Department of Human Services

Methodology

Clinical and Professional Considerations

Participant Inclusion Criteria

All residents of the AYTC were considered eligible for participation in the screening project, but project resources did not permit all young people in custody to participate. This excluded young people detained in Policy Custody, or those still undergoing intake screening/assessment in the Saltbush unit at AYTC. The behaviour of the young person was considered on a day-to-day basis, with the possibility of young people not being assessed on a particular day if their recent behaviour indicated they would be unsafe or not amenable to participation. Additional consideration was given to whether the assessment process would cause distress for individual young people. Finally, potential participants were prioritised based on their period of detention (or likely release date) to ensure participants were given sufficient opportunity to complete assessments within each of the three disciplines. Further prioritisation was given where necessary to young people about whom little information was known, rather than re-assessing young people who had established disability diagnoses.

Consent

Participation in the screening project was voluntary. Informed consent was required from all young people who met the inclusion criteria in order to participate. YJAIS commenced screening assessments with participants only after informed consent was obtained. YJAIS staff followed a standardised process of gaining informed consent from each participant using an informed consent form (Appendix A) which was designed to convey information to young people using Easy English and visual images. Specific consideration was given when developing the consent form to ensure information was understood by young people with poor literacy, English as an additional language and/or suspected intellectual, cognitive or speech/language needs.

Background Information Forms

A list of all young people scheduled to participate in the screening project was sent to Youth Justice primary allocated Case Coordinators and Case Managers to gather information about existing health reports and/or known diagnoses. A ‘Background Information Form’ (Appendix B) was developed to aid in this process.

Assessments

Assessments were undertaken by YJAIS staff (Deputy Principal and Senior Psychologists, Senior Speech Pathologists and Senior Occupational Therapist), and an Occupational Therapist employed by the Department for Education (Youth Education Centre).

Each young person was given the opportunity to participate in multi-disciplinary assessment where possible. Selected assessments are listed in Table 1 and descriptions of these assessments are provided in Appendix C. Assessments used in the screening project were selected with the following considerations:

  • Information that the assessment yielded in terms of identifying a range of disability-related needs (for example, risk of language disorder; identification of memory or intellectual functioning impairment), whether they were screening assessments versus comprehensive assessment, and how this information related to the project objectives.
  • Assessment administration time to minimise impact on young people.
  • Validity and reliability of assessments, including whether assessments were normed on Australian and Australian Aboriginal populations, where possible. Unfortunately, due to the fact that both Occupational Therapy and Speech Pathology are emerging disciplines in the Youth Justice setting, existing assessments specifically developed for use in this context were not found, and no assessments used in the screening project have been normed specifically for an Australian Aboriginal population, which is a limitation.
  • Assessment purchase cost.
  • There was not a consistent order of assessment by discipline across all young people because assessments were scheduled based on availability of staff and young people.
  • Within disciplines; order of assessments for speech pathology were:  CELF-5 screener, TNL, USP; and for psychology and occupational therapy, they were varied for each individual depending on preference of young person and background information obtained.
  • Assessments used were not intended to be diagnostic in nature and there was no intention for the results to identify diagnosable disorders (for example, as per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition [DSM-5]) (see Note 1).

Note 1: Hence, the terminology of “disability” or “disability-related needs” used herein is not indicative of a diagnosed disorder, but instead intended to be consistent with the World Health Organization definition of Disability: That is, Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Accessed online at: https://www.who.int/topics/disabilities/en/

Table 1: Discipline-specific assessments utilised in the screening project

Psychology

Occupational Therapy

Speech Pathology

Youth Level of Service / Case Management Inventory 2.0 (YLS/CMI 2.0)

Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI)

Clinical Evaluation of Language Fundamentals Fifth Edition (CELF-5) – Screening Test

Weschler Abbreviated Scale of Intelligence – Second Edition (WASI-II)

Sensory Profile 2 (<15yrs)

Adolescent and Adult Sensory Profile (>15yrs)

Clinical Evaluation of Language Fundamentals Fifth Edition (CELF-5) - Understanding Spoken Paragraphs

Adolescent Psychopathology Scale – Short Form (APS-SF)

Delis Rating of Executive Functioning (D-REF)

Test of Narrative Language – Second Edition (TNL2)

No data

Cognistat

No data

Logistics

Consultation with Staff and Young People

Information sessions regarding the processes, intentions and logistics involved in the screening project were conducted with:

  • AYTC Accommodation Unit staff
  • AYTC Assessment and Case Coordinators
  • Community Youth Justice Custodial Case Managers
  • Youth Justice Aboriginal Advisory Committee
  • Youth Education Centre leadership staff

prior to the commencement of the screening assessments.

Internal and external Youth Justice stakeholders were consulted prior to, during and following the completion of the screening project through the YJAIS Internal Steering Group in order to:

  • Gain cultural guidance for culturally safe and responsive processes within the project
  • Provide operational guidance and insight regarding the completion of the screening project and the impact this would have on day-to-day AYTC operations.
  • Gather pertinent information relating to individual young people.
  • Assist with identifying potential risks or challenges relating to individual needs of young people and prioritising assessments for young people prior to release.

Residents of each accommodation unit at AYTC who were likely to be asked to participate were given the opportunity to attend information sessions provided by YJAIS staff.

Appointment Scheduling

The YJAIS team was responsible for scheduling all assessment appointments during the screening project. Within the custodial environment of AYTC, this required multiple logistical considerations, such as:

  • YJAIS staff availability and general business-as-usual workloads.
  • Assessment tool availability (with multiple staff sharing resources and attempting to complete concurrent assessments)
  • Operational requirements, including availability of escort staff, booking times, room availability, and court appearances.
  • School commitments and other professional appointments for the residents.

Prioritisation of assessments occurred according to:

  • resident consent (or refusal) to participate
  • length of Detention Order/Remand period
  • special requests from case managers
  • attempts to obtain complete data (that is, from each discipline).

Where YJAIS staff were aware of and able to access existing assessments, these were used as evidence of already existing disability-related needs in order to reduce the assessment requirements and load for young people.

A weekly schedule was distributed to:

  • AYTC accommodation supervisors and managers
  • security and visits staff
  • the Youth Education Centre
  • Assessment and Case Coordination and Custodial Case Management teams
  • Youth Justice Programs staff.

Business Intelligence and Data Analysis

Participant demographic information (for example, age, gender, Aboriginal status, VONIY completion dates and need level identified, nights in custody) was obtained from the Connected Client and Case Management System (C3MS) with support from the Youth Justice Strategy, Policy and Reporting business unit.

Screening assessment results data was collated by YJAIS team members and entered into a spreadsheet. Data analysis was completed by a commissioned academic researcher from the University of Adelaide. Pearson Correlations, Independent Samples T-Tests and Chi-Square analyses were used to assess associations between variables and to identify between-group differences.

Partnerships

Throughout the AYTC population screening project, the YJAIS team was reliant on a number of key partnerships to ensure effective planning and implementation of the project. Table 2 provides a brief outline of these key partnerships.

Table 2: Key partnerships

Stakeholder

Nature of Partnership

External or Internal Partnership

Youth Education Centre (YEC) (Department for Education)

Assistance from Sue Maney, Occupational Therapist, to complete occupational therapy screening assessments throughout the four-week screening period.

Agreement by YEC to remove young people from classrooms to allow them to participate in assessments during screening period.

Sharing of education-related allied health assessments/reports for young people with pre-existing disability-related needs that had been previously identified.

External

Child and Adolescent Mental Health Service (CAMHS)

Assistance from Kate Desborough, Speech Pathologist, Forensic team, to complete and share information from Speech Pathology assessments for existing CAMHS clients throughout the four-week screening period.

External

Metropolitan Youth Health (MY Health)

Sharing of pre-existing health-related diagnoses and any pertinent medical information of participants.

External

University of Adelaide

Detailed analysis of assessment results data and report review by Dr. Catia Malvaso.

External

Department for Child Protection, Psychology Services

Sharing of relevant, pre-existing assessment reports, and notification of any imminent scheduled psychology assessments for young people under the Guardianship of the Chief Executive.

External

Youth Justice Aboriginal Advisory Committee (YJAAC)

Cultural consultation regarding the project; seeking input for cultural considerations especially with regards to liaison with young people and their families.

External

Case Managers / Case Coordinators

Collection of background information and sharing of known pre-existing diagnoses and health-related reports for participants.

Internal

Adelaide Youth Training Centre (AYTC)

Increased demands placed on operational staff (Youth Workers, Behaviour Support Officers, and in particular the Duty Supervisors) due to the high number of resident movements required during the screening period.

Internal

Youth Justice Strategy, Policy and Reporting

Collation and analysis of participant demographic data from C3MS.

Internal

Cultural and Ethical Considerations

Prior to and During Screening

Special consideration was made to ensure the impact on the participants resulting from the physical, cognitive and emotional fatigue inherent in completing assessments with three disciplines in a relatively short time frame was not placing them at an unfair risk of harm. This was achieved by:

  • remaining flexible with assessment times and being willing to re-schedule sessions if requested by the young person
  • offering drink/movement breaks throughout assessment sessions in a manner that did not impact assessment validity (that is, between assessments)
  • monitoring behaviour, communication with AYTC staff, and checking in with participants
  • choosing assessments to ensure the total assessment time for each discipline would not exceed approximately one hour and that participants would be provided with opportunities for ample rest between assessment sessions.

It was acknowledged that in an ideal situation, multiple assessments would not be completed with an individual on the same day. The impact of fatigue on a participant’s capacity to complete an assessment and the potential impact this has on assessment scores was a constant consideration for therapists.

Appointments were scheduled to ensure participants were provided sufficient time between assessment sessions for rest and recovery. Participants were scheduled with no more than one discipline/therapist on a particular day and were not scheduled for assessment sessions on subsequent days. Due to time constraints, participants were scheduled to meet with each discipline for approximately one hour, during which the therapist attempted to complete their discipline’s assessment battery.

Therapist discretion and ongoing consultation with participants and staff were used to determine whether a young person was willing and/or able to continue with each assessment. Young people were provided the ability to cease assessment sessions at any time.

Cultural Safety and English as a Second Language

YJAIS recognised the critical importance of cultural consultation to ensure that the project was designed and delivered in a culturally safe and responsive manner. YJAIS consulted with the Senior Aboriginal Advisor during the development phase of the project, regarding the project concept and methodology. Consultation was also held with the Youth Justice Aboriginal Advisory Committee, with guidance and input explicitly sought in relation to interpretation of assessment results, follow-up after assessment and engaging Aboriginal young people and their families. YJAAC members were supportive of the project.

As mentioned previously in the report, the assessments were not intended to be diagnostic. Furthermore, the language assessments were not designed to comprehensively differentiate between ‘Language Disorder’ or ‘Language Difference’. Language Difference refers to the differences due to bi- or multi-linguilism, which are not an indication of Language Disorder. The CELF-5 Screening Test manual describes that failure to meet the age criterion indicates ‘risk of language disorder’ but acknowledges further comprehensive assessment is then indicated.

When young people presented with English as a Second Language (including Aboriginal Language) whereby an interpreter was needed and could not be arranged, the decision was made to not include the young person in the screening project due to the potential impact this could have on validity of assessment results.

Previous participation in assessments

Therapist discretion was used in instances where individual young people had pre-existing diagnoses or evidence of recent participation in similar assessments was accessible. In these situations, one or a number of screening assessments were omitted to ensure young people were not subjected to unnecessary repetition of assessments.

Use of visual tools to aid in assessment facilitation

The YJAIS team made every effort to ensure all young people were provided with optimal opportunities to complete each assessment to the best of their abilities. This included the use of visual aids to complement facilitation of assessments that included young people answering large numbers of questions, in particular those when they were required to provide responses via a Likert scale. Examples of visual aids used are included in Appendix E.

Incentives

Incentives to encourage young people to engage in the screening project were agreed upon through consultation with Accommodation Supervisors and young people. Young people who agreed to complete all assessments were provided the choice between 30 minutes extra television time, or five additional phone calls. These incentives were identified as they were aligned with existing incentives available for attainment by residents through the AYTC Behaviour Support Framework (BSF). Posters were developed and placed on walls in all residential units outlining basic information of the screening project and the incentives offered to participating young people (Appendix D).

It was acknowledged that no young person should feel pressured or coerced to participate in the screening assessments. As such, it was emphasised that should a young person decline to participate, that this would not have any impact upon their daily scoring or periodic review progression through the mechanisms of the BSF.

Post-Screening

Careful consideration was given to ensuring that young people were able to potentially benefit from participating in the screening assessments, either directly or indirectly. A direct benefit was considered to be greater insight and knowledge about their individual needs and the communication of that information with their family and professional support networks, including potentially increased or enhanced direct service provision from Youth Justice and other agencies. An indirect benefit was considered to be a more informed and responsive Youth Justice service system, including operational and case management.

Following the completion of the screening project, all effort was made to ensure assessment results were disseminated to all participants regardless of whether new areas of need had been identified. A summary report template (Appendix F) was developed to ensure information was shared in a way that could be easily understood by young people and their family/caregivers. Assessment Summary Reports were uploaded to C3MS, email and/or phone contact was made with relevant Case Managers/Case Coordinators and where deemed appropriate and logistically feasible, YJAIS team members met with young people to share assessment results and to consult regarding possible next steps (discussed in more detail in Client Outcome section below). When further actions were required (for example, external referral) YJAIS staff liaised with Case Managers/Case Coordinators regarding an action plan.

Challenges and Learnings

Throughout the screening project process, a number of challenges and learnings were identified by the YJAIS team relating to the project timeframe and sample size, staff resources, assessment limitations and interpretive considerations, and data analysis challenges. For a more detailed outline of these, refer to Appendix G.

Page last updated : 02 Sep 2020

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