Consultation Paper

Now Closed

This online engagement was hosted on YourSAy from 9 November 2020 to 31 January 2021. Find out more about the consultation process. Below is a record of the consultation.

Consultation on the draft Model of Care for Phase 1 of Youth Treatment Orders

Download draft Model of Care for Phase 1 of Youth Treatment Orders consultation paper PDF

The Youth Treatment Orders program provides the option of mandatory treatment for children experiencing drug dependency. The Youth Treatment Orders program is a measure of last resort, where all other appropriate and less restrictive means of drug assessment and treatment have been exhausted.

To provide a legislative framework for the Youth Treatment Orders program, the Controlled Substances (Youth Treatment Orders) Amendment Act 2019 was passed by Parliament on 14 November 2019.

The Youth Treatment Orders program will commence for children experiencing drug dependency in the Kurlana Tapa Youth Justice Centre, previously known as the Adelaide Youth Training Centre, and may expand to other children in the community. Community implementation of the program will depend on a review of Phase 1 of the Youth Treatment Orders program and a further decision by government.

The draft Model of Care for Phase 1 of Youth Treatment Orders for Phase 1 of Youth Treatment Orders (the Model of Care) sets out how the Youth Treatment Orders program will operate in the Kurlana Tapa Youth Justice Centre. The State Government is seeking feedback on the draft Model of Care for Phase 1 of Youth Treatment Orders to ensure the voices of a broad range of stakeholders are heard, including children and their families.

The purpose of this Consultation Paper is to provide a summary of the draft Model of Care for Phase 1 of Youth Treatment Orders and information on how to provide feedback, which can be found at the end of this document. This Consultation Paper should only be used as a summary document and should be read in conjunction with the draft Model of Care for Phase 1 of Youth Treatment Orders document.

A new approach to drug treatment for children

Drug dependency can have a devastating impact on children and their families. The State Government has introduced new laws to allow mandatory treatment for children experiencing drug dependency.

The Youth Treatment Orders program aims to treat drug dependence in children in the hope of reducing the likelihood and severity of drug related harms. Through the Model of Care, the Youth Treatment Orders program has been designed to support children in the Kurlana Tapa Youth Justice Centre and post-release. This includes ensuring the safety, and rights of these children are maintained throughout the program.

Assessment and treatment processes have been informed by the best available evidence for the treatment of children. Special consideration has been given to the provision of trauma informed care and the specific and complex needs of at risk and marginalised groups of children.

The Youth Treatment Orders program does not replace the voluntary drug assessment and treatment services. The program is not a punishment and balances the need to respect the rights and autonomy of children and the special obligation of the community to care for and protect children.

Principles

The Model of Care has been developed with the best interest of the child as the paramount concern. This includes ensuring the mental, physical and social development of each child is a priority, including protecting their autonomy and personal liberty as much as possible.

The Model of Care provides ways of protecting children from activities that could harm their development including the use of dangerous drugs. The Model of Care ensures services provided as part of the Youth Treatment Orders program work toward what is best for each child and protect their right to privacy.

SA Health is committed to providing a Model of Care that provides safe and high-quality treatment. The Model of Care includes principles underpinning the design and operation of the model, intended to optimise the outcomes for children and their families.

A full statement of program principles is at Appendix 1, at the bottom of this page.

Statement of Rights

The Statement of Rights sets out the rights of children subject to court proceedings, and provides information that can be of assistance for children and their families, guardians or advocates. All children subject to proceedings of the Youth Court for Youth Treatment Orders will be provided with a Statement of Rights.

The Statement of Rights outlines the responsibilities of assessment and treatment services as part of the Youth Treatment Orders program. This includes support options for children during assessment and treatment, as well as rights to accessing culturally safe and appropriate health services.

The Statement also includes information on free legal representation available to children, as well as information on rights of appeal of Youth Court orders.

The full Statement of Rights is at Appendix 2 at the bottom of this page.

Aboriginal and Torres Strait Islander children

Aboriginal people experience disproportionate drug-related harms that contribute to the disparities in health and life expectancy between Aboriginal and non-Aboriginal people[1]. This burden also falls disproportionately on Aboriginal children compared to non-Aboriginal children and Aboriginal children are overrepresented in juvenile incarceration, including Kurlana Tapa Youth Justice Centre.

The Model of Care recognises that Aboriginal children require safe and culturally responsive services that are holistic and address a broad range of social and emotional needs as part of treatment for drug dependency. Assessment and treatment for Aboriginal children under the Youth Treatment Orders program will be accessible, culturally appropriate and prioritise connections to family and community. In recognising the strong evidence of the effectiveness of family therapy in reducing substance use in children, the Model of Care recognises the importance of having trained Aboriginal staff to work therapeutically with Aboriginal children and their families and carers and provide linkages to culturally appropriate programs, services and professional staff.

Responding to the individual needs of children

Children from culturally and/or linguistically diverse backgrounds, children with disability and children with co‑occurring mental health issues have the right to be treated on an equal basis as other children. Assessment and treatment services provided as part of the Youth Treatment Orders program will be provided to these children in a way that is accessible, inclusive and individualised according to the child’s needs.

Youth Treatment Orders assessment and treatment processes have been developed to minimise the risk of traumatising, or re-traumatising, children subject to orders. This includes application of trauma informed principles throughout the program, as well as access to interpreters and the provision for a Youth Court authorised person to accompany the child to program related appointments.

To ensure the voices of children are heard as part of this consultation, documents which outline the draft Model of Care for Phase 1 of Youth Treatment Orders and respond to frequently asked questions have been developed in a format which can be understood by children.

We have created a Consultation Paper Easy Read Version and Q&A Easy Read Version.

Draft Model of Care for Phase 1 of Youth Treatment Orders

The draft Model of Care for Phase 1 of Youth Treatment Orders defines the way health services are delivered under the program, and sets out the principles, governance and service delivery arrangements for the effective implementation of the Youth Treatment Orders program. It sets out agency roles and responsibilities in the delivery of assessment and treatment services, as well as a clear Statement of Rights and obligations of children who are subject to orders. The Model of Care applies only to children subject to detention in the Kurlana Tapa Youth Justice Centre.

The Youth Treatment Orders program is informed by the best available evidence for the treatment and care of children experiencing drug dependency. Importantly, the Model of Care ensures that all processes and services delivered through the program have the best interests of the child as the central and paramount concern.

The Model of Care was developed by SA Health in collaboration and consultation with multiple stakeholders across South Australia. This includes Chief Executive nominees to the Interagency Working Group developing the Model of Care: the Attorney-General’s Department, South Australia Police, the Department for Child Protection, the Department for Education, Courts Administration Authority, the Department of Human Services and the Department of the Premier and Cabinet.

SA Health are represented on the Interagency Working Group by Drug and Alcohol Services South Australia, Child and Adolescent Mental Health Services and the Office of the Chief Psychiatrist

There are three stages to the Youth Treatment Orders program:

1. Application to the Youth Court: A parent, guardian or another person with a proper interest in a child applies for the Youth Court seeking mandatory drug assessment of a child if they are concerned the child may be drug dependent and at risk.

2. Assessment Order: When in the best interest of a child, the Youth Court can make an Assessment Order if it is satisfied that:

• there is a reasonable likelihood that the child is habitually using one or more controlled drugs; and
• the child may be a danger to themselves or to others; and
• the child has refused to voluntarily seek a relevant assessment; and
• no other appropriate and less restrictive means is available to ensure the child receives a relevant assessment.

The child will be required to attend the Kurlana Tapa Youth Justice Centre health centre where they will be assessed by a Child Psychiatrist, Addiction Medicine Specialist and Paediatrician. The assessment may recommend treatment and provide an opportunity for voluntary engagement.

3. Treatment Order: The Youth Court may make a Treatment Order if a child has been assessed as being drug dependent in accordance with International Classification of Diseases Version 10 (ICD-10) diagnostic criteria, and the Court is satisfied that:

• the child may be a danger to themselves or to others; and
• the child has refused to voluntarily seek relevant treatment; and
• no other appropriate and less restrictive means is available to ensure the child receives relevant treatment; and
• the treatment and care pursuant to the order will be governed by an appropriate treatment and care plan directed towards treating the child’s dependency on controlled drugs.

The Treatment Order is only made when the Youth Court is satisfied that treatment is governed by an appropriate treatment plan developed after a comprehensive assessment taking into account individual needs, comorbidity issues, patient preferences, and requirements of Youth Treatment Orders legislation has been prepared following consensus by the assessing medical consultants. The Treatment Order requires the child to receive treatment as set out in the treatment plan.

A Treatment Plan can be made for up to 12 months. Treatment is completed when:

• the Treatment Order expires
• significant goals of the treatment plan are met, or
• the term of custody expires.

An overview of the draft Model of Care for Phase 1 of Youth Treatment Orders is presented below.

Case Coordination Team

A Case Coordination Team will be established to facilitate the program between the Youth Court, the Kurlana Tapa Youth Justice Centre, health services and other service providers assisting the child and family or carers. The team will be staffed by qualified allied health and Aboriginal health staff, with experience in working with children.

The Case Coordination Team will be responsible for:

• ensuring children subject to the Youth Treatment Orders program are treated in line with the principles of the program
• facilitating access to community-based services available under the program for children in the community with substance use problems where they are not being used by children released from the Kurlana Tapa Youth Justice Centre
• providing information to families and carers regarding community-based assessment and treatment services and supports available to assist them and their child once released from Kurlana Tapa
• facilitating information sharing (in accordance with legislation and information sharing guidelines) between agencies to support informed and effective decision making that is in the best interests of the child
• liaising with services currently engaging with the child and family or carer (in accordance with legislation and information sharing guidelines) in order to facilitate comprehensive and coordinated care for the child
• working with Kurlana Tapa Youth Justice Centre staff to assist in the coordination of services delivered in Kurlana Tapa
• liaising with treatment services being provided as part of the Youth Treatment Orders program to ensure comprehensive transition planning is in place for children transitioning to the custody of the Department for Correctional Services while subject to a Treatment Order
• coordinating aftercare and follow up for a child exiting the program and their family or carer for up to 12 months to support a continued link to voluntary services, where appropriate.

Follow up and support from this team will be available for any child who has been subject to an Assessment or Treatment Order, for up to 12 months, depending on their individual circumstances and needs and will continue to be available to the child even if they turn 18 years of age during this 12 month period.

Application for assessment

Parents, guardians and other people with a proper interest in a child may apply to the Youth Court seeking mandatory assessment of the child who is already subject to detention in the Kurlana Tapa Youth Justice Centre.

The Case Coordination Team will engage the child subject to an application and their families to provide information, support and advice regarding Youth Court proceedings and the Youth Treatment Orders program.

Every child subject to Youth Treatment Order proceedings is entitled to be represented by a legal practitioner at no cost to the child. The child will be informed of their right to legal representation in the Statement of Rights which must accompany every application. If the child opts to be represented it is anticipated that in most cases, either the Legal Services Commission or the Aboriginal Legal Rights Movement will be appointed to provide representation.

Assessment Order

The Youth Court can make an Assessment Order in respect of a child who is already subject to detention in a training centre at the time the order is made. The Youth Court may make an Assessment Order if satisfied that:

• there is a reasonable likelihood that the child is habitually using one or more controlled drugs; and
• the child may be a danger to themselves or to others; and
• the child has refused to voluntarily seek a relevant assessment; and
• no other appropriate and less restrictive means is available to ensure the child receives a relevant assessment.

The assessment will take place within 2 business days of the order being received. Assessment will be undertaken in the Kurlana Tapa Youth Justice Centre health centre, a separate environment within the centre campus that provides rooms for confidential assessment, treatment and counselling.

The child will attend an appointment where they will be assessed by a Child Psychiatrist, Addiction Medicine Specialist and Paediatrician who will be assessing factors relevant to their speciality. The appointment will be conducted in one location for the minimum reasonable time required for an appropriate assessment. A consolidated report will be provided to the Youth Court.

A child subject to an Assessment Order may request independent medical drug assessment for submission as evidence to the court. The legal representative, support person or advocate of the child will facilitate this process. The Legal Representation Scheme, to be established under the Act, will fund costs associated with obtaining independent evidence.

Treatment Order

Following assessment, the Youth Court may make a Treatment Order if a child has been assessed as being drug dependent in accordance with International Classification of Diseases Version 10 (ICD-10) diagnostic criteria, and the Court is satisfied that:

• the child may be a danger to themselves or to others; and
• the child has refused to voluntarily seek relevant treatment; and
• no other appropriate and less restrictive means is available to ensure the child receives relevant treatment; and
• the treatment and care of the child pursuant to the order will be governed by an appropriate treatment and care plan directed towards treating the child’s dependency on controlled drugs.

The senior medical consultants will develop a treatment plan as part of the assessment process. The treatment plan will identify goals, risks, and appropriate treatment options. The treatment plan requires regular review and updates over time in line with the child’s progress towards treatment goals and ongoing requirements.

Evidence-informed treatment options include:

• withdrawal management followed by discharge into continuing treatment
• psychosocial interventions including comorbidity interventions for example:
  • Cognitive Behavioural Therapy (including relapse prevention)
  • Motivational Interviewing
  • Case Management
  • social skills training (focussing on issues relating to drug dependence), building social network/social capital
  • harm reduction education
  • relapse prevention planning
• youth therapeutic interventions for mental health comorbidities (integrated care with substance use treatment)
• family support and counselling
• medication assisted treatment (where appropriate)
• aftercare
• program engagement enhanced by reward strategies (positive reinforcement, avoiding punishment orientated approaches).

Treatment will be delivered in the Kurlana Tapa Youth Justice Centre health centre. Treatment will be offered at times that suit the child’s overall program at the Centre.

A Treatment Order can be made for up to 12 months. However, a Treatment Order can be changed or revoked if the Youth Court is satisfied that there has been a significant change in the circumstances which led to the harmful drug use by a child. Processes for changing or revoking an order are outlined in the draft Model of Care for Phase 1 of Youth Treatment Orders.

Treatment is completed when:

• the Treatment Order expires
• significant goals of the treatment plan are met, or
• the term of custody expires.

Relapse prevention and aftercare

A transition plan is developed alongside the treatment plan to support the child’s continuity of care following release from the Kurlana Tapa Youth Justice Centre. Transition plans are regularly reviewed for all children engaging in treatment as part of a Treatment Order.

Children subject to Treatment Orders are involved in pre-release transition planning and linked with a relevant community-based service(s) for drug treatment prior to release whenever possible.

Aftercare will be provided for up to 12 months by treatment providers, in the form of follow up, support for relapse prevention and residential rehabilitation as required. Children receiving treatment in residential rehabilitation will receive education support which is age and developmentally appropriate.

As an additional measure, the Case Coordination Team coordinates follow up and aftercare to children and families. This involves providing outreach to homes, other services, or public places to connect with children and family members. Continued support is provided post-treatment including harm reduction and relapse prevention strategies, referral to relevant services and case management. Services are provided on a voluntary basis.

The Case Coordination Team can also coordinate support to children and families who are waiting for available services or children who experience barriers engaging in treatment services.

The Case Coordination Team is not able to provide face to face services in rural and remote areas, however it can coordinate Drug and Alcohol Services SA and Child and Adolescent Mental Health Service staff (in person or via tele-health) to provide follow up in regional areas.

These services will be made available to other children in the community if not being utilised by children released from the Kurlana Tapa Youth Justice Centre.

Working with family

The involvement and needs of families and carers of children subject to Youth Treatment Orders have been considered throughout development of the draft Model of Care for Phase 1 of Youth Treatment Orders. Participation of families in a child’s treatment will always be considered, and where appropriate families will be included as part of the treatment plan. The treatment plan will ensure no further harm to a potentially strained relationship between the child and their family.

The Case Coordination Team will provide aftercare and follow up for children exiting the Youth Treatment Orders program and their families for up to 12 months, on a voluntary basis.

In matters where there is concern that a child is at significant risk of abuse or neglect, a notification to the Child Abuse Report Line will be made and information will be assessed as per Department for Child Protection policies and procedures.

Family and advocate access to information

All children engaged in the Youth Treatment Orders program will have the opportunity to nominate an advocate or family member who they wish to be kept informed about their progress in the program. The child’s legal representative will assist the child to identify and nominate this advocate or family member.

Nominated individuals will have the child’s permission to receive information about their treatment progress and assist in transitioning the child through Youth Treatment Orders program into voluntary treatment, relapse prevention and aftercare.

Visitor scheme

The Training Centre Visitor is an independent statutory officer who reports to Parliament through the Department of Human Services. The Training Centre Visitor’s role is to promote and protect the interest and rights of children sentenced or remanded to detention in a youth training centre in South Australia.

Children subject to Youth Treatment Orders in the Kurlana Tapa Youth Justice Centre will receive the same protections afforded to any child sentenced or remanded to detention in the Kurlana Tapa Youth Justice Centre, including access to the Training Centre Visitor.

Evaluation and reporting

The Department for Health and Wellbeing will prepare an annual report detailing statistical information on uptake, demographics and costs associated with the Youth Treatment Orders program. Information pertaining to children subject to Youth Treatment Orders will be de-identified.

Recognising this program is new to South Australia, an independent evaluation will be conducted by an independent research institution with experience in this area.

The evaluation will assess:

• how effectively treatment service providers are meeting child and family needs and provide recommendations for areas of improvement
• identify any adverse events and unintentional consequences of the Youth Treatment Orders program and associated Model of Care for Phase 1
• assess the impact of the program on specific groups of children, for example, Aboriginal children, their families and communities, and those under the guardianship of the Minister
• compare the relative effectiveness of the Youth Treatment Orders program among children who are subject to custody within the Kurlana Tapa Youth Justice Centre with existing voluntary treatment outcomes, and
• make recommendations to inform any further expansion of the program.

An evaluation report will be provided by the Minister for Health and Wellbeing to Parliament between the third and fourth year after commencement of Phase 1 of the Youth Treatment Orders program. Implementation of Phase 2 of the program for other children in the community will depend on a review of Phase 1 of the Youth Treatment Orders program and a further decision by government.

Appendix 1 – Program principles

[1]. Wilson, M., Stearne, A., Gray, D., & Saggers, S. (2010). The harmful use of alcohol amongst Indigenous Australians.