25/02/2020

With a background in child and adolescent psychiatry and mental health, Prue entered the Department for Child Protection in February 2019 eager to support staff to manage complex cases and embed more therapeutic approaches.

Dr Prue McEvoy’s first year as the department’s Lead Psychiatric Director has been a whirlwind of progress and learning.

“From the moment I walked in the door I felt very welcomed, and I could see that my colleagues were eager to explore new ideas and ways of working,” Prue said.

During the past 12 months she has seen real changes, including a positive shift in the way the department approaches complexity.

“Our work is incredibly complex, and as a workforce we need to focus on what we can control,” Prue said.

“I have seen a change in our willingness to acknowledge complexity and escalate decisions.”

“To me, escalation is a really good thing, but I think historically it may have felt like a failure for some people.”

Prue believes that this shift in thinking is leading to better case outcomes, with staff tackling complex problems from many angles and sharing the risk.

“Now I am seeing case managers saying ‘hey- there are a lot of issues feeding into this case… this needs some extra thinking’ and then seeking advice and input from others,” she said.

This approach is the foundation of the department’s Complex Case Review Meetings, which were established last year under Prue’s guidance.

The meeting is a mechanism for the child’s care team and other relevant parties to meet and consider a case together, taking into account the child’s trauma history and individual needs.

“Since we started I have chaired more than 90 complex case reviews and follow-up meetings, demonstrating a significant effort to wrap supports around children and young people with highly complex needs,” Prue said.

Prue, the case manager and supervisor are often joined by representatives from other agencies who intersect with the child.

“Other agencies are really stepping up and saying that they are here to help, meaning we can address health, education, housing and a range of other needs at the same time,” Prue said.

“The feedback I’m getting is that case workers are feeling backed-in and that we are making a difference in the lives of children and young people with highly complex needs.”

Prue also sits on the recently established Interagency Therapeutic Needs Panel (ITNP), which is collaborative practice model run by SA Health. The panel includes people with expertise from Child Protection, Education, SAPOL, SA Ambulance Service, Child and Adolescent Mental Health Service, Housing and Youth Justice.

“The two panels really complement each other - ITNP allows us to step in early when children and young people are first placed in care, and get things right from the start.”

“This is about government as whole recognising that children and young people coming into care do have special needs, and that we need to give them a focussed and targeted response”.

The ITNP identifies a broad range of needs and services that will support children and young people in care and makes recommendations for the case worker to implement.

Prue is an advocate for the care team model at all levels of complexity.

“Sometimes the chaos in a child or young person’s life can be exacerbated by the system, particularly when people aren’t talking to each other and supports aren’t linked,” Prue said.

“The concept of a care team is so important when making decisions, as it increases consistency and stability while reducing reactive decision-making.”

“A care team has a shared understanding of a child’s individual needs and issues, allowing us to respond in a more proactive manner.”

Over the coming year Prue plans to focus more on facilitating interventions before cases reach crisis point, further developing pathways for staff to escalate matters and seek advice, and continuing her work on therapeutic models of care.