Young people tell the Royal Commission how the care system should be

a group of young people at the Royal Commission consultation.

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Thirty-five young people under, or previously under, the the guardianship of the Minister gave their views of the child protection system in a consultation with the Child Protection Systems Royal Commission on the afternoon of 25 March 2015.  The young people were invited to work through a series of scenarios involving an imaginary family and their children and to speculate what could and should be done to support and protect them.

Guardian Pam Simmons said that she was very pleased with the result.

‘As always the young people amazed us with their thoughtfulness, enthusiasm and generosity and I know that the Royal Commission will benefit from the immediacy and relevance of the young people’s contribution.’

While views differed on some of the detail, one young person summed up for all with, “The children must be heard -in their own words.”

The consultation was a partnership between the Royal Commission, CreateSA and the Guardian’s Office, who will share the outputs from the session, with the support of Red Cross SA who provided an excellent meeting space.

 

Wellbeing of children and young people in care 2010-11

The Guardian’s Office monitors the circumstances of children under the guardianship, or in the custody, of the Minister. The feedback and findings collected during monitoring activities are reported in detail to the agencies involved and to the relevant Minister.

In the 2010-11 report we focussed on children’s safety, security and stability of placement, contact with family, friends and cultural community and participation in decision-making.

The report Wellbeing of Children and Young People in Care 2010-11 summarises the collected information.

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Wellbeing of children and young people in care 2009-10

The Guardian for Children and Young People monitors the circumstances of children under the guardianship, or in the custody, of the Minister for Families and Communities. The feedback and findings of monitoring activities are reported directly to the agencies involved and to the Minister.

The Report on the Wellbeing of c&yp in care in SA 2009-10 summarises the information  in one place about three priority areas identified by the Office and makes the general conclusions available to a wider audience.

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Wellbeing of children and young people in care 2008-09

The Guardian for Children and Young People monitors the circumstances of children under the guardianship, or in the custody, of the Minister for Families and Communities. The feedback and findings of monitoring activities are reported directly to the agencies involved and to the Minister.

The Report on the wellbeing of children and young people in care in South Australia – 2008-09 summarises the information in one place and makes the general conclusions available to a wider audience.  We will publish a written response from Families SA in the near future.

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Physical restraint in residential care

In April 2009 the Guardian initiated an inquiry into the use of restraint in residential care facilities following reports from some youth workers and residents that physical restraint was used too often and young people were suffering injuries.  The inquiry was conducted by Associate Professor Andrew Day and Dr Michael Daffern and the inquiry report, Policy and Practice in the Use of Physical Restraint in SA Residential Facilities for Children and Young People, was released on 13 January 2010.  The full report is available for download and a summary.

Use-of-Restraint-Report-2010

Use-of-Restraint-Report-summary-2010

The inquiry found that the use of physical restraint has been falling since 2007 but that it could be reduced still further.  Restraint should only ever be used where the young person is at risk of immediate and serious harm to themselves or to another person nearby.  It is a ‘last resort’ intervention.  It should not be used because a young person is cheeky, refuses instructions, is shouting or throwing things around.  It should only ever be used by people trained to restrain safely.

The vast majority of residential staff are extraordinary people and are doing a great job under very difficult circumstances.  The failures identified in the inquiry report are systemic failures and should not reflect on the many dedicated workers and managers, nor on the young people who act out their distress. The failures were with inconsistent policies and practices, too many residents housed together, not enough on-the-job training and reflection on incidents, and not enough specialist support for young people with high needs.

There were different rates of use of restraint in different places and generally there was lower use in non-government houses.  This was a function of the size and design of the facility and higher investment in training and support. We could not answer the question about whether South Australia had higher rates of use than elsewhere because the data is too inconsistent to make any comparisons meaningful.  Instead the researchers could say that the rate of use could be reduced further.

To minimise the need to use physical force five recommendations were made.  In summary these were to replace the large residential units with smaller home-like houses of three or four young people, provide more on-the-job training and support for staff, change the regulations in the Family and Community Services Act 1972 so that restraint is never sanctioned for non-compliance, have specialist advice more readily available for children with the highest needs and have more rigorous external monitoring so that patterns are picked up early.

So much goes well in our residential care sector and we learn as much from what works well – see our report What works best in residential care – as what doesn’t. We do though tend to review things that we are concerned about and that we want to do better at.  As one young interviewee said, ‘I know it takes a lot out of them emotionally,’ referring to youth workers.  Compassion and understanding is a great place to start.

Report on the physical restraint of children in South Australian residential facilities

[This article was first published in The Advertiser 13 January 2010.

The Use-of-Restraint-Report-2010 on which it is based and the Use-of-Restraint-Report-summary are both available in PDF.

Using force to hold, immobilise or move a child who is in danger can be a normal protective response.  Pushing, pulling and lifting may be necessary to protect the child or others nearby from immediate and serious harm.

I have just completed an inquiry into the use of physical restraint of children in South Australian residential facilities.  Residential facilities for children and young people in state care are run by government and non-government organisations.  Children stay for periods of a few days to a month.

Included in the inquiry were the youth training centres at Magill and Cavan.

I started the inquiry because we had heard from some young residents and staff that restraint was used often and children were suffering injuries as a result of being restrained.

In other countries children and young people have died in schools and residential facilities from asphyxiation as a result of physical restraint. Some methods of restraint are very dangerous, particularly when they involve neck holds, obstruction of the nose or mouth, or holding a child face down on the ground.

Thankfully, we did not hear of any incidents of children dying recently in children’s services in Australia as a result of a physical restraint. However injuries were confirmed, reinforcing the evidence that restraining a child can be dangerous.

Restraint also has a considerable psychological effect on both the child and the staff involved.

We found that the use of restraint is decreasing and awareness of its dangers is rising.

Nevertheless restraint was not uncommon and was sometimes used inappropriately, such as when a young person refused repeatedly to comply with an instruction and emotion was high.

Restraint is more common in the facilities which accommodate higher numbers of children; not because the staff are any less skilled than others but because it is so difficult to keep everyone safe in a home with ten young people compared to four. Some young people were restrained often and undoubtedly had extremely challenging behaviour.

Fortunately, the background research and findings make us confident that we can make all children’s residences safer.

First, we would have no more than four young people in any one house, maybe up to six in some circumstances.  Second, we would have a consistent positive approach to bad behaviour, and restraint would never be sanctioned for non-compliance or punishment.

Third, care staff would be well-trained and well-supported to act professionally, warmly and calmly.

Fourth, specialist advice would be provided for the care of children with extremely challenging behaviour and a review of all incidents would be done routinely.  And fifth, there would be rigorous external monitoring of use of restraint so that patterns could be picked up early.

The inquiry found that there are inconsistent procedures and practice in children’s residential facilities and a number of situations in which it was unclear how staff should manage difficult behaviour.   For example, plucking children from harm’s way is easy to defend as necessary but is it right to haul  a 14 year old boy out of bed on a third attempt to get him to school?  And is it right to immobilise with an arm hold a distressed 13 year old girl who is lashing out at anyone who comes near her?

It is these types of difficult situations that residential care workers routinely face, and they have to decide whether or not and when restraint is required.

Residential staff want the best for children in their care.  They need our support and government’s commitment to achieve this.

Within the next few years I hope to see the larger residential facilities replaced with home-like residences, specialist advice for children with high need and consistent guidance to staff on dealing positively with problem behaviour.

Numbers add up to cause concern

  • On an average day in SA there are 345 children and young people in some form of residential care, including those in secure custody.
  • Over a 27 month period (Jan 2007 – March 2009) there were 19 confirmed cases of injury of children in residential care as a result of physical restraint.
  • Most of those restrained are male.
  • Many residents will never experience a restraint but some are repeatedly restrained, usually over a short period of time.
  • Residential facilities for children and young people in state care are run by government and non-government organisations and children stay for periods of a few days to a few years.
  • In the past decade in Australia there have been incidents of serious injury of children in formal settings which have triggered inquiries, such as a 2006 WA Ombudsman’s investigation, a 2007 review by the WA Inspector of Custodial Services and a 2001 NSW Community Services Commission review.

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Physical restraint – what the literature tells us

In April 2009 the Guardian commenced an inquiry into the use of physical restraint of children in SA residential facilities. As part of the inquiry the researchers, Associate Professor Andrew Day and Dr Michael Daffern, reviewed the written evidence and theory on the effectiveness and safety of restraint.
Restraint can take several forms. Most think of ‘hands-on’ restraint, where one or more people take hold of the person to control them.
Restraining devices to limit movement are sometimes also used, as is seclusion in a room and chemical restraint with drugs to manage extreme behaviour. This inquiry focused only on ‘hands-on’ restraint.
The use of restraint on children or young people is regulated to some extent by conventions, legislation and procedures which, if not actually contradictory, come from different perspectives. The UN Convention on the Rights of the Child, the Charter of Rights for Children and Young People in Care, regulations to the 1993 Children’s Protection Act and government and non-government procedures all have implications for practice and the legality of practice. The tension lies between the rights of a child to freedom from coercion or force and the right to safety from harm.
There is little empirical basis to determine when restraint is appropriate. There is no evidence to support the view that physical restraint assists children or young people to learn self-regulation or that it helps them to acquire useful and appropriate interpersonal skills. Physical restraint is a potentially dangerous practice and discussion on its use is highly charged. Restraint can appear to a child like abuse, frightening them and alienating them from care givers who administer it. Restraint can lead to serious injury and death, and the evidence from overseas confirms the high risk and the adverse psychological impact on staff and residents. However restraint can, and is, used to prevent immediate and significant harm.
Attitudes to the use of restraint are divided among the young people in residence. In a recent Scottish study, for example, residents agreed with staff that physical restraint would ensure young people’s safety in some circumstances. They advocated the use of non-physical alternatives to de-escalate situations and reserving the use of physical restraint to a last resort.
Some researchers have noted a major reduction in the use of restraints when the behaviour management practices of care staff are examined and modified. Training and ongoing support for workers and carers in applying behavioural techniques has been shown to produce major reductions in the need for physical intervention in several settings accommodating young people. This suggests that regular review of practice is needed to ensure that restraint is only used when all else has failed and where there is a high risk of serious harm.
The inquiry is due to conclude in early 2010 and further information will be available in future newsletters.

Response to Discussion Paper, Attorney- General’s Department – Review of Domestic Violence Laws

Among other statutory functions the Guardian for Children and Young People acts as an advocate for the interests of children under the guardianship, or in the custody, of the Minister for Families and Communities.  We have a major interest in preventing children from requiring statutory protection and protecting children from harm.

This response is prepared on the basis of the Office’s experience in investigating individual matters and talking with experts in the area of children and domestic violence.

You can download a PDF file of the Response to the domestic violence law review.

Office of the Guardian’s Monitoring Framework

The Office of the Guardian’s Monitoring Framework is the basis of our monitoring and intervention.  It is derived from the Charter of Rights and contains 12 statements which encompass our aspirations for children and young people in care.

  1. This child lives in a kind and nurturing environment.
  2. This child is safe and feels safe.
  3. This child is loved.
  4. This child is receiving appropriate shelter, clothing and nourishment.
  5. This child is cared for in a placement that is stable and secure.
  6. This child has a secure personal space to which she/he can withdraw and where personal things are kept safe.
  7. This child has contact with family, friends, and cultural community that provide emotional support and identity.
  8. This child has access to health and disability services that meets his/her needs.
  9. This child is getting an education suited to her/his needs and the opportunity for artistic, cultural and sporting development.
  10. This child understands to the full extent of his/her capacity why he/she is in his/her current circumstances.
  11. This child has knowledge of and participates in decisions that affect him/her.
  12. This child has regular contact with the same case worker who is skilled, knowledgeable, respectful and advocates energetically in the child’s best interests.