Residential care is where the young person is in ‘a residential building whose purpose is to provide placements for children and where there are paid staff’ (AIHW).

You can read our Report on residential care for young people in care in 2011-12 in PDF.

Be notified about our reports as they are released via our Twitter feed.

The Year in Review 2010-11

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Spike is cared for by a young man we’ll know as Daniel and they live at the Queenstown residential care unit. Though Spike is now settled and comfortable in his temperature-controlled aquarium, it was not always so.

Spike moved in with Daniel at his previous placement only after Daniel wrote a letter to the manager, successfully requesting a variation to the no-pet policy.

When Daniel moved to Queenstown it was without Spike, who had become lost. Several months later, Spike was found comfortably settled under a lounge suite and he and Daniel were reunited, much to the joy of Daniel — and the relief of staff at his previous placement.

‘The staff here value the skills and personal growth that pet ownership can bring for some of our residents and the way the presence of pets contributes to a more home-like environment,’ explains Sue Wilson, Supervisor at Queenstown.

‘Daniel is very passionate and knowledgeable about his pets and a keen member of a herpetology club where he entered a raffle – and won a snake!

‘We tried keeping the snake but it escaped and, understandably, some staff were quite concerned so we had a problem.’

Fortunately Mark, one of the Queenstown staff, fostered the snake and replaced him with another stumpy which Daniel named Roadkill.

‘Daniel and the snake still have access visits,’ explains Sue.

Spike has pioneered the way for a small menagerie of animals that now call Queenstown home.

‘After 12 months we have, as well as Spike and Roadkill, two turtles, two budgies and some goldfish,’ says Sue.

As a footnote, is seems that telling the gender of a lizard is not easy. The experts at the herpetology club have determined that Spike should have been named Spikette so the delighted Daniel now has what he hopes will be a breeding pair.

Watch this space…

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You can now read the Office of the Guardian’s Response to Directions for alternative care in PDF on the website.

As trained art therapist Ellen Sallows explains, ‘It is the process of producing art that is the key to art therapy, rather than the product.

‘Each piece of art is a developmental journey that parallels the journeys our young people are taking in their lives.

‘To start, to anticipate and plan progress, to control yourself and the medium, to encounter difficulties and deal with them appropriately and to persevere until something is completed – these are developmental experiences that many of our young people, with their turbulent pasts, may not have had the chance to practice.’

Ellen explains how each aspect of an art therapy program can be tailored to the developmental stage of young people, how photography can be a way to experience the world through the security of a viewfinder, how puppetry can be a safe vehicle for role play and how drawing can be a journey starting with representing inanimate objects, then animals and finally to re-engaging with people.

Along with the input from the X-Streams case workers, the support workers and carers, in the houses and the psychologist, feedback from art therapy provides a fuller understanding of a young person’s current progress and issues at the weekly team meetings.

‘We have had some of our young people for nearly two years now,’ says Ellen.

‘When they first came to art therapy, many were in pure survival mode, completely reactive, isolated, frantic and destructive. The same young people today are much more comfortable within themselves with the confidence to plan and undertake art projects, the resilience to meet the inevitable setbacks and the perseverance to see them through.’

And though the changes in the young people and their behaviour is the real product of art therapy and the other care and supports that are provided at X-Streams, it is hard to look past the remarkable quality of work on display and documented in the recently published book, Keys.

‘Certainly, the recognition and praise the artists have had from their peers and from the community has benefited their self-esteem,’ says Ellen.

X-Streams is a residential care program proved by Baptist Care (SA) for young people 14-17 years.

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.

This new fact sheet talks about the purpose of the visits and how they are usually conducted.  It is hoped that it will help residential care workers to most effectively integrate the visits into the house routine, to understand what the advocates will be doing and to prepare young people for the visit.

Download and read the  Monitoring visits to residential care fact sheet, also available in a graphic free version for reproduction on black and white printers.

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.

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.

[sidebar - 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.

Published in The Advertiser 13 January 2010