SHERWOOD HOUSE A summary of initial outcomes achieved in the first 12 months of implementation of an innovative program to provide therapeutic support.

SHERWOOD HOUSE A summary of initial outcomes achieved in the first 12 months of implementation of an innovative program to provide therapeutic support in an environment that offers the option for containment

Introduction

Sherwood House is a new innovative therapeutic residential program established by the Department of Human Services, Community Services within South West Sydney in February 2009.

This presentation seeks to provide an overview of the context within which the model has been established, key elements of the model and its function, and broadly describe the outcomes achieved in its first 12 months of service.

Service GapSherwood House has been specifically founded to meet the needs of a

target client group for whom which there is currently limited or no service options.

Client characteristics:

Young people in Out-of-Home Care

Unable to be successfully supported in community settings

Chronic behavioural challenges that pose significant risk to themselves and others

Complex trauma symptoms

Requirements for specialist case management

Placement approved by the Deputy Chief Executive

Placement by Supreme Court order

Managed under Supreme Court case management

The needs of this group of young people require Assess to a suitable (safe) accommodation setting

Setting with capacity for containment

Trained staff with a high level of supervision and access to direction

Staff contingencies that support physical management of high risk behaviours in a safe manner

Intense targeted therapeutic support that is multi-element and consistently delivered over time and across all settings

Complex and intensive case management services

Active engagement of specialist services (inter-departmental as required)

Support that is not time limited but structured around client needs and the outcomes achieved

CURRENT SERVICES

Rest

ora

tion

Imp

atie

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ealth

Facility

Psychiatric Annals 35:5 May 2005. Full version www.tramacenter.org

Psychiatric Annals 35:5 May 2005. Full version www.tramacenter.org

The Attachment, Self-Regulation and Competency (ARC) model provides a component-based framework that broadly guides the work within Sherwood House.

Psychiatric Annals 35:5 May 2005. K.J Kinnibutgh LICSW, M. Blaustein PhD, J. Spinazzola PhD.

Sherwood House

Our commitment is to provide a safe, nurturing and

therapeutic residential service that enables children

and young people to develop to their full potential.

Sherwood Entry and ExitThe identification of individual case planning and therapeutic goals is undertaken for

each young person entering the program. It is through the revision of these goals that determination of a suitable exit plan and timeline can be shaped.

Generally these include:

Specific health management issues including medication review and appropriate engagement of required specialist and services

Healthy lifestyle habits and routines

Functional and meaningful family contact that is safe and sustainable for the young person

Reduction of anti-social and damaging high risk behaviours

Increase in emotional resilience and capacity to modulate behaviours

Increase in engagement with education and personal development opportunities

Increase in capacity for positive peer engagement (recreational / social)

Permanency planning for future living situation that meets needs

The young person’s beliefs in relation to their readiness to move on

Staff Model

Staff Training

Sherwood House provides a structured in house staff training program that includes :

Policy and procedural review

Induction and buddy shifts

Shift leaders meetings

Team meetings

Formal topic training

Access to manual resources

Team debriefing

Therapeutic Support Program

Summary of Sherwood Program Structure

Therapeutic Support ProgramCommon behavioural support challenges for target young people

include;  

High levels of anxiety and withdrawal

Difficulties with emotional regulation

Aggressive and defiant behaviour

Complex family issues

Learning difficulties

Trauma related symptoms

Difficulties with peer relationships

Inability to monitor pitch, inflection and tone of voice

Misreading facial expressions

Misjudging personal space

Mistaking other non-verbal cues

Sherwood House: In-house Program

SOCIAL SKILL THERAPEUTIC INTERVENTION PROGRAM (2X WEEKLY)

MUSIC THERAPY (WEEKLY)

MOVEMENT AND DRAMA THERAPY (WEEKLY)

The Sherwood Education Program

Classroom to support the young people re-establish their routine participation in formal education programs in the grounds of Sherwood House

A dedicated part-time teacher who provides face to face teaching two days each week

Distance education with the support of staff complete their curriculum requirements.

One of the young people has been able to return to a full time placement in a local school

Program ReportingThe reporting requirements of the program are significant and matched to regular

scheduled Supreme Court review. Data is tracked and analysed on a monthly basis.

Critical elements of data include:

Case management milestones

Health management goals

Medication management and impacts

Incident profiles

Behavioural scales

Mental health scales

Client wellbeing self reports

Program participation and community access

Reference Person Program

Therapeutic goals and progress

Client evidence Based Outcomes (Sample Data Summary)

Impact of Incidents

0

5

10

15

20

25

30

35

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10

Months

Num

ber

of in

cide

nts

High

Medium

Low

PRN

The Step-Down Models

The transition from the Sherwood House model has required the development of a linked program to allow gradual progress and the continuity of program elements

The program has achieved the transition of one young person and is currently preparing for the exit of a second

Challenges

Building management and design to ensure a robust safe setting

Staff matching and retention

Family engagement

Establishment of the step-down model

Future Planning

Ongoing refinement of the therapeutic program

Enhanced projects for community participation for the young people

Creative options to support family engagement

Ongoing investment in service partnerships and collaborative work

Questions