Mental illness and FASD in SA’s young offenders

picture of young person in hoodie

Findings from a recent study by paediatricians and researchers from the Telethon Kids Institute has revealed the high rate of neurodevelopmental impairment in young people in youth detention in Western Australia.

Almost 90 percent of detainees suffered from some sort of impairment and over one third showed severe physical and mental impairment due to excessive alcohol consumption by their mothers during pregnancy.

‘We must be concerned about the risk that similar rates of neurodevelopmental impairment and foetal alcohol syndrome disorder (FASD) exist among young offenders in South Australia’, said Guardian for Children and Young People, Penny Wright.

‘This study highlights the vulnerability of young people, particularly Aboriginal youth, within the justice system and the importance of reliable diagnosis to identify their strengths and difficulties, in order to guide and improve their rehabilitation.

‘Young people with neuro-developmental impairments need early assessment and diagnosis, appropriate interventions and access to support.

‘Knowing if young people are affected by these disorders will enable our community to create more effective diversion programs when they come in contact with the youth justice system and better rehabilitation programs for those who end up in custody.

‘Diagnosing these disorders is a complex process requiring skilled practitioners but the investment would more than pay off in terms of diverting young people away from offending and helping those who do offend return as positive members of the community.

‘A submission made by the National Organisation for Foetal Alcohol Syndrome and Related Disorders to the South Australian Inquiry into the Sale and Consumption of Alcohol in 2013 called for all people entering prison or juvenile detention to be screened for FASD.

‘The submission noted that “Current cognitive behavioural approaches used both in custodial settings and in the community are ineffective for individuals with FASD and it is highly likely that this is a contributing factor in high rates of recidivism.”

‘Understanding the prevalence of FASD in youth detention in South Australia is a crucial step in ensuring effective interventions to promote support and rehabilitation.’
You can download the Guardian’s media release from this link.

What is therapeutic residential care?

21 November 2017

In June 2017, 550 of the 3,484 children and young people in out of home care in South Australia lived in either residential or emergency care rather than home-based care such as foster, relative or kinship care.

We know that residential care should do more than just warehouse vulnerable children and young people, that what they experience there will have a profound effect on their future health, emotional and social adjustment, identity and life prospects. The children and young people who find themselves in residential care have experienced the same or more of the trauma and dislocation in their lives as others coming into care and need the same or more care and nurture to be able to heal.  Commissioner Nyland made the call that all residential care in our state should be ‘therapeutic’.

But what is therapeutic residential care?

This is a question for all child protection jurisdictions across Australia. The Guardian’s Office is leading a national policy development process to articulate what constitutes therapeutic residential care for the Australian Children’s Commissioners and Guardians (ACCG) group.  The statement will identify the essential elements that a service will need to provide to warrant the designation as ‘therapeutic residential care’.

These are some of the themes that emerged during its development.

Children and young people in therapeutic residential care are at the centre of the care model and live in an environment that emphasises their wellbeing and safety.  They are informed about and can influence decisions that affect their lives, are empowered to know and enjoy their rights. They have access to formal and informal mechanisms for resolving concerns, including through access to independent monitoring and grievance mechanisms.

Those from diverse cultural backgrounds have access to culturally appropriate care, in particular those from Aboriginal and Torres Strait Islander and other culturally and linguistically diverse communities.

Children and young people who have disabilities or are experiencing psychosocial issues have an environment that responds to their needs, as do those in regional areas. Wrapped around the children and young people in therapeutic residential care are comprehensive and coordinated services to meet the full range of their needs, including access to appropriate external or mainstream services.

Restabilising a sense of stability is important to traumatised children and young people so when changes of care placement are made, they are done with particular care and sensitivity to the needs and wishes of the one being moved and also the peers who share their space and their lives.  Where it is safe to do so, priority will be given to maintaining links with the child or young person’s family and significant others.

These are all necessary conditions for therapeutic residential care but could equally be what we aspire to in all residential care.

What is unique and critical to therapeutic care is that the residential care house is staffed with appropriately trained people who develop therapeutic relationships that respond to attachment-related and developmental needs.  Staff will be trauma-informed and, in turn, build the capacity of children and young people to form positive relationships with others.  Each child or young person will have an individual therapeutic care plan which is regularly reviewed.  Staff will have the training, supervision and support to understand and respond to the challenging behaviours that sometimes accompany trauma.  Personal relationships are key and staff need to be retained for a long time to provide a secure, stable and consistent base for recovery.

Guardian Penny Wright will present a draft proposal defining therapeutic residential care to the national ACCG meeting in mid-November.  The Australian Human Rights Commission and Commissioners/Guardians from the Northern Territory, Victoria, Tasmania and Western Australia have provided feedback on earlier drafts.

We will provide you with updates as the national conversation continues.

For an introduction to the practice of therapeutic care, see our article Healing Developmental Trauma from February 2015.
This item first appeared in the November 2017 Guardian’s Newsletter which you can download now.

Therapeutic care – everywhere

10 October, 2016

Themes from Nyland  #6

The team from the Guardian’s office have analysed the 850 pages and 260 recommendations from The life they deserve: Child Protection Systems Royal Commission Report[1].  We have extracted some themes and priorities to allow us to critique the government’s response, judge the improvements over time and to shape our own work.  Following is a description of the issues and a short list of things to watch for in the reform process.  The first five in the series are available.[2] We will post the rest over the next few weeks. [3] 

Commissioner Nyland’s description of the need for a therapeutic approach to child protection rests on three understandings.

  1. Most, if not all, children taken into care will be experiencing trauma. It will have been  caused, if not by prior abuse and neglect, by the dislocation of their lives caused by the experience of coming into care.
  2. Treatment of developmental trauma is not rapid and cannot be delivered by professional intervention alone. Therapy requires consistent long-term work, with consideration of the child’s care environments, home and school, specialist therapy and support from others in the child’s life.
  3. Supporting a child affected by trauma, especially one with high and complex needs, requires adults to collaborate closely and share an understanding of what causes behaviours and how to respond appropriately.

In residential care and emergency care, all staff need to be trained in the effects of developmental trauma, how to support a trauma–affected child and how to respond appropriately to challenging behaviour.  Commissioner Nyland recommends a ‘streamed’ model of residential care where the specific needs of each child can be met in an appropriate setting.[4] 

Home-based care, which will continue to provide the bulk of out-of-home-care, presents some particular issues.

Home-based carers are not experts in trauma. They rely on the professionals to support them by identifying and addressing issues which emerge as the child grows. Two principal barriers to therapeutic support for placements were identified: one, that foster parents fail to communicate with support workers about the nature and severity of the problems with which they are grappling; and two, that professionals charged with supporting the placement do not refer the foster parents to appropriate support at an early stage. 

There also remain serious barriers for children requiring specialist therapeutic services.

… the therapeutic needs of many children in care are still being neglected. While there are some examples of very good service from the Agency, not all children with a demonstrated need are receiving assessment and support.

… [therapeutic] services for children in care are scattered across a number of agencies, each of which apply their own criteria for eligibility.

… greater investment in therapeutic services is needed for children entering and living in care. The assessment of their needs, and the processes for referring them to the appropriate service, should be better coordinated. 

As reform progresses we look forward to seeing:

  • The application of a therapeutic framework across all residential care environments giving a theoretical basis for care decisions.
  • Training, ongoing professional development and support for residential care workers in working with children affected by developmental trauma.
  • The initial and ongoing training for all foster carers to include the effects of and suitable responses to developmental trauma and the availability of therapeutic assistance.
  • Improved systems for the timely assessment and provision of therapeutic services to children who need them, especially in rural and remote areas.
  • The provision of therapeutic support to home-based placements that are identified as being at risk of breakdown.
  • The inclusion of Strategies for Managing Abuse Related Trauma (SMART) training in the professional development of all educators who work with children in care. 

Please join the discussion via the reply box leaving a name and an email address in the spaces provided.  We will remove them from the published post if you request in your reply.

1 Unless otherwise noted all quotes are from The life they deserve: Child Protection Systems Royal Commission Report,

2 See also previous ‘Themes from Nyland’ posts on Coordination and Collaboration, The voice of the child , Emergency care, Residential care and Home-based care.

3 This is not intended to be a précis of Commissioner Nyland’s report which provides a very clear and readable summary.  Because of the Guardian’s mandate, this analysis will tend to focus on issues for children in out-of-home-care.

4 Commissioner Nyland also recommended the establishment of secure therapeutic care facilities where young people in care can be detained for a period of time during which they will receive therapy.  Although the Commissioner sets out a number of safeguards and conditions, the Guardian believes that this model will not produce significant long-term benefit for the young people so detained and that the detention of young people who have committed no offence raises important human rights concerns. 

Are mental health services for young people in care getting better?

graphic of six hand-drawn children's facesIn mid-February 2012, the Guardian published a report on The Unmet Need in Mental Health Services for Children and Young People in Care based on a 2011 audit of 60 case files of children and young people in care which is available for download

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The audit uncovered some examples of very good practice but it also showed a pattern of delayed and ad hoc assessment and service provision. Many young people did not receive comprehensive psychological assessments and  the median time between the assessment recommendations and the first service was five months.  The case files demonstrated the need for more active management of mental health problems.  This included prompt referrals following assessment and regular joint child protection and mental health service reviews of progress on recommendations and referrals.

At the same time as the Guardian’s report was being written, Families SA was developing a framework for the provision of therapy services which promised to address waitlists and reduce the time between the identification of mental health concerns and the provision of services.  It proposed to enhance clinical assessment and quickly match the young person to a suitable service provider by means of a triage panel comprising mental health professionals from a range of services.  The proposed framework would also ensure that the young person’s progress would be monitored and the performance of the triage system itself scrutinised.

By September 2012, the Families SA Therapy Framework had reached final draft stage in consultation with the major government and non-government service providers but little has changed for young people in need of mental health services since the publication of the Guardian’s February 2012 report.

‘The triage model has been in use internally by Families SA Psychological Services for about six months now and to date the process has considered a small number of referrals for young people’, said Nicole Stasiak, Director Statewide Services in Families SA, ‘and we have learned some valuable lessons on how triage can work.’

Families SA has also developed a training package to upskill staff in the care and protection system who have not had therapy experience.

‘The Framework has been merged into the Families SA Redesign Program and is now known as the Therapeutic Services Project and the triage panel model remains a major part,’  said Ms Stasiak

‘By September 2013 the triage panel will  include representatives from government and non-government mental health service providers.  It  will be allocating referrals,  monitoring the progress of young people and evaluating and  reporting on the performance of the system and providers.’

Case files examined in the Guardian’s 2011 audit demonstrated inconsistency in the effectiveness of case work, failing to ensure that assessments were done, to follow up on referrals or to integrate the therapeutic services into case planning or work in other areas of the young people’s lives.

We will follow up the issue of mental health services for young people in our Twitter feed.

link to twitter

Young people and the non-hospital based services review

Commissioned in August 2012, the Review of Non-Hospital Based Services led by Warren McCann looked at the performance and outcomes of 235 individual non-hospital based services across South Australia’s metropolitan Local Health Networks. The Guardian’s response to the review of non-hospital based services in January 2013 considers the impact on child and youth primary health care services for young South Australians and implications for child protection in the future.

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link to GCYP twitter

Meeting the mental health needs of young people in care

graphic of six hand-drawn children's facesLast year our Office audited 60 case files from five Families SA offices to determine the unmet need for mental health services for children and young people in care.  A 2010 consultation with mental health professionals had suggested that the mental health needs of young people in care were not always being met. The audit did not examine the quality or outcomes of the intervention, only how needs had been identified and services provided to meet those needs.

The audit showed that the majority of children and young people whose files were viewed had received a service.  There was evidence of flexibility in service provision and, in half the cases, of therapists being prepared to stay with the client over a period of time.

Where needs were not being met it was for three main reasons.

Fifty four of the 60 children and young people had at least one mental health assessment completed but most of the assessments were made to inform court order applications and judicial decisions.  These addressed issues relevant at that stage of entry into care but did not comprehensively address the child’s social and emotional wellbeing or identify psychological conditions needing attention, set therapy goals and highlight risks.

There were long delays between assessment recommendations and the first service appointment, with a median delay of five months.  A small number were not referred at all while about a quarter had to wait for over three months for their worker to make the referral.  Adding to the delay, waiting times for first appointments were sometimes lengthy, with 38 per cent waiting between four and eleven months for a first appointment.

There was limited consideration of the child’s mental health that was documented in case planning (58 per cent made reference to mental health recommendations) or in annual reviews (24 per cent considered mental health recommendations).

The audit also uncovered examples of effective cooperation. Qualitative data collected during the audit showed strong collaboration between case managers and mental health services in approximately one third of cases, although this was not documented in case plans.

While carer participation was frequently not evident and some carers actively blocked therapy, there were examples of carers engaging in therapy and, on occasions, sourcing therapy for children or themselves following agreement with case managers.

Since the Report was published, Families SA has developed a framework for the provision of therapy services to children and young people in care.  It promises to address waitlists and reduce the time between the identification of mental health concerns and service provision, enhance clinical assessment and match the child or young person to an appropriate service provider.  Under the framework new Families SA mechanisms will monitor the provision of therapy to children, advocate for them and cooperate with service providers in case planning.

Read the other findings and recommendations in the summary report on our website.

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The release of the Office’s reports are always notified first on Twitter.

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What’s been done March – May 2012

The Office’s report on a case file audit to assess unmet need for mental health services among children and young people in care was released on 16 February.  Discussion has commenced with agencies affected by the findings.

The report on the wellbeing of children and young people in care for 2010-11 was released on 26 April, following discussion with the Departments about the conclusions. This year the Office reported on safety, placement stability, family contact and participation in decisions.

Following internal reviews of our individual advocacy activity and the visits to young people in residential care some changes have been made.  Changes in individual advocacy will re-emphasise hearing directly from the child or young person.

Relationships Australia (SA) has endorsed the Charter of Rights, taking the total number of endorsing agencies to 47.  The Charter Implementation Committee continues to meet quarterly to share information about issues and challenges in meeting the rights and the Charter Champions now number 124.  Many Charter Champions are now using the special Champions graphic on their email signature to show their support for the Charter and young people’s rights.

In the first quarter of 2012 the Office visited 11 residential sites and audited 31 annual reviews.

picture of cover of assessment toolIf you missed its release in January, there is a new tool on the ISG resources page  to help you assess your ISG (information sharing) procedures for both content and quality. The other good news in this regard was the Commonwealth Privacy Commissioner’s ruling that SA non-government organisations will not be in breach of National Privacy Principles by sharing information where serious harm can be anticipated, provided they follow the ISG.

The Youth Advisors provided advice on parallel planning for young people leaving care and barriers to accessing health services.

Office staff and youth advisors have contributed to community visitor (mental health) training, workplace learning for Families SA staff, development of a carer assessment panel and therapeutic principles for residential care.

Jodie Evans has joined us as an Advocate, replacing Belinda Lorek who is on parental leave.  Jodie brings a wealth of experience in youth justice, here and in the UK, and assisting vulnerable witnesses in prosecutions.

All the latest news from the Office is on our Twitter feed.

link to twitter

The unmet need in mental health services for children and young people in care

In 2011 the Guardian’s Office audited 60 case files from five Families SA offices to understand the extent and nature of unmet need in mental health services for children and young people in care.  The audit did not attempt to examine the quality or outcomes of the intervention.

The audit showed that the majority of children and young people whose files were viewed received a service.  However, many needs were not being met for reasons which included:

  • assessments that did not focus exclusively or primarily on the child’s mental health
  • delays between assessment and provision of the service and
  • little integration of mental health issues and progress into case planning and annual reviews.

Read the findings and recommendations in the Unmet need in mental health services summary on our website.

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link to GCYP twitter

What’s been done – September to November 2010

The Office has joined the consultation on the 2010 update of South Australia’s Strategic Plan to propose this target specific to children in care:

Exceed the Australian average for wellbeing of children and young people in out of home care, as indicated by educational achievement, stability and successful transition to adulthood.

We are also supporting new targets for healthy child development and prevention of abuse and neglect of children.  Team members have attended consultation workshops, participated in online conversations and prepared a submission, Making our state a better parent.

The Charter of Rights was tabled in Parliament on 30 September 2010. Two additional agencies, Cora Barclay Centre and West Coast Youth Services, have endorsed the Charter, taking the total to 45 agencies. A survey of agencies who have endorsed the Charter closed on 11 October. The response rate was very high and a report on the findings will be finalised in November.

A discussion paper on improving the mental health of children under guardianship was released for consultation on 16 September. Work on this will continue in November.

Advocate Belinda Walker spoke at the ICAN and Mentoring Statewide Conference, Youth development: everybody’s business, on 27 August focussing on the importance of children’s rights and involvement in developing Individual Education Plans.

The Guardian’s Office has released A Community Visitor Program for Children in State Care report on the feasibility of introducing such a program in South Australia. The report includes background research on other community visitor programs, the outcomes from a discussion with South Australian experts and consultation with the Guardian’s Youth Advisors.

In the period August to October staff from the Office audited 57 annual reviews and conducted 21 monitoring visits.

A report on the Office’s audit of annual reviews of children and young people in care has been compiled and provided to the Minister following opportunity for comment from Families SA. A Summary of the 2009-10 Audit of Annual Reviews is available in PDF.

With the South Australian Council of Social Service (SACOSS), the Office continued a series of information sessions for the NGO sector about the Information Sharing Guidelines (ISG) and is receiving positive feedback about the booklet A Guide to Writing an ISG Appendix. We have been working with Anglicare and Community Centres SA, formerly CANH, to promote the ISG.

The selection process for committee members for the Youth Advisory Committee (see the article on page 6) was held in August and September and the first meeting was held on 1 October.

The Guardian’s 2009-2010 Annual Report, was tabled in Parliament on
30 September 2010.

The independent Report on the Review of Performance and Effectiveness of the Office that was commissioned in April has been delivered.  As well as the evaluation, the report contains suggestions about needs and priorities gleaned from a wide range of stakeholders which will  be included in forthcoming strategic planning.

The brochure You and your future: choosing the right path to university has been updated and reissued for 2010-11 with the assistance of the three South Australian universities.  Distribution has started with the help of Families SA offices, the Department of Education and Children’s Services, the universities and YACSA.  Copies of the brochure can be ordered from the materials page of our website and can also be viewed  in a PDF version.

The Office responded to the Department for Families and Communities’ consultation on directions in alternative care which closed on 3 September.  The Response to Directions for alternative care is available in PDF on the Guardian’s website.

Rapid Response is five

An across-government policy initiative, Rapid Response was developed to ensure that children and young people under the guardianship of the Minister received the health, education, welfare, housing and disability services to which they were entitled.

An evaluation report released in June 2010 reports that the five-year persistence with Rapid Response has paid off with greatly increased awareness of the circumstances and needs of children and young people under guardianship. Focus group participants reported increased inter-agency collaboration and recognition that agencies adopt different practices to meet their needs.

Matt Kay, Social Worker at the Marion Families SA Office describes how well cooperation can work for young people in care.

When her carers noticed that a client had dental issues that were affecting her health, the young woman was dismissive, saying that health services don’t listen, don’t understand and don’t do what you need.

The nurse I contacted at the public dental clinic was very understanding and promised to be flexible with the appointment timing, to explain carefully what needed to be done and to allow time to do as much work as possible at the one appointment to minimise return visits. The young woman got what she needed and was pleased.

Not all services respond quite this flexibly but we don’t always have to bring up Rapid Response – some services just get it.

The Report notes that prioritising of children and young people under guardianship for services had been most effective where additional resources had been provided, such as special funding to CAMHS. Where the resources were not topped up, they were sometimes in competition with other young people and families with high needs or children at risk. These are the very early interventions that might prevent young people coming into care. Flagging that children and young people were under guardianship did not automatically create the necessary capacity to respond where the level of demand was already high or where clinical assessment was a prerequisite for service.

Elissa-Jane Dix, Supervisor of the Connected Care Team at Port Pirie Families SA Office reports that their office has good relationships with its local agencies.

We can just make a call so it isn’t often necessary to invoke Rapid Response formally. The awareness of guardianship children is already there in most agencies but this may have been an effect of Rapid Response.

Colleague, and Supervisor of the Family Support and Child Safety Team Christy Brown adds,

Many of our local agencies are proactive, like our dental service that actually contacts us to make sure their lists are up to date.

Getting services for children who are placed in Adelaide can be a bit slower but this is probably due to the high demand on services.

The report concludes that Rapid Response has had considerable success and that there is value in continued investment in training, information, resources and the ongoing support of senior management.