Young people transitioning seminar - video transcript

(Damian O'Neill - a Senior Analyst within the Oranga Tamariki Evidence Centre)

(Māori spoken) Good morning, tenakoto katoa. (Māori spoken 00:09) 

Welcome to the end of the working week and a second presentation on our precious young people. In this presentation I'm going to talk about a survey we
did of the young people, 15 to 17 year olds, who are moving out of care, out of the care of the chief executive, into independence.

And before I talk about the survey findings, some research context -- the context for the research.

So each year 600 15 to 17 year olds currently in the care of the chief executive move away, hopefully on a journey towards successful independence and
adulthood. These are primarily coming out of youth justice facilities, out of whānau caregiving arrangements, foster care and NDI(?) residences.
This cohort, the 600 people a year moving out of care, they typically have poorer wellbeing outcomes than the average New Zealand 15 to 17 year old who
hasn't had any contact with Oranga Tamariki. The IDI tells us that this cohort is ten times more likely to be involved in minor offending, 50 times more
likely or around 50 times more likely to be involved in serious offending. They're half as likely to have left school with a qualification, three times
more likely to have wound up in hospital before they turn 20.

So it's a cohort we are worried about and from next year we've got new legislative obligations on Oranga Tamariki to assist these people. Primarily we
need to be keeping contact with them and providing advice and assistance for them up to the age of 21 and then being available for more advice and
assistance up until 25 and also up until the age of 21 we need to be providing them with some kind of caregiving support if they want to come back to live
with a caregiver we need to help them do that.

So to meet these new legislative obligations we developing a new transition support service, Oranga Tamariki. So it's a exciting new service, people are
very focused on this at the moment, as you would expect, and it's going to help us meet these obligations and turn these stats around.
So why do we do the research? Well, to build a systematic understanding of the transitioning cohort. So we have some insights from a lot of research in
the past and from the IDI and so forth, but there are some things we don't know enough about, about the prevalence of certain needs and circumstances and
the service availability for this group.

So a survey was a way to get the systematic information about that, about the prevalence, and all of this is designed, or intended to, inform the design
of the new transition support service. And if we get the transition support service right then the young people leaving our care are going to be better
prepared and supported to manage their transition.

So we do want to make sure that we get the service right. Often people try to set up new things and they don't work quite so well and some examples of
that include, you know, the Wellington bus service which is a dog's breakfast, as we know. Brexit is that a train wreak coming or what? But there are
some good examples where things do work out well and, like Susan here, I have a fondness for quotes. It's a hundred years old from across the Atlantic,
but it is so poignant that I'd like to share it with you. So this is from Franklin Roosevelt the former United States president, coming out of the
depression of America, some bold new thinking:

"We cannot always build the future for our youth but we can build our youth for the future."

So you know a huge investment approach and a break for tradition for the United States investing in infrastructure and people. And for us I think it's
really poignant for our service because we can't keep these young people in care, but we can set them up and help them so that they're ready and they are
successfully moved to independence.

Personally I think he's probably the best United States president in the last 100 years. The current one notwithstanding.

So what do we do? We assess the need across the full cohort, the level of need. So what proportion of a low, medium, high, and very high risk. So we
looked at a bunch of risk factors across the group and we found that 40% were very high or high needs. So they're most at risk, and that's something like
240 young people a year in this category.

So we undertook a survey of these young people or about these young people so that we can make sure the service was going to be informed by their needs
and if we can get their needs met not only will we turn the stats around, but also that the medium and lower needs people will benefit too because the
services will be available for them also.

So just quickly talk about methodology. We randomly selected 135 young people who we'd identified as high or medium high needs and we undertook a bunch
of structured interviews, 120 structured interviews with the social workers who knew the young people best. So we didn't interview the young people, it
was the social workers who knew them and knew the lay of the land with regard to service availability. It was a structured interview around their
relationships and their behaviours, their needs and the challenges that they're facing, their service requirements and the availability of those services
in the area. These interviews took about 30 minutes, they were undertaken by a team here in Oranga Tamariki who knew about high needs people, and we got
a great response rate of 89% which demonstrates the level of commitment from the social workers to take that time out and also from this team who followed
up with them and made times to interview them over the phone whenever the social worker might be available.

So between the 89 survey response(?) rate, which was phenomenal for a survey these days, as you probably know, the high numbers of people that we
interview, it ended up being 120 and the random nature of the survey. You know for us that's all just great, it gives us a real sense of -- it's a robust
methodology that's convincing for the likes of Treasury, because it gives us narrow confidence intervals and we can generalise to a wider population which
is the high needs cohort moving out annually.

So what did we find? Just getting on to the results now. There's four main chunks to the results so I'll move through them relatively quickly. And the
full report is now available online too, so if you want to explore them in more detail I'll give you the link at the end of the seminar. So firstly we
found one in five young woman are a parent or a caregiver or expecting to be. One and three of the young people were in a new placement in the last three
months, which is a relatively high level of instability. And that may reflect the past instability with the time and care with Oranga Tamariki and it's a
predictor of future instability as well, which the worst case scenario is homelessness and a third not in regular education training or employment. So
that's a worry. They're a NEAT(?) -- a third of them are a NEAT and likely(?) this reflects some instability and where they're living, it means that
they're not connecting to services or schools if they're moving around a lot and not building up the relationships that they need. And we found that
three and five have a trusted positive adult in their lives, which is great. That's really important for resilience, as the literature tells us, that
there is someone there for a soft landing to support them and they can learn from the mistakes in that context. But two in five don't have that. So
that's a concern for us and that's something that the service will be aiming to address. And three in five exhibit dangerous or risky behaviours weekly.
So nine out of ten of these young people regularly were a danger to themselves or others, so that's alarming. Three and five of them, 60%, once a week at
least, they were doing things like lashing out and assaulting people, verbally abusing people, stealing, absconding, hanging out with dangerous types,
dangerous other people. This is what's coming through in the survey. And it was widely seen as such low emotional regulation. So it was really
spontaneous acting out behaviour for a number of them.

So the second part was around health and disability related needs. So we asked around three particular types of health and disability related needs
because we knew that that was a likely feature of this group. Firstly we looked at mental health. So we found that four and five, 80%, had a mental
health need. Primarily, or half of the cohort, there's 120 per annum leaving care have a trauma or stress related disorder. Nearly a third have an
anxiety disorder like obsessive compulsive disorder. And a quarter had a depressive disorder. And there's a lot of interrelationships between these if
you had one you're likely to have a few mental health issues, but these were the three main ones.

When I think of my time working in mental health services, half have a traumatic or stress related disorder, I think of two types in particular, these are
the post-traumatic stress disorders where something really stressful has happened to you. Shocking, you know, possibly before care, maybe during care in
Oranga Tamariki and these things really impact on young people, more so than they do adults, we're able to put things into context that much more. And
post-traumatic stress disorder is a syndrome of behaviours of panic attacks and anxiety and acting out depressiveness. So that's the stressor related --
post-traumatic stresses related disorder. The other one I think of is the emotional attachment stress disorder, where if a young person's been let down
when they're younger and people haven't been there for them, they develop a reaction to forming relationships. So they avoid forming strong bonds with
people because they possibly expect the worst to happen, they're going to be let down, so they have a sort of stand alone posture in the way they engage
with the world. So they're difficult to engage for us as an organization.

Three in five have a substance abuse issue. So half are smoking marijuana, a third are drinking alcohol, one in six are using tobacco and synthetic
cannabis. Less than 10% we have found were using methamphetamine or P, which we half expected high rates of that. In the YHA(?) population much more
highly represented in this group. And again if you're a 15 year old sitting at home drinking alcohol or going out and under a bridge or something you're
likely to be smoking alcohol -- smoking pot or tobacco as well.

Half of the people have a disability. These were mainly neurological disabilities, so a quarter of the cohort had a neurological disability, like foetal
alcohol syndrome, autism or Asperger's disease. And one in five had an intellectual disability.

Things like physical disabilities, sensory disabilities, learning disabilities, again, we found they were less than 10%, so smaller than we anticipated.
And just finally on health and disability we found a high rate of comorbidity. So most of these young people had multiple needs, complex multiple needs.
So within the substance abuse camp and the mental health camp, if you had one you're likely to have more needs just within those needs. But across the
needs we found that two thirds had more than one need type. So if you had a stress related disorder you're likely to be abusing substances, if you had a
disability you're more likely to have an anxiety disorder as well.

So this is a sense that -- and for this population the needs aren't simple and straightforward, they are complex, compounding and the new service is
really going to have to get on top of assessing needs and understanding them and planning for them with an integrated service response.
Thirdly we looked at service availability and take up. And across the three types of needs we found a theme of patchiness in availability. So firstly --
well, just only, we've only got time to look at one, I'm going to look at the mental health needs. The four out of five who had a mental health need.
And the social workers told us that these young people would benefit from the kind of services they needed, really were mainly DHB, children and
adolescence mental health services, from NGO's treatment programs and also from private counsellors and therapists doing stress related therapeutic
programmes like dialectical behavioural therapy.

So of these people with mental health need, seven in ten were thought to have the mental health services that they need available to them. Which you can
look at this two ways, that's great, most of the people have a sufficient level of service available to them, but three in ten did not. They may have had
some partially available to them, but three in ten did not. So that's a cause of concern for us and it's worse in the provincial and rural New Zealand.
And then we asked, "Well so who's taking up these services and what are they doing to meet their needs and are they meeting their needs?" We found that
four in ten were accessing the services and meeting their needs. Again some are doing this in a piecemeal or sporadic fashion, but only four in ten were
seen to be addressing their needs. There's lots of good reasons for this and the new service is going to have to be very mindful of these, but these are
things like transport issues, motivational issues, it's probably not a priority for a teenager to be attaining treatment programmes and there's a history
of suspicion of services and government as well, if not Oranga Tamariki they may well have had poor experiences also with the providers of these health
services. So that again is another barrier, and of course they're optional as well.

And finally we looked at living arrangements going forward, because this is one of the things that we need to be on top of because the new legislation
requires us to provide caregiving support once these young people -- or for these people once they leave care right up to 21. So we asked what kind of
living arrangements they're going to need going forward and three out of four were identified as requiring some kind of supported living arrangement. So
basically roughly a quarter required 24 hour support, these tended to be the people with disabilities currently in NGO residence. Another quarter were
seen to be much more able to be relatively more independent, but they would still need some on-call support. So they might be able to flat but they were
seen to be best flatting near someone who could be there to -- they could call on at the drop of a hat to help them. And we've got some really good
examples of that with a few NGOs around New Zealand at the moment working with Oranga Tamariki and these tend to have a flat on site of where their
properties are or they might have a cluster of flats and there might be a supervisor able to live in one of those flats and some young people are living
in the other flats by themselves or with others, and that's kind of testing their independence and building up their independent skills, but they might
need to call on the supervisor to help them move people out of their flats who they don't want there, their friends that pop in or they might have a drug
overdose or anything like that or it might be as simple as helping them cook a meal. And these on-call supports living nearby arrangements with a
supervisor, they're great for this notion of building up life skills or scaffolding they talk about, you know, starting with some basics, like cooking
some baked beans and showing them and then coaching them and then they're able to do it and building up to more sophisticated repertoire of cooking. Same
with hygiene, budgeting, emotional management.

And the final one, regular check ins. So a quarter were roughly needing -- they could live in the community, they could flat, but they seem to be
benefiting from someone dropping in on a regular basis. Some of them weekly, some of them daily. Just to check everything's okay because you know things
can spiral out of control pretty quickly, but these people were seen as closer to independence but still needing regular check ins.
And we asked, "Is this person likely to want to say to Oranga Tamariki, 'Yes, please I will take you up on this new right I have to remain or return with
a caregiver'?" and we found that one in three said, yes, they're likely to take up that offer and there's another bunch as well who -- it was uncertain at
this point. So potentially up to 45%.

So this is really important for us to have a sense of the scale of how we're going to meet these needs and think about that across New Zealand, you know,
the range of caregivers that are available, some will not want to have an 18 year old, 19 year old, 20 year old in their house if they've got younger
children. So we need to find out more about that, and the same with NGOs will have rules. So this gives us all something to think about as we're moving
towards July 1 next year when the new service is going live.

So the research has been designed to inform the development of the new transition service and what we found was there is high levels of risk to harm
themselves and others within the transitions cohort and in particular this group of high needs, and these complex mixtures of health and disability
related needs. So it's not a simple group to work with. And this is informing the development of the new transition service.

So regionally, on a case by case basis, the transition design team are moving around New Zealand working with other agencies, health, ACC, education and
Housing New Zealand to map out what services are available in those regions and what the gaps are and then looking at those gaps and thinking, "Well how
can we address those gaps?" For example it might be with regards to eligibility criteria. Some rules, for example, with disability support services
you'd need to have an IQ of below 70 to access these particular services. That's not going to work for some of our people but they will still need
disability support. So can we work with the Ministry of Health to provide greater leeway on the eligibility criteria or do we need to be thinking about
providing our own disability support people. The same with accommodation, we want to enable supported living, if that's what the people need. We've got
to find out which caregivers and which NGOs are going to be happy to keep 18 to 20 year olds, you know, work with them to try to enable that if they're
not ready and be willing to work with Housing New Zealand to step into space if we have to.

It's also informing that scoping of the transition specialist role. So this is a new role being set up. It's currently being debated where it's going to
sit. It may well be with a partner outside of Oranga Tamariki or might be a mixed model and this research is been used to try to argue for the case that
we need really low ratios of transition workers to the young people, potentially as low as one to seven. And also it's informing what that role will
involve, which clearly is going to involve brokerage of services, building that strong relationship and trying to get them to go along and to engage with
those services.

And that's the whirlwind tour of the needs survey that we undertook, some of the highlights. It is available online now, that web address or you can go
to Oranga Tamariki's site and Google transition needs survey and you should be able to find it. Thank you.