitable

accommodation for the young person• Have purchasing power (quick access to

sufficient brokerage)• Have flexibility of operation• Ideally be able to deliver “on the spot”• Be committed till personal capacity and

natural networks take over.

Implications for policy

• Challenge the tendency for services to be episodic, short term and tightly rationed.

• Support the development of – Robust– Local– Flexible

intervention teams

For professionals

• Interdisciplinary and multi-skilled orientation, collaborative and reflective

• Strong emphasis on intentional relationships and purposeful intervention

For Research

• We need to do it and evaluate it

• Includes topping up those programs already close to the ideal

• More grounded theory work on behaviour management and limit setting which avoids more coercive and stigmatising options would be useful

Postscript

Some items to take away for further digestion and dialogue:

• Some participant inputs

• Fifteen propositions from first and second wave analysis.

• Some additional references

Participant Vision

I would codify in some way that it is a human right to have somewhere to live. I would codify in some way that adolescents have the absolute right to have caring adults who will look after them until they are ready to move out on their own. (Participant 2)

Participant Vision

I would create a place where they could go, houses where they could live that were well supervised, where the kids were safe, where their possessions were safe, where they didn't have to be every night if they couldn't be there, but their bed was not taken away (Participant 3).

Participant Vision

The things that enable it, the best resource that any organisation or agency has are its workers. I'm not talking about money or cars or mobile phones, it's the people who do the face to face work with the kids. Investing in their skills, investing in their support and investing in their mental health, they are all appropriate use of resources. (Participant 2)

Participant Vision

When we are thinking of an optimal system, it would cost more than it costs now, because it would have a greater mixture of options if we are talking about the out-of-home care system. Even with a focus on intensive case management services there is still a concern about having different types of accommodation available for different kids and for different lengths of time. The optimal system would need to be much more flexible to enable them to receive the right service at the right time. (Participant 1)