Safety in residential care

graphic of residential care

When we take children[1] into the care of the state, a prime responsibility is their safety.

We have matched comments about safety given to the Office of the Guardian by children during our monitoring visits and advocacy with those from the December 2016 Royal Commission paper Safe and Sound.  There were overwhelming similarities.  In this article we blend the two sources to consider the questions ‘do children feel safe’, ‘when do they feel safe’ and ‘what would they suggest to make things safer?’

How safe do children feel in residential care?

Residents often feel unsafe in residential care. Bullying and harassment are common. Adolescents report that they are frequently worried by the threat of sexual harassment and assault. Older residents say that the impact of witnessing violence, self-harm and the abuse of fellow-residents, leaves them stressed and feeling unsafe.

Children generally think it is unlikely that they would be abused or harmed by a worker, although a small number report that they have encountered or heard about abusive staff. Some are concerned by the behaviours of ‘creepy adults’ and those who try to create inappropriate and overly-familiar relationships with them. Children assess how safe workers are based on their past experiences of abuse, by watching the adults’ behaviours and by how other residents act around them.

Many children describe residential care as feeling unsafe due to its instability and frequent changes of staff. Some relate times when they were moved to less safe residential care placements for no reason than that other young people could take their rooms.

A few adolescents report that adults outside of residential care take advantage of children in care, exploiting their need for a sense of belonging, accommodation and money. A few report that some children in residential care engage in prostitution.

When do children in residential care feel safe?

Children feel safe in a placement that is home-like and where young people feel welcome.  They like it where things feel ‘normal’ and where adults look out for them.

They want to see that organisations and workers take a resident’s safety seriously, that they are interested and take measures to protect them.

They feel safe when there are cordial relationships with their fellow-residents and workers, and that there are other supportive relationships, such as with a social worker or teacher, with people outside of the unit.

Really building relationships with kids works, because then they feel safer to come to you with pretty much any problem.  They’re not going to come to you with problems, even if it’s something as simple as being bullied, they’re not going to come talk to you if they think you don’t like them or don’t listen.

Safe and Sound, p 66

Stability and predictability are important.  Children need to know what is going to happen, and that any difficulties with fellow-residents can be resolved.  Routines, reasonable rules and an opportunity to have a say in decisions give them confidence and sense of control.

They believe that when they are safe, children and young people feel relaxed and calm and are less likely to be aggressive and to harm each other.

Younger residents tend to value security measures such as locks on doors, surveillance equipment and alarms.  In contrast, for older residents, these measures reinforce their sense that residential care is not home-like and is unsafe.

How could we make things safer?

Placements

Find more suitable care arrangements, particularly for those who are younger and more vulnerable and make better placement decisions that allow residents to have a say in how they are matched with other residents. Treat residential care as a long-term arrangement and make sure that changes are kept to a minimum.

Staffing

Train staff about the things that can harm children and their vulnerabilities, particularly their inexperience about sexual relationships and exploitation.  Have sufficient numbers of properly trained staff so that they have the time to develop relationships, are around and have the time to watch out for threats.

Cooperation

Train staff to take on parent-like responsibilities for protecting residents from harm.  Get staff to discuss with residents the risks and how to keep themselves safe. Get staff and residents to work together to identify safety risks and develop ways of dealing with them. Staff need to take the initiative in enquiring after residents’ safety because it is easier for staff to ask residents if they are being harmed rather than waiting for them to report it. Try to create an atmosphere where there are positive relationships between residents where young people can look out for each other.

Hearing the resident’s voice

Staff need to be prepared to listen when residents raise concerns and to be understanding and patient, even when the issues do not seem important at first.  Residents need to be informed that it is OK to raise an issue, what sorts of issues to raise and how to do it.  Make sure that it is safe to do so and that they will not suffer retribution.

A lot of the time it can feel like nothing happens [when an issues is raised] or it gets lost or stuck in the system… No matter what, [issues] should be followed up by someone and the young person should be kept in the loop with regular communication.

Young person in residential care

The Child and Young Person’s Visitor Scheme that is hosted in the Office of the Guardian is now well under way and we look forwards to presenting more of the views of children and the state of the system in future articles.

[1] We use the term ‘children’ to include children and young people up to the age of 18 years. We use terms such as ‘adolescent’ and ‘pre-teen’ to refer to specific age ranges within that group.

Some favourite artwork from young people in care

We would like to share with you some of our favorite artworks from young Aboriginal people in residential care that have come to our notice in the past year.  Please click on the thumbnails to see a bigger version.

Security and stability of placement dominates requests for advocacy

picture of suitcase

The Guardian’s Office received a record 96 in-mandate[1] requests for advocacy in the first quarter of the new year, representing 127 children and young people.

This was an increase of 35 per cent in inquiries and a 24 percent increase in the number of children represented compared to the preceding quarter.

Last year the Office averaged 64 in-mandate requests per quarter.  This follows the trend of an increase in the number of requests for advocacy and in the complexity of the issues raised.

The top five people who initiated in-mandate requests in July-September 2018 were:

Adults in the child’s life                                  42

Children and young people themselves      33

Department for Child Protection staff          10

Health, education and youth justice              5

Non-government organisations                     3

The top five presenting issues (by inquiry)[2] were:

Stability and security of placement              29

Safety                                                                21

Participation in decision making                   18

Contact with significant others                      15

Appropriate care                                               24

These are also the top five issues identified in the Guardian’s 2017-18 Annual Report and substantially the same as those reported in previous years.

The 33 children and young people who requested advocacy directly were in the following care arrangements:

Residential care                                             16

Adelaide Youth Training Centre                     5

Relative care                                                    4

Foster care                                                       2

Commercial (emergency) care                       2

Unknown                                                          4

 

[1] The Guardian is mandated by legislation to promote the interests of children and young people below the age of 18 years who are living in out-of-home care.  Another 17 inquiries were determined to be not within the Guardian’s mandate and those callers were assisted to make contact with a more appropriate organisation.

[2] Young people often present with multiple, interrelated issues.  Presenting issues are counted as primary and secondary and these are added to achieve the numbers reported.

Community visitor programs – what we can learn from Oakden

[Oakden residents] lacked any voice themselves. They were entirely dependent upon others for their care and their safety”. – Commissioner Lander, p190 1

There are many lessons to be learned from the report by Commissioner Bruce Lander QC on the events at the Oakden nursing home, many of which can be applied to other facilities in our state.

Residents of the Oakden facility should have been protected from abuse and mistreatment by layers of overlapping protections which were the the domains of many different people at different levels of government, administration and service provision.

They, their families and the community, would have expected government and senior departmental officers to provide adequate resourcing and oversight and to have policies and procedures in place to ensure suitable levels of care, management and supervision. The training and professional standards of the staff working there should have provided another level of protection. Effective complaints procedures for residents and concerned others should have provided additional safeguards as should have accreditation inspections by external bodies.

Finally, the residents of Oakden relied on community visitors to bring an independent and critical eye to the conditions they experienced.

Commissioner Lander set out in forensic detail how each of these layers of protection failed and his report sounds a warning for any organisation that provides care for vulnerable people in a closed or secure environment.  Regarding the operation of the relevant community visitor scheme (CVS) –

…consideration needs to be given as to whether the CVS in its current form is an appropriate safeguard for those suffering mental illness who are housed or treated in treatment centres, limited treatment centres, or authorised community mental health facilities. [p307]

Commissioner Lander’s critique of aspects of community visiting at Oakden raised questions for all such schemes, not just those visiting mental health services. The Guardian’s Office is currently in the process of establishing two separate community visitor schemes, so the issues he described are instructive as we attempt to craft models for the protection and wellbeing of young people in residential care and in youth detention. These are some of the issues.

Should schemes use volunteers or paid visitors?

Volunteers are assumed to bring into the institution expectations and standards reflecting those of the broader community. Because volunteers are not paid, that could potentially mean larger numbers of visitors within a given budget allowing more frequent visits.  But is it reasonable to expect volunteers to accept the rigorous selection process, training and complex tasks required of a visitor? Commissioner Lander noted that some visitors to Oakden may not have had the necessary skills and support to identify problems, report them and intervene on behalf of residents. He favours a model in which visitors are paid, comprehensively trained, and operate within a rigorous model that has sound documentation and effective accountability mechanisms…


This is the first part of a longer paper which goes on to consider the use of volunteers as visitors, the concept of visiting versus inspection, unannounced visits, visitor independence and the place and value of visitor programs. For the full version, download Community visitor programs – what we can learn from Oakden.

1 Oakden: A shameful chapter in South Australia’s history.

SA spends more on child protection and gets less – 2016-17 ROGS

diagram showing child protection services

The Productivity Commission’s 2016-17 Report on Government Services (ROGS) helps understanding of how the South Australian Government’s expenditure on child protection has changed and how it compares with other states.

Child protection services expenditure in SA per child* has increased significantly from $749 to $1,396 in the period 2013-14 to 2016-17 but the real interest is how this translates into the different services that comprise child protection:

  • in protective intervention services we spend $90 per child, which is just 41 percent of the national average
  • in family support services we spend $131 per child, 49 percent more than the national average – an increase of over 300 percent in the the period 2013-14 to 2016-17
  • in intensive family support services we spend $83 per child, roughly on par with the national average
  • in out-of-home care (foster, kinship and residential care), we spend $1,092 per child which is 91 percent more than the national average.

Out-of-home care consumed 78 percent of the SA child protection budget in 2016-17.

Why does SA spend 79 percent more than the national average on out-of-home care?

One of the reasons is that SA relies much more on relatively expensive residential care (properties staffed with paid workers) rather than home-based care (foster and kinship care). In 2016-17 in South Australia it cost, on average, $670,142 per child in residential care compared to $48,005 per child in home-based care.  Another reason is that SA has relied more than other states on so-called ’emergency’ care which makes use of private agency staff to provide care in rented accommodation – more costly but far less suitable to the needs of children.

*refers to a resident child 0-17 in the SA population as a whole.

There is much more detail in our paper South Australian child protection expenditure from the Report on Government Services 2018, available for download now.

 

Young people speak about protecting their rights in residential care

Following up from Commissioner Nyland’s recommendation #136 in her August 2016 report on child protection systems in South Australia, the Guardian asked CREATE to ask some young people in residential care what they knew about their rights and how they thought that they could be best protected.

Here are some of the things they said.


You can download the above in text form 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.

Statistics about children in care – June 2017

30 October 2017

The number of children and young people in the care and guardianship of the Minister in South Australia at 30 June 2017 was 3,296.[1]  up from 1,791 at 30 June 2007.

chart showing numbers of young people on orders

Most were in the 10-14 years age range and the distribution is shown in this graph.

chart showing age rangesRates of growth of those coming into care

The rate of growth in the numbers of children and young people in care each year is very variable, reflecting changes in the policy and practice of the child protection system and well as changes in society and the economy.

chart showing growth rates for young people on ordersAboriginal and Torres Strait Islander young people

The proportion of Aboriginal and Torres Strait Islander children and young people was 34.3 per cent at 30 June 2017, the highest number yet in a steady upward trend. This may reflect a number of factors including a greater willingness of Indigenous young people to identify as such, changes in child protection practice and increasing difficulties being faced by Indigenous families.

chart showing the rate of ATSI young peopleNumbers of young people in residential care

The proportion of children and young people accommodated in residential care is on the rise, reaching 11 per cent at 30 June 2017.2  Residential care is not the model favoured by most young people or recommended by authorities.   It has expanded because of the inability to source foster and kinship care placements to meet the growth in numbers entering care.

chart showing the proprtion of children in residential careThere were 107 residential care houses at 30 June 2017.3 Most houses are of a small scale accommodating three young people but five of the properties were large scale units, designed to accommodate between eight and twelve children and young people.

chart showing number of residential care propertiesFor information on the numbers of children and young people in emergency care, please see our recent post Addressing the emergency in emergency care.

1 Children and young people in the care and custody of the Minister, for whom the Guardian has a specific mandate, are a similar but not identical cohort to children in out-of-home care.

2 This does not include children and young people in emergency accommodation or the small number in houses with less than three residents.

3 These numbers provided by the DCP Licensing Unit do not include a small number of additional placements with less than three residents, including which brings the total to 132 for 30 June 2017.

A place to call home for children in state care – residential care

house and heart graaphic7 February, 2017

One of the greatest issues facing us when we remove children from their birth families is finding safe, stable and nurturing homes in which they can live.

In the second part of this three-part article we look at the problems in residential care identified in Commissioner Nyland’s October 2016 report and the Government’s response in December.

The first part of the series, on home-based care appeared on the Guardian’s website on 24 January, 2017.

 

Residential care historically fulfilled two functions.  It was the placement of choice for young people where home-based care was assessed as not being suitable and a time of assessment or a temporary  alternative for the few children who could not be found a home-based placement. The growth in the number of children in state care and the dearth of home-based care placements in recent years has meant that it has become a staple of the system, currently accommodation over 10 per cent of the children in state care.

In her report Commissioner Nyland described a system in which many children were unhappy in unsuitable environments in which children as young as nine years were housed.  Some children lived in fear and were allegedly subject to abuse from other children and workers.  She recommended an extensive program of reform which emphasised improved recruitment, training and supervision of staff, clearly articulated and enforced standards of care and a strengthening of the voice of the young residents.  Most of her recommendations have been accepted by the Government.  These are the major changes.

  • There will be more stringent recruiting of residential care workers including psychological testing (R138) and strict probation and review requirements will be introduced (R139).  The Government has also accepted in principle the recommendation that supervisory staff in residential care should be better trained and qualified (R147).
  • It will be required that residential care youth workers will be properly supervised and, where necessary, performance managed (R148).
  • There will be ongoing training for residential care workers with an emphasis on the risks and dynamics of abuse in institutions (R140).
  • Single person shifts will not cease but the Government has accepted in principle that the use of commercial carers in residential care should cease (R150).
  • Outsourcing of residential and emergency care will continue and expand as residential care is expanded, contrary to Commissioner Nyland’s recommendation although the Government has promised increased scrutiny on the quality of outsourced care (R151).
  • Improved processes and pathways for residential care staff to observe and report concerns about the behaviour of staff with respect to children will be introduced (R142).  A tracking system will bring together and respond to information collected about suspicious staff behaviour from various sources (R143).
  • Residential care will be streamed to better meet the needs of different young people with provision for short-term assessment placements and therapeutic placements for children with high needs and will incorporate measures by which the system’s performance can be evaluated (R146).
  • Residential care houses will be developed where there is need in regional areas (R217).
  • The Government has accepted in principle that no child under 10 will be housed in residential care (except as part of a sibling group) and that no house will accommodate more than four children but will only commit to considering the closure of large units (R149).
  • The Government has accepted the idea of a whole-of-sector model of therapeutic care to be rolled out across child protection, including residential care (R146).
  • There will be proper recording and tracking of physical restraint used against children in residential care (R133) and (R141).
  • A community visitors scheme in residential care and emergency care houses will be introduced (R137).
  • Children in residential care will be supported with an education program to understand their rights (R136) and have a direct line of complaint to the Chief Executive of the Department for child Protection (R134) and a quarterly report on those complaints will be provided to the Guardian for Children and Young People (R135).

The full paper A place to call home for children in state care is available for download.