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PARTNERSHIP BETWEEN
Prepared by Steven Walker and Carmel Flavell
CONTENTS
Additional benefits as a result of the Partnership Include
Macarthur
District Temporary Family Care and Brief Therapy Solutions Partnerships
Providing Opportunities for Change program increases
the opportunity for families in the Macarthur Region to access family therapy
and behaviour management support within a holistic therapeutic and social framework.
This programme is offered to families who have simply run out of any other option
to access respite services and effectively manage serious behaviours in the
home, school and wider social environment.
Additionally the programme deliberately opens up opportunities for access to
other services including respite and family social opportunities as a result
of individual family’s increased confidence in managing and the consequent reduction
in serious behaviours. Both services working together in partnership increases
the ability to provide services and social supports for families who would otherwise
not have access to such service provision and in all likelihood there would
have been a significantly increased risk of harm to the family and the child.
Either
during intensive intervention by Brief Therapy Solutions or at the completion,
families are offered the ongoing assistance of the parents' support group, Family
Connections. This group has developed as a direct consequence of the involvement
of families in the Intensive In-Home Interventions and is supported by Macarthur
District Temporary Family Care. The aim of this group is to assist continuing
emotional and practical skill development for all family members who have experienced
a significant struggle with serious and dangerous behaviours.
MDTFC operates within the continuum of care provision with additional gains made from the holistic approach provided by Brief Therapy Solutions.
Brief Therapy Solutions and Macarthur District Temporary
Care Inc.
(1) Address the serious impact of challenging behaviour issues on the
family.
(2) Reduce the risk of harm to children.
(3) Support and increase family relationships and functioning.
(4) Increase social opportunities and support for the whole family.
Should
there be current concerns relating to the safety or welfare of a child or young
person, the concerns must be brought to the attention of the Department of Community
Services.
The
Intensive In-Home Intervention starts with two weeks of up to 8 hours in the
family home, followed by an additional 36 hours over an individually negotiated
time frame. These hours can be negotiated if the intensity is too much for any
given family. Usually issues relating to cognitive or developmental challenges
on the part of the primary careers is a factor here. Clients can
expect to work with a fully qualified and experienced accredited member of the
Australian Association of Social Workers. Brief Therapy Solutions
currently services Campbelltown, Southern Highlands and Wollondilly Shire.
Macarthur District
Temporary Family Care Inc:
Macarthur District Temporary Family Care is a non-government community service agency that aims to provide high quality short term substitute care programmes to families in crisis as well as for families with children who have special needs arising out of physical and/or intellectual disabilities.
The aims of the programmes are largely achieved through the high standard of care made possible by the nurturance and security of family life provided by approved licensed volunteer host families, overseen by suitably qualified staff and in consultation with a community based Management Committee. MDTFC services the Camden, Campbelltown and Wollondilly Local Government Areas.
MDTFC operates 17 programmes that assist children and young adults with disabilities to access social opportunities under the banner of respite placements.
Development of the Model:
Research within the Macarthur areas of Campbelltown, Camden, and Wollondilly areas, If Only They Would Listen To Us .Atkinson, Kearney, Knox, Matlock, Parameter, Yazbeck (1995) indicated that parents have identified serious behaviours in children with disabilities as a major concern.
This issue was again raised in the 1999 University of Western Sydney, Macarthur Campus in the 'Building Bridges' Conference for Families in Partnership. The history of concern raised in studies and conferences about the lack of family behaviour management services offered in the Macarthur region was also a point of contention raised by families. In addition, there has been a history of no other alternative but respite as a stopgap measure in providing families with time out from the challenges and frustration associated with ongoing serious behaviours in the home. Often services identify the risk of behavious as being a concern and reason for having to withdraw services or refer on. The respite program offered to all families is often unable to be used due to serious behavioural issues of the child or young person.
Although from a research perspective little evidence is yet available for the effectiveness of any particular intervention approach in managing or providing outcomes for serious behaviours overtime. Published research findings suggest that a combined approach involving the family system, social environment and school do appear more effective over time, particularly noted are Functional and Multi-systemic family therapy approaches. These approaches among other components, address family relationships, problematic communication dynamics within the home and social environment utilizing among other strategies Collaborative Problem Solving approaches (Green, 2001; Greene and Albon, 2004; Greene, Albon and Goring , 2003) and behavioural triggers specific to the family and child. As a result of these studies the In home therapy component of the intervention supports the family and its individual constituents in the social and emotional change while taking into account the significant possibility and impact of the broader social environment. The in home intervention component incorporating school and social environment is particularly useful as evidence suggests that “Training proximally to where such skills are to be performed requires, by necessity, considerably greater involvement from the training and interaction partners(eg. Parents, teachers, classmates) thus supporting generalization of the skills required (Greene et al, 2004).
Evidence also suggests that long term support in the social and family context aids in maintenance of the gains made in the therapeutic process. Research on therapeutic outcomes spanning 40 years clearly identifies the impact of extra-therapeutic factors including resources, events and social opportunities on positive outcomes ( Miller, Hubble and Duncan 1999, 2002). Given this substantial and growing evidence base this partnership has actively facilitated the use of peer support and family social group functions as a active ingredient in the therapy process.
Partnerships Providing Opportunities
for Change
An Overview
The Partnerships Providing Opportunities for Change programme provides an innovative opportunity for families to better manage serious behaviour issues in the home and in the broader social environment.
This partnership works to provide respite for families experiencing serious behaviours thus opening the doors to other resources and possibilities for change and access to the broader social environment.
This partnership integrates tailor made, Intensive In-Home Family Interventions, school support, respite support, as well as community and personal support networks specific to the nature and impact of the challenging serious behaviours. Consistency and creativity in the behaviour management approach is necessary across home, school and other social environments.
Underlying principles
Aims of the Programme:
The Partnerships Providing Opportunities for Change programme aims to provide an innovative opportunity for families to better manage serious behaviour issues in the home and in the broader social environment.
The Referral Criteria Include:
1. Other less intrusive intervention and support avenues have been explored.
2. The family is currently in serious crisis (This can also include child safety and risk concerns).
3. There is an inability for the family to access services as a result of the seriousness of and perceived risk associated with the behaviour.
4. The family has an existing involvement with Macarthur District Temporary Family Care through any of its programmes.
5. There are no age requirements. (Though usually families referred have children ranging from 4 to 15 years.)
There are four integrated components to the Model:
1. The initial referral.
A joint visit is made to the referred family by an accredited social worker from Brief Therapy Solutions and a respite co-ordinator from Macarthur District Temporary Family Care. The options are explained to the family, and if the family requests, the intervention can commence soon after the initial interview.
2. The Intensive In-Home
Intervention.
Intervention commences at the request of the family and is implemented according to the families' needs, current behavioural concerns and risk factors.
Consistent with outcomes research indicating that up to 40% of therapy outcomes can be attributed to Extra-therapeutic events (Miller, Hubble and Duncan 2000). As an active component the intervention encourages the involvement of individual members of the Family Connections Group of which the members have completed an intensive intervention. Individually these Family Connections group members, be they individual parents or whole family’s, support new participant family’s through the experience of the intervention and initiate supported contact with the broader Family Connections Group.
This process runs along side the in home aspects of the intervention when appropriate and agreed to by the participant family. Due to the often initially challenging and dangerous behaviours and the potential for integrity conflict of the therapeutic process this connection is initially under the direction of Brief Therapy Solutions.
4. Family Connections- social support.
In a significant number of occasions family’s involved in an in home intervention have identifies social isolation as a significant concern. Often the fear of the behaviour in public is noted as the reason. Families currently involved in an intervention can nominate at any time with or without the support of a peer or family to make contact with and attend functions of the Family Connections Group.
The Family Connections group has been involved in a weekend family camp in December 2003, ongoing family / peer support and a range of other social activities that have assisted all members to better understand and manage behaviours over time. This group challenges the view that serious behaviours necessarily prevent families from venturing out into the community. Family members have indicated that these activities have further enhanced the individual family goals identified at the commencement of the In Home Intervention and assisted in maintaining social environment and learning opportunities.
This
model has allowed Brief Therapy Solutions and Macarthur District Temporary Care
to develop a cutting edge programme supporting families who have experienced
significant behaviour issues, avert or decrease significant risk of harm to
children and families and increase an appropriate norm social environment encouraging
further social skill development. The result is that family’s that were or may
have become further entrenched in the respite and child protection systems have
alternative opportunities opened.
Quantitative Data
The project currently uses several evaluation tools to assess outcomes and therefore the effectiveness of the partnership.
A range of clinical assessment tools are used pre and post to measure changes and inform practice during the In Home Intervention. In addition, outcome measures and therapeutic process measures are used throughout the intervention. These tools provide numerical data in which improvements and effective practice can be evaluated.
Qualitative Data
Qualitative
measures are included throughout the conection with the Family Connections group
as a measure of change. Peer Support Family Members also provide ongoing feedback
as to their involvement with families. This feedback is reviewed in review meetings
with family members and management on a regular basis.
Quantitative Outcomes
After 12 months of the partnership operating as a pilot program the partnership has produced extremely successful results. The primary aim of the partnership being increased access to services such as respite, and broader access to the social community resources.
Of the families having difficulty accessing or maintaining respite and initially taking part in the trial;
33% of families at conclusion were able to access respite services previously not available as a result of serious behaviours
33% of families who originally sort respite as a break from the serious behaviours no longer considered respite a necessary option after behavioural intervention program completed.
33% of families did not complete the intervention or declined an intensive intervention at initial referral.
Qualitative Outcomes
Parents
have fed back on the impact of this service on their families. Some comments
include;
'My son is more tidy and confident, he now knows he's good with his hands, good at maths and more independent.'
'I feel calmer overall.'
'I have no need to smack the kids anymore.'
'I use more social networks.'
'I can take him anywhere now and it is not a problem.'
Internal Staff Development
The training of staff in behavioural management and family therapy strategies on a case by case basis. This has proven to be invaluable to the staff of Macarthur District Temporary Care in increasing assessment and respite management skills.
Family Opportunities
Completion of this programme has meant that families have been able to go on to develop relationships with other services appropriate to their needs and long term goals. Families have been able to clearly identify the services most appropriate to their needs and in context of the changes that have been made during the In Home Intervention. Several families have identified the need to change respite arrangements that were in place at the commencement of the Intervention so as to better meet their individual needs.
Community Access
The development and piloting of this project over an 18 months period has seen an increase in community awareness of service difficulties in supporting families in managing serious behaviours. The Partnership has seen increasing enquiries regarding the partnership and accessing the services available. A consequence has been that clients of services outside the partnership have been able to access the intervention by negotiating referrals to Macarthur District Temporary Family Care or brokering the service initially through Brief Therapy Solutions. There have been several occasions in which serviced have jointly funded an intervention.
Professional / Community Education
The
Partnerships Providing Opportunities for Change Model was presented at the Intensive
family Services Conference, April 2004.
Presented to Families in Partnership planning day, March 2004
Presented to Royal Prince Alfred Hospital Social Work In-service, July 2004
Macarthur District Temporary Family Care has sponsored a short video supported by some of the parents who have completed the intervention and are now supporting others.
From a qualitative perspective our file reviews indicate that at least two families involved in the Intervention (over the twelve month period- January 2003 February 2004) have ceased any increasing involvement with the NSW Department of Community Services.
In one instance a family identified as being at high risk by the Department due to serious behaviours and sibling risk, concluded the intervention with indications of no further involvement from the Department apart from support with specific activities.
The potential savings as a result of diversion from out of home care and the associated long term emotional effects on children and families are not to be underestimated.