Working with Children with Complex Presentations: A New Zealand Approach
2002; Volume: 31; Issue: 2 Linguagem: Inglês
ISSN
0112-109X
Autores Tópico(s)Family and Disability Support Research
ResumoThis paper describes ongoing research and practice undertaken by Department of Child, Youth, and Family specialists and social workers Working with two children described as having high and complex needs. The paper first describes characteristics (familial, historical, behavioural, cognitive) of each child and the previous diagnostic understandings formed about them. It then describes the theoretical models used and the programmes developed to address each child's individual complex needs. The interventions were conceptualised as multi-disciplinary and multi-systemic. An Action Research approach was used. This allowed constant adjustment of the intervention to account for developing understandings gained with regard to the theoretical constructs, as well as the ability to respond appropriately to the daily practical experience of the children and those involved with them. ********** The and Complex Needs Programme was developed within the Department of Child, Youth, and Family (CYF), in a move towards greater intersectoral collaboration. It is aimed at children identified as having needs for care and treatment so severe that they require a specially tailored, individually developed intervention. Wells and Smith (2000) estimated that approximately 120-200 children within New Zealand currently meet this criterion. They found that one third of the Department's clients had a moderate to severe mental illness (assessed by ah appropriate clinician), and service provision to these clients was problematic. CYF Tauranga was given High and Complex Needs funding to develop a wrap-around programme for two identified special needs children. The site was very representative as it contains both the best and worst social indices in the country. No body of research of practice exists in New Zealand with respect to the design, management, implementation, and delivery of treatments for multiple needs children. Interventions for the two boys we have named Jack and David, had to be designed and delivered in the absence of practice wisdom, programme guidelines and protocols, or a body of trained staff. The interventions had to be designed, implemented and evaluated as a stand alone project. Child Characteristics Jack Aged 11, Jack is one of four children born to a mother with a diagnosis of severe paranoid schizophrenia. His grandmother also has this diagnosis. Both women remain in sheltered care. His father, in whose sole care he mostly lived up to the age of 5, has been described as unusual, socially isolate, with strange ideas about life and about Jack. Jack has a complex ethnicity of mixed Eastern European/ New Zealand European/Central American heritage. He came into the care of CYF service when he was abandoned by his father at age 5. At that time Jack stated that he thought he was a car (an Austin Princess). He has supervised contact with his mother. Jack has a complex psychiatric and medical history, first identified as having (possible/potential) mental illness at age 5. Suggested diagnoses (made by both psychiatrists and psychologists over the next 7 years) included Asperger's Disorder; Pervasive Developmental Disorder; Autism; Atypical Depressive Disorder; Schizotypal Personality Disorder; Attachment Disorder; and Post-traumatic Stress Disorder. There has been considerable conflict among professionals about probable diagnosis, treatment, and medication. More recently he has been found to have some neurological problems. Long term observation of Jack since he came into CYF care, suggests he shows strong indicators for a history of disturbed (disorganised) attachment and experience of significant abuse and trauma from ah early age. He is highly reactive to verbal cues (raised voices, critical comments or teasing), has little sense of social relationships, poor management of internal emotional states, and a limited sense of himself. …
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