Department of Human Services

Case Studies

The following case studies are included to provide some illustrative examples regarding the direct and indirect impact on young people as a result of their involvement in the screening project, and the impacts from gaining important information about their needs that otherwise would likely have remained unknown. Names have been changed to de-identify individuals.

Case 1: ‘Matthew’

Background

Matthew was seventeen years of age when he participated in the screening project.  He arrived in Australia at the age of eleven years and English was an additional language. Matthew had an extensive history of offending, that commenced at an early age (11 years). Data extracted from C3MS showed that Matthew had spent a total of 1,208 days in custody since his first admission until his last release (a period totalling 3 years, 3 months over a 6-year period) with a total of 59 admissions to custody. This data emphasises the difficulties Matthew had exhibited desisting from offending behaviour.

Needs

The Screening Assessment (utilising the Weschler Abbreviated Scale of Intelligence) indicated that Matthew presented with significant difficulties in his cognitive functioning. Results of this assessment indicated that Matthew’s level of cognitive functioning was within the Extremely Low Range at the 0.3 percentile. This means that approximately 99.7% of his peers performed better than Matthew. On the basis of these results, further comprehensive assessment was deemed necessary.  A Child and Adolescent Mental Health Services (CAMHS) Speech Pathologist attempted to undertake screening assessments of Matthew’s oral language and narrative skills. The assessments were commenced with Matthew, however he declined to complete the assessments. The following observations were made during speech pathology sessions with Matthew:

  • He had some difficulties following complex spoken directions and remembering and repeating spoken sentences.
  • He had difficulties remembering the main parts of a story read aloud to him and retelling this story.
  • He made errors in grammar and sometimes had a slow rate of speech during conversation.
  • He appeared to benefit from strategies used to support his understanding of spoken information, including using pictures and diagrams to explain ideas, summarising and repeating key information, and asking Matthew to explain concepts in his own words.

Increased Service Delivery

As a result of the Screening Assessment, a full cognitive assessment (Weschler Adult Intelligence Scale – Fourth Edition) was undertaken and confirmed deficits in Matthew’s intellectual functioning. Functional assessments (Vineland Adaptive Behaviour Scales – Third Edition) were also undertaken, which indicated that Matthew presented with deficits or impairments in his adaptive functioning. Matthew’s assessment results indicated that he met the criteria for Intellectual Disability in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). Following confirmation of an Intellectual Disability, an access request to the National Disability Insurance Scheme (NDIS) was completed by Matthew’s case manager, with support from YJAIS.

Case 2: ‘Amy’

Background

Amy was aged sixteen years when she participated in the screening project. Amy identified as having Aboriginal ancestry, her first language was English, although she did have some exposure to Aboriginal English (a blend of Ngarrindjeri language and English). She was under the care of the Department for Child Protection, with a history of complex trauma, lengthy Youth Justice system involvement, substance misuse and school disengagement. Prior professional reports suggested that Amy’s presentation indicated an Intellectual Disability. However, accompanying evidence of formal, standardised assessment was not available during the collection of background information.

Needs

During the Population Screening Project, the Weschler Abbreviated Scale of Intelligence, Second Edition (WASI-II) was consented to and used with Amy. Her results indicated that Amy’s overall cognitive functioning was in the Low Average range. However, there appeared to be a significant discrepancy between her verbal and non-verbal cognitive abilities, with non-verbal abilities being in the Average range. It was noted that Amy was therefore unlikely to meet the criteria for an Intellectual Disability. Collateral information indicated that Amy had learning potential beyond what had previously been assumed.

Language screening results from the CELF-5 Screening Test (Clinical Evaluation of Language Fundamentals 5th Edition) indicated Amy was at risk of Language Disorder with her language abilities potentially being below expected levels for her age. It was considered unlikely that these difficulties could be explained by language difference, due to Amy’s limited exposure to Aboriginal language. On the basis of these results, further comprehensive assessment of Amy’s language skills was deemed necessary.

Increased Service Delivery

The results of Amy’s cognitive screening further informed the need for a comprehensive Speech Pathology assessment with possible intervention. From a diagnostic perspective, these results were also provided to stakeholders (Youth Justice, Department for Child Protection and school staff) as part of a differential diagnosis (that is, clarifying the prior concerns regarding Amy’s intellectual functioning). Ultimately, this also informed case management and ongoing criminogenic intervention offered to Amy by Youth Justice staff.

As a result of her participation in the screening project, language assessments (including the CELF 5 battery) were conducted with Amy to evaluate her oral and written language abilities. Amy was found to have moderate language difficulties overall, with a marked difference in her abilities across different tasks. Results were discussed and strategies developed with Amy to support and build her language skills. These skills were practiced; for instance, making a sentence more complex by using a subordinating conjunction (for example, ‘although’, ‘so that’). Results and strategies were shared with stakeholders to enable her to participate in discussion and improve her ability to participate in education.

Case 3: ‘Tom’

Background

Tom was aged fourteen years when he participated in the screening project. He first came to the attention of Youth Justice in March 2018 and had been in custody on remand on seven occasions since that time. He was subject to a Detention order on one occasion for a three- month period, at the time the screening project was underway.

Needs

The Screening Assessment (utilising the YLS-CMI) indicated that Tom presented with significant difficulties in his criminal behaviour and thinking (conduct), with drug and alcohol use. The CELF-5 Screener results showed that he was at risk of language disorder, that is, his language abilities were inadequate for his age. On the basis of those results, further comprehensive assessment of Tom’s language was deemed necessary.  Furthermore, assessment results suggested the need for offence-focussed intervention.

Increased Service Delivery

As a result of the screening assessment, comprehensive assessment of Tom’s language was undertaken by a YJAIS Speech Pathologist. This comprised of the core language subtests of the Clinical Evaluation of Language Fundamentals Fifth Edition (CELF 5), the CELF-5 Observational Checklist and school observations. The assessment indicated that Tom had overall mild oral language difficulties (Core Language Score of 79, 8th Percentile Rank). He exhibited particular difficulties in understanding complex semantic concepts and understanding large amounts of verbal information. These results were discussed with Tom and strategies were developed and practiced with him to support his language in all environments. For example, asking for clarification when he has not understood what was said, using written information to support him in understanding complex spoken information. A report was written and strategies were provided to the Youth Education Centre and his community based school to support his learning. It had since been reported that he was consistently engaging in school after leaving custody in October 2019.

Page last updated : 02 Sep 2020

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