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By Christine Miller MAPS and Amanda Bond, Adolescent Forensic Health Service, Centre for Adolescent Health, Melbourne.

Working with young offenders poses unique challenges. They engage in risky behaviours, have significant primary health needs, and possess a range of mental health issues and complex behavioural concerns, including their offending behaviour. They have a high need for general and specialist healthcare, yet by and large are disenfranchised from the service system. For psychologists in particular they represent a group who may benefit greatly from mental health and behavioural interventions, but the very nature of young offenders' presentations - their lifestyle, their attitudes, their developmental phase - means that they are unlikely to engage in traditional talking therapy. In order to work with these young people, clinicians need to be creative in their approaches, and services need to be dynamic and innovative in their delivery to engage and motivate them.

About the Adolescent Forensic Health Service

The Adolescent Forensic Health Service (AFHS) is a unique service that offers a holistic approach to health care to young men and women aged between 10 and 21 years who are on juvenile justice orders in Victoria. AFHS has been operating since 1999 and is funded by the Juvenile Justice and Youth Services branch of the Department of Human Services Victoria. AFHS is a multidisciplinary service that integrates primary health, mental health, alcohol and drug treatment, health education, counselling, family therapy, and offence-specific interventions. The aim of the service is to improve the overall health and wellbeing of young people, reduce offending behaviour and improve community safety.

AFHS provides clinical services, health promotion and education, and offence-specific programs to young people in custody and on community based orders. Clinical services include general medical, sexual health, alcohol and drug treatment, dental, optometry and physiotherapy care, in addition to specialist forensic assessment, individual, group and family therapy, dual diagnosis interventions, and forensic child and adolescent psychiatric care. The Health Promotion and Education unit's focus is to promote healthy behaviours and reduce harm through education. The unit covers a broad range of topics that are of particular relevance to at-risk young people, including alcohol and other drugs, blood borne viruses, sexual health, parenting and nutrition. AFHS also offers three offence-specific programs - the Be Real About ViolencE (BRAVE) program for young men and the Relationships And ViolencE (RAVE) program for young women, which focus on violent offending; and the Male Adolescent Program for Positive Sexuality (MAPPS), which focuses on sexual offending.

How therapy is done

Health education, safe behaviour, mental health, the dangers of alcohol and drug use, and counselling are not ideas that are immediately attractive to young offenders. Messages promoting healthy behaviours, reducing harm, and encouraging behaviour change need to be delivered in a way that ensures that young people will listen and engage. Young offenders present with a variety of disruptive behaviours, and frequently show poor attention and concentration. Therapeutic modality is particularly important and at AFHS we use a variety of experiential techniques in the hope of capturing and maintaining young offenders' interest.

Language can often elude young people. Props are used to assist communication; drama and role play are used to demonstrate behaviour and act things out, as opposed to talking about them; and art work is used to encourage young people to represent their thoughts and feelings. Group work offers young offenders the opportunity to work with, and learn from, their peers. The challenging of beliefs that occurs within the peer group and the opportunity to practice pro-social behaviour and receive feedback is seen as an important dynamic in motivating and assisting change. Peer educators are used to deliver health education workshops, and outreach is used where possible in the community to bring service delivery to the young people.

One of the unique aspects of the sexual offending program, MAPPS, is the transition camp in which the young people attend a three-day intensive wilderness-based program. The camp uses adventure activities such as abseiling to physically challenge the young people, then draws on their emotional reactions in therapeutic activities to assist them to recognise and understand their own feelings and develop empathy.

For further information regarding the service or any of the programs offered please visit our website www.rch.org.au/afhs or contact the authors christine.miller@rch.org.au, amanda.bond@rch.org.au