Take Two - Third Evaluation Report More than Words ... - Berry Street

Take Two staff Raeleen McKenzie and Dr Chris Tanti
along with Dr Jenny Dwyer are coaching staff on the
model and a new contract was signed in 2009 to provide
training for a further two years. Although the Just Care
model stands separate from other aspects of the Take
Two role, it builds on the theoretical and therapeutic
approach of Take Two and applies understanding of the
theories to a different context.
3.7 Take Two Infant Mental Health
Project
Take Two holds an unequivocal stance on the pivotal
opportunities and heightened risks associated with
infancy. Infancy is a time of great vulnerability and also
of great promise, the greatest growth and organisation
in the brain occurs before the age of three years and the
template for future relationships is established in early
relationships. Development moves along at an amazing
pace from the complete helplessness of the newborn to
the relative physical and emotional sophistication of the
three-year-old.
The developmental tasks of infancy are enormous and
acute distress and disruption at this time can have farreaching
consequences for the infant and their carer(s).
Take Two contends that early, effective interventions at
this time can alleviate distress and facilitate attachment
to a parent or carer, preventing or reducing long-term
dif culties. The fundamentals of attachment theory
indicate that the primary attachment relationships are
usually established within the rst three years of life,
and therefore systemic and therapeutic interventions
in the parent–child or carer–child relationship can
maximise the formation of a secure attachment and the
resilience that this brings to the child. This can reduce
the likelihood of signi cant developmental disruptions
and the attendant effects. Yet despite all this, there are
few referrals of infants and young children to Take Two.
There are substantial numbers of child protection
clients less than three years of age in Victoria (DHS,
2002c), and so can be assumed to have suffered the
trauma of their abuse andneglect. There are, however,
no speci cally targeted therapeutic services focused on
their recovery. Both Take Two and CAMHS are funded to
see infants but neither receives many referrals. There
are many reasons for this, not least a lack of awareness
of the impact of trauma and disrupted attachment on
infants in both therapeutic and child protection staff,
and the immediacy of responsiveness required by child
protection staff and other professionals.
In February 2007 Take Two decided that a response to
the twin facts of low infant referrals and the missed
opportunity that this represents for intervention and
prevention was necessary. An Infant Mental Health
Project aiming to address some of the barriers to
therapeutic service delivery to infants was formulated
and trialled in the Southern Metropolitan region.
The aim of this Infant Mental Health Project is to
increase the capacity of Southern Metropolitan region
Take Two and child protection staff in understanding and
working with the mental health needs of child protection
clients less than three years of age. The approach was
to provide fortnightly secondary consultation by Take
Two to the High Risk Infant Team in the Southern
Metropolitan region.
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Six consultation sessions were held in 2007, with ve
occurring fortnightly over September and October and
one in December. Sessions in November and December
were cancelled for various operational reasons. All
sessions were well attended by workers in the High Risk
Infant Team. Consultations were led by senior Take Two
staff.
As expected, a high need for infant mental health input
was found. Infants were described as considerably
distressed. Child protection staff were task focused,
particularly on their mandate to investigate and
intervene to stop the child being exposed to harm from
abuse and neglect. The sessions were often used to
consider what capacities were required in the parent
to provide adequate care for the infants. Because of
a background of distress and disruption, as well as
some developmental delays, all infants presented for
discussion had special needs that would have challenged
most parents or carers.
Fortnightly sessions were overly ambitious and workers
experienced con ict in their desire to attend amidst the
demands of their demanding workloads. Three referrals
were made to Take Two for ongoing therapeutic work.
Child protection workers reported that they found the
consultations useful and wanted them to continue.
They requested that the consultations follow a format
of education on speci c topics that would then guide
case discussion.
The model of consultation is being documented in the
Take Two Practice Framework and implementation
across the program via training and supervision has
been expanded in 2009.
3.8 Neuropsychology service and
research at Take Two
The neuropsychology service to the Take Two program
has been operating since May 2005. This specialist
service has been available to all Take Two regions
and to a limited extent to the Secure Welfare Service.
Neuropsychological assessments and feedback have been
provided by Victoria University Doctor of Psychology–
Clinical Neuropsychology trainees under the supervision
of Dr Alan Tucker (Clinical Neuropsychologist). Between
2005 and 2008 a total of 50 children and adolescents,
ranging in age from 4 to 17 years, were formally
assessed by nine doctoral trainees. These trainees were
typically in their nal year of clinical neuropsychology
training, had had several prior clinical placements, and
were on 40-day placements at Take Two (usually two
days a week).
The neuropsychology assessments are conducted in a
developmental framework of the emerging cognitive,
emotional and behavioural skills of the children. In
view of its importance for age appropriate and adaptive
functioning at home, school, therapy, and in the wider
community, these assessments have usually focused
on cognitive functioning. Accordingly, the aim of the
neuropsychology assessment is to produce a pro le of
the cognitive abilities of the child. The pro le typically
includes the vital cognitive skills of visual spatial ability,
visual perception, receptive and expressive language,
information processing speed, verbal memory, visual
memory, verbal learning, attention, and executive
cognitive functioning. Such assessments go well
beyond the more limited assessment of cognitive
function as re ected in an IQ score. An important part
Frederico, Jackson, & Black (2010) “More than Words” – Take Two Third Evaluation Report, La Trobe University, Bundoora, Australia