Therapeutic approaches
The relationship between young people and staff underpins everything. This doesn’t just include the people who work with the young people all day. I was walking around one day with the regional manager, who is the boss of all the centre managers in the Murcia region, and I saw him greet a young person who was being admitted as if he was his own son. The young person had tears in his eyes, and I watched a level of care from senior management that I will never forget. Another day I saw a young man walk into the kitchen to talk to the female cook. During the five-minute conversation the young person was visibly relaxed, and they shared a joke. Later when we had finished eating, the young people made a point of thanking the cook personally for the meal through the window where the food had been passed. Young people teased staff and staff teased young people, everywhere I went I could see a level of trust that can’t be faked. There was a group of young people who announced they had had lunch with “The best deputy manager in the centre” within earshot of the other deputy manager. Everyone laughed.
Families are an important part of Spanish culture and an essential part of the Diagrama model. Social workers run therapeutic and criminogenic group programs and do individual work with families. Where families need support, they are linked to social services. Social workers at one centre run a group program with multiple families, requiring them to come to the centre for ten, four-hour sessions over ten months. At the end of the program the relationships built were so strong I saw a group photo of the families and staff in crazy costumes, laughing. Family therapy is for every young person’s family and must occur before young people can visit home. The needs of the young person and family come before any focus on the offence. I was given an example of a girl who was sexually abused by a relative and later used serious violence against a family member. When they first met with the family, they focussed on the girl’s needs and therapy, then on restoring the family relationships and finally as a group they discussed the girl’s offence. Families come on centre to visit but also for family fun days and events, for example sports carnivals involving family members, and for young people to show off their new skills to their families, such as how to train a dog.
Psychologists and psychiatrists are in every centre, as well as occupational therapists, speech therapists and other professional services – this is the technical team. Psychologists work with young people individually and in groups. I met a group of young men who were involved in a group program about anger and emotions. One young man said “Boys need to talk about their feelings. One time when I was mad at this guy (key worker) I felt like my world was going to end. He’s like my second dad. If I don’t talk, I explode.”
There are animals in every centre – I saw turtles, fish, cats, dogs, sheep, horses, bees and birds. Apparently, the level of calm needed to work with bees is incredibly therapeutic. Young people can spend time with animals from the day they arrive if their psychologist recommends it, and if it is risk assessed. Young people ate extremely healthy meals and were required to eat at least half of everything they were given (e.g. half the salad, half the vegetables, half the fish). One young person said to me, “I never ate salad before, now I love it!”
Staffing
There are positions called educators, degree-qualified workers who spend all day with the young people, mentoring, educating and supporting them. A smaller number of staff fill a security role, and only these staff intervene when there is an incident. Incidents requiring security intervention are incredibly rare, in one centre for over 60 young people they had not had a single incident requiring restraint last year. Most staff I spoke to had been with Diagrama for more than ten years, it is a job people want and hold onto. The educators take on a lot of responsibilities our case workers (social workers/psychologists) do in Queensland, such as being their key worker, setting goals together, ensuring the centre does its part to meet the goals such as organising programs to meet their needs and help them achieve their goals. This frees up the social workers to spend their time focussing on family relationships.
Educators are not teachers; young people go to school on centre or in the community and there are teachers there. The role of educator means you are continuously mentoring and educating young people about life. Young people work alongside educators in all parts of their day, and the activity often relates to a skill or passion the educator is sharing with the young person, such as building gardens, training for a marathon, learning yoga, training animals or any other skill. Young people are responsible for the maintenance of the centre, again working alongside educators. There are other positions that come on centre as specialists such as carpenters or welders. The young people’s activity must be useful, “They are not building a brick wall to learn the skill then knocking it down again, they are building a brick wall to sit on around the water feature they built last summer.”
I asked various young people what made a good educator, and some of the responses I got were, “Telling me when I’m doing the wrong thing and helping me do better”, “Someone who is aways with me”, and “Someone who doesn’t judge me”. Even when I wasn’t asking about staff, young people often told me their advice to make sure the Australian system was as good as possible was to fill the centres with caring and loving staff.
Incentives and reintegration
I saw a lot of things that would make people in my centre worry, like ligature points or young people using metal spades, rakes and power tools with security staff over 100 metres away. Educators did not carry radios, there were no body worn cameras and CCTV was only in hallways. I asked a few teachers if they felt safe at work and they said, “Absolutely, always.” I asked the welding teacher if anyone had used his equipment unsafely and he said “No, if I think they don’t know how to use the equipment, I’d do it myself or show them again”. He didn’t even understand I was asking if anyone had used the equipment as a weapon and thought I was asking if the young people were able to use the equipment without hurting themselves.
I think one of the biggest motivators for safe behaviour for young people in Diagrama centres is the ability to go off-centre when they have earned this privilege. Most centres have about 30% of their young people off-centre every day. In the centre I saw where most young people are 18-23, about 50%, and in an open centre, 100% of young people go off-site every day, some with an educator and some on their own. While off centre, young people can do almost anything at all related to their reintegration. The concept is that while they are still connected to a supportive environment (the centre), they should try out their new skills and failing is a learning opportunity. They might, for example, spend a day with family members after working hard to restore the relationship. Once in the home environment, familiar struggles arise, maybe the young person gets angry and aggressive with a family member, or goes out drinking with friends. Returning to the centre there is now an opportunity to work through what went wrong and find out where there still needs to be work done before going home permanently. Other opportunities to fail and learn are through ‘autonomy units’, where young people live without staff, have access to mobile phones, social media and continuing support from educators. With all these young people going off centre every day, mostly unaccompanied by staff, there is a tiny percentage who do not return to the centre by choice. In one centre there were 4000 LOAs last year, only four returned after the time they were due back on centre and all returned by choice.
I asked a management group about the young people who regularly used violence in the community but do not use violence in a Diagrama centre, “What makes violent young people not use violence here?” Their answer was, “The group - seeing other young people doing what they are supposed to.” This is an important learning for me. It will be more difficult in our Queensland centres because of the high frequency that young people are remanded for short periods of time, then are released from court. However, the Diagrama model started with the same problem and the system has changed over the years to create a base level of behaviour, which is observed by any new young person coming into the environment. Young people start with no privileges, everything is earned. Their basic human rights are met (healthy food, access to sports, fresh air, a comfortable bed etc.) and they are treated with love and respect. However, they do not have access to any of the ‘nice’ things they are seeing other young people enjoy – e.g. video games in their bedrooms, the ability to walk alone from place to place within the centre, the ability to choose what their daily schedule looks like, extra phone calls, time on a mobile phone, time in the gym, a later bedtime, music players in their room, time off centre. Even gang members from different gangs mix in the units. While in the induction unit from day one, with no extra privileges, they learn the rules and are encouraged to follow them so they can move into one of the other units where the privileges start building up. I was told that sometimes young people who started in opposing gangs and ended up living together, “Learn they’re not so bad after all and they have a lot in common.”
I met the man who started Diagrama 31 years ago. As well as the importance of having the right people in the job, we spoke about the strict rules and consistent consequences in Diagrama centres. He told me that the structure, routine and consistent consequences enable the therapy to take place because young people don’t have to wonder what the outcome of their behaviour will be. With this question out of their minds they can relax and think about healing. Young people know exactly what will happen if they break a rule, so they are in charge of the outcome when they make a decision to follow or break it. Young people learn the rules, are given a handbook and supported to understand them in detail. The rules and consequences are visible to everyone. If a rule is broken, the educator will let a coordinator know and gives the context, then the coordinator decides the consequence within set parameters. For example, refusal to do a chore might mean you have to do extra chores for three to five days. The context might be that the young person just got off the phone to find out his grandmother is sick, which will result in the coordinator deciding the young person will do chores for three extra days, not five. But there is always a consequence. This system also removes the risk of staff favouritism and allows the educators to remain advocates for the young people as they are not deciding how strict to be with anyone, the rules are set and consistent across centres.
Young people with mental illness and learning disabilities have a different set of consequences. Young people can move up or down levels based on a decision by a multi-disciplinary team. Rules are relaxed as young people move through levels towards autonomy. I saw a line graph on one centre’s wall with young people’s steps up and down the levels charted. All the young people had gone up and down a number of times but the general trend for every young person was in an upwards direction.
Final thoughts
The management at Diagrama told me they have made many mistakes along the way – there was even a time when they used separation as a punishment, which would never be considered now. They continue to look for innovation and have a well-staffed research team that looks for best practice world-wide so they can continue to improve. I noticed a lot of common elements with the Missouri model (structure and routine, staff relationships, therapeutic processes) and I have definitely got some ideas about what we might be able to trial when I get home. Staff at my centre at home will be laughing as they read this blog because I’ve always believed the best way to make a rule is to talk about it with the young person and consider the situation on a case-by-case basis; now I’m thinking we might need to make a rule book! If this is you, I miss you all and I can’t wait to see you when I’m back.
