‘The Power of We’

Noel MacnamaraManager Therapeutic Care

Australian Childhood Foundation

Australian Childhood Foundation (ACF)

Independent children’s charity committed to prevention of child abuse & neglect

Provides range of specialised counselling programs to abused children, young people and families

Undertakes advocacy for abused children, research & education in child abuse, and prevention programs

Provides training nationally

Therapeutic Care Programs

TrACK (Treatment And Care for Kids) – Melbourne with Anglicare Victoria Eastern Region and the DHS

TrACK Adolescent– Melbourne with Anglicare Victoria, Youth For Christ and the DHS

On-TrACK – Canberra with Barnardos and the DHCS

Circle Program - Victoria with Anglicare Victoria Eastern Region, Oz Child Southern Region, Anglicare Victoria and WestCare (Salvation Army) and in Gippsland Anglicare and Uniting Care Kilmany and the DHS

Fresh Start – South Australia with Anglicare SA and Families SA.

Residential Therapeutic Care pilot- Melbourne with Anglicare Victoria and DHS

Residential Therapeutic Care –Tasmania with Salvation Army and DHHS

Therapeutic Family Group Homes – Perth with Uniting Care West and WA Government

Over 180 children and young people 5 States/ Territories and 14 partnerships

Trauma, Children and the Systems that Serve them…

The Good News• There are many different systems that can help children

when traumatic events occur.

The Bad News • Unless these different systems work together in a

coordinated fashion, they maybe useless or-worse still- get in each other’s way.

Collaboration

• Therapeutic models of care require a multi-systemic, consistent and holistic approach across the range of environments in which the child or young person lives. Interventions are most successful when carers, support networks and professionals enact collaborative and intersecting functions that can achieve protective, reparative and restorative objectives for children.

(Tucci and Mitchell, 2009)

Partnerships

• Partnership approaches recognise complex and interlinked nature of issues for children and families and are better able to address complexity through interlinked interventions.

(Winkworth and McArthur, 2007).

A Changing Landscape

• The landscape of working with children and young people who live within the Out of Home Care System is changing. Governments, organisations and services that have traditionally been separate (health, education, mental health, foster care and residential care etc) are moving towards greater cooperation and integration in recognition of the view that this is a far more effective way of meeting the diverse and complex needs of these highly vulnerable children.

A Changing Landscape

• Growing awareness of overlapping professional, organisational mandates and client needs, due to insular, singular and fragmented service approaches has also resulted in a shift towards more holistic and contextualised understandings of problems and service provision (Gardiner, 2000)

• It has become increasingly apparent that collaboration is essential to address the multi-faceted nature of the complexity of problems children in the OoHC system face and to make services more relevant, effective and integrated.

A Changing Paradigm

FROM OLD PARADIGM

• HOARDED• SILO• RISK AVERSE• BOUNDARY

MARKING• MY TURF,

YOUR TURF

TO NEW PARADIGM

• CO-PRODUCTION• INTEGRATED• RISK TOLERANT• BOUNDARY

RIDING• OUR TURF

Collaboration

“Collaboration is not rocket science – it is harder!”A Friend

Key Factors for Effective Partnership Working:

• Commitment• Clear Leadership• A Clear Focus with Common Aims• Accountability to Each Other (Trust)• Accountability to Better Outcomes for Children• The Importance of Regular Meetings at Strategic Levels in the

Partnership• Communication• A Clear Understanding How Each Partner Works• Stewardship

Partnerships…

• can allow for diverse thinking and values to lead to better outcomes• provide opportunity to share a workload and resources• partnerships build capacity of their members• can create the environment for taking risks in developing new

service models• create the motivation for people to pull together, which• in turn drives and sustains the partnership

Multidisciplinary Working

• Multisystem collaboration is critical to improving traumatised children's well-being. However, collaboration is difficult to achieve. There are many barriers to true interdisciplinary work. These challenges may be surmounted as individuals recognise the benefits of creating collaborative relationships.

Partnerships are…

• A means not an end not an end in itself

• Developmental

• Inclusive and supports shared power

• Diverse

• Sharing resources, risks and rewards

• A lot of Planning and Hard Work

Good Collaborative Practice Includes:

• Respecting individual expertise and celebrating professional diversity, for example recognise and value difference; build a definition of expertise that values diversity

• Stressing interpersonal flexibility and value of personal relationships within the team

• Actively engaging diverse perspectives independent of their status in the team

• Reflecting collaboratively on problems prior to prescribing solutions • Working towards mutuality of terminology in the team and service

delivery activities.

Some Tricky Issues

Differences in…

• Legislation and Legal Systems• Policies and Guidelines• Histories and Philosophical Origins• Organisational Culture

Barriers

• The reasons for establishing the partnership must be clearly articulated, understood and accepted by members.

• Realistic expectations and an accurate appreciation of capacities, including authorities, skills and resources of the other partner’s environment is also crucial.

• Trusting the other. Considerable work may be required to overcome some initial suspicions about the partnership and its purpose.

Barriers

• Personal Professional power/ perspectives, beliefs and behaviourProfessionals working in different disciplines and/or working in different agencies may operate with different knowledge bases, discourses and frameworks, poses unequal status and be afforded differing levels of professional autonomy. These factors may led to different conceptions of trauma, abuse and neglect.

• Systemic Time, resources, staff changes, policies and procedures -e.g., confidentiality and information sharing. Organisational structures and working practises.

• Environmental Competing mandates, organisational parameters and prioritiesThe same pressures as those on the wider public: children’s rights ignored; denial of abuse; reluctance to intervene.

Collaboration can produce amazing results…

The Treatment And Care for Kids Program

• Previous multiple placements

• Attachment issues

• Problematic sexual behaviours

• Running away

• Damage to property

• Defiant behaviours

• Low self esteem

• Tantrums/outbursts of anger

• Poor social skills

• School refusal

• Behavioural problems at school

• Aggression

• Disturbed or antisocial behaviour patterns

Summary of Outcomes for Children in TrACK

An evaluation has found that for all children in the TrACK Program there was positive change reported in a number of areas:

• A clear sense of connectedness and belonging with their foster families.

• Continuous and stable placements for a group of children who had histories of multiple placement changes and instability.

• All children attending school regularly.• Significant changes reported in the children’s mental health as

evidenced by the marked improvement in the mental health circumstances of children who had ceased taking medication for significant health and mental health issues.

• Significant decreases in violent or problematic sexual behaviour have been achieved in children for whom these were issues.

Circle Program: Lilly’s Story

• Lilly was nine months old when she was removed from her mother. However, Lilly’s trauma started during her mother’s pregnancy due to substance abuse issues and exposure to domestic violence. Lilly was designated as a High Risk Infant within the Victorian Child Protection system.

• Lilly’s mother Danielle was living with her parents. She has a mild intellectual disability and her parents have their own issues. Lilly’s grandmother has regular psychiatric admissions and her grandfather is an angry and volatile man. He was abandoned himself as a child and left in an orphanage.

• At nine months old, Lilly could not roll over or sit up unassisted. She could not communicate and would not connect emotionally with those around her. She had been left to go without food for up to 13 hours and had lost the ability to show when she was hungry. She was basically left without stimulation, care or nurture most days.

Circle Program: Lilly’s Story

• By the time Lilly came into our care (Circle Program) she was 18 months old and had already experienced two out-of-home care placements. She still could not crawl, walk, speak or eat solid food. She had significant difficulties sleeping.

• Lilly was being taken twice a week to access with her grandfather. She was being medicated to enable this to occur.

Circle Program: Lilly’s Story

• The Circle partnership of ACF, DHS and the Foster Care Agency collaborated together to produce a placement that would meet Lilly’s significant needs, a court review of the access arrangements and Best Interest Plan review of the case direction and a trauma needs assessment.

• Lilly has caught-up developmentally. She now walks, talks, laughs and plays. She is taking solid food and her sleeping patterns are stable. Her access has been made safe and does not involve any medication. These changes would not have been possible with all members of the partnership working together.

Final Comment…

• Partnership isn't an easy destination to reach.

But while the journey might be, at times, arduous, the

payoff for the children and families we work with once

you arrive can be well worth the effort.