AICAFMHA:
promoting mental health for young Australians
Australian Infant, Child, Adolescent and Family Mental Health Association Ltd
ABN 87 093 479 022
Building Bridges For Resilient Youth
Robyn Sutherland, Pat Mead and Greg Shepherd, Adelaide Central Mission and
Adelaide Women's & Children's Hospital
Youth and Parent Successful collaborative working relationships between organisations, be they government or non-government, are still fairly rare. Why is this? We can all understand that it enhances client access to service, reduces duplication, opens up lines of communication and increases agency knowledge. The brick wall that we keep running into materialises when we attempt to bring together services from differing philosophical backgrounds, where practice and training have little in common, where funding agreements require different outcomes and there have been long held beliefs of distrust of each other. Let's be honest, even agencies within the same organisation can have difficulty in achieving any form of working partnership.
This paper is a template of a working collaboration between a number of government and community based agencies. These services took the risk of suspending all their preconceived ideas so they could achieve a consistent and shared approach to case management. This unique working relationship was formed between Youth and Parent Services, The Hospital Links Program, The Adelaide Women's and Children's Hospital and The Hospital to Home Transition Team (Adolescent Services Enfield Campus).
- services (YPS) is an early intervention service to prevent homelessness and support families committed to resolving conflict and working towards reconciliation/restoration. There are two sections within YPS, counselling and an accommodation component called 'Ruby's'.
- The Hospital links Program (HLP) defines and improves the discharge outcomes of disadvantaged and at risk youth, 12 to 18 years. Through the work of HLP in building effective links between the hospital and relevant youth services disadvantaged young people are now referred appropriately and supported in both systems.
- The Hospital To Home Transition Team (HHTT), Adolescent Services Enfield Campus (ASEC) is a state wide multi disciplinary service, which works with young people who have experienced a severe mental health issue. The program provides an activity based therapeutic group program, which is conducted 4.5 days per week.
- The Boylan Ward is an open in patient unit within the Adelaide Women's and Children's Hospital (AW&CH) that provides specialist care and support to children and adolescents with mental health issues.
- The Adolescent Ward is an in patient unit of the AW&CH, which caters for the needs of young people, aged 12 to 18 years, with a variety of acute and chronic conditions.
The common client group between these services is young people, 12 to 18 years of age,
experiencing a mental health issue, and at imminent risk of becoming homeless. It was
clearly evident to all the services involved that no one organisation had all the
expertise or resources to meet these clients’ needs. Requiring accommodation or
experiencing a mental health issue are only two of the factors that contribute to their
homelessness. Drugs and alcohol, unemployment, exclusion from school, violence, abuse,
grief, family breakdown and difficulty accessing income make up their diverse backgrounds.
Working with a young person in isolation on only one or two issues without addressing any
of their other concerns often leads to less than adequate outcomes. Without the ability
for agencies to be able to work together collaboratively we set up an environment where
these young people are more likely to be caught on the homelessness treadmill.
Back to top
The aim of forming this collaboration was to optimise the treatment outcomes for these young people and their families. The hospital would now be able, with the assistance of the Hospital Links Program, to make direct referrals to Ruby's. In the past this would have meant a lengthy process of negotiation with at least one other referring agency and involved the young person and their families going through two assessments. In turn clients at Ruby's who came via the hospital could access clinical and community services promptly and with a minimum of fuss. Staff at Ruby's were now confident in working with young people who presented with a range of mental health issues.
One area of the collaboration that should be highlighted is the written protocol between these organisations with a focus on shared case management. The protocol clearly delineates each service’s area of case management. For instance Boylan and Adolescent Wards hold clinical case management. HHTT has community clinical case management and YPS holds therapeutic case management and day to day case coordination.
One of the fundamental aspects to ensuring that this collaboration was going to be a success was a commitment by all parties to work as equal partners with open and effective communication.
We do this by:
- Liaison and consultation on a regular basis
- Assisting each other with difficult situations
- Attending each other’s team meetings or ward rounds as required
- Staff networking through service visits
- Sharing training
An unexpected outcome from the partnership has been the level of professional trust
that has grown amongst the agencies on witnessing each other's work practice. This means
that professional conflict is reduced to a minimum and when it does arise there is the
ability to deal with it honestly and effectively. There has developed a maturity of
approach that allows agencies to disconnect from service ego and focus on the clients best
interest.
Back to top
Susan was 16 years when she was referred to Y.P.S. She had been in Boylan Ward for two weeks after an episode of violence and self-harming. Over the last few years she had numerous admissions to hospital for anxiety, depression, self-harming, and violent outbursts. Susan wanted to be at home with her family but they felt unable to deal with her violent outbursts and suicidal ideation. Initially it was thought that she may have to live in the youth accommodation sector but there was fear from her family and workers that this would have disastrous results. Susan saw a private psychiatrist who prescribed medication to assist in the management of her issues. Definite diagnosis was difficult due to her complex needs. The hospital referred Susan to Hospital Links who in turn referred her to Ruby's. YPS held an interview at the hospital and Susan was accepted into the service.
Hospital Links immediately organised a case conference with her psychiatrist, Boylan Ward, ASEC, Ruby's, Susan and her family. This meeting was to define areas of responsibility and set out a case plan in the event that Susan would need to be readmitted to hospital. This plan was written up and placed in the front of her Hospital and YPS files. Accident and Emergency, Boylan Ward, Adolescent Ward, and YPS staff would then be aware of the procedure for readmittance. In this case, clinical case management was held by her psychiatrist who gave Ruby’s a 24-hour contact number to be used at any time if advice and support was required.
Over the 9 months that Susan was involved with Ruby's she had one visit to Boylan Ward. This was planned and seen as Susan taking care of her mental health. She saw her psychiatrist fortnightly and a Ruby’s staff member attended the last part of each session to pass on and gather information. She attended ASEC 2 days a week and they assisted her on returning back into the education system.
Susan is now living successfully at home and is doing well in her studies.
The following data was collected by Ruby's and starts from the inception of the protocol in 1997 to Dec. 2000. The focus for Ruby's around the clients covered in this data is the restoration of young people back home to their families with appropriate support from the community based mental health sector.
Printable Version