A child or young person's journey through residence
What's Important To Us
We want children and young people to reach their full potential. Residential care provides a safe and stable placement for children and young people when they are not able to be placed in the community. A residential placement is a supportive environment with a focus on thorough assessment, so that we understand and meet the needs of the child or young person. The goal of any residential placement is to create sustainable behaviour change which enables the child or young person to return to their community.
This key information provides guidance for residential staff while children and young people are in a residence.
Preparing for arrival
When a child or young person first arrives at a residence, they will probably be really anxious about having left their family, friends and places that they are familiar with. Be prepared for their arrival by familiarising yourself with any information you already know about the child or young person. Check CYRAS for information and identification of any needs and risks, and check with the child or young person's site social worker that you have all the information you need in preparation for their arrival. Familiarise yourself with the child or young person's family group conference plan, and review the relevant comprehensive assessments of need completed by the site social worker.
Talk with the child or young person's site social worker about your expectations of what items they need to bring with them to Residence. This will include a custody order, medical consent and sufficient clothing and personal items for their residential stay. If these items are unavailable of the day of admission, ask the site social worker for these to be provided as soon as practicable.
Use the Residential Assessment Triangle to think about where in the residence this particular child or young person is best placed. Talk to your team leader about the group dynamics in the residence and any other factors the team leader will need to consider when making this decision.
Key Information: Grief and separation - When a child or young person enters care
On arrival
Whilst undertaking the admission process reassure the child or young person and acknowledge that they may have concerns about the residence and not know how things work and who to talk to. Arrange for someone to show the child or young person around once you have completed the admission. Let them see where they will sleep and other key parts of the residence as soon as possible as this will help lessen any anxiety.
Take the time to explain some of the details around residential routine, let them know that they will get an introduction and orientation to the site, and introduce them to staff members that they can talk to if they need help. Also remember to provide them with a copy of the Charter for Children and Young People in Care (under 12 and over 12), and talk with them about it, answering any questions they might have about their rights.
Talk with the child or young person about who they wish to have contact with from home whilst they are in residence, and ensure that they understand the process for this to occur. If there are people that have been deemed unsafe for a child or young person to have contact with during their residential stay, it is important that they a provided an explanation of why this is.
Initial screening and checks
Complete the screens for the admissions process which will help you to assess the child or young person's physical and emotional health upon arrival. This includes a CAGE or SACS assessment, a Kessler screen and a Suicide screen (see Practice Tools policy). In youth justice residences this will also include using the MAYSI-2 check.
In addition to an initial health check, a TRAX or Wellbeing Assessment may also need to be completed (see Practice Tools policy). It is important that during these screens any immediate health needs (i.e. sight or hearing) or mental health needs are identified and that action is taken to meet these.
Check to see if the child or young person has arrived at the residence with any medication. If they have arrived with medication, make sure that this is handed to the nurse or shift leader as soon as possible. It is important that medication is kept secured and safe at all times and that the child or young person receives it when required.
The child or young person's property is signed in and labelled when they arrive so that they don't lose anything during their stay. Some items will not be allowed in the residence so be careful about what goes into the unit with the child or young person and what will be kept safe for them until they leave.
Engaging with the child or young person
When a child or young person is placed in residential care, it is important that we understand their strengths and needs and support them to change their behaviour and improve their wellbeing. Manage your interactions with the child or young person to reinforce that they are safe and their views are respected. Let them know that even when they get something wrong they can use this experience to learn new things - these are ‘teachable moments'. Making sure that children and young people feel safe in their placement is very important; they will not be able to focus on making changes and trying new things if they feel unsafe.
Role-modelling pro-social behaviour is essential to children and young people. Children and young people who enter residential care may not have had adults in their life who have been able to guide them about appropriate interactions with others and how to resolve conflict in a safe way. This is an ideal opportunity to role model behaviour which encourages children and young people to see different ways of interacting with others.
There are times in the residence that children and young people may be more anxious and/or vulnerable (e.g. before a Court hearing, prior to whānau coming for a visit). Familiarise yourself with both the operational plan and Individual Care Plan for the child or young person. These will assist you in making sure that your responses to children and young people correspond to their needs. If you need more information you can talk to the Case Leader for the child or young person. Take note of anything that you may need to watch out for, particularly at night time or after certain activities such as phone calls or visits.
An important part of a child or young person's stay in a residence is them knowing that they are able to raise any concerns that they have. Make sure they are familiar with the grievance process when they arrive at the residence, and discuss this with them regularly. Hand out grievance forms when they are asked for and, where appropriate, support the child or young person to complete these. Children and young people should be made aware of Grievance Panel members and their role, in addition to their right to choose to have independent advocate support with their grievance.
Hold regular forums for children and young people to talk about their rights in and out of residence, and gaining their views. This is a great way to engage children and young people, and helps us understand areas which we could build on as a service.
Medication
Each residence has a dedicated medical team that can assist you to administer medication correctly. Staff members who are designated to administer medication (i.e. Shift Leaders and Team Leaders) should go over the medication files with the nurse and clarify any instructions which may not be clear to them.
All medication is administered in a safe manner, and documented in the correct medical file. It is important that you make a record of occasions when medication is refused by a child or young person, and that you pass this information on to the medical team. If medication is consistently refused, talk to the case leader or Team Leader Clinical Practice. Record when a child or young person refuses their medication and return it to storage.
Behaviour change practice
All children and young people need routine, structure and boundaries to help them be successful. In the residential setting we recognise that care team staff are the primary agents to promote behavioural change. Your ability to develop and maintain warm and nurturing relationships, as well as enforcing consistent behavioural limits, will have a significant impact on children and young people's ability to make sustainable changes.
In order to support best outcomes for the children and young people in residential care maintain an approach that is consistent with the Code of Conduct. We expect you to:
- use respectful and professional language at all times
- attend all training workshop opportunities in behaviour change practice
- consistently model values such as respect, honesty, and responsibility
- take responsibility for their own behaviour
- recognise when mistakes are made and take appropriate action, such as apologise
- maintain effective communication with children and young people and with other staff
- manage conflict constructively
- have a positive attitude to work.
Our residences provide a structured day with opportunities for developing and practicing behaviours and skills that children and young people need for everyday living.
We use a contingency management approach (a ‘points and levels' behaviour management system) with children and young people to help shape desired behaviour. The points system emphasises recognition of and attention to pro-social behaviours, aiming to increase their use by the child or young person.
The daily living environment provides teachable moments. Teachable moments are learning opportunities at times when the child or young person behaves inappropriately or is having difficulties managing distressing feelings such as anger, frustration or anxiety). Direct-care team staff can assist the young person to problem solve, develop coping strategies, or make appropriate choices. With your support, children and young people can then learn and practice the skills needed to manage their feelings and behaviour in a socially acceptable way.
The residential environment provides an ideal opportunity for powerful or influential positive role modelling to occur. As social learning theory has shown, pro-social modelling is a highly effective way for the young person to learn to perform new skills and behaviours. The direct-care team have a crucial role in making this approach work in our environment.
Punctuated practice
All staff working in the residential environment receive training in the Punctuated Practice approach. Punctuated practice works best when practitioners can quickly identify the level of the behaviour, and the level of the required response.
Punctuated practice relies on staff connecting and engaging with children and young people. This is about keeping everyone safe in our environments using safe strong practice.
Punctuated practice is used to accurately identify both appropriate and inappropriate behaviours demonstrated by children and young people and where there is a need for a response, it occurs in a timely manner at the appropriate level. Punctuated practice is dependant on staff assessment and connection with the child or young person, to best understand the triggers and early warning signs of escalating behaviours.
It is important to recognise that behaviours can quickly escalate from low level to high level. It is important for staff to be looking out for triggers and early warning signs in order to intervene as early as possible at the lowest form of intervention.
It is important to review your responses to high level behaviour to assess if the behaviour started as high. It may be that it started as medium or low level behaviour and was not appropriately identified at the time, and as such escalated to high level. This is included in the shift debrief.
Our operational plans are individualised for each child and young person and provide management strategies for care team staff to consistently manage specific risks or behaviours of concern. Operational plans include triggers for behaviour and strategies for staff to influence positive behavioural change and de-escalate difficult behaviour.
Points and Levels behaviour change system
We use a contingency approach (a ‘points and levels' behavioural system) with children and young people to help shape desired behaviour. The Points and Levels system emphasises recognition of and attention to pro-social behaviours, aiming to increase their use by the child or young person.
The system incorporates a ‘response cost' component designed to help the child or young person understand the negative consequences and disadvantages of reliance on inappropriate behaviours. In tandem with this, we focus on teaching the young person the appropriate behaviours to use in place of the inappropriate behaviours. Through this approach we aim to reduce the child or young person's reliance on inappropriate behaviours as a way of functioning.
The points system incorporates the use of ‘levels' to support the child or young person's progress in learning and maintaining the behaviours and skills they will need for a successful and sustainable transition from the residence. As the child or young person is able to consistently demonstrate pro-social behaviours, they will be recognised by graduating through the 1, 2 and 3 Level incentive system.
The points system and levels are designed so as to emphasise the positive motivational value for the child or young person.
The points system:
- is designed for practicality, simplicity and ease of use by staff
- is designed for ease of understanding and ‘use' by the child or young person
- is ‘operated' by the Care Teams and Case Leaders
- is in operation 24/7; across daily routines, programmes and school sessions in the residence
- is computer based for efficiency and to facilitate regular evaluation of the young person or child's progress against specific objectives within their behaviour management plan
- ensures an emphasis on recognising and rating the positive behaviour demonstrated by children and young people. Ratings are weighted to ensure positive behaviours carry a higher tariff, in comparison with inappropriate behaviours.
Teachable moments and pro-social modelling
The care team have tremendous potential to positively impact on the children or young people's well being, motivation and behaviour change:
- As you spend the most time with the children or young people you are present when most ‘teachable moments' occur
- The children or young people may tend to be guarded and ‘say what they think needs to be said' in a one to one session with a therapist. However in their daily living environment where they are more likely to be at ease and familiar with the surroundings, the child or young person is more likely to be open about their core beliefs, attitudes, behaviour and feelings. The care team is ideally placed to pick up on opportunities for open discussion with the children or young people. In this sense they are well placed to contribute to the development of appropriate behaviour management plan objectives, which sets the scene for appropriate therapeutic intervention and behaviour change
- The daily living environment provides opportunities for adult intervention during times when the young person behaves inappropriately or they are experiencing feelings that are difficult to manage (anger, stress, anxiety). The care team can use teachable moments to assist the child or young person to problem solve, develop coping strategies, then learn and practice the skills needed to manage their feelings in an appropriate way
- The daily environment provides an ideal opportunity for powerful or influential positive role modelling to occur. As social learning theory has shown, modelling is a highly effective way for the young person to learn to perform new skills and behaviours. The care team clearly has a crucial role in making this approach work in our environment. Therefore maintain a professional role at all times, and remain aware of the impact that you have on the children and young person in your care.
Shift planning and debriefing
When planning for a shift it is important that any other professionals that may require access to the children and young people, such as health and education professionals, or programme providers, are considered and consulted in the planning as appropriate. Make sure you have a good understanding of the time that is set aside for each activity and how you can change the plan throughout the shift if this becomes necessary.
Shift debriefing ensures that all information from the shift is captured, and any information about specific children and young people is passed on to the appropriate people within the wider residential team for follow up. Debriefs review the effectiveness of the planning and measure this against a variety of areas including safety, communication, teamwork, and strategies for managing both the group and individual needs amongst the children and young people. There may also be occasions where a serious incident has occurred during the shift, and it is important to remember that a Psychological First Aid debrief is available.
Night-time monitoring
Visual checks of children and young people in their rooms at night are complemented by audio monitoring.
The frequency of visual checks of children or young people is determined in Operational Plans, when it is assessed that more regular checks are required.
During the night one ground check is to be completed of the residence building. This includes checking the perimeter of the residence and the outside of all bedroom windows.
Secure care
The ability to provide secure care is an option to consider preventing children or young people being a risk to themselves or others, when there is no alternative to ensuring safety. This is a means of managing a particular behaviour as opposed to being a punishment. It is important that children and young people are given a clear explanation as to the reason that they have been placed in secure care.
Whilst in secure care, a child or young person receives individualised programming that allows you to assess how they present as a risk to themselves or others. Once this is determined, appropriate interventions are put in place. Short-term, targeted programmes such as managing anger, getting along with others and understanding the Court process can assist in reducing the ongoing risk of harm. The child or young person also continues to receive educational support and regular access to recreation while staying in secure care.
The child or young person's Individualised Care Plan and/or Operational Plan may also need to be altered after they have been in secure care to outline different or stronger interventions which are hoped to help prevent further incidents.
Managing incidents
Children and young people who require residential care often have complex needs and behaviours. Fostering a structured, predictable and pro-social environment is essential to reducing children and young peoples potential to be elevated in their behaviour. The best way to ensure the unit is settled is to be proactively communicating with the children and young people, and responding to behaviour triggers early. This will involve line of sight approach being maintained, as well as understanding the individual triggers of each child or young person.
When an incident occurs in a residence, working together as a staff group will ensure the best possible response. Make sure the incident details are recorded in full so that there is an accurate account of what occurred. This is important as incident reports can be used to support and evidence social work reports, court reports and other documentation. Record the category of the incident on the incident report and follow the required actions depending on the chosen category.
Once the incident has been resolved, help to settle the child or young person involved and take note of any other children and young people you may need to monitor as a result of the incident.
Security and emergency management planning
Because we have the care of the children and young people 24 hours a day seven days a week when they are in a residence we need to have appropriate measures in place to deal with any event that may arise. Familiarise yourself with the Security Management Plan and the Emergency Management Plan so that you know what to do in an emergency and how to assist in maintaining security.
Preparing the child or young person to leave the residence
Residences are not a destination for anyone, but rather part of the care journey to meet a child or young person's permanent care needs. The multi agency team is central to ensuring robust planning for children and young persons transition from residence. The multi agency team may include the child or young person, family/whānau, residential staff, site social worker, health and education providers and significant others involved with the child or young person.
From the child or young person's very first day in a residence, planning for transition from residence will be captured in their Individual Care Plan within the first seven days of admission. Transition planning will identify the needs of the child or young person, including care arrangements, whanau support, education and/or vocational options, linking into appropriate health services and other identified specialist support services (such as alcohol and drug counselling or anger management support).
The residential multi agency team assists in developing and monitoring the objectives of the transition and make sure that:
- the transition plan is in place as soon as possible
- information about the child or young person is shared appropriately with those involved with the child of young person
- post placement visits are arranged
- there is assistance to help get the placement back on track if it is needed.
Key Information: Preparing for independence
Key Information: Towards independence - Voices of young people
Key Information: Transitioning between placements
Key Information: Returning children safely home
Key Information: Supporting young people to return home safely
