closed institutions and their alternatives: what works? presentation eusarf conference 22th...
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Closed institutions and their alternatives: What works?
Presentation Eusarf Conference
22th September, 2005 ,Paris
Situation in Belgium
• Regional Juvenile Courts • Common answer to serious offences = forced
residential treatment• In the Flemish region (population 6 million
people): 3 closed institutions for boys run by the Flemish government (Cap.182) and one run by the federal government (Cap. 25)
Closed Institutions in Flanders
• Population characteristics– Boys from 12 -18 y
– Delinquent behaviour
– And/or serious conduct problems• Aggression
• Oppositional behaviour (acting-out)
• Limited Capacity– cap. 212 for boys
• Boys are isolated from participation in society
Our (open) organisation
• Vzw Sporen: different departments
• Department ‘De Pas’ : – focus on adolescent boys (14 y - max 21 y)
– goal = re-integration
– 3 treatment models available
• residential care
• intensive family preservation
• independent living of youngsters with intensive coaching from the service
History of ‘De Pas’
• Started in 1991 as a training group for boys to become independent of their families.
• Reasons for referrals by judges– assumption: residential care = safer than living in the
own environment
– Residential care used as a sanction
– assumption: independence = a good thing
“ a political problem”• Critical incidents• Public opinion: “youth protection” – “youth sanction”• Appeal of the juvenile court magistrates• European Convention on Children’s Rights• Overcrowded Community Institutions (terminal)• 1st Youth Detention Centre (Everberg)• Catg 1 B: alternative programs• Legally stated continuum from less to more intervening
measures
What did happen?• A little progress in practical skills (cooking, public
transportation, cleaning..)
• Therapists focused on their own relation with the individual boys and tried to teach them how to live without adult caretakers around them
• Massive negative impact of peers: reinforcement of anti-social behaviour in the institution (aggression, drug abuse, vandalism..) This overruled the impact of the therapists.
• Little involvement of family members
• Lots of incidents and poor outcomes
• Very high turnover staff members
Outcome 2000-2002 (%)
Outcome 2000-2002
20
3327
16
4
05
101520253035
Home andfamily
Independant closedinstitution
restrictiveresidential
care
other(neutral)
Outcome 2003 - 06/2004 (%)
Outcome 2003-06/2004
26 26
48
0 00
102030405060
Ho
me
an
dfa
mily
Ind
ep
en
da
nt
livin
g
clo
sed
inst
itutio
n
rest
rict
ive
resi
de
ntia
lca
re
oth
er
(ne
utr
al)
Why did we make a shift ?
• We had to!
• Traditional residential setting aiming for autonomy/independence of the adolescent boys
• Culture of aggression
• Priority to “personal relationship” – “negotiations”
• Attitude towards families: theoretical view/reality
No perspective – “No Future”
• School drop-outs
• Illegal drug abuse
• Verbal and physical aggression
• vandalism
• Antisocial peers
• Staying out overnight
No perspectives - continued
• The “coach” – “educator”
• Fading away of boundaries and limits
• Institutional context
• “Procession of Echternach”
• “Asking Parents”
New goals
• coach adults to reinforce responsible behaviour
• help restoring links with school, work, family..
• be very clear about society rules
• primary goal = reintegration in family
• Progress to be proven by facts
– ex: goes daily to school/negative on drugstest and so on...
• Period of living in residence = period used to re-engage family
• Goals of the adolescents should address concerns of family and/or court
Staff Issues
• Organisation of training and supervision is inspired by family treatment models like
• multi-systemic treatment
• Homebuilders /families first/Fam/Fim
• All workers must develop skills to engage family members and others meaningful persons
• Worker can no longer take over tasks and responsibilities of caregivers
The Gearbox of “De Pas”
• Vector 1: context-oriented
• Vector 2: group-oriented
• Vector 3: individual-oriented
• Vector 4: making sense of school/work
• Vector 5 & 6: drugs and aggression
• Vector 7: attitudes of the social worker
CANO-principles
• Reconnecting the youngster with his context• Positive belief in possibilities• Problem-solving attitude• Strengthening of the youngster’s natural
network• Sharing responsabilities = re-engaging
families• Integrated model
Principles MST (Henggeler, et. al.)
• Understand the Fit Between the Identified Problems and Their Broader Systemic Context• Emphasize the Positive and Use Systemic Strengths as Levers for Change• Promote Responsible Behavior and Decrease Irresponsible Behavior among Family
Members• Interventions should be Present-Focused and Action-Oriented, Targeting Specific and
Well-Defined Problems• Interventions should Target Sequences of Behavior within and between Multiple Systems
that Maintain Identified Problems• Interventions should be Developmentally Appropriate and Fit the Developmental Needs of
the Youth• Interventions should Require Daily or Weekly Effort by Family Members• Intervention Effectiveness is Evaluated Continuously from Multiple Perspectives, with
Providers Assuming Accountability for Overcoming Barriers to Successful Outcomes• Promote Treatment Generalization and Long-Term Maintenance of Therapeutic Change
by Empowering Care Givers to Address Family Members’ Needs across Multiple Systemic Contexts.
Beliefs Homebuilders -Families First
• Safety for children is our highest priority.
• The family is the focus of service.
• Children are better off with their own families whenever safely possible.
• Troubled families can change.
• Families are colleagues of the staff members.
• Families’ beliefs and values must be respected.
• It is the worker’s job to instil hope.
• A crisis is an opportunity for change.
• Inappropriate interventions can do harm.
Recent outcomes (%)
Outcome 07/2004-08/2005
65
10 155 5
010203040506070
Hom
e an
dfa
mily
Inde
pend
ant
livin
g
clos
edin
stitu
tion
rest
rictiv
ere
side
ntia
lca
re
othe
r(n
eutr
al)
Evolution Outcome (%)
20
33
27
16
4
26
26
48
00
65
10
15
55
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Period 1 Period 2 Period 3
other (neutral)
restrictive residentialcare
closed institution
Independant living
Home and family
Consequences for clinical practice
This change = culture shock• new goals for all levels in the organisation
• general agreement to work differently
• different skills needed for all practitioners• changes always imply discomfort
• other requirements, new job descriptions
• old patterns tend to last longer than expected• new image must be made known to judges and
referral agencies
Consequences for the Government Policy
• Policy based on results, not on populism or (manipulated) public opinion
• Recognition for changed needs of youth care organisations
• investment in research (what works) instead of investing money in ‘more of the same’
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