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
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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
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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
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…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
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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
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