Connecting with youth at risk: who works and what works?

Connecting with youth at risk: who works and what works?

Connecting with youth at risk: who works and what works?

Symposium64Melissa van Dorp, Academic Workplace for At-risk Youth (AWRJ), The Netherlands; Eva Mulder, Academic Workplace for At-risk Youth (AWRJ), The Netherlands; Karin Nijhof, Pluryn, The Netherlands; Fleur Souverein, Academic Workplace for At-risk Youth (AWRJ), The Netherlands

Room 2EWed 14:00 - 15:30

Youth (at-risk to be) involved with the justice system pose a complex population: they display a large variety of cognitive, psychological and social problems. It is often difficult to engage these youth in treatment and motivate them to move towards behavioral change. Especially youth placed in secure residential youth care institutions pose a challenging group. In any setting youth care workers need to provide these youth with a context that is both safe and structured with boundaries as well as therapeutic and developmentally appropriate. The therapeutic alliance or the way staff-youth interaction is shaped is hereby paramount. In this symposium, we will focus on what works in connecting with this complex group of youth. Based on interviews and consultations with the youth themselves, we examined what is important in connecting with adolescents, how they perceive different forms of contact with care providers, and how the connection between the adolescent and the care provider can be used to ensure safety within the walls of the institutions.

Presentation 1:Small-scale groups as an alternative for secure residential care: What works according to professionals, parents and youth
Secure residential youth care is an intensive type of out-of-home care for children with serious behavioral and emotional problems, where they receive treatment in a secured environment. Despite that problems of children and youth that receive residential care are complex and treatment at home is no longer seen as an option, the design of secure residential care facilities is questionable.. Living groups in secure residential facilities usually consist of eight to ten children, and a large team of group care workers. Recently there is increasing attention for the development of small-scale groups that exist of a maximum of six – preferably four – children, and stability in group care workers. It is argued that a small-scale model supports an individualized, continuous and integrated care. However, it is not yet clear what the definition of small-scale is: how small is a small-scale group? What is the ratio of youth care workers to children? Further, how do children, parents and youth care workers experience living or working in a small-scale group. What are the key elements and possible benefits of small-scale care, as an alternative for large scale secure residential care facilities? The current presentation focuses on these questions that were explored in a research project in The Netherlands involving a literature study and interviews with youth, parents and youth care workers in small-scale residential care facilities. We would like to share these results with the public and engage in an interactive way about the recent development of small-scale care.

Presentation 2:Perspectives of adolescents and professionals on seclusion in secure residential youth care
Youth placed in secure residential youth care typically present a variety of challenging behaviors. In this context, seclusion is often seen as a “last resort” strategy to manage these challenging behaviors. The use of seclusion is controversial, as it can have negative physical and psychological consequences for both youth and professionals. More awareness of the detrimental effects of seclusion have led to efforts to reduce and prevent its use. However, there is a wide disparity in how seclusion is defined. This leads to a diffuse image of what is considered seclusion, complicates measuring its prevalence and the effect of reduction strategies, and hampers initiatives to reduce its use. Therefore, the objective of this study was to develop a shared definition of seclusion by examining how adolescent (ex-)patients and professionals in secure residential youth care organizations perceive (the use of) seclusion. This shared definition would enable monitoring the use of seclusion in secure residential youth care and as such serve as a tool to provide better care. The Delphi-method and focus groups were conducted with respectively 29 and 21 participants from eleven secure residential youth care organizations in the Netherlands. The process of defining seclusion was characterized by a diversity of opinions among participants and revealed the existence of various types of seclusion in practice. This lead to a broad definition of seclusion, which can be used to monitor the use of seclusion, learn from feedback on its use, and reduce seclusion in secure residential youth care.

Presentation 3:Providing youth with a secure and therapeutic environment: establishing relational security in juvenile justice institutions
Secure juvenile justice facilities need to provide youth with a structured, therapeutic, and above all safe environment. Given the complexity of the population within these institutions this is a challenging task: staff need to handle externalizing as well as internalizing problems, with incidence of aggression and violence on one hand and self-harm and suicidal behavior on the other. In managing this complex population, security provides the framework within which structure and care can be safely provided. In an institutional setting there are three distinct, but inter-related elements of security: physical security (e.g. locks and seclusion), procedural security (e.g. restrictions in visits) and relational security (a constructive alliance between youth and staff). There is ample literature showing that high physical and procedural security measures may have detrimental therapeutic effects and do not necessarily increase safety. On the other hand relational security may allow establishing both a supervised and structured as well as therapeutic and safe environment. However, the current scientific literature is lacking an unambiguous substantiated conceptualization of relational security, specifically its operationalization in the context of juvenile justice facilities. The current presentation focusses on extensive qualitative research in a semi-open small-scaled community based juvenile facility. This facility is grounded in a relation security approach. Integrating the perspective of both staff as well as youth and their parents from semi-structured interviews, the current paper presents a conceptualization of relational security and its facilitators and barriers.

Practices in ambulantory & residential care of children and youngsters
connecting, youth at risk
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