New Pathways Residential Treatment Services

1. New Pathways Residential Treatment Services For Young People who have Sexually Abused Leah Berry- Clinical Manager Cass Herring- Cluster Manager

2. New Pathways Residential Treatment Services • Only OOHC Service Provider in Australia responding to the needs of adolescent males aged 13-17 years who have sexually problematic behaviours AND high & complex needs. • Funded by the NSW Department of Community Services (DoCS) for 6 placements.

3. High & complex needs • Multiple &/or traumatic placement breakdowns • Poor impulse control &/or stress intolerance • Educational difficulties including inability to attend mainstream schools • Attachment difficulties • Poor self image • Self harming behaviours • History of Inappropriate Sexual Behaviours • Verbal & Physical Aggression (that may result in property damage) • Low level criminal behaviours (eg property damage, theft etc) • Intellectual Disabilities (mild-moderate) • Poor communication & social skills

4. New Pathways Residential Treatment Services

5. Therapeutic Milieu • Crisis = Opportunity • Underlying Theoretical Frameworks: • Good Way Model (Ayland & West 2004) • Sanctuary Model (Abramovitz & Bloom 2003) • Circle of Courage (Brendtro, Brokenleg & Bockern 2002) • Positive Peer Culture (Vorrath & Brendtro 1984) • Offence Specific/ Relapse Prevention (Ayland & West 2004; Cahn 2001) • Cognitive Behavioural Therapy • Psycho-educational Treatment

6. Trauma Sensitivity Parallel process “traumatized people are frequently misdiagnosed and mistreated in the …system… Because of their characteristic difficulties with close relationships, they are vulnerable to become re-victimized by caregivers. They may become engaged in ongoing, destructive interactions, in which the…system replicates the behaviour of the abusive family” (Herman 1992)

7. Trauma Sensitive Intervention • Adolescents who sexually abuse almost universally have some form of trauma in their histories ( McMackin et al, 2002). • Neurological Impact – structural and functional differences (Teicher et al, 2002) • Responding to a young person’s needs not reacting to their problems. • Understanding Vicarious Trauma of the staff team.

8. Trauma Histories

9. Four pillars of trauma sensitivity • Safety – physical and emotional, sanctuary, consistency, predictability, honesty, transparency, reliability, availability, continuity • Emotion management – tools to assist with reflection, awareness, labelling of emotion, negotiation - to promote a more rational/cognitive style of problem solving • Loss – empathy and support around the ‘pain’ of multiple losses (family, home, friends, community etc) • Future – generation of hope, belief, competence

10. The Sanctuary • SAFETY is the fundamental motivational drive • Bowlby – safety is the function of attachment behaviours • Maslow – safety is the most fundamental of human needs • Erickson – trust based on safety and comfort is the first psychosocial stage of development

11. Therapeutic Milieu & Anglin (2002) • Treatment Milieu- 24 hour roster; primary focus on “life space” intervention not just individual counselling. • Specialist Youth Workers are vital to process significant issues & behaviours whilst still relevant to the young person. • CSOCAS & ANZATSA accredited staff. • ALL staff are trained in ALL training models to ensure staff consistency and safety and security for the young people. • TCI, RAP, LSCI, Trauma Sensitive YW, Sex Offence Specific, Adolescent Mental Health, Good Way training, “in House” Induction

12. Translating the Therapeutic Milieu into OOHC • Demanding Greatness (not expecting perfection & not expecting obedience) • No Punishment (Natural & Logical Consequences) • Reversal of Responsibility: Young people are not responsible for creating their problems but they are responsible for how they respond to them!

13. Case Study - Craig

14. Craig (Part One) • Under the Care of the Minister until 18 • Previous Diagnoses: • Severe Oppositional Defiant Disorder • Severe Conduct Disorder • Borderline Intellectual Disorder • Language Delay/ Disability • Previous Exposure to: • Parental Neglect & Alleged Physical Abuse • Drug & Alcohol Issues • Alleged Sexual Abuse (from numerous male adults)

15. Craig’s Sexualised Behaviours • Entry into New Pathways due to: • Alleged Sibling sexual abuse • Active involvement in a Paedophile ring • Recruiting a young person for Paedophiles • Public Masturbation • Approaching young children and asking them for sex • Frottage • Alleged sexual acts with animals

16. Craig’s Presenting Behaviours • Threats of violence towards staff and other residents • Threats of sexual harm towards staff & their family members • Inappropriate touching • Extreme sexualised language and gestures • Repeated attempts to shock and scare staff • Self-harming • Intimidation; Physical aggression & abuse • Manipulation • High impulsivity

17. The Good Way Model • Originally developed for the Well Stop Program in New Zealand, by Ayland & West (2006). • Based on Narrative therapy, positive psychology, trauma theory and special education - helping our young people externalise their behaviours • The Islands of progress • The Gang of Three and Wise Men • Incorporating relapse prevention planning

18. The Gang of 3

19. Circle of Courage(Brendtro, Brockenleg & Bockern 2002)

20. Circle of Courage(Brendtro, Brockenleg & Bockern 2002) • When growth needs are met; Youth have positive outcomes. • When growth needs are frustrated; Youth show problems.

21. Breaks in Craig’s Circle of Courage • Belonging: Craig believes that only his Mum loves him; and that he is not sure where he fits in with his family. • Minimising his involvement with paedophiles and minimising what they did to him. • Mastery: Came to New Pathways with a long list of things that he couldn’t do! (eg unable to make friends, can’t live with other people, won’t be able to learn to read or write etc)

22. Breaks in Craig’s circle of Courage • Independence: Craig struggles with recognising that he is capable of making his own decisions. Craig entered New Pathways convinced he only had deficits to his personaility. • Generosity: Inappropriate social skills; wanting to be liked and make friends however unsure how to do this (often resorting to bribes or grooming behaviours).

23. Responding to Craig: Therapeutic Milieu • Highly structured environment (including a daily treatment schedule mapping out all activities and timeframes throughout day) • Consistent “SAFE” messages from all staff to all sexualised & aggressive behaviours (eg “You’re safe here mate, we’re not going to hurt you, you don’t have to act/ speak that way anymore because you’re safe”) • Strength-based responses - constantly reframing to positives

24. Impacts of Therapeutic Milieu • Within two months of entering New Pathways : • A significant decline in sexualised language and behaviours was observed. • Within three months: • When escalated Craig was able to refrain from using sexualised language. • Craig was demonstrating an ability to plan rather than react impulsively • Made a commitment to want to change his sexually abusive behaviours!

25. Questions? Contact details: Leah Berry: leahb@youthoffthestreets.com.au Cass Herring: cassh@youthoffthestreets.com.au