Cleveland Youth Detention Centre inspection report: Focus on separation due to staff shortages

Our inspection focus

In this inspection of the Cleveland Youth Detention Centre (the centre), we focused on the use of the separations caused by staff shortages, because of the impact on children’s wellbeing and human rights. In our future inspections of the centre, we will focus on all types of separations as well as other issues.

Separation occurs when a detention centre employee places a child in a locked room alone. It is also sometimes called isolation or segregation.

It can be appropriate in certain circumstances to separate a child. For example, it may be an appropriate short-term response to an incident where a child’s behaviour threatens the safety of others. Also, the centre-wide lockdown that occurs each evening from 7.30pm to 7.30am is an appropriate separation, as it provides time for children to sleep in their own rooms.

It becomes a problem when children are separated for much of the day. It is also an issue when the main cause of separation during the day is staff shortages.

In recent years, the centre’s use of separation in response to staff shortages has been persistent and frequent. The Queensland Audit Office report Reducing serious youth crime – Report 15: 2023–24 identified the link between staff shortages and separations at youth detention centres. It found the centre had the highest number of staff shortages across the three youth detention centres in Queensland.

Impact of separation on children’s psychological wellbeing

A number of reviews, commissions and courts in Queensland and across the country have considered the legal and psychological impact of separations on children. These include the following:

In 2017, the Australian Children’s Commissioners and Guardians Statement on Youth Justice Detention declared that:

Children are particularly vulnerable because they are still in crucial stages of development – socially, psychologically, and neurologically. The experience of isolation can interfere with and damage these developmental processes. For children and young people with mental health problems or past experiences of trauma, isolation practices can have severely damaging psychological effects. Where children and young people are at risk of suicide or self-harm, isolation is likely to increase their distress and suicidal ideation and rumination. (p. 21)

The 2017 report of the Royal Commission and Board of Inquiry into the Protection and Detention of Children in the Northern Territory heard from a range of experts about the harm caused by isolation (see pp. 285–287 Volume 2A). The Commission received evidence that isolating prisoners causes long-term psychological issues. In relation to children, it heard that

… isolation is inappropriate for children and young people due to the risk of psychological harm to their brains when they are still developing. The part of the brain that controls impulses, the prefrontal cortex, can be impaired permanently, limiting a child’s or young person’s impulse control.

The Commission considered that the psychological effects can be amplified for Aboriginal children and young people, particularly those from remote communities, due to specific cultural needs.

The Commission also cited the Royal Commission into Aboriginal Deaths in Custody: National Report which, twenty-five years earlier:

… noted the ‘extreme anxiety suffered by Aboriginal prisoners committed to solitary confinement’. It noted, ‘it is undesirable in the highest degree that an Aboriginal prisoner should be placed in segregation or isolated detention’.

The final report of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the Disability Royal Commission) focused specifically on this issue (see p. 107 of Volume 8 (Criminal justice and people with disability)). It accepted the evidence of witnesses that isolation and solitary confinement exacerbates the difficulties experienced by children in detention who have cognitive impairment and brain injuries. It went on to make a recommendation (8.3) that all Australian jurisdictions should introduce legislation to prohibit solitary confinement in youth justice settings.

In its annual report for 2022–23, Queensland’s Child Death Review Board published an in-depth exploration of the youth justice system, focusing on the stories of two boys who were Indigenous Australians.

The Board observed that both boys had experienced separation during their time in detention, in the year prior to their deaths. One of the boys was detained at the centre. The Board concluded that periods of separation can impact a child’s health and wellbeing in severe, long-term and irreversible ways. It stated that:

Many of the children and young people in detention have experienced a life of significant disadvantage and marginalisation, with many being the victims of abuse and neglect. Being confined in a cell for extended periods of time, without interaction with peers, family, culture, and support networks creates an environment of re-traumatisation. Research has shown pre-existing mental health problems are likely exacerbated by experiences during incarceration, such as isolation, boredom and victimisation. As First Nations adolescents, separation and solitary confinement likely had additional and compounding impacts. (pp. 38–39)

The Board also explained that both boys experienced ‘heightened emotions and behaviours as a direct result of extended periods of separations and the associated reduction in access to activities and programs’. (p. 39) This led to behavioural incidents that increased as the time they were locked in their cell per day increased.

The Board reported that the Department of Youth Justice (the department):

… acknowledged the flow on effects of extended separation in its report to the Board, including:

• escalated behaviours
• fractured relationships and breakdown of therapeutic alliances [work with psychologists and case workers]
• reduced compliance and commitment to programs
• additional workload placed on staff in a therapeutic position required to support young people
• lack of privacy due to speaking with young people through their doors. (p. 40)

Court decisions have highlighted the length of separations

In 2023, the Childrens Court of Queensland and the Childrens Court (two different courts) expressed concern about the duration and impacts of separation at the centre. The following examples of court decisions highlight the nature of staff shortage separations at the centre at the time.

1. On 24 January 2023, in the matter of Commissioner of Police v David Taylor (a pseudonym) the Childrens Court at Mt Isa conducted a sentencing proceeding. This was for a child who had been held at the centre on remand (awaiting sentencing) for 26 days between December 2022 and January 2023. A report was provided to the court that addressed the child’s separation for 21 of those days. Referring to the report, the court highlighted that:

• David’s unit was only appropriately staffed on one of the 21 days.
• On average, David was only out of his cell for 2 hours and 37 minutes per day.
• It is likely that David only left his unit block on one of the 21 days.
• David was allowed to make phone calls when he was out of his cell.

2. On 2 February 2023, in the matter of Re JG (2023) QChC 3, the Childrens Court of Queensland heard an application for bail. The child was a 16-year-old girl diagnosed with disabilities including foetal alcohol spectrum disorder (FASD). She had been subject to a long-term guardianship child protection order since she was four years old. The court heard that she was held in detention on remand for 94 days from May 2022 to early 2023, including 60 days from late November through to the date of the hearing. Referring to the authorised separation report, the court stated that:

• For 30 of the 59 days dealt with in the report, the child had been locked up in her cell for 21 to 24 hours per day.
• For three days, she was locked in her cell for 24 hours per day. 
• The child had less than five hours out of her cell for 40 of the 59 days.

3. On 21 February 2023, in the matter of R V TA (2023) QChC 2, the Childrens Court of Queensland heard a sentencing proceeding. The court noted that the child being sentenced had disabilities including FASD, and had been subject to abuse and neglect. As part of the proceeding, the court considered a separation report that contained information about the detention of the child for 87 days from 25 November 2022. Referring to the report, the court highlighted that:

• For 78 of the 87 days of detention, the child was confined in their cell for 20 hours or more each day.
• For 10 of those 87 days, the child was confined for 24 hours per day.
• The child developed behavioural problems on days when they were separated.

4. On 17 March 2023, in the matter of R v Nathan (a pseudonym) (2023) QChC 4, the Childrens Court of Queensland heard an application for bail. The court stated that:

… repeated separation for 11 hours and 59 minutes … coupled with the 12-hour overnight lockdown, amounts to 24-hour solitary confinement, less one minute. (pp. 3–4)

Separation of children in terms of human rights

The separation of children is a significant human rights issue. The department’s operational policy on separation acknowledges that its use has the potential to impact the following human rights:

• Protection from torture and cruel, inhuman or degrading treatment (s 17 of the Human Rights Act 2019)
• Humane treatment when deprived of liberty (s 30 of the Human Rights Act).

The Queensland Human Rights Commission provided a detailed submission to us about human rights and separation (see Appendix C). The submission states that:

Depending on the circumstances, the ongoing involuntary separation of a child from others in a locked cell may amount to torture, cruel, inhuman or degrading treatment under s 17 of the HR [Human Rights] Act.

A number of human rights instruments relate to the rights of children who are separated and to the issue of solitary confinement.

The United Nations Standard Minimum Rules for the Treatment of Prisoners (Nelson Mandela Rules) apply to all prisoners (including children) and define solitary confinement as the confinement of prisoners for 22 hours or more a day without meaningful human contact (Rule 44).

The United Nations Rules for the Protection of Juveniles Deprived of their Liberty (Havana Rules) strictly prohibit solitary confinement of a child or young person as a disciplinary measure. They state that it constitutes cruel, inhuman or degrading treatment and is strictly prohibited (Rule 67).

The Nelson Mandela Rules prohibit the use of solitary confinement for any person with mental or physical disabilities if that confinement would exacerbate their conditions. They reiterate the strict prohibition on the use of solitary confinement for children (Rule 45).

The Istanbul Statement on the Use and Effects of Solitary Confinement (Istanbul Statement), prepared in response to the increasing use of isolation in prisons, states that solitary confinement should be absolutely prohibited for children under the age of 18.

The role of Inspector of Detention Services

The Inspector of Detention Services was established under the Inspector of Detention Services Act 2022 (the Act) to provide independent oversight of detention services and places of detention in Queensland.

The purpose of the Act is to promote the improvement of detention services and places of detention, with a focus on humane treatment of detainees and on preventing them from being subjected to harm.

Key functions of the Act involve inspecting detention services and places of detention (once every year for youth detention centres and once every five years for adult prisons), and then reporting to the Legislative Assembly with advice and recommendations.

As required by the Act, in August 2023, the Inspector of Detention Services published the Inspection standards for Queensland youth detention centres (the standards). These are designed to provide consistent, transparent assessments of youth detention centres and are intended to protect the basic rights of children in these centres. We refer to relevant standards from this document throughout this report.

Our inspection process

The inspection process included:

• reviewing information from relevant inquiries, reports and court decisions
• reviewing relevant legislation and policies
• assessing data held on the department’s information system (Detention Centre Operational Information System – DCOIS)
• obtaining information from the government departments responsible for providing detention services at the centre: Department of Youth Justice, Department of Education, and the Townsville Hospital and Health Service
• seeking submissions from a range of other government bodies, including agencies with oversight of youth detention centres
• engaging with government agencies and other services such as the Public Guardian’s community visitor to the centre
• seeking submissions from community organisations
• engaging with community service providers including Aboriginal and Torres Strait Islander organisations
• interviewing and engaging with staff at the centre, including managers, operational staff, therapeutic staff, and teachers
• attending the centre to conduct an onsite inspection in October 2023 on weekdays and a weekend. The inspection included observing
  
  • accommodation units, including independent living units and behavioural support units
  • classrooms
  • health service facilities
  • casework and administration facilities
  • recreational facilities, including the sports field and undercover sports area
  • visits facilities on the weekend when most visits occur
• listening to the children who were detained at the centre.

We also benefitted from access to information and analysis from previous investigations conducted by the Office of the Queensland Ombudsman from 2021 to 2023.

As required by s 24 of the Inspector of Detention Services Act we provided a copy of the draft report to notifiable entities including:

• Hon Yvette D’Ath, Attorney-General and Minister for Justice and Minister for the Prevention of Domestic and Family Violence
• Hon Di Farmer, Minister for Education and Minister for Youth Justice
• Mr Bob Gee, Director-General, Department of Youth Justice
• Mr Kieran Keyes, Chief Executive Officer, Townsville Hospital and Health Service 
• Mr Michael De Ath, Director-General, Department of Education.

We received written responses from the Director-General, Department of Youth Justice; Director-General, Department of Education; and the Chief Executive Officer, Townsville Hospital and Health Service. Copies of the written submissions are attached to the report.

How we refer to the department

The department responsible for administering the Youth Justice Act has been subject to several name and organisational changes for the periods of time covered by this report.

As a result of machinery of government changes that came into effect on 18 May 2023, the youth justice function was removed from the former Department of Children, Youth Justice, and Multicultural Affairs and transferred to the Department of Youth Justice, Employment, Small Business and Training.

Further changes on 18 December 2023 removed the youth justice function from the Department of Youth Justice, Employment, Small Business and Training and created a new department, the Department of Youth Justice.

To avoid confusion, we simply refer to the department that has responsibility for administering the Youth Justice Act by its current name or as ‘the department’ in this report.

A note about the data and terms we have used in this report

Some sections of this report rely on data obtained from the department’s DCOIS. The department has expressed concern about the reliability of this data, so where possible, we have used alternative sources. However, where there were none, we have used the data in DCOIS.

The information contained in graphs 1, 2 and 3 in this report is derived from a separation ‘matrix’ provided to us by the department. The matrix documents the use of staff shortage separations at the centre during 2023 in terms of whether the type of separation was ‘night mode’ or ‘continuous cell occupancy’ (CCO). We explain these terms in Chapter 2.

We use the terms to explain the nature of staff shortage separations. This is particularly important in relation to night mode separations, which have caused us most concern. This is because, when combined with the usual evening lockdown, they can cause children to be locked in their rooms for more than 22 hours in a single day.

In relation to graphs 1, 2 and 3, we acknowledge the department’s advice that they do not take account of incidents that may occur when young people are out of their rooms during a staff shortage separation. If an incident (for example, a young person assaulting another) occurs during these periods, a second separation is not recorded in the DCOIS, as young people are already subject to a separation. This is to ensure these events are not double counted.

To remove any doubt, the staff record the incident and link it to the existing separation event. An analysis of incidents occurring during these periods of separation would improve the interpretation of the data. While we acknowledge these concerns, we note that the number of night mode and CCO separations remains accurate.

Acknowledgements

We wish to acknowledge the support and assistance we received throughout the inspection process from the department and its staff at the centre.

We would also like to acknowledge the assistance of staff from the Department of Education and the Cleveland Education and Training Centre, and the staff from the Townsville Hospital and Health Service and the Cleveland Youth Detention Medical Centre.

A range of government and non-government stakeholders provided valuable information during the inspection process, and we thank them for their assistance. We particularly want to thank the staff of the Office of the Public Guardian who helped us by sharing valuable knowledge of the children’s experiences.

Finally, we acknowledge and thank the children who took the time to speak to us and share information about their experiences with and perspectives on the use of separation at the centre.

‘Separation’ is a term used in the Youth Justice Regulation 2016 (the regulation) to describe when a detention centre employee places a child in a locked room alone.

Under s 21 of the regulation, a detention centre employee may separate a child for one of the following reasons:

1. if the child is ill; or

2. at the child’s request; or

3. for routine security purposes under a direction issued by the chief executive; or

4. for the child’s protection or the protection of another person or property; or

5. to restore order in the detention centre.

For example, separation may be used as a response to an incident if a child’s behaviour threatens the safety of others. This is recorded as a separation under s 21(1)(d) of the regulation. One of the routine security purposes referred to in s 21(1)(c) of the regulation is the overnight lockdown that occurs each evening from 7.30pm to 7.30am.

During the day, youth detention centres aim to allow children out of their rooms from 7.30am to 7.30pm to participate in a structured daily routine that includes schooling, programs and activities.

A staff shortage separation, recorded under s 21(1)(d) of the Act, occurs when children are not able to be allowed out of their rooms (for part or all of the day) because there are not enough operational staff to maintain the safe supervision ratio. As specified by the Youth Detention Centre Certified Agreement 2023, this is a minimum of one detention youth worker to four children.

Detention youth workers are responsible for the day-to-day management, supervision, security and care of children detained at the centre. They perform roles such as supervising children within their accommodation units and escorting them from the units to school, programs (for example, therapeutic activities or programs aimed at addressing offending behaviour) and activities within the centre.

For a 12-bed accommodation unit, three youth detention workers need to be present for the whole day to achieve the safe supervision ratio that allows all the children in the unit to be out of their rooms and participating in the day’s activities. The eight-bed units need two youth detention workers for this to occur.

Operationally, shift supervisors are generally not included in the safe supervision ratio. However, under the certified agreement, section supervisors can be included as short‑term backfill for detention youth workers if, during a shift, there are emergent or extenuating circumstances.

Critically, on most days at the centre, there are not enough operational staff members to meet the safe supervision ratio. When this occurs, the department’s policy on separation authorises the approval of an incident-related separation under s 21 of the regulation.

Each day, based on the number of staff available, shift supervisors recommend (to a delegated decision-maker) how many accommodation units can be fully opened and how many are subject to separation.

Types of staff shortage separations

Under the regulation and relevant youth justice policies, separation can be authorised by different officers for different periods of time. For example, a staff shortage that occurs for a single day will involve an initial authorisation for up to 2 hours, followed by a further authorisation for 2 to 12 hours.

For many years, staff at the centre have used local terms to describe two different modes of staff shortage separations that have very different features. These terms, which do not feature in any legislation or departmental policy documents, are ‘night mode’ and ‘continuous cell occupancy’ (CCO). They use these terms to describe the modes of separation that apply to all children in an accommodation unit. Each still requires authorisation.

Night mode is the most serious form of staff shortage separation. This is when all of the children in an accommodation unit are separated in their individual rooms during the day from 7.30am to 7.30pm. It is called night mode because it is similar to the type of separation that occurs during the overnight lockdown (between the hours of 7:30pm and 7:30am).

While children are predominantly locked in their rooms during a night mode separation, they may be escorted out of their accommodation unit to attend a visit, a medical appointment or a program. Also, they are usually provided with short periods of out-of-room time to make phone calls. Most of their other contact during night mode is conducted through their room’s closed doors (with other children) or through the intercom (with staff).

Continuous cell occupancy (CCO) is when all children in an accommodation unit are separated in their individual rooms for part of the day, but there are enough staff present in the unit to allow the children to come out of their rooms in small groups (of up to four children per detention youth worker to meet the 1:4 safe supervision ratio) into the common areas of the unit for longer periods of time.
There can be a lot of variation in the amount of time that children are out of their rooms during a CCO separation. A detention youth worker explained to us that during a CCO, the children will be ‘rotated’ (that is, released) out of their rooms into the accommodation units in groups of four at a time.

Reduced separations during 2023

Graph 1 shows the number and types of separations in accommodation units in response to staff shortage incidents each month at the centre over a 10-month period in 2023. It also shows the number of ‘risk separations’ (which, unlike the staff shortage separations, are imposed in response to behaviour) that occurred during the same time.

Graph 1: Total number of separations in accommodation units each month – 1 January to October 2023

Note: This does not include part-day separations.
Source: Compiled by the Inspector of Detention Services using information from the Department of Youth Justice’s Separation Approval Records Matrix CYDC 2023.

It’s clear that the overall number of separations across the centre declined during 2023, particularly from July onwards. From this time, the number of night mode separations began to significantly increase, as the centre sought to reduce the number of separations occurring on consecutive days.

The reason for the increase in night mode separations

During our onsite inspection from 18 to 21 October 2023, a shift supervisor explained to us that the centre started placing children in night mode about eight weeks earlier, so that they would not be locked in the units for days in a row. The supervisor explained that this enabled more children to be out of their accommodation units on a structured day, but also meant that more children were locked in a room all day and not out on rotation inside their accommodation units, as they would be if were under a CCO.

This matched what children in the Corella and Kestrel units told our officers. They said they are often alternated between night mode and regular, unlocked mode, but they have no days where they are considered in continuous cell occupancy.

Using night mode more frequently gives the centre a better chance of avoiding consecutive days of separation than using CCO. This is because fewer staff are required to supervise an accommodation unit while it is in night mode. The centre can ration out the available staff between units.

The upside is that children can have at least some days during the week out of their rooms for a full day. The downside is that on the days they are in night mode, they are kept in their rooms for the full day.

The following two graphs show the decrease in the centre’s use of separation during 2023 for each accommodation unit. We selected two periods of time for the graphs. The first, in Graph 2, is 8–15 January 2023, which was the first full operational week of January 2023 after the Christmas – New Year period. The second, in Graph 3, is 15–22 October 2023, which was the week we conducted our inspection.

Please note that children in the centre’s two four-bed independent living units – Osprey and Sandpiper – are not subjected to separation very often, because they each require only one officer for them to operate their structured day.

In the period from 8 to 15 January 2023, 104 (71 CCO and 33 night mode) separations occurred. This was not an unusual week at that time. Records show that similar levels of separation occurred in the week before and the week after.

Graph 2: Number of separations by unit from 8 January to 15 January 2023

Source: Compiled by the Inspector of Detention Services using information from the Department of Youth Justice’s Separation Approval Records Matrix CYDC 2023.

The improvement in the situation by October 2023 can be seen in Graph 3, which shows the separation of accommodation units in an eight-day period. The centre had a total of 53 separations, which is just over half of those that occurred in January 2023.

Most accommodation units were separated for three to five days out of the eight-day period, rather than all eight days. However, the type of separation was predominantly night mode (41) rather than CCO (12).

Graph 3: Number of separations by unit from 15 October to 22 October 2023

Source: Compiled by the Inspector of Detention Services using information from the Department of Youth Justice’s Separation Approval Records Matrix CYDC 2023.

Decrease in duration of separations

The Department of Youth Justice (the department) provided analysis about the duration of separations of individual young people at the centre. It shows the length of time young people have spent in separation significantly reduced in the first 9 months of 2023–24 compared to 2022–23.

In 2023–24, almost two-thirds (65%) of separations lasted less than 2 hours compared to the previous year, when only a quarter (25%) of separations were under 2 hours. Further, the proportion of separations lasting between 2 and 12 hours decreased significantly from 75% in 2022–23 – now making up only a third of separations (33%).

Furthermore, the departments analysis showed that in 2022–23, the average length of a separation at the centre was 8 hours and 36 minutes. For July 2023 to March 2024, it was 4 hours and 24 minutes – a 47% reduction.

Separation on consecutive days

Figure 1 shows that, during 1 July 2021–30 June 2022 and 1 July 2022–30 June 2023, many children were often separated on consecutive days, including some for more than 70 days in row.

Figure 1: Children at the centre in separation for 20 or more hours on consecutive days in the 2021–22 and 2022–23 financial years

Source: Compiled by the Inspector of Detention Services using information from the Department of Youth Justice.

As discussed earlier, since the middle of 2023, the centre staff have sought to reduce the number of separations that occur on consecutive days. They have been able to do so by increasing their reliance on night mode, but also because of increased staffing levels (see below).

In our inspection, we considered the conditions children experience when they are subject to a staff shortage separation for some or all of the day, including:

• accommodation while separated
• how much time children spend out of their rooms when separated
• how much meaningful contact the children have with others while separated.

The United Nations Standard Minimum Rules for the Treatment of Prisoners (Nelson Mandela Rules) apply to all prisoners (not only children) and define (in Rule 44) solitary confinement as the ‘confinement of prisoners for 22 hours or more a day without meaningful human contact’.

Accommodation while children are separated due to staff shortages

Children who are subject to a staff shortage-based separation are locked in their own rooms, which are located within the accommodation units. The rooms have a window; a built-in bed base with mattress, pillow and bedding; bathroom facilities (shower, toilet and basin); shelves; desk and a stool. Access to the rooms is through a heavy steel door with a viewing window. Rooms we observed had clean bedding, but most had a lot of scratches and tagging all around them, including on the observation window in the door and the screen in front of the television.

When locked in their rooms, children can speak to operational staff through the door or via an intercom. When visitors or other staff come to see them, they also have to speak to them through the door, usually through the grill at the bottom of it. We discuss this later in the chapter. We observed that some children locked in their units had pulled their mattress onto the floor in front of the door so they could lie on it and talk through the grill, to be heard by other children also locked in their rooms.

Photos 1 and 2: A typical accommodation room

Most accommodation units (other than the two behavioural support units) have a common area that includes a kitchen benchtop and sink, a television, at least one phone on the wall, and some seats and tables. Some of those we visited had a lot of graffiti on the walls and windows but were otherwise clean, with no rubbish visible.

Photo 3: Kitchen area in Heron Unit. Photo 4: Common room in Corella Unit

During continuous cell occupancy (CCO) separation, children are often allowed out of their rooms into the accommodation unit’s common area and exercise yard. An exercise area – known as a fernery – usually adjoins the common area. It is enclosed by metal screens.

Photos 5 and 6: Examples of exercise yards (known as ‘ferneries’)

Food is provided to the children regularly during the day – for breakfast, morning tea, lunch, afternoon tea and dinner. If the children are locked in the rooms at these times, the detention youth workers deliver the food to their rooms (by opening the door and giving the food to the child, not simply sliding it through a slot).

Time out of room

When an accommodation unit is not subject to a staff shortage separation (because it is fully staffed), and the day is not disrupted by other incidents, children are released to outside activities at 7.30am and they return for evening lockdown at 7.30pm. During this time, the aim is for them to participate in a structured daily routine of education, programs (for example, therapeutic programs run by psychologists) and recreational activities.

When CCO separation is used, children are released (or ’rotated out’ to use the terminology of the Cleveland Youth Detention Centre – the centre) from their rooms to the accommodation unit for part of the day.

However, when children are separated in night mode, they spend almost all of the day in their room and have little, if any, time outside of it. They are often allowed out for a short time to make a phone call. Sometimes they are escorted out of the unit to attend a visit, go to a medical appointment or attend a program.

We considered whether children were being confined to their rooms for more than 22 hours a day.

To do so, we reviewed the records from the department’s information system (Detention Centre Operational Information System – DCOIS) of children who were separated in response to staff shortage incidents at the centre:

• from 19 to 21 October 2023 (while the inspection team was onsite)
• from 16 to 17 October 2023 for the three accommodation units that were in night mode separation on consecutive days.

Time out of room during staff shortage separations from 19 to 21 October 2023

The records, and Figure 2, show most children did not have any time out of their rooms during the separations. The records did not state why children were not provided with out‑of-room time.

Figure 2: Out-of-room time for children in continuous cell occupancy and night mode separations from 19 October to 21 October 2023.

Source: Compiled by the Inspector of Detention Services using the Department of Youth Justice’s separation group documents.

During our inspection, we spent time in accommodation units on Saturday 21 October 2023 as well as on the previous two weekdays. We observed that children appeared to spend less time out of room on the Saturday and decided to conduct further analysis. Figure 3 shows the results.

On that day, of the 97 children at the centre, 46 were in separation across six accommodation units. All six units were in night mode. According to separation records, of those 46 children, 42 received no out-of-room time, and the remaining four received less than 40 minutes out of their room. The 51 children who were not in separation on that day were released from their rooms for a structured weekend day.

Figure 3: Out-of-room time for 97 children at the centre on Saturday 21 October 2023

Source: Compiled by the Inspector of Detention Services using the Department of Youth Justice’s separation group documents.

Time out of room during night mode separation on consecutive days on 16 and 17 October 2023

As noted in Chapter 2, in June 2023, the number of night mode separations began to increase, as the centre sought to reduce the number of separations occurring on consecutive days. It achieved its objective, but some separations on consecutive days do still occur. Figure 4 shows how children can be separated for 36 hours with the approval of night mode for one day and up to 60 hours of separation when consecutive separations are approved.

Figure 4: Example of total separation time when children are in night mode for consecutive days

Source: Compiled by the Inspector of Detention Services.

In the week prior to our inspection, three accommodation units (Ibis, Brolga and Cassowary) were in night mode separation for consecutive days on 16 and 17 October 2023.

We examined the separation reports in the department’s DCOIS information system, and identified the cumulative out-of-room time for each of the children over those two days. The results are set out in Table 1.

Table 1 – Cumulative out-of-room times for each child in Brolga, Ibis and Cassowary units – 16–17 October 2023

Source: Compiled by the Inspector of Detention Services using separation reports in the department’s DCOIS information system.

Having children separated on consecutive days, particularly when it is night mode separation, is especially concerning. During our inspection, we spoke to the centre’s psychologists about the psychological impact of separation. They told us that the timeframes in which they would see a decline in the mental health of children who were separated depended on each child. It can occur after a day for some but can take longer for others.

However, they also advised that the effect is usually noticeable by the second day of separation.

Meaningful human contact

While the Nelson Mandela Rules do not directly define ‘meaningful human contact’, other experts have done so, based on how it is referred to in the Rules. The Queensland Human Rights Commission included an interpretation in its submission to us (see Appendix C):

Meaningful interaction requires the human contact to be face to face and direct (without physical barriers) and more than fleeting or incidental, enabling empathetic interpersonal communication. Contact must not be limited to those interactions determined by prison routines, the course of (criminal) investigations or medical necessity.

(Source: Penal Reform International Head Office and Human Rights Centre University of Essex, Essex Paper 3: Initial guidance on the interpretation and implementation of the UN Nelson Mandela Rules, 2017, 88–89.)

We reviewed separation reports from the department’s DCOIS to understand the type of contact that children have with others when under separation. The reports we reviewed were for units in CCO and night mode separation from Thursday 19 October to Saturday 21 October 2023 – the days of our onsite inspection.

The review showed that children have meaningful human contact when in CCO separation. For example, when they are released from their room into the common area of their accommodation unit, they can mix with other children (usually in groups of four, due to the safe supervision ratio) and an officer. Other opportunities for meaningful contact may also arise, such as attending visits, school or programs.

However, children who are in night mode separation have significantly less meaningful contact. Of particular concern is the minimal amount of contact that occurs in night mode separation on weekends.

Two daily routines that occur even during night mode separation that are consistently recorded in the records are:

• delivery of meals to accommodation rooms for breakfast, morning tea, lunch, afternoon tea and dinner
• visit by nurses to units, usually in the morning.

In most instances of night mode separation, children are also provided with out-of-room time to make a phone call (see Table 1).

Sometimes children have contact outside of the accommodation unit when they attend a visit from a family member or lawyer, or a medical appointment. Occasionally, they may also be escorted to a program. The records indicate that these types of contact are not regular or frequent.

Officers who run programs for children, including therapeutic and recreational programs, have responded to the use of prolonged separation by devising innovative unit-based models to provide programs and activities to children. The children come out of their locked rooms into the unit’s common areas to participate in the programs. Records the centre provided indicate that these are provided to children during CCO and night mode separations.

We also saw some children in accommodation units that were in either CCO or night mode separations leaving their unit to attend programs when detention youth workers were able to escort them.

Design of accommodation rooms

Much of the other contact that children have is through the locked door of their accommodation room when there are visitors to the unit (such as cultural liaison officers, psychologists or case workers). The records indicate that these types of visits are also occasional rather than regular or frequent.

Children are able to use the intercom in their rooms to speak to a detention youth worker. They may do this to ask to see their caseworker, or to request that a movie be played or activities be provided.

Giving children meaningful human contact is difficult when they are separated in a locked room, especially in night mode. Caseworkers and psychologists told us they often have to speak to them about sensitive matters through their locked doors. This provides little privacy, as other children and staff can hear the conversations.

The design of the doors of the accommodation rooms does not allow people to easily speak to a child who is locked in their room. We observed youth detention workers, client services staff (including the children’s caseworkers and psychologists), and a visitor from the Office of the Public Guardian speaking to children locked in their rooms through the door grate, including by sitting on the floor.

Photos 7 and 8: Sitting on the floor to talk to children locked in their rooms

The level of meaningful contact reduces significantly on weekends, because most client services staff (which includes caseworkers, psychologists, sport and recreation officers, and cultural liaison officers) do not normally work on weekends.

This means the children in units subject to separation likely interact only with the unit’s staff and have limited access to any recreational activities. We witnessed this, on a Saturday.

We did, however, see an officer from the client services team (who had volunteered to work on the weekend) sitting on the floor outside a child’s locked door playing cards with him, passing cards under the door. That officer explained that if they were not sleeping, multiple children in a unit can participate in activities such as bingo or word search competitions that can be played through their doors.

We observed that the Cleveland Youth Detention Centre (the centre) has some great facilities including an excellent school, good library and outdoor recreation areas. We also met many staff members who have been frustrated at how staff shortage separations hamper their ability to provide services to the children.

There was a palpable sense of relief among many staff that the use of separation had recently reduced, and that the children were able to leave their accommodation units more often to participate in activities and programs.

In its submission, the Office of the Public Guardian noted that ‘once in detention, separation operates to limit their [children and young people’s] access to services and support, including education and reintegration services’.

In the following sections, we discuss the impacts of separation on children’s access to cultural support, health, education, psychological support, recreation, activities and visits.

Cultural support

Of the children detained at the centre, 97% are Aboriginal and/or Torres Strait Islander peoples.

Staff at the centre spoke to us about the benefits (they have seen) of providing cultural support to children. One officer told us that when cultural support staff come to an accommodation unit and see the children, it creates a more relaxed atmosphere in the unit. We were told that, unfortunately, these interactions are infrequent.

Given the predominance of Aboriginal and Torres Strait Islander children at the centre, it was disappointing to hear from children, staff and community stakeholders that there was limited cultural engagement, interaction and support provided to children, especially to those subject to separation.

Some community organisations have expressed concerns about children’s cultural disconnection. We heard from children that they do not receive visits from cultural Elders groups anymore. While there were some cultural programs running at the time of our visit, yarning circles for both girls and boys were not in use. (Yarning circles allow for experiences, knowledge and stories to be shared in a respectful way.)

The Department of Youth Justice’s separation policy states that when a child is in separation for two consecutive days or longer, regular support ‘from cultural unit staff and/or cultural liaison officers must also be considered as a therapeutic intervention’. However, records we reviewed show very limited or no cultural interaction with children while they were in separation, including with children who were separated on consecutive days.

We were told that staff vacancies in the cultural unit were the reason why the level of services to children was reduced. At the time we finalised this report, the centre had filled most of the positions.

Health services

Youth justice principle 21 in the Youth Justice Act 1992 states that a child who is detained in a detention centre should have access to dental and medical services. Health services are provided to the centre by the Townsville Hospital and Health Service.

Pleasingly, the provision of health services to children has not been interrupted by the centre’s prolonged use of separation. Access to the onsite nurses and medical centre has been prioritised by the centre.

The Townsville Hospital and Health Service confirmed:

• Nurses visit children in the accommodation units for their medication rounds, health assessments and treatments when operational staff are present and they are advised that it is safe to do so. This occurs even when children are in night mode separations.
• The centre provides a dedicated escorting officer to ensure children can attend medical appointments. (We observed this occurring.) The availability of escorting officers ensures that separations rarely impact on the running of health clinics, including dental, visiting medical officer and nursing clinics.
• The visiting medical officer attends the accommodation units to provide health services to children if they are a priority and there are insufficient staff to escort children to the medical centre.

We support the continuing prioritisation of access to health services.

Education

Youth justice principle 21 of the Youth Justice Act states that a child in a youth detention centre should have access to education appropriate to the child’s age and development.

The centre has a Department of Education school onsite to ensure children have access to a range of educational services, including school-based classes, art classes, hospitality, woodwork and mechanical programs. The school day is split into four sessions.

A 48-week school year has been introduced at all youth detention centres (compared to a 41-week school year in Queensland state schools in 2024) to provide more opportunity for education and programs to be delivered to children.

Photo 9: A classroom in the school. Photo 10: The centre’s library

During our inspection, we saw some children attending school sessions. The Department of Education confirmed that children’s attendance at school increased in the latter half of Term 3, 2023, following the centre’s efforts from July 2023 to reduce the number of separations occurring on consecutive days.

However, on the days children can attend school, very few attend for a full day (that is, all four sessions). We reviewed records relating to children’s attendance at school for one day in September 2023. As shown in Graph 5, 69 children attended either one or two sessions of school. Only four attended all four sessions.

Graph 5: School attendance on 12 September 2023

Source: Compiled by the Office of the Queensland Ombudsman from a Department of Education student subject class roll-marking summary.

The Department of Education entered into a service level agreement with the centre. It allows teachers to deliver school sessions to children in a small number of specific accommodation units (after a risk assessment is conducted) when prolonged separations occur.

While this is not a preferred method of teaching children, it enables teachers to deliver school sessions to at least some of the children while they are in separation. It is a good example of the innovation in practice that the centre and service providers are pursuing to address the impacts of separation.

The West Moreton Youth Detention Centre (which is a new centre) has a room attached to each accommodation unit that can be used for delivering education or programs. The Cleveland Youth Detention Centre would benefit from something similar.

The Department of Education advised us that, in addition to the impact of separations, the infrastructure at the centre does not allow all students to attend all four sessions a day. This is especially the case when the centre is operating at or near capacity.

The Department of Education also told us that children may have therapeutic support sessions and meetings with case workers, medical appointments, meetings with legal representatives and court attendance requirements, all of which may impact on their attendance at a school session.

Despite the efforts of the teachers and staff, most children who are separated on a school day are still unable to attend the school and participate in classes, or have a teacher attend their unit. Instead, they must rely on education packs being given to them to complete. They are a poor substitute for face-to-face education in a classroom with a teacher.

The Department of Education advised that the education packs were developed for independent learning due to operational staff not always being able to provide one-on-one education assistance to children in the units when they are separated.

Teachers rely on centre staff to distribute the packs, and usually on the individual commitment of each child to complete them. We were informed by accommodation unit staff that they do distribute the packs to children when they are separated. However, children told us the activities in the packs are usually either too easy or too difficult for them to complete on their own.

Therapeutic programs and support for children

Youth justice principle 21 of the Youth Justice Act states that a child in a detention centre should have access to the therapeutic services necessary to meet their needs.

The centre has programs and support available to children to help them change their behaviour and make better choices. These are in line with trauma-informed practice principles, which encourage safety, trustworthiness, choice, collaboration, empowerment and respect for diversity through programs and services. They are run by therapeutic staff in the centre’s client services team, including:

• psychologists
• speech-language pathologists
• caseworkers
• program officers, including Aboriginal and Torres Strait Islander program officers.

The department’s separation policy states that, where resources permit, all children separated for two consecutive days or longer must be visited daily by a nurse and/or caseworker or other member of the multi-disciplinary team.

In the week of our visit, records showed that, during extended periods of separation, some children were visited by a caseworker or psychologist in their accommodation unit, and some children left their unit to attend a session with a speech pathologist or psychologist. However, we were also told that this did not always occur – particularly on weekends, when therapeutic staff do not work.

Caseworkers and operational staff spoke of large caseworker caseloads due to the number of children in the centre. In units that were separated, we heard several children using the intercom to ask to see their caseworkers.

Psychologists at the centre expressed concern that their work and that of caseworkers is predominantly reactive rather than proactive, and that the need to prioritise suicide risk assessments leaves them little time for undertaking proactive interventions with children to aid their rehabilitation.

The importance of privacy

When a unit is in continuous cell occupancy (CCO) separation, caseworkers and psychologists are usually able to have a more private conversation with children during the periods of time they are out of their rooms, for example, by finding a space in the unit’s enclosed outdoor area. But that is not possible when a unit is in night mode.

Instead, they lean over or sit on the floor outside the door of the child’s room, speaking with them through the grill at the bottom of the door without being able to see the child. We saw this occurring and were able to overhear parts of the conversations. Other children and centre staff would also have been able to hear them.

This clearly does not give privacy to a child being asked to provide clear and accurate information to those tasked with assessing their health and wellbeing. Nor does it allow the person conducting the assessment to physically observe the child and conduct a face-to-face assessment.
This does not comply with youth justice principle 21 in the Youth Justice Act, which states that a child in a detention centre:

… should be given privacy that is appropriate in the circumstances including, for example, privacy in relation to the child’s personal information.

The centre has a dedicated therapy room for psychologists to use to conduct sessions with children, but this relies on operational staff being available to escort each child. When there are operational staff shortages, this is not always possible.

Photos 11–14: The therapy room

As mentioned earlier, recent designs for youth detention centres in Queensland include a room within accommodation units that can be used for educational and therapeutic programs. These rooms offer the added benefit during separation of ensuring children and staff can have more private conversations, such as for therapeutic assessments.

Children who are subject to separation should be receiving more proactive therapeutic services and access to meaningful daily conversations with therapeutic staff, including caseworkers and psychologists. They should be able to access these services outside of their rooms in suitably private spaces and not only through their locked room doors.

We have made recommendations about improving the centre’s staffing model and ageing infrastructure in Chapter 7.

Restorative practice

Restorative practice aims to support effective relationship management and conflict resolution for children, through both formal and informal means. Pleasingly, the centre is dedicating more resources to its restorative practice team.

We observed multiple ‘couch time’ sessions during the inspection. The sessions involved children and staff in a unit gathering in the morning – usually on the couches in the unit’s common area – to discuss how they feel and their goals for the day, and to reinforce the importance of respectful relationships. These sessions are not able to occur when children are separated in their rooms.

The Restorative Practice Coordinator attended some of the couch time sessions and was also observed having individual discussions with children about their behaviours towards staff and each other. This was in response to concerns from staff about conflict the previous evening that could have risked all children in the unit not being able to participate in a structured day, including attending school. That intervention meant all children were able to attend school.

Recreation and other activities

Staff shortage separations severely limit the ability of children to engage in any physical and recreational activity. The United Nations Rules for the Protection of Juveniles Deprived of their Liberty (Havana Rules) state children should have:

… a suitable amount of time for daily free exercise, in the open air whenever weather permits, during which time appropriate recreational and physical training should normally be provided (Rule 47).

In the centre, children in separation, including in night mode, are provided with activities from a library of activity-based resources (for example, colouring-in activities) to complete in their rooms. Some accommodation units have additional activity-based resources in their staff rooms.

Program officers reported being able to deliver more sport and recreational activities to children when separations were reduced. During the inspection, we observed children attending programs and cultural activities. We also saw children participating in physical activity on the oval, basketball courts and undercover sports area.

Photo 15: The oval

We heard from children that they like going to programs and the gym and wanted to go more. The chance to get outside and kick a football around was clearly popular with the children involved. Access to programs is important for children’s rehabilitation and their transition back to the community.

When children are let out of their rooms when their accommodation unit is separated, their time is usually spent in the unit’s common area or its attached exercise yard – the fernery. Our inspection officers saw some children participating in activities when in a CCO separation, including playing basketball in the fernery and board games in the common area with the detention youth workers.

While the exercise yard provides an opportunity for children to get some natural light and fresh air, records from the department and anecdotal evidence from children and centre officers show the children are more likely to use any time they are out of their rooms during the day to make phone calls. This is particularly the case when they are separated in night mode. This choice further limits their opportunity to exercise and socially interact with other children in recreational activities.

As we mentioned earlier, centre staff provide children with activity-based resources to complete in their rooms, and the centre’s school provides education packs. Children usually have to do these on their own. We saw some children in night mode separation completing some of these activities at their desks.

We also saw them sleeping, laying on their beds watching television or doing some form of exercise in their rooms.

Visits

Youth justice principle 21 of the Youth Justice Act states that a child in a detention centre should be helped to maintain relationships with their family and community. Access to visits is an important part of achieving this goal.

The centre’s visits team coordinates family and professional visits and court appearances for children. The team has a dedicated officer to escort children to the visits area, even when they are in separation.

The visits area is small for the number of children at the centre, which is a source of frustration for the visits team when they are managing a large number of professional visits and court appearances each week.

The required safe supervision ratio of one detention youth worker to four children still applies in the visits area, meaning it can contribute to the effects of operational staffing shortages on children in the units.

Children often must wait until all others in their accommodation unit have finished their visits or court appearances before being able to be escorted back together. This is because their detention youth worker is not able to leave to escort them back to their unit individually if there are not enough other staff to make up the safe supervision ratio.

As a result, children can wait in the visits area a long time, especially when professional visits or court appearances run late. We were given an example of 20 children being in the visits area at the same time, requiring at least five detention youth workers to be present.

We saw children attending family visits on a weekend, including a large family of visitors who arrived in a taxi organised by the centre. The family members we spoke to provided positive feedback on their engagement with the visits team, the process for booking visits and the assistance that is provided to families so they can visit children.

Innovative approaches

As mentioned, some centre staff have adapted their service offerings to cater for prolonged separations, including by developing unit-based services. While this is not the preferred method, it at least allows children in prolonged separation to continue to have access to services.

Also, some non-operational staff have been trained in the department’s authorised intervention responses, allowing them to escort children around the centre and interact with them without the need for an operational staff member. This helps to ensure children’s access to services can continue when operational staff escorts are not available, including because of staff shortages.

Despite the above, staff shortage separations continue to hamper the achievement of a regular structured daily routine for children. We also heard from staff that they do not have enough resources to undertake proactive work with children. We consider these issues further in Chapter 7.

The Cleveland Youth Detention Centre (the centre) has specific processes and delegations for approving separations. However, it focuses on accommodation units rather than on individual children, and the centre does not maintain adequate records on its decisions about separations. Also, it does not currently involve psychologists when making these decisions about vulnerable children.

Decision-making process

Separating (segregating) children is authorised under the Youth Justice Regulation 2016 (the regulation). The department’s separation policy provides further detailed information about it, including the requirements for delegated decision-makers.

Table 2: Delegated decision-making requirements in the department’s separation policy

Source: Youth detention centre operational policy, YD-3-8 Youth Detention – Separation, version 1.9, 2023.

It is worth noting that the time periods listed in Table 2 refer only to the daytime hours the child is separated. The total hours would be much higher if the evening lockdowns were added in.

Approval process

Shift supervisors are responsible for the operational roster at the centre. Each afternoon, they review it and identify how many units will likely be fully staffed for the following day and which units will not.

We observed the shift supervisors routinely arriving at work before their shifts started, to ensure they had time before the 7:30am accommodation unit unlock time – to further review and update the roster. They have to take into account staff who have called in sick or are otherwise unavailable for work, and staff who have failed to attend work.

As shown in Table 2, shift supervisors can make the decision to separate a child for up to two hours. As the accommodation units unlock at 7:30am, this means they have the authority to separate the children until 9:30am.

After 9:30am, the shift supervisors are required to have the approval of either the deputy director or the executive director to separate children for two to 12 hours (if it is the first day of separation) or 12 to 24 hours (if it is a second consecutive day of separation). Approval from the senior executive director is required to separate children on a third consecutive day (that is, for greater than 24 hours).

These approvals are given either in a telephone call or in a text message exchange in which the decision-maker is only provided with how many units in total will need to be separated. Neither the request nor the approval at that time identifies which unit/s or which children will be in separation. No file note of the telephone conversation or copy of the text message is saved in the department’s recordkeeping system, as is required by the Public Records Act 2002.

An email is then sent to the decision-maker that includes details of the specific units that have been separated. The centre’s ‘bed state sheet’ is attached to this, identifying the children who are in each unit.

The decision-maker replies to that email, including in the reply that an approval was made by either a telephone call or a text message and specifying the time that it was made. They also state that specific considerations were taken into account in making the decision to approve the separation. These emails are usually sent by the decision-maker outside the required time period for approvals, and in some instances, close to the overnight lockdown time.

The regulation specifically states that a child may be separated. The department’s separation policy states that both the officer recommending separation and the delegated decision-maker must consider, on a case-by-case basis, the totality of the situation, the risks posed and the impacts on the child.

The decisions communicated by telephone or text message are made without information about the specific units and specific children being separated. This means decision-makers do not have all the data they need for an informed decision about separating each child, including:

• consideration of the child’s human rights
• humane treatment
• any identified risks of harm to the child
• how long the child has already been in separation.

This is not intended as a criticism of the operational officers involved in the approval processes; in fact, the opposite applies. In making the above observations about the approval process, we acknowledge that shift supervisors do an extraordinary job each morning.

They manage an intense and, at times, hectic process. They have to devise the day’s approach to rationing out the available operational officers to the accommodation units, and other vital tasks. They do this while coping with late-arriving information about staff availability and other factors.

However, given the importance of properly authorising all separation decisions, we recommend that the process be reviewed.

Considering psychological impacts when separating children

Therapeutic staff, specifically psychologists, should be included in decision-making about the continuous use of separation, to ensure the wellbeing of each child is considered. This is particularly important when considering the risk of physical or psychological harm that separation may pose.

In this regard, the United Nations Standard Minimum Rules for the Treatment of Prisoners (Nelson Mandela Rules) state:

The imposition of solitary confinement should be prohibited in the case of prisoners with mental or physical disabilities when their conditions would be exacerbated by such measures (Rule 45(2)).

In 2023, the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the Disability Royal Commission) made a recommendation (8.3) that all Australian jurisdictions should introduce legislation to prohibit solitary confinement in youth justice settings, including a requirement to take into account a child’s disability needs before any isolation period is authorised.

We could not identify any evidence of communication between operational staff and therapeutic staff about continuous use of separation in response to staff shortages or the effect this may have on children’s health and wellbeing. We confirmed this in our discussions with staff.
The executive director advised us that separations are operational decisions, and that it would be difficult to involve psychologists in the process.

While we acknowledge that it would be hard to involve them in the daily decisions made each morning about separations, it should be possible for their views to be sought in cases where a child has already been in separation for a full day, and there is a risk of a consecutive day of separation being required.

During our inspection, we identified issues about the use of separation that are not limited to staff shortage separations. They relate to the:

• accommodation used for separation (other than staff shortage separation)
• need to conduct regular observations of children in separation
• separation of children in behavioural support units
• need for the Youth Justice Act 1992 (the Act) and Youth Justice Regulation 2016 (the regulation) to better address separation
• need for more accountability about the use of separation.

Separation rooms and holding cells

Children are locked in their accommodation rooms during staff shortage separations, and sometimes for other types of separatations.

However, other purpose-built rooms, known as separation rooms and holding cells, exist in the Cleveland Youth Detention Centre (the centre) to enable children to be separated for short periods.

Separation rooms

Separation rooms are located within accommodation units. Centre staff advised us that the rooms are only intended for short-term separations in response to behaviour incidents, to manage risk. They said they are used if a child cannot be safely separated in an accommodation room.

We saw the separation rooms, which are small rooms with bare cement floors and walls covered in graffiti. They are empty, with no toilet, running water, bed or seat. 

Photos 16–20: Separation room

Holding cells

Holding cells are in the admissions area of the centre and are usually used to hold children for short periods of time as part of their admission to the centre. Like separation rooms, they do not have built-in bed bases or bathroom facilities. They do have a built-in bench for a child to sit on.

We found the holding cells at the centre to be much cleaner than the separation rooms.

What the separation rooms and holding cells are used for

The intended use for both separation rooms and holding cells is brief intervention. However, during the inspection, we observed instances of both types of rooms being used to accommodate children overnight. For example:

• On the second day of the inspection, we saw that children were in each of two separation rooms in an accommodation unit. Both had slept overnight there, with each having been given a mattress and bedding to put on the floor to sleep on. We heard one child screaming and bashing his fists on the door of the room, asking to be let out.
  
  The reasons we were given for the centre separating the children in those rooms was that each of their accommodation rooms was uninhabitable. One child had flooded his room with water and the other’s room had an infestation of ants. There were no spare accommodation rooms to place the children in.

• On the third day of the inspection, we observed a child sleeping on a mattress on the floor of a holding cell. Staff explained the child had arrived at the centre the night before and had refused to submit to a partially clothed search. This was deemed necessary before he could be moved to an accommodation unit, due to his previous history of concealing dangerous items on arrival at the centre. As a result of his noncompliance, he remained in the holding cell overnight.

How does the centre compare to other youth detention centres on this issue?

Other Australian jurisdictions have legislated that the physical environment of the place where a child or young person is separated should be no less favourable than the physical environment of other places they occupy, such as their accommodation room.

Independent custodial inspectorates in both New South Wales and Western Australia told us that toilets and access to running water are provided in separation rooms or similar facilities in their respective jurisdictions.

In 2017, an inquiry into the use of isolation, separation and lockdowns in the Victorian Youth Justice system reported many isolation rooms lacked toilets, hand basins, benches and beds (Victoria State Government, Commission for Children and Young People, The Same Four Walls; Inquiry into the use of isolation, separation and lockdowns in the Victorian Youth Justice system, March 2017).

The inquiry report recommended that the Department of Families, Fairness and Housing immediately upgrade all youth justice isolation spaces to include sanitation (direct access to toilets) and ensure sanitation was included in the design of any new youth justice facility.

This recommendation was accepted and has since been implemented. Action has been taken to ensure the seclusion rooms are fitted, at minimum, with a washbasin and toilet. Therapeutic features have also been added to the seclusion rooms. They are now painted, have mattresses, and have therapeutic resources (such as stress balls and therapeutic pillows) to help young people to self-regulate.

Interestingly, adult prisons in Queensland also provide the basic facilities of a toilet, basin with running water and a bed in their detention units.

The following United Nations Rules for the Protection of Juveniles Deprived of their Liberty (Havana Rules) are relevant to this situation:

31. Juveniles deprived of their liberty have the right to facilities and services that meet all the requirements of health and human dignity.

32. The design of detention facilities for juveniles and the physical environment should be in keeping with the rehabilitative aim of residential treatment.

33. Every juvenile should, in accordance with local or national standards, be provided with separate and sufficient bedding.

34. Sanitary installations should be so located and of a sufficient standard to enable every juvenile to comply, as required, with their physical needs in privacy and in a clean and decent manner.

37.Clean drinking water should be available to every juvenile at any time.

Children should not be treated less favourably than adults. They should not be locked in rooms without a toilet, running water and bed, especially overnight. Even in the situation where rooms are only used for short-term separations, it is difficult to understand why they are designed without these facilities.

Implications for other Queensland youth detention centres

The Director-General of the Department of Youth Justice (the department) has advised us that separation rooms are included in the design plans for the new youth detention centres being built in Woodford and Cairns.

On 26 March 2024, we advised the Minister for Education and Minister for Youth Justice (the Minister) about our concerns under s 17(5)(b) of the Inspector of Detention Services Act 2022. We made four recommendations to the Minister, which are included in this report as recommendations 5 to 8.

On 18 April 2024, the Director-General of the department responded to the recommendations made to the Minister. He explained that the use of separation rooms has been an essential response option for the safety and security of staff, children and visitors in a youth detention centre, with a range of legislative, policy and practice safeguards in place that govern their use. The Director-General’s response to each of the recommendations made to the Minister are detailed, in full, below.

On 13 May 2024, the Minister also responded, noting the Director-General’s responses to our recommendations.

While we appreciate the Director-General’s response to the four recommendations we made to the Minister, the use of rooms without any basic facilities to separate children, sometimes overnight, is an issue fundamental to humane containment. Children cannot continue to be locked in these empty, concrete rooms, even for short periods of time.

It is especially difficult to reconcile building rooms without basic facilities at two new youth detention centres with government assurances that the centres will ‘include therapeutic design elements aimed at supporting the rehabilitation of young people’. (Joint statement from the Premier and the Minister for Education and Minister for Youth Justice, Construction starts on youth detention facility at Woodford, February 2024).

We acknowledge that considerable time and cost is likely to be involved in undertaking the recommended infrastructure improvements. Recommendation 7 directed to the Queensland Government and Department of Youth Justice provides support for infrastructure improvements through additional funding.

In the meantime, if the centre intends to continue to use the rooms in their current form ‘when absolutely necessary and for the shortest possible time’, it must improve their condition and consider what soft furnishings (examples of which we have seen in adult prisons in Queensland) can be added.

Regular observations of children in separation

Locking a child in a room by themselves carries a high level of risk, so they must be checked (observed) regularly. Standard 16 indicates that care should be taken to reduce risks of self-harm and suicide, including through effective observations.

Section 21(4) of the Youth Justice Regulation requires detention centre employees to keep children who are in separation under observation. Staff must observe a child who is separated in a locked room at least once every 15 minutes. This includes when children are asleep in their rooms at night and when they have been separated for any reason during the day. The frequency of observations can be increased based on an individual risk assessment of a child.

At the centre, staff are required to physically observe a child through the window in their room door. They must physically identify each child and make sure the child is settled. Once they have confirmed this, the officer presses a button located outside the room to electronically record that they have completed the observation. The centre must be confident that staff are complying with these requirements.

Compliance with observation requirements

An audit of compliance with observation requirements was conducted by centre staff on 20 October 2023 during the onsite component of our inspection. This showed non-compliance by staff with requirements to conduct observations of children in separation (see Figure 5).

This included a failure to observe a child who was assessed as requiring observation at the increased frequency of every 10 minutes.

Figure 5: Audit of observations conducted 20 October, 2023, between 11.00pm and 3.00am – actual versus required observations

Monitoring compliance with observation requirements

The audit of compliance conducted on 20 October 2023 was the first that had been conducted since November 2022.

We raised our concerns about the gap between audits with the department immediately after our onsite inspection. In response, all youth detention centres were directed to prepare a forward plan of proactive audits of observations.

The department’s Youth Detention Inspectorate also adjusted its inspection program to include reviewing compliance of observations of children at youth detention centres. It completed that review in its December 2023 inspections.

Separation in behaviour support units

The centre has two behaviour support units (BSUs) called Lorikeet and Hawk. Each unit can accommodate four children. They are intended to be used to provide children with intervention and therapeutic care to address their behaviours.

The department’s policy on behaviour support in youth detention centres states that it will be underpinned by principles of trauma-informed practice.

The policy also states that behaviour support will be multi-disciplinary, therapeutic and undertaken collaboratively with young people. It describes referral of a child to a behaviour support unit as being an appropriate consequence of high-level examples of challenging behaviour (such as assaulting other people or causing property damage).

The department advised us that the profile of the children in detention at the centre from 1 January 2023 to 31 December 2023 included:

• 72% who had some involvement in domestic and family violence (whether as victims or perpetrators)
• 42% who had experienced mental health issues
• 78% who had substance abuse issues
• 84% who were assessed as high or very high on the Youth Level of Service/Case Management Inventory (which estimates the level of risk for antisocial behaviours and indicates areas for intervention)
• 99% who were being detained for moderate or serious levels of the offences they had or were alleged to have committed.

While our focus was on the use of separation, our inspection has identified three issues about BSUs at the centre that do not appear to support the department’s stated policy of trauma-informed, therapeutic practice, namely, the:

• state of the physical environment
• frequency of use of separation in the units
• limited access to services and activities.

The physical environment in the BSUs does not appear to support their therapeutic intent. At the time we visited them, they were in separation mode. While the Lorikeet unit was clean, without any build-up of rubbish, it had a large amount of graffiti etched into the glass panels, painted on the walls, and scratched into the paint on the door frames and window frames. The common area did not have a kitchen bench or sink.

The children we spoke to in one BSU stated they would like to see the floors in their rooms fixed, as they were currently just concrete with leftover adhesive from the previous flooring.

Children accommodated in the centre’s BSUs tend to spend a large proportion of their time in youth detention in them. Both BSUs experience large numbers of staff shortage-related separations.

Graph 1 (in Chapter 2) shows the number of separations for all accommodation units at the centre between January and October 2023. The graph does not break down the figures into individual units, but during this period, Lorikeet was subject to more separations caused by staff shortages (253) than any other accommodation unit. Hawk had the third highest number (228). Most of these were night mode separations, as shown in Graph 6.

Graph 6: Number and type of separations in the behaviour support units from 1 January to 31 October 2023

Notes: This information does not include part-day separations. Risk separations occur in response to behavioural risk as opposed to being related to staff shortages.

Source: Compiled by the Office of the Queensland Ombudsman using information from the Department of Youth Justice’s Separation Approval Records Matrix CYDC 2023.

We reviewed the records of three children who had been held in the BSU for long periods. The cases all showed the children had limited contact with the non-operational staff, including programs, recreation and cultural teams. For example, one child who was in separation for 181 days in the BSU spent only 4% of that time outside his room. He only engaged in activities outside the BSU on 32 occasions in the 181 days, including attending school only three times.

Considered together, the combination of the poor physical environment of the BSU, the frequency of use of separation, and the limited access children have to services and activities casts doubt on the extent to which detention in the BSUs is likely to improve a detainee’s behaviour.

But this is not to say that such improvement is not achievable. We were told of an example where collaboration between multi-disciplinary and operational teams at the centre resulted in a child accommodated in a BSU making significant progress in addressing his challenging behavioural issues.

If the department is serious in its aim of using BSUs to improve the behaviour of children in youth detention centres, it needs to ensure sufficient and dedicated resources are available to prevent staff shortage separations and provide children with intervention and therapeutic care.A multi-disciplinary team needs to be responsible for the day-to-day management of the children in a BSU and for developing plans for their progression back to (non-BSU) accommodation. The children need to have access to support services to address their challenging behaviours, including health staff, caseworkers, psychologists, program officers and teachers.

Better addressing separation in the Youth Justice Act and regulation

The Youth Justice Act gives the Director-General of the Department of Youth Justice general powers for managing detention centres. While the Act includes a charter of youth justice principles, it contains no specific sections setting out the preconditions and safeguards for the use of separation. Instead, these are left to regulation and departmental policy.

By way of contrast, the Corrective Services Act 2006 specifically addresses the use of separation for adults in Queensland prisons, including preconditions for its use, the period of separation, access to review, and the need for regular health examinations.

In other Australian jurisdictions, conditions for separating a child in detention are also included in primary legislation. In New South Wales, s 19 of the Children (Detention Centres) Act 1987 No 57 requires:

• the nature and duration of the separation to be reasonable and have regard to age, maturity, mental health and development stage
• the physical environment of the place the child is separated to be no less favourable than the physical environment of other places the child is detained in the detention centre
• the duration of separation to be for the shortest time possible
• children and young people to be provided with some means of usefully occupying themselves.

In Queensland, the Youth Justice Regulation contains two sections about separation:

• Section 21 sets out the circumstances in which separation may occur, who may approve the separation, the requirements to conduct observations, and when a child must be allowed to leave the locked room.
• Section 22 requires a record to be kept for each child who is separated.

There are no specific sections setting out the minimum conditions of separation.

Again, this stands in contrast to s 4 of the Corrective Services Regulation 2017, which addresses the minimum conditions of separate confinement. It states that Queensland Corrective Services must ensure a prisoner undergoing separate confinement:

1. can access reticulated water, a toilet and shower facilities that, as far as practicable, are constructed in a way to prevent the prisoner from associating with other prisoners; and
2. is given the same type of mattress, sheets, blankets and pillow as the prisoner would have were the prisoner not in separate confinement; and
3. is given clothing appropriate for the prevailing conditions; and
4. is given the opportunity to exercise, in the fresh air, for at least 2 daylight hours a day, unless a health practitioner advises that it would not be in the interests of the prisoner’s health to exercise for a stated period or indefinitely.

Another difference between the regulation of separation in Queensland’s adult prisons and youth detention centres is that the Corrective Services Act provides for external review of safety orders (which authorise separation of a prisoner) after certain periods. There is no such right provided for children under the Youth Justice Act or its regulation.

The separation of children in youth detention centres is an important matter of policy, with significant human rights impacts. As a matter of good legislative practice, significant matters of this type should be addressed in primary legislation – as is the case in the Corrective Services Act – with additional detail included in the relevant regulation.

In 2023, the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the Disability Royal Commission) recommended (in Recommendation 8.3) that all Australian jurisdictions introduce legislation to prohibit solitary confinement (which they defined as being the enforced isolation or segregation for any purpose of a child or young person for 22 or more hours in any day) in youth justice settings.

Amending the Youth Justice Act as recommended aligns with the Queensland Government’s acceptance in April 2024 of Recommendation 27 of the Youth Justice Reform Select Committee’s interim report. This said that the Queensland Government should set clear and enforceable limits on the use of ‘separations’ at youth detention centres. In accepting the recommendation, the Queensland Government stated that it:

… commits to setting clear and enforceable limits on separations. Separations are subject to strict approvals, supervision protocols, time limits and record keeping, ensuring they are reasonable and justified, in keeping with the legislative requirements of the Youth Justice Regulation 2016.

Performance reporting on separation

The department does not publicly report on the use of separation.

The Australian Government Productivity Commission’s Report on Government Services has a ‘Time out-of-cells (average hours per day)’ performance indicator for adult prisons. It describes this as an indicator of success in meeting governments’ objective of providing a safe, secure and humane custodial environment. This indicator is reported on by Queensland Corrective Services for adult prisons.

In February 2023, the department accepted a recommendation made by the Office of the Queensland Ombudsman to introduce a performance indicator on the average number of hours a child spends out of a locked room each day for each youth detention centre. The department is yet to implement the recommendation.

Recently, the Queensland Child Death Review Board made a similar recommendation to the Queensland Government in its Annual Report 2022–23, namely, to improve reporting on youth detainees’ time out of cells.

In April 2024, the Queensland Government also accepted Recommendation 26 of the Youth Justice Reform’s report. This included that the government should ‘begin reporting, within three months, on when ‘separations’ or ‘night mode’ are used as a result of staff shortfalls.’
The department advised us that it is supportive of improving reporting on restrictive practices (such as separation), including a specific measure for out-of-room time. This is being developed through inter-jurisdictional working groups to support the Youth Justice National Minimum Data Set (an annual collection of information on young people under youth justice supervision in Australia) and annual reporting in the Report on Government Services.

As noted in earlier chapters, the Cleveland Youth Detention Centre (the centre) has reduced its use of staff shortage separations since 2023. However, this is still a serious problem that continues to have a range of impacts on the wellbeing of children, the services that they can access, and the broader operations of the centre.

During our inspection, we identified a range of reforms that are needed to improve the centre’s workforce capacity and infrastructure, and more broadly the information systems of all youth detention centres.

Operational pressures on youth detention centres

Queensland youth detention centres are currently operating under extreme pressure due to high demand for detention places.

According to the Australian Productivity Commission’s Report on Government Services 2024, in 2022–23, Queensland had the highest average daily rate of young people in detention in Australia. This high demand has led to a utilisation rate of 98% in 2022–23 for its youth detention centres. This rate is also the highest in Australia, with the national average utilisation rate being 56%.

The Department of Youth Justice (the department) provided us with information showing that since 2018 (except for the years of the pandemic), the demand for youth detention centre beds in Queensland has seen the system operating above safe capacity. For Cleveland Youth Detention Centre, that is 85 per cent (95 detainees). The Queensland Audit Office report Reducing serious youth crime – Report 15: 2023–24 reported the centre operated at an average rate of 88 per cent utilisation between April 2022 and March 2023. Operating at (or near) 100 per cent capacity limits the centre’s ability to manage operational risks including:

• safety concerns
• issues where children cannot associate with other children or remain in their unit
• management of self-harm and suicide risk
• medical conditions, disabilities and cognitive functioning
• assisting children to stay in cultural groups
• gender and age
• routine and unplanned room maintenance or property damage.

Workforce review

We have previously mentioned the strategies the department is using to increase the centre’s staffing numbers, particularly for detention youth workers.

However, our inspection also identified a range of other workforce issues at the centre, such as the need to:

• address the workload of the centre’s therapeutic staff, including caseworkers and psychologists, to enable them to pursue more proactive work
• assess the adequacy of the current model for the delivery of cultural support to Aboriginal and Torres Strait Islander children
• support continuing workforce innovation in service delivery through initiatives such as training non-operational staff in the department’s authorised intervention responses
• consider how to improve the capacity of therapeutic and support staff to have regular meaningful contact with children who are in separation.

In its 2022–23 annual report, Queensland’s Child Death Review Board recommended that the department develop a workforce strategy for Queensland youth detention centres. In making this recommendation, the Board observed (at p. 41) that:

It is important for the system to consider how staffing issues will be overcome to ensure young people receive youth detention services that are vastly improved from their current quality. The Board considers that a clearer articulation of the role and purpose of the youth justice workforce is required to ensure Queensland attracts, supports and retains valued employees that can make tangible positive differences to the lives of young people. Workforce reform is needed that values key capabilities likely to drive behaviour change in young people.

The department has advised us it has developed a recommended operational model for the proposed new youth detention centre at Woodford. The model is based on research that highlights the critical role of professional staff in the provision of treatment and interventions to support young people in addressing their offending behaviours.

According to the department, an element of the model particularly relevant to issues identified in this report is that it will include:

… professional staff based in accommodation units, who will be responsible for the provision of intensive therapeutic interventions. These staff will work with detention youth workers and section supervisors in responding to the needs of young people. Building on current approaches, professional staff will upskill operational staff in communicating and responding to the needs of young people, resulting in a significant capacity uplift in working with young people, through practically implementing therapeutic approaches that focus on child development, trauma-informed practice, behaviour management, and restorative practice.

The model will provide an opportunity to enhance rehabilitative outcomes for young people through structural, workforce and practice innovations – all of which incorporate respect for culture and respect for the community. This also includes:

• new operational and professional roles to provide a range of therapeutic interventions, including Occupational Therapists, Social Workers/Family Therapists, and NDIS Team Leaders

• diversity of staff roles responsible for facilitating evidence-based programs and structured activities to young people.

We welcome the work being done to develop the proposed model for the Woodford centre. However, given the workforce issues we identified during this inspection, it is important that Cleveland Youth Detention Centre’s staffing model also be reviewed.

The aim of the review should be to develop a new staffing model that provides the centre with the skills, capabilities and capacity needed to provide a therapeutic operating environment and to achieve the results planned for the Woodford centre and for the other new centre near Cairns.

Infrastructure review

During our inspection, we identified a range of infrastructure issues including the need to:

• provide basic facilities such as a toilet, drinking water and a bed or seat in all rooms used for separation
• improve the behavioural support unit environments to help them meet their therapeutic goals
• add rooms to accommodation units (as is the case at West Moreton Youth Detention Centre) to enable the delivery of education and therapeutic programs to children from within accommodation units when necessary
• review the design of accommodation rooms and doors to ensure they facilitate meaningful engagement between children and staff.

The department is currently focused on the Queensland Government’s investment in the two new detention centres to be built at Woodford and near Cairns, and the youth remand facility at Wacol. While these new facilities are being built, it is important that existing older facilities also receive investment to improve their ageing infrastructure.

Proposals for the new youth detention centres include therapeutic design elements that aim to support rehabilitation for young people and improve community safety. As the Cleveland Youth Detention Centre will continue to be required to detain children for many years, its infrastructure should also support a therapeutic operating environment.

In pursuance of this goal, we recommend that the department develops an infrastructure strategy for the centre that includes a comprehensive, long-term capital improvement program.

This would align with the Queensland Government’s April 2024 acceptance of Recommendation 33 in the interim report of the Youth Justice Reform Select Committee.

Information systems upgrade

The department has advised us that it recognises the importance of transparent and accurate performance reporting, particularly in relation to restrictive practices such as separation. Further, it recognises that this information is critical to both separation 
decision-makers and oversight agencies in promoting legislative compliance and robust scrutiny of the use of these practices.

However, over recent years this has become increasingly problematic. The department’s existing information system (Detention Centre Operational Information System – DCOIS) was introduced in 2011 and is now classified as a legacy system. Its reporting functionality is limited and, despite regular upgrades, its design has not enabled the system to keep up with growing service complexity and reporting requirements.

These challenges were highlighted in early 2023, when several courts started requesting information about separation to inform sentencing decisions. At the time, DCOIS was unable to produce reports of sufficient detail and quality to ensure the court had a full appreciation of the way youth detention centres manage separations.

System upgrades delivered in November 2023 capture more accurate reporting of separations, better meet the needs of courts and enable the review of separation incidents; however, this is only an interim solution.

As part of the department’s youth detention infrastructure expansion projects, a replacement system for DCOIS is being scoped to ensure comprehensive, real-time reporting capability for separation and other restrictive practices within youth detention centres. As part of this process, the department is also seeking input from other agencies, such as Queensland Corrective Services, which uses a similar system and other jurisdictions.

The department is also committed to improving reporting on restrictive practices, including introducing a distinct measure on out-of-room time, as per the recommendations made by the Disability Royal Commission and the Queensland Child Death Review Board.

This is occurring via inter-jurisdictional working groups established to support the Youth Justice National Minimum Data Set (an annual collection of information on young people under youth justice supervision in Australia) and annual reporting for the Productivity Commission’s Report on Government Services.

Upgrading DCOIS also aligns with the Queensland Government’s April 2024 acceptance of Recommendation 3 in the interim report of the Youth Justice Reform Select Committee.