By Christine Miller MAPS, Manager of Forensic and Mental Health Programs, High Risk Youth Services, Royal Children’s Hospital, Melbourne

When it comes to helping troubled children no one practitioner, profession or service has all the answers. These children present with multiple problems across many domains and as a result there can be a number of different services engaged to provide assistance, treatment and support. In such cases clear and coordinated care, driven by robust and responsive case plans in which roles and responsibilities are clearly set out, is necessary. Where the needs are high, a multi-system approach is utilised that considers the vulnerability of the child, working together to remove or reduce the key risk factors, strengthen the protective factors and take a holistic approach to address the issues related to the child’s wellbeing. This is known as the ‘care team approach’.

Within this approach the psychologist has a pivotal role, particularly in regard to the adoption and implementation of a therapeutic framework for the care team and to ensure that the emotional and psychological needs of the child take priority in the broader case plan. Often the interface of the system can mirror and equal the complexity of the child’s presentation, and be equally as challenging to navigate as any challenging behaviour exhibited by the child. It is therefore important for psychologists who find themselves involved in the care of complex and vulnerable children to understand the nature and operations of care teams and how the role of the psychologist can contribute to achieve positive outcomes for children and their families.

What is a care team?

A care team is the network of professionals, parents, caregivers and any other significant adults that have been gathered around the child and charged with the responsibility of providing quality nurturing care and the coordination of service delivery. The care team is responsible for setting the direction of the child’s treatment, delivering the intervention, managing the ecological impacts and overseeing any statutory requirements.

In theory, care teams can be convened for any child whose particular vulnerabilities and needs are complex and for whom care is delivered by multiple professionals or across a number of agencies and systems. However, the most vulnerable children are frequently engaged in the child protection system and therefore care teams are most commonly set up to support the needs of children under child protective orders and in out-of-home care. The composition of a care team will vary depending on the issues and needs of the individual child and his or her family, however it will always include the child protection practitioner, the child's case manager, the placement agency case worker, caregiver(s) or residential staff and, where appropriate, the parents (Victorian Government Department of Human Services [DHS], 2011). The care team may also be extended to include personnel from any other agencies involved in the child’s treatment, such as drug, disability and mental health services.

For care teams that are convened around children in the out-of-home care system the foundation principles are “the things ‘any good parent’ would naturally consider when caring for their own child” (DHS, 2011). The purpose of any care team is to ensure that services work in an integrated fashion to meet the needs of vulnerable children. Central to this intent for all care teams is the philosophy of collaborative practice and working together in the best interests of the child. The role of the care team is to meet the goals of the statutory case plan and promote the child’s safety, stability and development via direction and management of the range of professionals that comprise its membership. A care team needs to be flexible and responsive to the ever changing needs of the child and should work together in a dynamic way to assess, plan and implement holistic care.

Who leads a care team?

The child protection worker or delegated community services organisation case manager is responsible for coordinating the care team. Given the statutory nature of the lead agency and the fact that the other services involved are typically those which are publically funded, additional funding is not provided for the operation of a care team. Costs are absorbed from within the services and cooperation is driven by the shared commitment to, and recognition of, the need to work collaboratively in the best interests of the child.

Requirements of a care team

The care team is required to make decisions in regard to who will undertake specific tasks to ensure that the needs of the child are being met whilst in out-of-home care. According to child protection principles (DHS, 2011), in carrying out this task the care team is obliged to:

  • Respond to the needs of the child and ensure the placement is providing for the child's safety, wellbeing and stability
  • Work in a collaborative way and contribute towards the development and implementation of the statutory case plan and looking after children framework, which specifies seven life domains important to the healthy development of a child, and ensure that communication is maintained so that all relevant parties are kept up to date with important information
  • Maintain confidentiality and privacy and not disclose personal and confidential information that is not relevant to the provision of good care to the child
  • Support the child's relationship with his or her family where appropriate
  • Share the responsibility for specific tasks such as transport of children for contact visits, medical appointments, educational or therapeutic services and supervising contact visits where possible and appropriate.

Key considerations for care teams

In order to ensure that the philosophy of collaborative practice and the child’s best interests is achieved, due consideration needs to be given to the organisation of the care team and processes that govern it. Mutual co-operation and decision-making based on the combined knowledge and expertise of all members of the care team are the foundations of its effectiveness. When working as part of a care team it is important to be mindful of the broader roles and responsibilities of the other professionals and agencies who comprise the membership of the team, and the team must engage in a robust dialogue as to how they will work in collaboration to be effectual for the child at the centre of the process. As statutory services are involved, certain governance structures, roles and responsibilities can be pre-determined such as the participation of the care team in the statutory case plan and the frequency of meetings for the care team. While these things may seem straightforward, the nature of service systems, the individual considerations of agencies, differing organisational philosophies and professionals’ individually-held frameworks and risk management concerns can all too often lead to systemic conflict that detracts from the central client needs and renders a care team dysfunctional.

A care team in action

A functional and effective care team should demonstrate the following.

  • A care team should have transparent expectations around communication, decision making and attendance.
  • Roles and responsibilities for all members of the care team should be clearly defined. Such role clarification is important to avoid duplication and working at cross-purposes or outside scope of practice.
  • Goals need to be clearly defined and prioritised with all members of the team having a shared understanding of, and commitment to, these goals. Goal setting should include how the needs of the child will be responded to, when these responses will occur and by whom, and what the review dates will be.
  • Dispute resolution processes need to be clearly articulated.
  • Timely information sharing processes that allow for collaborative work but do not breach other codes for confidentiality need to be determined.
  • Meeting frequency and location should be planned and regular.

Psychologists in care teams

Psychologists are frequently amongst the membership of care teams and can provide valuable input to the team. The psychologist typically fulfils the role of therapeutic specialist in the care team and is usually responsible for leading the assessment of the child and developing the therapeutic plan. A comprehensive biopsychosocial assessment provides an understanding of the child’s developmental history and needs from which an intervention plan is formulated. The psychologist is well placed within the team to lead the therapeutic component of the care and ensure that a therapeutic framework is applied to the care plan.

Children develop within the context of family and other significant relationships and it is the quality of these relationships that shapes and forms their future selves. Children with complex needs and those in out-of-home care frequently have histories of traumatic experiences. Experiences such as abuse, neglect, exposure to violence and the impact of other stressors can alter the child’s developing brain leading to long-term emotional, behavioural, cognitive, social and physical problems. Working as the psychologist in a care team involves engaging and educating the other members of the team to understand the child’s behaviour from a trauma informed framework that considers the neurobiology of trauma. Psychologists can engage the other members of the care team in this approach and assist them to understand that the challenging behaviours of these children are a manifestation of what has happened to them. With this assistance, care teams can then develop therapeutic responses to address the child’s needs, manage behaviour and work within the system to create a safe, nurturing and healing environment for the child.

The author can be contacted at Christine.Miller@rch.org.au

References

Department of Human Services. (2011). Child Protection Practice Manual. Accessed 22 May 2012 from http:/www.dhs.vic.gov.au/cpmanual/best-interests-case-practice. Victoria: State Government of Victoria.

In Psych June 2012