1 Brighter Futures: Experiences and lessons learnt. Presented by Matthew Solomon and Kerry Gwynne ACWA Conference, Sydney 2010

2 Outline of presentation 1.Context of work in early intervention support for vulnerable families 2.Description of model of practice 3.Lessons learnt 1: Service Structure 4.Lessons learnt 2: Program Components 5.Lessons learnt 3: Organizational 6.The worker experience 7.The family experience 8.Conclusion

3 Context - Brighter Futures  Operational by 1/1/2007 (Northern Sydney)  TBS is Lead Agency in 8 regions (metro and rural/regional)  One of 14 Lead agencies across NSW  targeted support to vulnerable children and families with children aged under 9 years or families who are expecting a child  aim to help prevent problems from escalating to crisis point  up to 2 years support  complement and build on existing service networks in communities to support families showing early signs of child protection issues.  Each region develops local response and service model

4 Context: Referral criteria PARENTCHILD + Lack of parenting skills Substance abuse Difficult child behaviourLack of family/social supports Domestic violence Parental Mental health Parental learning disability

5 Model of practice Partnership with parallel teams Dalwood Spilstead Model:  Single governance with integrated services provided by the one team.  Team case management.  Integration of 3 evidenced based modes of intervention: 1. Family support and home visiting. 2. Intensive child development focus including early intervention preschool. 3. Parent / child attachment interventions.  Routine outcome measurement regime integrated into clinical practice.

6 Early Years Centre Child Development Family support Parent-Child R’ship Play Therapy Speech Pathology Home-based ECE Occupational Therapy EI Preschool Father’s Program Volunteer Home Support ATSI support Counselling Financial advice Welfare & Housing Parenting Programs Parent-Child Interaction Interventions Supported playgroups Home visiting Art Therapy Dalwood Spilstead Model

The Team 1.Family Workers: SW, Psych, Early Childhood Nurse. 2.Father’s Program Co-ordinator. 3.ATSI Family Worker 2.Early Childhood Educators 3.Clinical Psychologists 4.Speech Pathologists 5.Occupational Therapist 6.Art Therapists 7.Special Education Consultant 8.Home Volunteer Support Co-ordinator. 9.Admin & Manager

 client engagement and retention  case planning and management  efficiency of service delivery  measurable outcomes for families 8 Lessons learnt: Service Structure

Client Engagement and Retention  Creating an “easy to engage service” rather than focusing on “difficult to engage clients”.  Attrition rates: SPRC May 2009 Interim Evaluation Report - 20% of cases closed as “Goals Achieved”.  Our experience for same period: Clients Referred117%Closed Cases44% Assessed as low need1612%Moved out of area12% Unable to contact32.5%Transferred to Child Protection49% Declined32.5%Not Engaging12% Entered program9679%Became un-contactable24.5% Moved out of area prior to contact. 54.3%Completed with Goals Achieved3682%

10  Comprehensive family-centred assessment and goal setting  Parallel parent and child approach.  Team case Management  Combination of interventions:  Family support and home visiting for parents.  Child development early intervention services  Parent - child attachment interventions.  Continuum of services form drop-in / home-based support to therapeutic interventions. WELFARE SUPPORT SPECIALIST THERAPY Case Planning and Case Management

Efficiency of Service Delivery The sum is greater than the parts of a diverse team. Range of parent programs: Individual counselling and professional home visiting Referral, advocacy & welfare assistance Parent education programs: Triple-P, The Incredible Years, TIPS. Parent support groups, life skills and leisure skills groups. Adult education on site in partnership with local TAFE Grandparent support group. Financial mentorship. Father’s Program Volunteer Home Support: 2 hours of goal oriented support in the home. Parent In Action Group: Building capacity via self determination. Intensive children’s EI services: Early Intervention preschool with 1teacher to only 5 children. Regular individual Speech Pathologist, OT, Play therapy, Clinical Psychologist on the team. Parent – Child Attachment interventions: Supported Playgroup programs, PCIT, WWW, Steep, Marte Meo.

12 Measurable Outcomes  Regime of measures built into routine practice.  Family and child functioning; client and clinician rated  Administered prior to program entry, routinely and at exit. The Parent Stress Index The Being A Parent Scale The Child Behaviour Checklist The Northern Carolina Family Assessment Scale. The ADST and Brigance Developmental Screen Norm-Referenced Speech and Language Assessments Goal Attainment Scaling

Figure 1. Comparison of Mean Results on Northern Carolina Family Assessment Scale. n=38 families. p< Sample includes families who attended Spilstead Brighter Futures services for a minimum of 12 months during A score of 0 = adequate family functioning. 13

14 Brigance Developmental Testing. Sample included all children between 12 months – 6 years who received a combination of children’s services for at least 12 months during n= 33. Figure 4. Pre-Post Means on Brigance Child Development Testing Effect Size: (Cohen’s d) = 0.6 Moderate (p<0.001)

Figure 6. Improvement on Brigance Testing for Children Initially Identified in the Clinical Range of Delay n=14. 15

16 Lessons learnt: Program Components  quality children’s services  parenting programs  home visiting services

17 Quality Children’s Services  First Goal of the Guidelines: 1. promote healthy development in children. SPRC evaluation of BF almost 30% of children rated by carers as having a medical condition or a developmental problem. 42% moderate, 20 % severe. Our Experience: 70% under 5 years demonstrated delays on norm-referenced screening. 95% of these children demonstrated speech and language delay. 70% demonstrated social/emotional disorders. Speech Pathology and other therapy services is essential.  Spilstead Preschool modelled on Highscope has been achievable.  1 teacher ; 5 children plus volunteer teacher’s aide.  12 mths – 6 year old children, 2 days per week  Maximum group size of 10.  Relationship based model of attachment with teacher.  Intensive allied health intervention.  Individualized special education programming.

 Group programs:  Incredible Years including Child-Led playgroup.  Triple P  TIPS  Practical “hands on” approach  Supported infant playgroups.  Thematic playgroups with parent education followed by play session.  Individual programs:  PCIT  Watch, Wait and Wonder  Marte Meo  Steep Seeing is Believing. 18 Parenting Programs

 Professional Family support in the home.  Early Headstart Early Childhood Educator Home Visiting  Volunteer Home Support  Individual parenting programs in the Home 19 Home Visiting

20 Lessons learnt 3: Organisational  service establishment,  community partnerships,  recruitment and retention of staff

21 The Benevolent Society experience  SPRC findings  8 regions  Rural vs metro

22 The worker experience Reflective journeys of practitioners

23 “The integrated team approach to the Brighter Futures program really ensures a secure, cohesive and stable base for both families and workers and provides opportunities for more intensive support and better outcomes.” Kathryn Prowse, Social Worker

24 “Working alongside family counsellors, occupational therapists, psychologists, teachers, and art therapists provides me with a real knowledge of the child’s needs and factors that may be impacting on their learning. Working in the intensive preschool with teachers allows us to group together children with similar needs. This allows us to treat many more children”. Lynn Shakenovsky, Speech Pathologist.

“Its been great to see how we can involve fathers from the start (even when they are in separated relationships) when a whole team of people values their contribution and role. Regular case conferencing is the key’ Jesse Wynhausen, Psychologist and Father’s Program co-ordinator.

The family experience What is one of the most valuable things about this service? Professional advice given by experienced people. Speech pathology has given my child a very valuable service I otherwise could not afford. Everyone is so down to earth and treats you like a normal person. Care, case worker being interested in you and your family. Helping you step forward in life. Ongoing company from family worker providing ideas, networks, help an encouragement. Parenting courses, incredible years and Triple P. Play group, counsellor, pre-school, speech therapy. When I need help I can ask for it, when I want to try things on my own I am encouraged to do this. Providing services for families that can't afford to pay for private therapies. THE FAMILY EXPERIENCE

Connection to Aboriginal community and support services. Someone who I trust always listen to me. I feel good and feel comfort because of my family worker. For me helping me realize, I myself deserve to feel a good sense of worth for myself which then reflects on relationships with my kids ( in good ways) encouraging a bit more love than ever before. The respect of the staff. I feel I can trust them with the safety and security of my children. I have been given direction, encouragement and support through some of the worst times of our lives. Tracey is always just a phone call away. Bernie is just an appointment away. That no one is judgmental. 27 THE FAMILY EXPERIENCE

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Fay, T and Carr, F, ‘‘Tailoring Early Intervention Programs to the needs of families: Illustrative case studies from an Integrated Parent-Child centre.’’ Developing Practice Journal number 25 Autumn/Winter 2010 References: Gwynne KD, Blick B, Duffy G, “Pilot evaluation of an early intervention program for children at risk.” Journal of Paediatrics and Child Health, 2009, Vol 45. Issue 3. pp