Original Title: Avis: les meilleures pratiques de prévention et d’intervention en matière de fugues auprès des jeunes hébergés en centre de réadaptation pour jeunes en difficulté d’adaptation

Authors' objectives: In January 2016, the cases of young girls who had run away from an integrated health and social services centre (CISSS) were widely publicized. Some of the parents turned to the media, both social and traditional, in an attempt to find their child, and to express their deep concerns. Some of them pointed out that running away was one of the reasons for their child being placed in a rehabilitation centre for young persons with adjustment problems and were alarmed that the centre was unable to protect their child. Given the situation, the Minister for Rehabilitation, Youth Protection, Public Health and Healthy Living, Lucie Charlebois, appointed André Lebon to act as an independent external auditor to check that all the supervisory rules and procedures for preventing youths from running away were being enforced at the CISSS concerned. After examining the recommendations in the Lebon Report [2016], the Ministère de la Santé et des Services sociaux (MSSS) asked the Institut national d’excellence en santé et en services sociaux (INESSS) to draft a report on the best runaway prevention and intervention practices for youths living in rehabilitation centres for young persons with adjustment problems. For the purposes of drafting this report, INESSS developed an overview, which was published separately, of runaways and current runaway prevention and intervention practices used with youths at Québec rehabilitation centres for young persons with adjustment problems [Institut national d'excellence en santé et en services sociaux, 2017]. This document constitutes the final report submitted to the Minister and addresses a measure set out in the recent MSSS action plan [2018]. It is also intended for managers and youth workers at integrated health and social services centres (CISSSs), integrated university health and social services centres (CIUSSSs), and all the resources that work with young persons living in rehabilitation centres and their families.

Authors' results and conclusions: (EFFECTIVENESS OF RUNAWAY PREVENTION AND INTERVENTION PRACTICES) The runaway prevention and intervention practices identified in the scientific literature are quite varied. Many of them address runaway risk factors (e.g., family conflicts and conduct disorders) and unsafe behaviours associated with running away (e.g., the use of psychoactive substances and unsafe sexual practices). Other interventions seek primarily to influence protective factors or the underlying motives for running away. Still others are multicomponent and nationwide in scope in order to prevent and act in a global approach on the phenomenon of runaways. Very few studies have evaluated the effectiveness of specific practices for youths living in rehabilitation centres. The results reported in the effectiveness studies led to the following five statements of scientific evidence: S1 Interventions focused on family and interpersonal relationships help reduce runaway risk factors (e.g., family conflicts, psychological distress and suicidal ideation), unsafe behaviours during runaways (e.g., alcohol or drug use, unsafe sexual practices and delinquency), and runaway episodes (risk, frequency and duration). S2 Educational interventions on the issues of runaway increase young people’s awareness of the realities of being a runaway and help reduce the risk of runaway and of unsafe sexual practices. S3 Interventions focusing on unsafe behaviours during a runaway episode help reduce the occurrence of these behaviours, such as problem psychoactive substance use, unsafe sexual practices and delinquent behaviours. S4 Access to community resources and support services (shelters and helplines) by young runaways improves interactions with the family, decreases unsafe behaviours (e.g., alcohol or drug use, unsafe sexual practices and delinquency) and shortens the duration of the runaway episode. S5 After the young runaway returns, an interview with him/her on the runaway episode (events, experience, underlying motives and alternatives) helps put the necessary interventions in place and thus reduce the risk factors (e.g., problems with peer and family relationships, a feeling of insecurity and low self-esteem) and the likelihood of a repeat episode. (ACCEPTABILITY AND APPLICABILITY) The acceptability and applicability of the practices mentioned in the statements of scientific evidence (S1 to S5) were assessed based on contextual and experiential data found in studies concerning the perceptions and experiences of the persons involved in these practices (youths, family members and youth workers) and that identify the barriers and facilitators to their implementation. The assessment was also based on key literature on runaways and rehabilitation in Québec, and on consultations with a working group of experts who accompanied the project team at every step of the production of this report. On the whole, the five types of practices mentioned in the statements of scientific evidence (S1 to S5) were deemed acceptable by the stakeholders and applicable at Québec’s rehabilitation centres. Interventions targeting family and interpersonal relationships (S1) The opinions expressed by the youths and parents in the studies show the importance for youths to connect with their families and, consequently, their interest in working on furthering and maintaining these connections. In Québec, the family is considered a core element of rehabilitation intervention. In this regard, according to the working group, it is important to establish collaborative ties with the families of youths living in a rehabilitation centre and to provide these families support during a runaway. The youths surveyed also stressed the importance of having a quality relationship with their youth worker. However, staff turnover can impede the development of such a relationship. According to the working group, a positive social climate between the youths and all the youth workers is essential. The youths surveyed also stressed the importance of developing meaningful relationships with peers. As well, the working group says that a quality social network can act as a protective factor in youths living in a rehabilitation centre. Authorized or escorted outings therefore seem to be important opportunities for them to build meaningful relationships outside the rehabilitation centre. Educational interventions on the issues of runaway (S2) The youths surveyed stressed the importance of being informed of the realities and dangers associated with being a runaway and of the various resources accessible to runaways. In addition to increasing youths’ awareness, the youth workers surveyed also wished to acquire proper training on the issue of runaways and its associated problems. In Québec, the importance of making educational interventions directed at youth on the issue of runaway and other related matters (street gangs, sexual exploitation, etc.) was stressed numerous times in documents intended for protection and rehabilitation services for youths with adjustment problems. Interventions targeting unsafe behaviours (S3) In Québec, the practices used in rehabilitation centres for young persons with adjustment problems presently include individual or group interventions addressing unsafe behaviours, such as the use of psychoactive substances and unsafe sexual practices. Access to community resources and support services (S4) In general, the young runaways surveyed in the studies appreciated the resources that provided them practical support, such as shelters and helplines. In Québec, young runaways have access to shelter and help resources, especially in urban areas. However, it is necessary to establish formalized agreements between the CISSSs and CIUSSSs, community organizations and the police, and to review them on a regular basis in order to define their respective roles and responsibilities for when a youth living in a rehabilitation centre runs away. Furthermore, the working group agrees with the need to offer support services specifically intended for runaways through a variety of platforms (helpline, email, chatting, text messaging, etc.). It would also like these services to help maintain contact while the youth is on the run. Presently, social media are sometimes used. Given the legal issues relating to their use, the need to establish clear rules was pointed out. Post-runaway reception and interview (S5) The opinions of the young runaways and the youth workers surveyed underscore the importance of the post-runaway reception and the return interview with the youth. The youth workers mentioned the importance of discussing with the youth the underlying reasons for running away and the concerns that this caused. The youths indicated that overly punitive or dissuasive strategies should be avoided. According to the working group, punitive practices have been abandoned over the past few years in Québec in favour of a more empathetic reception. The group also suggests that young runaways be accompanied by someone they trust after they return so that they are more inclined to open up and express themselves. The working group also considers it desirable that runaways be allowed to return to their living unit to avoid the disruption caused by a change of living environment.

Authors' recommendations: This analysis led to fourteen recommendations, with subpoints. In addition to having been submitted to the working group, the recommendations were presented to three user committee liaison officers, to a group of young adults who had previously lived in a rehabilitation centre, and to INESSS’s Comité d’excellence clinique en services sociaux (Jeunes – Santé mentale – Dépendances – Itinérance). A few adjustments were made to the recommendations after these consultations. The recommendations are grouped according to the three main intervention time points: 1) preventing a runaway and a repeat episode; 2) during a runaway; and 3) after a runaway returns. Some of these recommendations are transversal and are presented last. The numbers assigned (R1 to R14) do not, therefore, reflect a priority ranking. Since the realities, the needs and the current resources and practices may vary from one region to another, it was decided not to prioritize the report’s recommendations. Lastly, several recommendations are directed at youth workers. Depending on the recommendation and the organization of services in the different regions, a youth worker can be an educator or the person authorized to apply the measures under Youth protection act. In other recommendations, the youth worker can be from a services program (young persons in difficulty, mental health, addiction, etc.), a school, a community organization or a police department. The notion of youth worker therefore includes anyone who works with a youth living in a rehabilitation centre and his/her family.

Authors' methods: Three main questions guided the drafting of this report. The first focuses on best runaway-related practices for youths living in rehabilitation centres; the second concerns the perceptions and experiences of the key individuals involved in these practices, namely, the youths, their families and the youth workers); and the third concerns the barriers and facilitators to the implementation of these practices. To answer these questions, INESSS conducted a systematic review to assess the effectiveness of runaway prevention and intervention practices together with the CIUSSS de la Capitale-Nationale through its Centre de recherche universitaire sur les jeunes et les familles (CRUJeF). The opinions of those involved in these practices and the barriers and facilitators to their implementation were the subject of a review and a narrative analysis, both conducted jointly with the Institut universitaire Jeunes en difficulté (IUJD) of the CIUSSS du Centre-Sud-de-l’Île-de-Montréal.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/avis-sur-les-meilleures-pratiques-de-prevention-et-dintervention-en-matiere-de-fugues-aupres-des-jeunes-heberges-en-centre-de-readaptation-pour-jeunes-en-difficulte-dadaptation.html

Year Published: 2018

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/avis-sur-les-meilleures-pratiques-de-prevention-et-dintervention-en-matiere-de-fugues-aupres-des-jeunes-heberges-en-centre-de-readaptation-pour-jeunes-en-difficulte-dadaptation.html

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Gouvernement du Québec