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Andrew Rush – General Manager: Family Services

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1 Andrew Rush – General Manager: Family Services
drummond street’s Family Services Model Using evidence to inform best-practice in family service agencies Andrew Rush – General Manager: Family Services Sophie Aitken – General Manager: Implementation and Quality Before we begin we’d like to acknowledge the traditional owners of this land, the Karna people, and pay our respects to Aboriginal elders past, present and future. Welcome and thanks for sticking around to listen today. Karen – had to return to her home town in NZ due to a family illness – sorry she couldn’t be here. Today we’d like to share with you drummond street’s family service model that has been shaped by evidence and by a desire to provide the greatest impact to the largest numbers of families and individuals in our community. We’ll talk about how we came to our practice model and some of the successes and challenges we’ve experienced in implementing it.

2 drummond street services
125 year+ not for profit community service agency Our Vision: For individuals, families and communities in Australia, well-being is supported and promoted throughout their life-cycles, and not just in times of crisis Two core areas of work: Provision of Services (responding to community need) Contributing to the Knowledge-base (evidence) Medium-sized family service agency with locations in inner melb and more recently in regional areas of Geelong and growth-corridor Wyndham over 125 yrs old – long history of providing services in the local community and adapting to changes in community needs, government/political priorities, and in leadership of the organisation. Around 9 yrs ago our current CEO KF took over the helm. At that time DS had just the one location in inner Melbourne and was well regarded in providing centre-based individual and relationship counselling and parenting support. Client group largely middle-class – what K likes to call the “worried well” and sessions over extended over very long periods – without always a clear end point. K felt that we had a responsibility to make better use of public money, to reach a larger number of families, particularly those with higher needs. She saw the potential of using a public health approach within family services – providing universal relationship and parenting support as a pathway into a range of more intensive services for those who needed it. As well as a commitment to providing maximum impact, KF was also passionate about using research evidence and evaluation to ensuring that we were providing the best possible service to our clients – hence the second core area of work – which she resourced through employment of a Director of Research and Evaluation and a partnership with Deakin University. So for many years a key aspect of our work has involved research and evaluation activities which we’ll talk more about later.

3 Using Evidence to Improve Practice
Community Needs Current Evidence Practice Organisation Outcomes Contribute to evidence base to inform service sector, first-to-know agencies, and policy makers Identify gaps in evidence- base to inform research needs Before we move in to talking about the Family Services Model – I just wanted to touch briefly on some of the ways that we use data and evidence and research in our work at DS – in a continuous cycle of learning and adapting A key aspect of responding to community needs is knowing your community, what groups make up your community and what services exist/don’t exist there, so you can provide the most valuable contribution. We have access to a wealth of information via population data-sets – examples, identify particular groups – helps to tailor programs/services Example: Inner Melb vs Carlton - AEDI data – carlton public housing estate Current evidence – not just programs but broader frameworks/components best practice. Allows identify gaps which we then work to address by conducting our own research What’s important is that it’s community needs that are driving it. Now going to hand over to Andrew to talk about the Family Services model – starting with some of the evidence-based frameworks which shaped our thinking…

4 Evidence-informed Practice Frameworks
Public Health Proportionate Universalism Early Intervention Family-based Approach Common Risk and Protective factors (across domains) Public Health framework dss provides services which span prevention, early intervention, treatment and recovery interventions, with a focus on targeting resources to intervene early to prevent problems becoming severe or entrenched Early intervention Early in life (children 0-3yrs) At risk families (multiple risk factors) Targeting family life transitions Early signs of behavioural/emotional disturbance in children Risk and Protective factors There are a set of common risk and protective factors which are known to impact on childrens’ well-being, and these factors are specifically targeted in our family service interventions to enhance the well-being of family members, and reduce the likelihood of future problems. Across domains of individual, family, school, community, life events, community/cultural factors Whole-of-Family interventions In recognising that family groups provide the earliest and most significant influence on the developing child, dss works to enhance overall family well-being, by assessing family functioning and providing whole-of-family interventions. By targeting family-level risk and protective factors we seek to improve outcomes for all family members. Child-Inclusive practice dss prioritises the needs and well-being of children within the family, both by working with the parents to improve family well-being and parenting (secondary service delivery) and by working directly with the children (primary service delivery). In any assessment and goal-setting with parents, consideration is given to the impact on children within the family.

5 Proportionate Universalism
“Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently. To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. This is called proportionate universalism.” - Professor Sir Michael Marmot (2010) - Review of effective evidence-based strategies for reducing health inequalities in England

6 What does Early Intervention mean for our Model?
Early intervention and prevention for children at risk of poor developmental outcomes: Early in life (0-3 years) Families with multiple family-level risk factors Children displaying early signs of behavioural or emotional disturbance - Targeting key vulnerable family life transitions

7 Key Vulnerable Family Life Transitions
Couple formation Transition to parenthood Parenting toddlers Starting Kinder/Child-care Starting Primary School/Secondary School Parenting adolescents Family separation Forming Step-families Our hope is that by engaging families during key transition points, we can assist them to develop coping skills/increase protective factors which they will serve them well the next time they face a family transition, thus influencing outcomes across the family life course

8 Family-based Approach
Investment in families important for improving health outcomes across life Family as the setting for promoting and building physical, mental and emotional, social, economic and cultural well- being (for children and adults) Increasing family functioning and well-being can have a positive impact on a range of risk factors such as mental illness, family violence, substance use, gambling

9 Life Events & Situations
Risk and Protective Factor Domains for long-term health and well-being outcomes for children Individual Family Factors School Context Life Events & Situations Community and Cultural Factors A document produced by the Australian Government National Mental Health Strategy (2000), Promotion, Prevention and Early Intervention for Mental Health – A Monograph (Monograph) provides factors generally accepted by practitioners and research as important contributors to the development of mental health problems and illness. These identified risk and protective factors build on the work of Fuller and McGraw (1996) and Blum and Resnick (1996), and provide a common set of risk and protective factors for multiple health risks including: mental illness; alcohol and other drug (AOD) abuse; violence; anti-social behaviour; crime and offending; school disengagement; and youth pregnancy. These risk and protective factors are used with families to prioritise areas for intervention and to identify strategies to enhance children’s mental health and wellbeing.

10 Components of Successful Early Intervention Programs for Families
Goal-directed programs, rather than those offering generic support  Target a number of risk factors, either simultaneously or sequentially Offer a shared empowerment to families Work with both parents and children, not necessarily together Includes some home-based support Programs that teach skills – focus on coaching to reinforce, apply & practice

11 Universal Promotion and Prevention
of family well-being risk & protective factors Screening for Risk Early Intervention - lower risk (Brief Support) Early Intervention - multi-risk (Intensive Family Support) Pathway to Tertiary

12 Proportionate Universalism - Drummond Street Examples
Seminars & Groups Targeted Universal Early Intervention  MyMob – app for keeping families connected – includes tips sheets Peer Education Program for African Parents 1:1 Intensive Family Support – therapeutic case-work Ready Steady Family (Just Families – Transition to Parenthood) Backyard Blitz – Outdoor program for vulnerable dads and their kids Parenting Anxious Kids Group Tantrums & Tiaras Reclaim Parenting – Parenting for Parents with Mental Illness HOPE program - home-based hands-on parenting education Working on Your Relationship Peer Education Program for Gay & Lesbian Parents BestMOOD – group program for parents and young people with depression, anxiety or drug use Raising Resilient Kids Family Literacy Program (CALD families) Circle of Security Group Parenting Teens Homework Club on Carlton Housing Estate 1:1 Parenting Support sessions Raising Happy Healthy Kids Supported Playgroups on Collingwood Housing Estate How to Talk so Kids will Listen, & Listen so Kids will Talk Making Stepfamilies Work Young Carers Break – Peer Support ATAPS Brief Psychological Interventions for Children and Queer Adults Proportionate Universalism - Drummond Street Examples

13 Centralised Intake and Screening Brief or Short-term Service
Individuals, Couples and lower-risk Families Seminars and Groups e.g. Parenting Groups and Seminars Activity-based Youth groups Mental Health Literacy Facilitated Playgroups Family Relationship Seminars and Groups 1:1 CaseWork e.g. Warm referrals Housing support Employment and Financial Management Linking to Community Supports 1:1 Counselling or Parenting Support (up to 6 sessions) Single Session Intensive Intake Brief Family Assessment and Case Plan Short-term parenting support Short-term counselling ATAPS (Child and Queer) Individual Specialist Psychological Counselling up to 12 sessions Intensive Family Support Families where children's well-being is at risk 1:1 Whole-of-Family Support for up to 12 months Whole of Family Assessment and Family Action Plan, may include counselling, relationship interventions, casework, parenting, peer support DIRECT ENTRY TO DSS: Community awareness and education programs, youth activities, community building & other engagement activities

14 Risk Factors Checklist 3 or more - referred for Intensive Family Support
Family/Couple Frequent Conflict/Family Violence Recent Stressful/Traumatic Events Economic Deprivation/Homelessness Social Isolation of Family/Lack of Community Connections Parental Mental Health Symptoms Poor/Inadequate Parenting Parental Substance Abuse Emotional/Behavioural/Mental Health Symptoms in Child Poor Physical Health of Child Poor Interpersonal Skills/Relationships/peer group (Child) School Failure/Disengagement Review of literature finds common family and child level risk factors for poor outcomes for children. AT ds we use these to determine the “dose” or intensity/level of support to provide to families. This allows us to ensure that our resources are directed to families that need it most. In past we had found that lower risk families were still coming in for long periods of time, given public money we have a responsibility to ensure that we targeting services to those who need it most. Consistent with the public health model – lower dose to lower risk etc. Evidence shows that where families experience a number of risk factors at the same time they are at increased risk, not just one risk factor

15 6 Domains of Family Well-being
Individual Well-being Connected Family Relationships Safe Family Environment Competent Parenting Material Security Connection to Community Individual Well-being - Mental health, physical health, substance abuse, interpersonal relationships, problem-solving skills and effective coping styles, Age appropriate development and school achievement Connected Family Relationships - Respectful, cohesive, secure attachment, good communication, Safe and Supportive Family Environment - Family harmony, Free from violence, psychological/sexual abuse, frequent conflict, Secure, stable family Competent Parenting - Warm, responsive parenting style, Consistent expectations/consequences for behaviour, Clearly defined roles and responsibilities within the family, parental involvement in children’s activities Material Security - Adequate financial and material family resources    Connection to Community - Family support network, and school/community family engagement Our family service practice is linked to these domains at all stages from assessment, to goal-setting, to interventions

16 Family Support Process
Intake – Risk Screening & program matching Assessment against Family Well-being domains Family Action Plan developed with family - goals linked to outcomes for children (intentional) Supportive Interventions Ongoing Case Reviews Closure


18 Implementing the Family Service Model
Not enough to have a well-articulated model and program logic … We found that once we had articulated a model framework, it was not enough to simply tell staff this is what we are now doing – we did this, but nothing really changed on the ground – needed the lessons from implementation science Having articulated our model we then needed to step back and look at what changes were needed at an organisational level to support the change….

19 Pre-Implementation Considerations to Support Family Services Model
Organisational Structure Identification of Staff Competencies e.g. Case work, Whole-of-family work, working with children, Parenting support, Group work/Seminars, Capacity to engage with at-risk groups) Identification of Fidelity Markers e.g. home visits conducted, all family members assessed, brief cases closed within 6 sessions, collaboration with other agencies, family action plan completed by 3rd session, % of CaLD families etc Review of Policy and Procedures Purchase of resources such as data systems, additional staff cars/phones for outreach work Work back from desired outcomes to facilitate organizational change in each stage of implementation Much easier to implement in setting up the new locations, than to change the operations at Carlton where we’d been operating for a long time Importance of fidelity markers – need to know whether the outcomes are due to the model or fidelity Competence – challenging from practitioner to supervisor to leadership levels

20 Core Implementation Components
One of common frameworks in Implementation Science – from the NIRN – there are others, but reflects the need for change across all levels of the organisation All out achieving outcomes

21 Organisational Drivers
Service Locations Co-locating with complementary services – Medicare Locals, Family Mediation Delivering services from public housing estates Organisational Restructure Integration of Family Services (counsellors, parenting support, youth workers, case-workers) Employment of Implementation Manager to drive the change Purpose Built Data System measure fidelity markers, staff performance, population outcomes Communication processes Regular meetings with leaders, supervisors and practitioners to facilitate implementation Facilitative Administration policies and procedures changed Integration of parenting support, youth services, counsellors under the umbrella of family services. Previously “silo-ed”. Facilitated integrated support of Intensive Family Support cases. By measuring fidelity to the model we can ascertain whether low population outcomes are a result of the intervention or poor implementation Caseloads need to be reduced to allow for intensive casework and additional staff development requirements The Model has been supported by co-locating DS programs with complementary services such as ATAPS and BetterAccess providers and Family Mediation Centres. Consistent with the intention to provide targeted services to vulnerable groups within our local communities, we have outreach family services at public housing estates with high CALD and Refugee communities, and low SES families. Both these approaches required significant strategic planning efforts at an organisational level. Meetings – Leaders to hold steady to course and to respond to feedback from staff and data to make changes, Supervisors and Practitioners to identify barriers to implementation

22 Fidelity Markers Benchmarks Right Dose
Benchmarks Right Dose 80% of Brief cases closed within 6 sessions 100% of cases with 3 or more risk factors allocated to Intensive Family Support Home-based Support 80% of Intensive Family Support cases include some home-based support Whole of Family work 80% of cases all family members assessed Targeting At-Risk Groups 50% of cases from identified at-risk groups (CaLD, low SES, young parents, ATSI, parent with mental illness, single parents) Intentional Work focused on family well-being and outcomes for children 100% of cases have a Family Action Plan on file 80% of goals are realistic, achievable and measurable 100% of goals linked to outcomes for children and family well-being domains

23 Competency Drivers Identify Practitioner Competencies Case work, Whole-of-family work, working with children, Parenting support, Group work/Seminars, Capacity to engage with at-risk groups) Staff Training/Professional Development Supervision & Coaching Performance Management New Staff Selection Building staff buy-in and readiness Gaining commitment involves identifying the advantage of the practice (What are the benefits for me and my clients?) and demonstrating the availability of the resources, training and leadership required to support and sustain change. To get people on board, need them to want to do it, not tell them they have to do it. Discuss with practitioners the barriers to implementation. In addition to staff competencies, staff were also hired for their knowledge of, and aptitude for, engaging the target population. For example, practitioners from CALD and Queer backgrounds were hired to better engage families from these high-risk populations. Challenge finding the right staff – Model requires staff to be adaptable and change their practice to respond to the needs of the family they are working with – requires energy and bravery! To ensure effective implementation, the competencies of supervisors also needed consideration. Our supervisors required a strong working knowledge of the Model, a commitment to implementing it, a capacity to provide coaching, strong performance assessment and management skills, and an ability to use data to inform decision- making.

24 In our experience it is not a linear progression but rather a continuous on-going cycle of adapting to changing needs/circumstances/evidence Although this diagram appears to imply a linear progression through stages, it’s important to remember that at any point significant changes in socio-economic conditions, funding, leadership, staff turnover, or other events may require the organisation to re-address activities of earlier stages of implementation. All this takes time – need to ask ourselves what is the priority – what can be done now Achieving these changes required a significant investment of time and resourcing. Time and cost constraints are a reality for family service providers in the not-for-profit sector, and can be a barrier to effective implementation. However having the capacity demonstrate the effectiveness of programs is becoming expected and essential in attracting funding, and implementing evidence-informed programs achieves the best outcomes for families and children, and is therefore worth investing in.

25 Evaluation - CFRE Centre for Family Research and Evaluation (CFRE) – partnership between drummond street and Deakin University Example: Just Families Risk and Protective Factors for family violence in couples transitioning to parenthood Develop screening tool for couples to identify heightened risk Training of first-to-know MCHC’s Seminar for couples delivered via MCHC’s Evaluation showed significant positive effects National roll-out and app Examples (e.g. risk factors associated with transition to parenthood Just Families; risk factors associated with GLBTI mental health), Conducted research where gaps identified, as well as evaluating programs. The value of working with academic partner – bring expertise in evaluation methods, ability to access and analyse population datasets, research resources, data analysis, dissemination.

26 Evaluation Framework Family Services Model
Evaluation Strategy for Family Services Model to measure client level outcomes across six domains of family well-being Well-validated measures have been selected, to match LSAC data where possible, to allow for comparisons with national population - Pre-Intervention Surveys (collected at the time of Intake), - Intervention Surveys (collected at 8-16 weeks after Intake) and - Post-Intervention Surveys (collected 12 weeks after the Intervention surveys). Data analysis involves mixed-model longitudinal analysis, with interventions to be examined individually or in a dose-response manner for families who access multiple interventions

27 Are we there yet? No end point – a continuous cycle of adaptation to change What we’ve learned: Adaptability and flexibility are key Commitment to research, evaluation and implementation Use the data/evidence available to ensure CQI Share learnings to ensure maximum benefit to families In summary, implementing evidence-informed practice is not as simple as grabbing a product off a shelf, it is a long-term process that requires careful planning, re-allocation of resources, and constant adjustment of organisational, staffing and leadership drivers. We’ve found that to achieve a practice that is truly responsive to the varied complex needs of our families requires flexibility and adaptability from the organisation and from our staff. That investing in research and evaluation activities, and partnering with an academic institution, has helped us to better understand the needs of our clients and to contribute to the broader evidence-base. After about 7 years we are still not there, and continue to learn and adapt and strive to achieve better results for our communities and families.

28 Andrew Rush, General Manager - Family Services Sophie Aitken, General Manager - Implementation & Quality drummond street services 100 Drummond Street Carlton VIC Ph: (03)

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