1200 Tymur Hussein - The Lighthouse Institute
3/27/2015 Lighthouse Institute Conference 2015 Treatment of ASD in Residential Out-of-Home Care Settings: A Case Study Outline ● Overview of Lighthouse Foundation ● Case Presentation ● Learnings Tymur Hussein, Director of Care Services Lighthouse Home Experience Theoretical Underpinnings • • • • • Attachment Theory Object Relations Psychological Wellness Care Team Carers Social Worker Psychologist External Consultancy Primary Experience IDP Community Events Transition Planning Therapy Supervision Risk Assessments Learning 4 Life Professional Development Trauma-Informed Systems of Care Trauma Neurobiology Assessment, Intervention, TOA Young People Profile at Intake Journey of YP through the TFMC™ (2012 – 2013) 17y Lighthouse Process 17% engaged in employment 20% engaged in training/educ ation 74% present mental health issue and/or diagnosis 27% present with charges & convictions Time-frame Intake Induction Weeks / Months Lighthouse Home Months / Years Transition After Care Months / Years Psychological Healing Process Identity confusion Attachment difficulties Holding space Trauma work Dealing with loss and rejection Developing insight and awareness Building trust in relationships Internal working models Developing autonomy New skills consolidation Confidence in relationship building Individual Development Plan Learning Physical development Emotional development Attachment Identity Social development Autonomy / life skills Relational and community Connectedness Fun / play / recreation Transition planning 1 3/27/2015 Projective Identification In projective identification the person who is targeted with the projection begins to behave, think, and feel in a way that is consistent with what is being projected into him Collective W Personal Projection Projective Identification Therapeutic Outcomes Assessment (TOA) The TOA™ is comprised of a survey measuring the following (8) developmental areas: ● Learning ● Physical Development ● Emotional Development ● Attachment ● Identity ● Social Development ● Autonomy/Life Skills ● Relational/Community Connectedness Relational Wellness can only be achieved through the combined presence of personal, relational and collective wellbeing LHF Trauma Informed Program Emphasis on clinical supervision and reflective practice Articulated theoretical framework Whole of organisation knowledge development program Completed every 6 months by young person, Carer, Psychologist, and Community Care Worker All staff role model a healthy sense of community Organisation is a therapeutic environment Internalised by the child Operations attuned to the therapeutic task Language is consistent, relationship orientated, and strength-based The Organisation as Therapist DSM-5 Criteria …continued A. Persistent deficits in social communication and social interaction across multiple contexts D. Symptoms cause clinically significant impairment in social, occupational or other important areas of current functioning B. Restricted, repetitive patterns of behaviour, interests or activities C. Symptoms must be present in the early developmental period E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder), or global developmental delay 2 3/27/2015 Case-Study: Danny • 16 year old male • Removed from bio parents due to neglect, placed in foster care • Diagnosed with RAD & ASD • Environmental neglect whilst in foster care • Came to Lighthouse Home in late 2013 Case-Study: Danny Danny presented with the following: • grief and loss • difficulty forming relationships • restricted interest in computer games • limited social reciprocity • difficulty seeing other people’s perspectives • no interest in attending community events …continued • limited independent living skills • difficulty planning ahead Therapeutic Plan Learning • Support continued engagement in a supported education environment. • difficulty regulating emotions • engaged in education Physical Development / Life skills • Ensure routines well-structured and communicated • Structured schedule re self-care • Cooking night …continued Circle of Friends task Emotional / Social Development / Attachment • Set scripts when apologising for upsetting behaviour • Give concrete examples and clear instruction 3 3/27/2015 …continued …continued • Learning when it is ok to hug and not ok to hug Community Connectedness • Work with other young people on how to best communicate with Danny • Regular community events • Consistent feedback from care team for building instrumental skills • Graduated community engagement • Affective education and emotion management Challenges …continued Sexualised Behaviours • Staff changes • Change in home environment • Competency development of care team • Being specific and advisory Therapeutic Outcomes …continued Learning Community Connectedness • • • Continues to be engaged in school Willingly attended birthdays and celebrations Participated in Community Family Meeting Physical Development / Life Skills • • Responding well to structured activities and routine Responding well to change Emotion / Social Development / Attachment • • • Conducts greetings and farewells Increased social reciprocity Secure attachment 4 3/27/2015 Learnings Questions Natural Setting Relationship and Community Focus Integrated Care Team Approach • Attachment and subsidiary attachment figures • Multidisciplinary team • Outcomes focused Professional Development and External Consultancy References The Department of Communities, Queensland: Positive and Protective: Identifying and Responding to Sexual Behaviours in Children and Young People. 2010. Facilitator Kit and Participant Workbook. www.communities.qld.gov.au/resources/childsafety 5
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