Please see Michele Oliphant

Identifying and Responding to Adolescent Violence in the Home as a Youth Mental Health Service

Proposal
A case reflection on the journey of identifying and responding to serious high risk adolescent violence in the home as a Specialist Youth Mental Health Service.

Abstract
Introduction / Overview
After the death of a family member due to Covid-19, the treating team at Orygen (youth mental health service, Victoria) identified an increase in the seriousness and frequency of violence being used by a young aboriginal person towards their mother and sister.

Method
Utilising a case study, this presentation will explore the successes and challenges in using the Multi-Agency Risk Assessment and Management (MARAM) Framework to provide an integrated service system response to adolescent violence in the home (AVITH) where the young person has a diagnosed mental illness.

Zanetta Hartley, Orygen Specialist Programs Specialist Family Violence Advisor, will break down how the team applied the MARAM Framework and Family Violence Information Sharing Schemes to engage external services to support the young person and their family including; Specialist Aboriginal Services, Victoria Police, Family Violence Services, youth inpatient unit, a Multi-Agency High Risk Family Violence panel and, more.

Results
Highlighting the initial success in engaging the family, the young person’s desire to connect to culture, this case observes a continued increase in seriousness of risk and frequency of AVITH and the complexity of the challenges faced when families want to protect the young person from a justice response and Mental Health and Specialist Family Violence Services are siloed.

Conclusion
Specialist Adolescent Mental Health services should continue to utilise the MARAM framework and information sharing schemes in collaboration with external services to connect and engage young people and their families to manage and reduce risk of AVITH.

We have entered a time of huge opportunity to improve our mental healthcare systems and supports, and this change is more necessary than ever before. We know that early intervention is key in helping children and young people with their mental health, but currently we’re letting all too many slip through the cracks. Unfortunately, we also know that the number of children and young people experiencing mental health issues is constantly rising, so why aren’t our systems changing to meet the need? Our health services need to listen to tales of people’s lived experience, I promise if you’re willing to listen, our insight is invaluable. I don’t have all of the answers on how to create a perfect system, what I do have though, is personal and professional insight into what’s not working at the minute, and what many young people need. There are endless access barriers to mental health and well-being services, which are actively blocking out young people and their families from getting adequate support. Other issues come up as a result of services and providers working as individuals rather than an integrated support system, with this failure we’re putting the burden of coordinating care on the young person and their family. I talk about these issues not because I want to be critical, but because I want to start conversations about change. It can be a brutal fight just to get help, so when someone can’t put up that fight, what’s their fate? Will our services step up or do we let them slip through the cracks too?

Over the last 10-15 years there has been a significant change in acuity, complexity and service delivery models within the Mental Health context. There appears to have been a marked increase in the presentation of suicidal, self-harming and trauma related presentations - with adverse childhood experiences being a complicating factor for most of these.

The significant impact of developmental trauma on neurobiology combined with ongoing communication failure impacts on capacity to self-regulate, develop identity, engage and participate. Challenges that can make it difficult for therapists to provide effective mental health treatment, can present a significant barrier to the generalisation of talking interventions, and may lead to increased therapeutic disengagement and dropout.

The use of therapeutic story formats to facilitate engagement and emotional/behavioural change has a strong evidence base in the literature. Implementation of these strategies had been observed to assist young people understanding abstract psychological concepts through an accessible and engaging process. So started the Evolve Therapeutic Services (ETS) Caveman Series development and journey.

The ETS Caveman Series is a free straightforward animated graphic novel style resource designed to assist children/young people, and their carer/s, in developing an understanding of stress and trauma, the body’s reaction to stress and trauma related emotions, and possible therapeutic ideas to reduce the impact of these overwhelming emotions. The free set of four language scaffolded easy to use therapy tools, and a separate user guide, has been specifically designed for children and young people presenting with a range of neurodiverse challenges and is intended to be used as a sequential interactive therapeutic ‘tool’. The Series can be used within a one on one therapeutic and/or group setting, and then within the home context to assist the generalisation of knowledge and strategies.

National child protection data show a consistent pattern of Aboriginal and Torres Strait Islander children being substantially over-represented in every area of the child protection system - almost 8 times as likely as non- Aboriginal and Torres Strait Islander children.

Within Queensland Evolve Therapeutic Services (ETS), a specialist Child and Youth Mental Health Service (Queensland Health), has been set-up to therapeutically support children and young people with care experience only. Since it’s launch in 2006, paralleling national data, the ETS program has seen an increase in the number of Aboriginal and Torres Strait Islander children being referred to the program increase.

However, despite the strong evidence and need for all mental health services to be culturally safe and appropriate, attempts to foster a stronger appreciation of the socio-cultural determinants of Aboriginal and Torres Strait Islander children Wellbeing has been challenging. With this in mind ETS have embarked on a journey to deliver culturally responsive and appropriate care. Part of our journey, through the amazing work and support of past and current Indigenous Program Coordinators, has been exploring, developing and embedding resources based around the Aboriginal and Torres Strait Islander world view of Social Emotional Wellbeing (SEWB) and health, as defined by Gee, Dudgeon, Schultz, Hart, and Kelly.

A number of resources have been developed with the intent to assist, educate and informed the ETS Statewide Program about the SEWB framework, in particular the SEWB domains, possible contributing / risk factors, and possible protective factors to consider in treatment planning and intervention. During the trial, and now staged implementation, of these resources, anecdotally there has been an increase in staff understanding of SEWB and the capacity to reflect / explore and then enact SEWB responsive treatment planning and care.

Adolescent violence in the home is commonly defined as “any act of a child that is intended to cause harm, psychological or financial damage to gain power and control over a parent”1 (p. 3). Although Adolescent Violence in the Home (AVITH) is recognised and acknowledged, it remains unaddressed and under-resourced. Research suggests that youth violence against parents can vary between 5% and 24% in the general community. Recent observation amongst the headspace Early Psychosis (hEP) Mobile Assessment and Treatment Team (MATT) is that use of violence by MATT clients (aged between 12 and 25 years) is likely closer to 50%. Despite this, there are no dedicated Adolescent Violence services available through headspace, and very limited options across other youth services in the south eastern region. There is an urgent need to better understand adolescent violence presentations within the MATT cohort, and begin to identify potential risk factors and indicators of violence for mental health clinicians and peer workers with MATT.
This paper reports on a project developed to identify characteristics of the cohort currently receiving service from MATT and potentially identify any particular characteristics of young people who are using violence at home. Such characteristics include:
• Age
• Gender
• Mental health presentation
• Co-morbid disability, such as ASD or intellectual disability
• Substance use
• Trauma background
• Exposure to adult domestic violence
We also ask three further questions regarding staff confidence and competence in managing young people who are using adolescent violence in the home. The findings of the project may be useful in designing future service responses to this particularly complex and vulnerable cohort of young people.

As many indigenous children present for counselling and psychotherapy to non-indigenous practitioners it is incumbent on us to integrate the knowledge shared with me by my local elders and through indigenous wisdom along with current evidence based techniques to create a more appropriate and engaging counselling method.
Using non-liner counselling with tangible objects to improve the interactions with the land and with the young person's own storyline we are able to strengthen the wellbeing of our young people using their cultural connections.
Engaging young people more in the process of counselling I hope that I am enabling them to better process their feelings and thoughts. Improved wellbeing will help with improved capacity to learn, connect and thrive "closing the gap" further.

As many indigenous children present for counselling and psychotherapy to non-indigenous practitioners it is incumbent on us to integrate the knowledge shared with me by my local elders and through indigenous wisdom along with current evidence based techniques to create a more appropriate and engaging counselling method.
Using non-liner counselling with tangible objects to improve the interactions with the land and with the young person's own storyline we are able to strengthen the wellbeing of our young people using their cultural connections.
Engaging young people more in the process of counselling I hope that I am enabling them to better process their feelings and thoughts. Improved wellbeing will help with improved capacity to learn, connect and thrive "closing the gap" further.

A Targeted Wait Time Reduction Program - What you Need to know for your Service


Demand for youth mental health services has been increasing year to year and often results in higher demand compared to available services. In addition, Covid-19 has added another layer of complexity in the way we support and provide service to young people in the community.

headspace Ballarat have been facing wait times for services in different facets of support including prior to the initial mental health assessment and then for further mental health supports including Medicare Benefit Scheme treatment.

With increasing demand, headspace Ballarat has developed an innovative and a targeted response for the unique service demands. The project has involved expanding service delivery to include a range of creative and technological options including groups, online programs, and virtual reality to assist individualised treatment modalities. The wait time project has also been targeted at early intervention to support young people early in the progression of mental health concerns.

The wait time project has faced several stages including
- Researching and benchmarking 12 existing programs.
- Choosing programs, seeking permissions, and completing training.
- Collaborating with the Youth Reference Group (YRG) for co-design, feedback and opportunities for youth co-facilitators.
- Trialling a range of programs with focus on target groups of young people, eligibility criteria, impact of covid-19 and delivery format. The 12-month trial period has seen young people, parents/carers, professionals and students attend across 11 different programs.
- Evaluating via qualitative and quantitative data and adjusting and refining the programs following feedback.

The selected evidence-based programs have been made available to young people accessing headspace services, parents/carers, professionals and community members in the regional area including community services personnel, as well as primary, secondary and tertiary school communities. The project has mapped out programs that target social determinants of health and a range of low to moderate mental health presentations.

In this section Jacqui will share some of key insights having taught the Greatfulness program to thousands of primary school children over the past four years. Jacqui will set the foundations for self-leadership through exploring topics such as self-care, self-belief and self-love.

Jacqui will also reflect on how creativity and flow can help young people tap into a greater sense of wellbeing and will consider the role of music in a young person's life. She will also talk about making the most of our imaginations and guide participants through a fun 'Headventure' (whichi is similar to a meditation/ visualisation practice) so that they too can experience what Jacqui shares with her students.

This session will hopefully awaken the participants curiosity, and invite a sense of wonder and will ultimately guide them to reflect on their own self-care and wellbeing. The real question is: how can we all bring a little more joy into our lives; despite the challenges?

Children from Culturally and Linguistically Diverse (CALD) communities represent a large and growing proportion of children in Australia, with some estimates suggesting 1 in 4 children and young people aged 25 years or younger are from CALD backgrounds. Children and families from CALD backgrounds experience challenges that can impact mental health, and can face unique barriers to accessing services, compared to the general population. Yet, there is limited research and evidence-informed resources on child mental health of CALD communities in Australia to guide practitioners when working with CALD children and families.

To understand what factors impact the mental health of children (<12 years old) from CALD communities, and what that means for practitioners, we developed an evidence-based package of resources including an evidence review, practice paper and resource sheets. This package will be used by the National Workforce Centre for Child Mental Health (Emerging Minds) in their program implementation. To ensure that the review and resources were tailored for practitioner use, we consulted with key stakeholders including mental health practitioners, practitioners specialised in supporting CALD communities, and practitioner advocates for CALD communities throughout the process. Insights from consultations were used to identify the scope of the review and guide the format, content development and delivery of the resources. The resources produced were targeted to non-specialised mental health practitioners, to help them support families from CALD backgrounds with children at risk of mental health difficulties.

This presentation will highlight the key findings from the evidence review and describe their implications for practice. It will showcase how we can co-produce resources with stakeholders such as practitioners, to maximise relevance and uptake of evidence in practice.