1. Therapeutic Under 13s Program

2.  In 2011-2012 Impact had an increased number of referrals for males under 13 years of age  Presenting behaviours were more complex, challenging and violent  Recognising the need for more innovative interventions, staff with specific skills and rethink our resources  The story of a young boy named Bill, 9 years old.

3.  To develop and deliver a Trauma Informed Model of Care for children under the age of 13 who were presenting in the residential OOHC system  To design and deliver a therapeutic program with the aim of assisting children to develop regulation skills in order to sustain a foster care placement  To have the children ready for foster care within 6 months of entering the program  To better understand what was needed to adapt our Model of Care (ARC+C) to better meet the needs of this cohort

4.  Impact had employed Youth Workers who did not want to work with this cohort  We really needed to unpack this issue with staff and the Management  Impact had to consider our recruitment and induction processes  Differing emotional needs meant differing resources – physical restraint  We had to ensure that our staff really understood Safe Attachment  Embedding all of this into therapeutic practice and then training

5. 5 ARCC + Safety and structure to stabilise distress Feelings & regulation of behaviour Strengths and life skills Protective links and sense of belonging Impact’s program model AttachmentRegulationCompetencyCommunity

6. 6 Carers understand trauma & manage their own feelings & reactions All carers give consistent responses Carers are attuned to the child: active listening, noticing triggers Routines & rituals are predictable, constant The most valuable ways that staff contribute to attachment

7. 7 A TTACHMENT R EGULATION C OMPETENCY C OMMUNITY Carers understand trauma Carers attuned Consistent responses Routines and rituals Recognise feelings & triggers Expand ‘comfort zone’ Express feelings safely Problem solving skills Positive sense of self Trauma experience integrated Belonging

8. What we came up with  A large eight bedroom house with three lounge rooms, three dining rooms, four bathrooms and a spacious undercover outdoors area  A property on acreage including an in ground pool surrounded by bushland and nature reserves located near the Hawkesbury River  A great therapeutic program focusing on Trauma Recovery and Safe Attachments with the aim of preparing the young people to sustain a foster care placement  Routine - Weekly schedules now more than ever needed to be predictable and consistent

9.  Care team consisting of Residential Manager, House Co-ordinator, Intensive Support Workers, and Clinicians  Highly structured program  A therapeutic model of care for children under 13 (ARC+C)  Use of physical intervention to assist emotional regulation  Focus on education  Rural property providing more relaxed lifestyle and space  Specific criteria for client matching  Focused recruitment and staff training

13. Incident Log January 2013 for client within program

14. Reduction in Incidents for client by November 2013

15.  Unavailability of suitable foster care placements  High cost of running program due to staffing levels and property damage  Landlord asking us to leave the property due to damage  Finding a new property  Managing violent behaviours in children  Difficulty client matching and the impact on other young people and the program  Operational challenges such as appointments, family contacts  Staff require a high level of support to critically reflect on their practice and debriefing  Expectations of caseworkers and other external parties

16.  Environmental safety plan  Risk assessments  Age is different- coming up to 13 years  No on site senior manager  Community involvement – scheduled activities  All children engaged in education, external therapy, community groups  The program has a high level of activity and play  Cultural program for children and the care team

17. Questions