Responding to a young person's complex needs
What's Important To Us
Some of the young people we work with may present with complex needs which require more intensive and specialised support than we alone can provide. It is important that we know when and how to access this support, and that we work hard to maintain good working relationships with the agencies providing this support to bring about the best possible outcomes for the young person and their family.
Complex needs in young people may encompass one or more of the following, including substance abuse, mental illness, criminal behaviour, harmful sexualised behaviour, physical or intellectual disability, and behavioural problems. The level of complexity will vary depending on the young person, their support system (and its capabilities), and the identified need or needs. As practitioners, working with some of our country's most vulnerable and at risk young people, we need to be particularly of the following complex needs:
Substance abuse
The teenage years are often associated with drug use, usually alcohol and marijuana. Multiple substance misuse tends to be common, with two-thirds of New Zealand adolescents with marijuana dependence also having a dependence on alcohol (Fraser & Tilyard, 2010). Research completed with secondary school students in 2007 found that 72 per cent of students had used alcohol, and the majority (61 per cent) were currently drinking alcohol. Of those students currently drinking alcohol, 30 per cent reported drinking weekly or more often, and 34 per cent said they had engaged in binge drinking (5 or more drinks within 4 hours) in the previous four weeks (Fortune, Watson, Robinson, Fleming & Denny, 2010).
Substance abuse can result in immediate and long-term health and social problems (including mental illness) and can affect intellectual development and educational achievement. Certain factors like a lack of connection with their whānau, school and community also put young people at risk of substance abuse (Stone & Matthews, 2009). Genetics also play a role, with research showing that children of addicted parents are more at risk for alcoholism and other drug abuse than are other children (Goodwin, 1985; Kumpfer, 1999).
When you are working with a young person who you believe is abusing alcohol and/or drugs, apply the SACS screening tool to understand the extent of their substance use and its impact on their day-to-day life. If you find that substance abuse is an issue for them, consider how it may be impacting on their emotional health and wellbeing and apply the Kessler and Suicide Screens. Remember there are drug and alcohol specialists within your local community who can help you figure out what to do next – give them a call to see what they suggest. Also, your office colleagues will no doubt have a wealth of knowledge and information about what they have already tried, and what has and hasn’t worked that they can pass on to you.
Mental illness
Around 20 per cent of children and adolescents in New Zealand are estimated to have mental health disorders or problems, with similar types of disorders being reported across cultures, and about half of mental health disorders begin before the age of 14 years (Fraser & Tilyard, 2010). The most prevalent mental health disorders among young people in New Zealand are anxiety disorders, depression and conduct disorder. Males tend to have higher rates of conduct disorder and attention-deficit hyperactivity disorder while depression and anxiety disorders are higher for females. In general, mental illness in young people leads to emotional distress, impaired functioning, physical ill-health and increased suicide risk. As well, young people who present with one disorder are at increased risk of other disorders. For example, concurrent symptoms of anxiety and behavioural disturbances are present in almost all cases of depression, between 50% and 80% of young people with depression will also meet the criteria for another mental disorder, and conduct disorder and/or oppositional disorder occur in around 25% of young people with depression (NZGG, 2008).
Mental illness is particularly common amongst young people who are involved with Child, Youth and Family, with one in five having a formal mental health diagnosis recorded on their file (Department of Child, Youth and Family Services, 2000). Conduct and oppositional disorders are likely to be present in 85 per cent of our youth offender population, while 30 to 40 percent of young people we work with are likely to suffer from a depressive or anxiety disorder (Department of Child, Youth and Family Services, 2000).
Working with young people who have a mental illness can be challenging. It is often difficult to know what to do or where to go to get help for the young person. Added to this, families of these young people will often be stressed and tired from trying to manage and support their young person. We need to develop a two-pronged approach whereby we support and advocate for the young person while also supporting their family.
Keep in mind that culture and religious beliefs can influence the way a young person and their family view mental illness. Even if you (as the social worker) are the same ethnicity as the young person, don’t make the assumption that you and the young person will share the same world view. When working with a young person who is from a different culture to your own, get advice from colleagues in your office, an appropriate cultural advisor, kaumatua, kuia, or religious or community leader.
Early involvement of mental health services is vital to ensure young people are appropriately assessed and provided with the safety, services and supports they need. Also, pay particular attention to young people who are displaying suicidal ideation or self harming behaviour. Use the appropriate screens and assessments (see the Practice Tools policy) and follow up any concerns immediately with the right people. If you have the slightest concern about a young person’s behaviour, talk to your supervisor or practice leader to make sure you are on the correct path.
For further information:
Disability
Data gathered by Statistics New Zealand in 2006 found that 10 per cent of children and young people in New Zealand aged 14 years and under had a disability. Of these children, the majority (46 per cent) had special education needs which included learning or developmental difficulties and learning difficulties such as dyslexia, attention deficit disorder and attention deficit hyperactivity disorder. The next most common disability types were chronic condition or health problems such as severe asthma, cerebral palsy and diabetes (39 per cent), and psychiatric or psychological disabilities (21 per cent). Just over half of children and young people with disability (52 per cent) were noted as having a single disability; the remaining (48 per cent) had multiple disabilities (Statistics New Zealand, 2007).
It is important to remember that a young person with a disability will have similar hopes and dreams to other young people, even though they will likely face greater challenges and barriers to achieving their dreams. Think about what you and others in your community can do to help them reach their full potential.
When working with a family who are caring for a young person with a disability, your assessment needs to include conversations with the family about what supports they require (i.e. respite, home help, educational support) so they can provide the best care possible. Remember that families in lower socio-economic areas and low income households will generally be less likely to know what supports are available to them and how they can access the supports they need (Ministry of Health, 2004).
Talk to your Regional Child Disability Advisor about your next steps, and make a referral to the Needs Assessment and Co-ordination Service who will help identify the young person’s needs and the disability support services available to them. Put your mind to thinking about what this young person needs now and in the future. If the young person is in our custody and likely to remain there until they are at least 17 years old, find out how you can make sure they have a smooth transition to adult services. What work needs to be done now to prepare the young person (and their family) for this?
Go to the Disabilities Pathway for more information, resources and advice.
Harmful sexual behaviour
It is estimated that children and young people are responsible for about one-third of all sexual abuse against children (Grubin, 1998), although the actual incidents of sexual abuse are likely to be higher due to low reporting rates. Other research by Venziano & Veneziano (2002) found that of all adult sex offenders, around half had committed their first offence as a young person with subsequent escalation in frequency and severity. Young people who display harmful sexual behaviour are likely to be male (92 per cent), have social skills deficits, lack sexual knowledge, and have high levels of social anxiety (Righthand & Welch, 2001; Veneziano & Veneziano, 2002). For some young people, the combination of the above characteristics can create difficulties for them in forming healthy relationships and lead them to meet their needs through unhealthy and abusive interactions with children.
Any work undertaken with a young person who displays harmful sexual behaviour requires a coordinated inter-agency approach which helps the young person to be accountable for their behaviour and make the necessary changes while also protecting the community. The earlier that the young person receives help and support, the more likely it is that their change in behaviour will be long-lasting. See Key Information: Working safely with young people who display harmful sexual behaviour for more details. The severity of their sexual behaviour will also need to be considered – for lower level harmful sexual behaviour (e.g. masturbating in public) it may be more appropriate to provide in-home support; a higher level of harmful sexual behaviour (e.g. sexual intercourse with a child) could require specialist residential treatment. Talk to your supervisor about which approach to take.
It is important to also consider the possibility that the young person’s harmful sexual behaviour may have stemmed from their own abuse as a child and they will need extra support to help them address any residual feelings from this experience.
For young people who have been victims of sexual abuse, whether by an adult or another young person, we need to think about the impact that the abuse has had on them. Consider the range of emotions that the young person might be experiencing – guilt, fear, isolation, sadness, anger, helplessness, shame. Research shows that young people who have been sexually abused are more likely to abuse alcohol and drugs, display inappropriate sexualised behaviour, experience anxiety and depression, negative peer involvement, self-harming and behavioural problems, and that these adverse effects may well endure into adulthood (Cleaver & Webb, 2007).
We need to be sensitive to what the young person is going through, and work with them to provide the specialist support they need to get their life back on track. Remind the young person that they did nothing wrong, and be there for them when things aren’t going so well. Keep an eye on their state of mind, and if you are concerned about their mental health, get help for them immediately.
Youth offending
According to a report released by the Ministry of Justice in 2010, apprehension rates of children and young people aged 10 to 16 years declined from 1995 to 2008, especially in the last three years. The rate was highest in 1996 at 2,469, dropping to 1,908 in 2008. However, while overall offending decreased, the rate of violent apprehensions among young people (14-16 years) rose – from 167 per 10,000 people in 1995 to 198 in 2008. The number of young people who were prosecuted also increased, up to 28.1 per cent of apprehensions in 2007 from 13.2 per cent in 1995 (Ministry of Justice, 2010).
A lot of times, young people who offend will also be dealing with care and protection issues, and it is important that we work together as an organisation to meet all of the young person’s needs. It is not important to the young person and their family who helps them, just as long as they receive the assistance and support required. Use the Young person and family consult to inform planning for the young person, and the TRAX adolescent assessment to help understand the young person’s strengths, risks and needs. Also remember to involve the young person, their family and other professionals in the planning and decision-making. Young people deserve to have the chance to say what they want their life to look like and are likely to have better outcomes if we give them this chance.
See Engaging with children and young people and Focusing on young people for more information. The Youth Justice pathway will show you the track that a young person has to walk down when they have offended.
References
Department of Child, Youth and Family Services (2000). Towards Well-being: Responding to the Needs of Young People. Wellington.
Grubin, D. (1998). Sex Offending against Children: Understanding the Risk. Police Research Series paper 99. London, Home Office
Fortune, S., Watson, P., Robinson, E., Fleming, T., Merry, S., & Denny, S. (2010). Youth’07: The Health and Wellbeing of Secondary School Students in New Zealand: Suicide Behaviours and Mental Health in 2001 and 2007. Auckland: The University of Auckland.
Fraser, T. & Tilyard, M. (2010). Childhood depression. Best Practice Journal: Special Edition, Dunedin.
Goodwin, D.W. (1985). Alcoholism and genetics. Archives of General Psychiatry, 42, 171-174.
Kumpfer, K.L. (1999). Outcome measures of interventions in the study of children of substance-abusing parents. Pediatrics: Supplement, 103 (5): 1128-1144.
Ministry of Health (2004). Living with Disability in New Zealand. Wellington.
Ministry of Justice (2010). Child and Youth Offending Statistics in New Zealand: 1992 to 2008. Wellington.
NZGG (2008). Identification of Common Mental Disorders and Management of Depression in Primary Care: An Evidence-based Best Practice Guideline. Wellington, New Zealand: Guidelines Group.
Righthand, S. & Welch, C. (2001). Juveniles who have Sexually Offended: A Review of the Professional Literature. Washington, D.C.: Office of Juvenile Justice & Delinquency Prevention.
Veneziano, C. & Veneziano, L. (2002). Adolescent Sex Offenders: A Review of Literature. Trauma, Violence & Abuse Journal, 3, 247-260.
