High-risk youth - advice
This advice provides additional information regarding working with high-risk young people.
Document ID number 2403, version 3, 17 April 2018.
See procedure High-risk youth for tasks that must be undertaken
High-risk youth are particularly vulnerable to risk of harm and require specific, intensive and strategic case management and planning.
Adolescence is a time for young people to challenge and test limits. Many young people who are child protection clients may have behaviours which are difficult but who are not necessarily considered to be at 'high-risk'.
Identifying high-risk young people
The criteria to identify high-risk young people are:
- young people who are clients of child protection
- generally aged between 12 and 17 years, but occasionally as young as 10 years of age
- who have multiple and complex behavioural and emotional difficulties, and
- who require long term and substantial support.
Multiple and complex behaviours include:
- emerging or diagnosed mental illness or psychological disorders
- suicidal ideation or self harming behaviour
- serious or escalating offending
- exposure to sexual exploitation
- association with sex offenders or other dangerous adults
- repeat risk taking
- high levels of aggression
- extreme challenging behaviour at home, school, or in out-of-home care
- use of drugs and alcohol to the extent that the young person's safety or development is at significant risk or their care or wellbeing is significantly jeopardised
- inadequate health care resulting in immediate and significant risk, including mental health
- severe conflict with parents and or family
- repeated running away
- isolated from family and peers.
This group may include young people with disabilities or who are homeless subject to a report to child protection. Within the target group, there are young people who are still at home but are in severe conflict with their family, young people who have recently left home and young people who have been unable to live with their family for a significant time.
Each of these situations is different and will clearly require a different service response. The reason for family breakdown and the likelihood of preserving the family will inform the type of response required by the young person.
Three service components that support high-risk youth are:
- Intensive Case Management Services (ICMS): These services are multidisciplinary and intensive youth outreach programs for young people who are at a high level of risk, where less specialised services are or would be ineffective.
- Brokerage funding: When service responses are unavailable through mainstream services, brokerage funds may be provided to tailor a response that meets the young person's specific needs. Examples include educational or day programs, mentoring and personal activities designed to build resilience and self esteem.
- One-to-one home-based care: This type of out-of-home care is an intensive placement for high-risk young people aged 12 to 17 years who are or have been listed on the divisional high-risk schedule. Each caregiver is specifically recruited and trained to care for high-risk young people with complex needs.
Priority access to mental health services for youth in out-of-home care
In terms of their overall health and wellbeing young people involved with child protection and placed in out-of-home care are a highly vulnerable group. The risk of mental health issues and the emergence of mental illness in this group is notably higher than in the general community child population. Policy guidelines issued by the Chief Psychiatrist set the framework for mental health services to give weighted and preferential consideration to infants, children and young people (up until the age of 18) who are placed by child protection in out-of-home care. It does so by directing area mental health services (child, youth and adult streams) to establish a service response that enables the most appropriate and timely assistance is either provided to or facilitated for this client group.
All referrals of infants, children and young people who are clients of child protection in out-of-home-care are flagged by the triage/intake service and a streamlined service response is provided to best meet their needs.
High-risk young people are highly vulnerable and frequently expose themselves to significant risks, serious injury and even death. The behaviours of these young people can strain the energy and resources of those around them.
It is important to take a team approach to risk and crisis prevention planning for these young people. Planning for how to manage crisis situations should be undertaken when things are calm and care team members can think clearly and logically about how best to offer protection.
Sometimes the histories of young people will provide evidence of a past crisis that should be discussed with supervisors and others in the care team. If the young person is in out-of-home care, safety plans should be developed and incorporated into the actions table and care and placement plan.
These plans need to identify the anticipated crisis and include:
- roles and responsibilities
- who is to be informed
- who will manage the situation
- what is the agreed plan of action, including involvement of other professionals.
These plans provide better protection for young people, direction for practitioners and share decision-making and accountability regarding complex situations. A good approach to crisis prevention planning, involving a number of care team services such as mental health, drug and alcohol and intensive case management services, is a multi-disciplinary case conference.
Generally crisis prevention planning for high-risk young people will require review on a frequent, sometimes daily or weekly basis, depending upon the degree of risk at any particular time. Planning for high-risk young people may also occur through the high-risk schedule.
The Practice guide: behaviour planning to best support children and young people in out of home care outlines elements of best practice to address more significant behaviours including high risk behaviours through the use of behaviour support planning.
The absence of a supportive and responsible adult in the life of a young person prior to reaching developmental independence puts the young person at risk. In particular, young people who are homeless do not have the continuity of support offered by an effective caregiver and are frequently in need of protective support.
Child protection is party to the Youth Protocol for homeless and unsupported young people, which places specific requirements upon practitioners.
Referral of a young person who is homeless to an accommodation service without arrangements for a risk assessment and ongoing case management is not a sufficient child protection response.
See advice Unaccompanied homeless children for further advice.
Core tasks for the practitioner include:
- Helping to put in place crisis support and care for immediate protection (for example, accommodation).
- Keeping focus on the young person's age and associated safety and developmental needs. There is a risk that young people who have become isolated from their family may be wrongly assessed to have a greater capacity to make independent decisions and prematurely live independently when compared to developmental expectations and community norms.
- Consideration of services to assist the reconnection of the young person with family or extended family (for example, mediation services).
- Consideration of services to support the young person living independently (for example, income support, accommodation and employment).
- Consideration of personal support needs (for example, counselling or treatment services regarding trauma from abuse).
- Consideration of a case conference with relevant professionals and the young person to develop or review a case plan.
Considerations for good practice
Working with young people can be particularly challenging given their stage of sexual, social and intellectual development, and the need to take risks, assert their independence and challenge boundaries and limits. It is imperative that child protection practitioners employ a collaborative approach with all young people. Critical decisions should be reached as far as possible through a participative process, based on clear discussion regarding roles and responsibilities, acceptable behaviour and consequences, and provision of safe decision making opportunities for the young person.
It is sometimes the case that the necessity to focus upon keeping the young person safe can detract from a more holistic approach to supporting healthy development and the promotion of social relationships. High-risk young people have developmental needs across the whole spectrum of health, education, emotional and behavioural development, identity and sense of self, family and social relationships and self-care. It is important that the case plan address each of these areas and the actions table outline goals and tasks to attend to them.
Case transfer and allocation
Due to the nature of the risks, which surround high-risk young people, they can be at significantly increased risk during periods where there is a transfer between teams, workers or placements. Extra care needs to be taken at these points to ensure that crisis plans are in place, young people and families have contact information and verbal and immediate handover information is provided to newly allocated practitioners without the need to wait for written transfer summaries.
It is critical practitioners new to the case take the time to read the complete client file, to gain a clear understanding of the young person's history of trauma and abuse, family and social networks, past crises, case planning and treatment history.
High-risk young people are likely at some point to have involvement in an incident, which requires the allocated practitioner or agency case manager to complete an incident report in accordance with the incident reporting guidelines.
In relation to incidents involving the use of physical restraint on children and young people in out of home care, practitioners need to refer to the Guide to emergency use of physical restraint in out of home care, which outlines the department’s expectations regarding:
- the use of physical restraint in emergency circumstances
- prohibited physical restraints and seclusion
- incident reporting requirements
- best practice guidance for reviewing incidents of physical restraint.