Stronger Families Safer Children Evaluation: First Stage Report

Transcription

1 Stronger Families Safer Children Business Affairs Stronger Families Safer Children Evaluation: First Stage Report January 2011 Department for Families and Communities Business Affairs Research Unit

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3 Contents 1 Introduction First stage evaluation focus and methodology Limitations Structure of the report Quantitative analysis Targeted Early Intervention Service (TEIS) Key findings Referrals Characteristics of families and children at Intake Service delivery information Case closure Case Outcomes Intensive Placement Prevention (IPP) Key findings Referrals Characteristics of families and children at intake Service delivery information Closure information Case outcomes Reunification Support Services (RSS) Key findings Program statistics Service delivery and closure information Case outcomes Conclusion Qualitative findings: Families SA staff Methodology Findings Implementation to date - overall assessment What is working? Emerging Issues Targeting and referral criteria - TEIS

4 3.3.2 Working together Workforce issues Family-focused child-centred practice Engagement and "persevering" Model and service capacity Outcomes and impacts Quantum of services Summary Qualitative findings: NGO stakeholders Overview Targeted Early Intervention Intensive Placement Prevention Reunification Support Services Suggested responses to enhance the program Summary and conclusions Quantitative data analysis Qualitative data Families SA SFSC service providers Emerging issues Referrals and eligibility criteria Engagement rates Effectiveness Workforce skills, capacity and values Working together Appendix A: Maps

5 1 Introduction In June 2008, the South Australian Government approved $28.2 million over 4 years to fund the Stronger Families, Safer Children (SFSC) Initiative to support vulnerable families. The aim of the initiative was to prevent children from vulnerable families entering or becoming entrenched in the child protection and alternative care systems. Through this initiative, Non Government Organisations (NGOs) are funded to work in partnership with Families SA Offices to provide families with a wide range of support services to achieve the outcomes of stabilizing and supporting families to care for children in safe environments. There are three streams to the program which aim to address presenting problems at differing stages within the child protection and care system: Targeted Early Intervention Family Support Services (TEIS) Intensive Placement Prevention (IPP) Reunification Support Services (RSS) The SFSC program was rolled out in April TEIS and RSS were implemented in all 18 Families SA Offices, and IPP was initially implemented in three Families SA Offices (two metropolitan and one rural). In May 2010, the IPP stream was extended to a further three Offices (two metropolitan and one rural). The organisations involved in service delivery are 1 : Anglicare SA, Centacare Port Pirie Diocese, Centacare Adelaide, Nunkuwarrin Yunti, Aboriginal Family Support Services, Uniting Care Wesley Port Pirie and Anglican Community Care. 1.1 First stage evaluation focus and methodology The evaluation of the SFSC program (designed and coordinated by the Research Unit, Business Affairs, DFC) will take place over two years, with two main reporting 1 Two maps of the distribution of the SFSC Programs and Service Providers are attached as Appendix A-1 and A-2 5

6 stages. 2 This report presents findings from the First Stage evaluation and identifies key issues and opportunities for program development. Targeted family support services such as those provided through Stronger Families Safer Children (SFSC), are not new, and have become a core and valued element of the family and child services system across the world. Numerous evaluations have identified the potential and success of such initiatives, including their ability to address child safety and care concerns. In this context, this First Stage evaluation does not focus on the question of whether the SFSC services are a worthwhile investment, but rather, on early outcomes; and whether implementation has achieved services and working relationships that are likely to deliver the best possible return from the investment - that is, the most positive outcomes for children and families. The following questions guided the quantitative component of the evaluation: 1. What have been the profile and needs of clients referred to the program? 2. How has SFSC impacted on the safety and stability of children engaged with child protection services? 3. What have been the impacts on the skills, capacity and resilience of families? Data collected routinely by NGO service providers and Families SA, covering a period of 15 months from program inception to mid July 2010, was analysed according to the relevant evaluation questions. In addition, the North Carolina Family Assessment Scale (NCFAS) 3, collected at intake and closure, was utilized to assess change in family functioning. Families SA child protection/alternative care data was also used to provide background information on child protection history and to assess impacts on child safety. An intake number common to all data sets was used to match client data from different databases for the purposes of analysis. 2 SFSC: Establishing the Evaluation Framework document prepared by the Research Unit provides a full description of the evaluation stages and components 3 NCFAS Scores - a worker (NGO) administered scale that provides pre-post measure of family functioning for families served by a program aimed at addressing child abuse/neglect issues. 6

7 Statistical methods were applied to analyse the data, using SPSS software (version 17.0), including descriptive analysis to report on clients demographic characteristics, their needs, nature of services provided, service capacity and early program outcomes. The qualitative component of the evaluation drew on the extensive experience of such services across the world for its focus. It is clear that there are a number of elements that need to be in place to ensure program effectiveness. These include: A strong working relationship and partnership between the service provider and statutory child protection authority Effective processes in relation to referral, assessment, decision making and case closure A service model which includes high quality interventions and is able to meet the needs of referred families A highly skilled workforce A family-centred but child-focused approach (i.e., working positively with families but with a clear focus on child safety and wellbeing issues). These issues have been the focus of the qualitative evaluation, explored through consultation with both the NGO and Families SA sector. Specific questions included: 1. What implementation issues have arisen that impact on outcomes? To what extent has the Stronger Families model, as originally envisaged, been implemented? 2. How effective have been the policies, procedures and processes established, including between Families SA, Community Connect and the NGOs? How have these influenced outcomes? 3. Have effective partnerships been established between Families SA and the NGOs? What has contributed to or detracted from effective partnerships? 4. What specific services are being provided by SFSC service providers, and to whom? How do these services relate to client needs? 7

8 The evaluation plan originally envisaged that the qualitative component of the evaluation would be undertaken by an independent consultant. However, difficulties in securing the services of a suitable evaluator, costs, and timeframes resulted in a split of responsibilities with: An external consultant conducting focus groups and reporting from the NGO sector; and The Research Unit, DFC reporting from Families SA staff Methodology specific to each component is described in the relevant sections of this report. The methodology for the evaluations was reviewed and approved by the Families and Communities Research Ethics Committee (FCREC) in July Limitations Due to limitations in the quantity and quality of quantitative data, it was not possible to explore the evaluation questions to the depth it was originally intended. In particular, there was limited data available to assess client outcomes, and results could not be assessed by sub-group (eg region, by demographic characteristics). Specific data issues are discussed in relevant sections of the report Structure of the report The report is structure as follows: Section 2: Quantitative analysis (by the Research Unit, DFC) Section 3: Qualitative analysis, Families SA (Research Unit, DFC) Section 4: Summary of qualitative analysis, SFSC program staff (Consultant Dr Paul Aylward, University of Adelaide) Section 5: Summary and conclusions Appendix A: Distribution of SFSC Services 8

9 2 Quantitative analysis Over the 15 month period covered by this report, a total of 303 families and 802 children were referred to the TEIS and IPP and an additional 123 families and 203 children to the RSS 4. This is a considerable number; however, when broken down across different program streams, demographics and stages of client involvement, numbers were sometimes too small to allow for reporting or sound conclusions. For example, NCFAS scores at closure were available for only a small number of clients, limiting the reliability of results and the potential for analysis. Similarly, analysis of outcome data post-closure was impacted by the small numbers of clients who had exited the program and the relatively short time between case closure and data analysis. Missing data was also a problem. For example, missing intake numbers made it impossible to link data (such as NCFAS data for the reunification clients) with Families SA administrative records. In view of the above, findings should be treated with caution and considered as indicative only. 4 Exact client numbers for the RSS program are not known due to reporting problems. 9

10 2.1 Targeted Early Intervention Service (TEIS) Key findings Referrals and entry into the program: Number of families % Total referrals Attempted to engage with Successful engagement Case closure Country offices made just over half of all referrals to the program, with Pt Pirie and Pt Augusta having the highest referrals rates 80% of families (for whom this information was available) were reported to have engaged successfully with the program There was no significant difference in engagement rates between Aboriginal and Torres Islander and non-aboriginal families The most common barriers to engagement identified were families inability to keep appointments; distrust or lack of understanding of the child protection system; refusal of service or parental mental health problems Families who were harder to engage included those with a previous Tier 1 notification and a history of confirmed abuse and/or child being placed in care. Client profile: A large proportion of families referred to the program were headed by a single female households (41%), with high rates of disability reported for both children and carers The majority resided in rental (mostly public housing) accommodation Large families were common, with nearly 40% having 3 or more children and 18%, five or more The majority (62%) of children were aged under 10 years of age Aboriginal families were well represented in the referrals (30% of families and 37% of children) All families had a previous involvement, in some cases quite extensive, with Families SA 10

11 The majority of families (96.5%) had been the subject of at least one Tier 2 notification (consistent with the programs aim to target medium to high risk families); almost half had also been subject of Tier 3 and over one third (36%) Tier 1 notifications (in some cases this involved multiple notifications) Allegations most commonly related to neglect (84%) followed by emotional abuse (68%) Nearly all families had been the subject of a child protection investigation with abuse substantiated in 77% of cases Most families (79%) had no history of children being placed in care. Services provided by TEIS: Families in the program received a wide range of services, with most supported by 5 or 6 service types Parenting skills development (80% of families) was the most common service type, followed by links to community networks and services (74%) and school/educationrelated children services (64%) The average duration of support (calculated for closed cases only) was 156 days. Outcomes of support: By mid July 2010, 95 cases (involving 91 families) had been closed Thirty two (34% of closed cases) were closed due to the successful completion of the program, the most common reason for closure Other common reasons for closure included difficulties in engaging families (24%) and families moving outside of the service area (12%) In 16% of cases, closure resulted from increased risk to children or due to children being placed in care Post-closure data from Families SA indicated that subsequent notifications were received in relation to 28% of all families who exited the program and 23% of the families who had successfully completed the program; however no children of the successfully-exited families were placed in care When available, NCFAS data indicated improved family functioning at closure for TEIS clients. 11

12 2.1.1 Referrals Since its inception, the Targeted Early Intervention Service (TEIS) received a total of 273 referrals relating to 263 families (10 families were referred to TEIS twice) and 697 children (Figure 1). TEIS attempted to engage with 221 families (84% of families referred); of whom 177 were recorded as having successfully engaged. At the time of analysis, 95 cases (34.8% of all referrals) relating to 91 families had been closed. Figure 1: Program statistics number of families referred to TEIS attempted to engage with successful engagement case closure Regional distribution of service referrals 5 Eighteen Families SA Offices made referrals to TEIS (Table 1). Referrals were particularly high in the rural/regional areas, with just over half of all the referrals (50.9%) coming from these areas. Port Pirie (12.1%) and Port Augusta (11.4%) made noticeably more referrals than other offices across the state. 5 Two maps of the Distribution of SFSC Programs and Service Providers are attached as Appendix A -1 and Appendix A

13 Table 1: Number of referrals made by each Families SA Office Families SA Office Number of referrals % Southern Adelaide Marion Mount Barker Onkaparinga (Noarlunga and Aberfoyle Park) Subtotal (Southern) Northern Elizabeth Gawler North East (Modbury and Enfield) Salisbury Woodville Subtotal (Northern) Country Ceduna Coober Pedy Mount Gambier Murray Bridge Port Augusta Port Lincoln Port Pirie Riverland Whyalla Subtotal (Country) Unknown Total Table 2 provides information about the number of referrals, by Indigenous status, made to each service provider. It is important to note that referral numbers, including numbers of Indigenous clients, are impacted by the level of funding, agreed targets, and geographical coverage of the service. Families SA offices do not choose service providers but refer to the designated service for the local area. Due to the location of the offices referring to the program, Centacare received the majority (57.9%) of TEIS referrals for both Indigenous and non-indigenous clients (Table 2). 13

14 Table 2: Number of referrals to each NGO by cultural background Service Provider Indigenous Non-Indigenous Not stated Total n % n % n % n % Centrecare UnitingCare Wesley Port Pirie Nankuwarin Yunti AFSS Catholic Diocese Port Pirie Unknown Total Characteristics of families and children at Intake Age and number of children in households Almost 30% of all the families and 37% of children in the program were Aboriginal and/or Torres Strait Islander. Of all children aged 0 to 17 years who were subject to a notification and substantiation in SA in , 18.6% and 31.4% respectively were Aboriginal and/or Torres Strait Islander. 7 In this context, Aboriginal and/or Torres Strait Islander families were well represented in the TEIS referrals. The average age of children was 7 years (median 6 years), with the majority (61.7%) under 10 years old (Table 3). 6 The total number of clients with culturally and linguistically diverse (CALD) background is not large enough to allow reporting. 7 Results derived from data held by Families SA. 14

15 Table 3: Age of children by cultural background Age groups Indigenous Non-Indigenous Not stated Total n % n % n % n % Not stated Total The number of children reported in each household ranged from 1 to 9 (Table 4). Although about 40% of family referrals included only 1 child, around 18% of families had 5 to 9 children, with a higher percentage of large families amongst Aboriginal and Torres Strait Islander clients (just over 25%). Table 4: Number of children in each household by cultural background Number of families Number of children in the Indigenous Non-indigenous Not stated Total household n % n % n % n % ~ Not stated Total Household and accommodation characteristics Close to half of all families referred (45%) were headed by a sole parent, most commonly a female (Table 5). A large proportion (70.7%) were in rental accommodation, with just under half (42.9%) living in public or community housing. Some (7.2%) were in accommodation indicative of housing or homelessness issues (e.g. rent free, boarding house or sleeping rough/transient). 15

16 Table 5: Household and accommodation characteristics Number of families (N=263) % Household type Household containing family members only Household containing a mixture of family and non-family members Not stated or inadequately described Household family composition One parent family - female caregiver Couple family - natural parents Couple family - step/blended parents Not stated or inadequately described One parent family - male caregiver Other relatives/kin as primary caregivers Accommodation type Public housing rental Private rental Purchasing/purchased own home Not stated Community housing rental Other Boarding house Rent free accommodation Sleeping rough/transient Disability status of children and carers 8 High rates of disability were reported. 9 Just over 20% of families were reported to include at least one child with a disability (Table 6). The most common forms of child disability reported were intellectual or learning disability (55.2%), sensory or speech disability (31.0%) and physical disability (20.7%). About a third (30.8%) of families were reported to include adult carers with a disability (Table 6). Of these, the most commonly reported adult disabilities were mental health problems (71.6%) and intellectual or learning disability (22.2%). 8 A family may include children or carers with more than one type of disability. 9 It should be noted that this data represents disability as reported by NGO service providers it is not known if the disability had been clinically assessed. The severity of disability was not reported. 16

17 Table 6: Disability status of children and carers Number of families (N=263) % Children No notable disability Having a disability Unknown Carers No notable disability Having a disability Unknown Child protection and placement history of referred cases In order to examine clients previous contact with Families SA, TEIS referral information was matched to the Families SA Client Information System (CIS). Since CIS is in transition to a new system, some child protection and placement information was unavailable for extraction. As a result, data on only 199 (75.7% of the total, n=263) were available for analysis. Results suggest an extensive involvement of the referred families in the child protection system prior to the referral (Table 7). Nearly all families (96.5%) had attracted Tier 2 notifications, reflecting the program s targeting of children at moderate to high risk of harm. The number of Tier 2 notifications per family ranged from 1 to 33, with a mean of 5 (median 3). Almost half of the referred families had been the subject of a Tier 3 notification and over one third (36.2%) a Tier 1 notification. The maximum numbers of Tier 1 and Tier 3 notifications relating to individual families were 6 and 10 respectively. The families were most commonly reported for neglect (84.4%), followed by emotional (67.8%) and physical abuse (52.8%). Nearly all (95.5%) of the families had been the subject of a child protection investigation with abuse substantiated in 77.4% of families. 17

18 Table 7: Contacts with child protection system prior to TEIS referrals* Contacts with child protection Number of families (n=199) % Type of notification Tier Tier Tier Notifier only concerns (NOCS) Type of alleged abuse Neglect Emotional Physical Sexual Outcome Investigation Substantiation *A family may have more than one contact with the child protection system. Most families (79.4%) referred to the program had not had any children placed in care (Table 8). Of those who did, the most common placement type was emergency care (16.1%). Table 8: Alternative care placement history prior to TEIS referrals* Alternative care placement Number of Families (n=199) % No placement Emergency VCA or parent/guardian authorisation month order Respite from foster placement Respite from birth family GOM Other *A family may experience more than one type of alternative care placement Service delivery information Engagement in TEIS Engagement information was available in relation to 228 referrals (83.5% of all referrals received by the program) (Table 9). Over three quarters of these referrals were reported to have led to clients successfully engaged in TEIS. A slightly higher rate of successful engagement was reported for Aboriginal clients. 18

19 Table 9: Engagement in TEIS by cultural background Engagement in TEIS Number of referrals Indigenous Nonindigenous Not stated Total n % n % n % n % Successful Unsuccessful Total Tables 10 and 11 compare current TEIS engagement outcomes with the families previous history of contact with Families SA. That is, Table 10 summarises previous notifications received in relation to the family, by type, level and outcome. Table 10: Contacts with child protection system prior to TEIS referral by outcome of engagement in TEIS Prior contacts with child protection Successful engagement in TEIS (n=135)* Number of families # Unsuccessful engagement in TEIS (n=40)* n % n % Type of notification Tier Tier Tier Notifier only concerns (NOCS) Type of alleged abuse Neglect Emotional Physical Sexual Outcome Investigation Substantiation # A family may attract more than one type of notification and alleged abuse. *Of the 221 families with engagement information, only 175 were successfully matched to Families SA Child Protection data. 19

20 Table 11: Alternative care placement history prior to referral to TEIS by engagement outcome Alternative care placement Successful engagement in TEIS (n=135)* Number of families # Unsuccessful engagement in TEIS (n=40)* n % n % No placement Emergency VCA or parent/guardian authorisation Respite from foster placement month order Respite from birth family GOM Other # Children in a family may have multiple placements. *Of the 221 families with engagement information, only 175 were successfully matched to Families SA Child Protection data. The data in Tables 10 and 11 suggests harder to engage families were more likely to have experienced: Tier 1 notifications with Families SA (57.5% of those who were not engaged had been the subject of at least one Tier 1 notification as compared to 30.4% of those who were engaged) confirmed abuse (90% of those not engaged had had at least one prior confirmation of child abuse in their family compared to 74% of those who were engaged) placement in care (65% of families not engaged had not had child(ren) placed in care prior to entry, notably less than the 81%of those successfully engaged). They were also subject to more notifications across the full spectrum of abuse categories indicating multiple notifications and greater complexity of issues. This suggests that the more complex and entrenched the child protection issues, the harder it is to successfully engage families Barriers to engagement Problems with engagement were reported for about half of the referrals (for whom the information was available) (Table 12). The four top barriers identified were: 20

21 inability to keep appointments carer(s) is/are distrustful of or lack understanding of the child protection system carer(s) declined services or carers were unwilling to engage and parental mental health. Some families were identified as presenting with multiple barriers to engagement. Table 12: Barriers to engagement* Barriers to engagement Number of referrals % (n=228) No Barriers identified Inability to keep appointments Carer(s) is/are distrustful of or lack of understanding of child protection system Carer(s) declined services/ Carers were unwilling to engage Parental mental health Not stated or not applicable Others Carer(s) lack of awareness of need for change Unresolved parental alcohol and/or drug misuse Carer(s) has/have a history of childhood abuse Domestic violence Unable to locate carers/ child(ren) Housing instability/homelessness * More than one type of barriers can be identified Support services offered The data from the SFSC services provides summary information on the range of support services offered to the families participating in TEIS (Table 13). Parenting skills development, links to community networks and services, services relating to school/education, counselling and housing/homelessness were the most frequently ustilised. 21

22 Table 13: Support services provided through TEIS* Support services Number of families who received service (n=170) 10 % Parenting skills development Links to community networks and services Children services/school/education related Counselling Housing/homelessness Financial support Mental health support Practical and structured in-home assistance Medical support Domestic/family violence interventions Drug and/or alcohol support Brokerage Family dispute interventions Child developmental delays assistance Disability support Therapeutic service interventions Offending related support Other *A family may receive more than one type of support service. Families received between 1 and 15 types of services, with a mean of 7 (median 6). Around one fifth of families received ten or more types of support, with one family receiving 15 forms of services. Just over 14% of families had been offered three or less types, with two families only receiving one form of service (Figure 2). 10 Of the 177 families reported as successfully engaged, seven families did not record support services information. 22

23 Figure 2: Number of family support services offered to families 30.0% 27.6% 25.0% Percentage of families 20.0% 15.0% 10.0% 5.0% 6.5% 16.4% 18.8% 14.7% 6.5% 9.4% 0.0% number of family support services Case closure By mid July 2010, 95 cases (relating to 91 families 11 ) had been closed, with 32 (35%) cases reporting successful completion of service Duration of support For the closed cases, the average duration of support provided was 156 days (range: 15 to 406 days) (Table 14). About 30% of cases received support for less than 100 days, with three families receiving services for less than one month. Around one in six cases (16.8%) had remained engaged with TEIS for more than 250 days, with four cases for over a year. (These figures are indicative only as the available data is limited and reflects the early stages of the program implementation). 11 Four families had been referred to TEIS twice. 23

24 Table 14: Duration of support Duration of support (days) Number of cases % Unknown Total Reasons for case closure Table 15 summarises the reasons for case closure. The successful completion of service was the most common reason (33.7%), followed by difficulties in engaging families (24.2%). Table 15: Reasons for case closure Reasons for case closure Number of cases % Successful case completion Difficulties in engaging families Family has moved outside of the service s geographical coverage area Child(ren) has(have) been placed into care by Families SA Risk to child(ren) had increased and the service was no longer appropriate, or incorrect referrals Change in child care arrangement Other (no details specified) Total Where children were placed in care (8 cases or 8.4% of case closures), in all cases parental incapacity was reported as a contributing factor. Other significant issues identified in those families were parental substance misuse, mental health issues, intellectual or physical disability and domestic violence. Eleven families exited the program as they moved outside of the service s geographical coverage area, interstate or within South Australia. For those who moved within South Australia, referrals were made to various services (e.g. Housing SA, Salvation Army and Anti-poverty team of Families SA office), or 24

25 discussion took place about the family being re-referred to the SFSC program in a different location Case Outcomes North Carolina Family Assessment Scale (NCFAS) The North Carolina Family Assessment Scale for General Services (NCFAS-G Version G2.0) is a family functioning assessment scale intended for low and moderate risk families. The scale is used to assess families strengths and problems across 8 domains: environment parental capabilities family interactions family safety child well-being social/ community life self-sufficiency family health. Each domain includes several subscales which are rated along a six-point continuum (clear strength, mild strength, baseline/adequate, mild problem, moderate problem, serious problem). The scales are used at the points of intake and closure, making it possible to assess changes in family functioning and wellbeing Families problems at intake NCFAS assessment scores at intake were available for 109 families. In each domain, nearly half of the families were assessed as having scores below baseline/adequate level (Figure 3). 25

26 Figure 3: Percentage of families with mild, moderate or serious problems at intake (N=109) Percent of families environment parental capabilities family interactions family safety social/ community life child wellbeing selfsufficiency family health Most commonly, problem scores were rated as mild. This would suggest that, despite their often extensive child protection history, at the time of referral most families were not presenting with a high level of risk Changes in family functioning At the time of analysis only 30 (or 31.6%) of the 95 closed cases had been assessed at closure using NCFAS. Of these 30 cases, only 12 were closed due to successful completion of service. Results should therefore be treated as indicative and regarded with caution. Figure 4 shows the overall change measured for the 30 families. Although the numbers are relatively small, the figures indicate that families for whom data is available made considerable improvements from the time of intake to closure, particularly in the areas of environment, family safety and family interaction. 26

27 Figure 4: Change experienced by families with case closure on the NCFAS domain scores (n=30) Number of families Environment Parental Capabilities Family Interaction Family Safety Social life Child wellbeing Self- Sufficiency Family Health Baseline or Above at Intake Baseline or Above at Closure Figure 5 presents changes experienced by the 12 families with successful completion of service. It demonstrates that by the time of case closure, 75% improved in the domains of environment and family interaction 58.3% improved in the domains of parental capabilities and family safety 50% improved in the domain of self-sufficiency 41.7% improved in the domains of child well-being, social/community life and family health. Of the domain scores which did not demonstrate any change during TEIS, around 70% were rated in the problem range at the time of intake. Positive influences on family functioning were therefore reported for most families who had successfully completed the service, indicating positive outcomes for the TEIS program. 27

28 Figure 5: Change experienced by families with successful case completion on NCFAS domain scores (n=12) 12 Number of Families or more no change or more Environment Parental Capabilities Family Interactions Family Safety Child Well-being Social/Community life Self-Sufficiency Family Health Child protection contacts following case closure Families SA child protection data was linked for 82 of the 95 TEIS cases closed between June 2009 and July 2010, including the 30 reported to have successfully completed the program. Nearly half (49%) of all cases were closed for more than 6 months, with 9% closed for more than 12 months. Around a third of cases had been closed for less than 3 months. Post-closure notifications had been received for 23 families (28% of the total, n=82) (Table 16), mostly at the Tier 2 classification level, with neglect being the most common. In 6 of these families, abuse was subsequently confirmed. Seven (23.3%) of the 30 families who had successfully completed the program had been the subject of notifications post-closure. One of these families attracted 3 notifications (Tier 2, Tier 3 and notifier concern); four families attracted Tier 2 notification; two families Tier 3 s, and three were subject of notifier concerns reports. No substantiations were recorded or more: deteriorated one or more scale intervals; +3 or more: improved three or more scale intervals. 28

29 Table 16: Contacts with child protection system after case closures* Contact with child protection Number of families (n=82) % Received at least one notification Type of notification Tier Tier Tier Notifier only concerns (NOC) Type of alleged abuse Neglect Emotional Physical Sexual Outcome Investigation Substantiation *A family may have more than one contact with the child protection system. In the vast majority of cases (86.6% of families), children did not require placement post-closure (Table 17). However, 5 families had at least one child removed from their care and placed under a 12 month order and children in 3 families were placed under a long term order (GOM18). No children from the 30 successfully completed families were placed in care. Table 17: Alternative care placement after case closure* Alternative care placement Number of families (n=82) % No placement month order Respite from foster placement Emergency month order GOM VCA or Parent/Guardian authorisation Respite from birth family 0 0 * A family may experience more than one type of alternative care placements. 29

30 2.2 Intensive Placement Prevention (IPP) 13 Key findings Referrals and entry into the program: Number of families % Total referrals Attempted to engage with Successful engagement Case closure The majority of referrals into the program came from two metropolitan Families SA offices (Elizabeth and Salisbury) 14 Less then half of the referrals resulted in a successful engagement Engagement rates were lower for Aboriginal families with only 1 family was reported as successfully engaged The inability of families to keep appointments was reported as the main barrier to engagement. Client profile: About a quarter (23.8%) of children (from 7 families) 15 were Aboriginal and/or Torres Strait Islanders Half of the families were headed by a sole parent Most families (63%) had one or two children Most commonly, families were renting in public or community housing A noticeable proportion was reported to have at least one child or one carer with a disability 13 The analysis of IPP data was impacted by small numbers of clients and missing data. Consequently, particular care should be taken when interpreting results in this section. 14 Originally, the IPP program was implemented in 3 locations (two metropolitan and one country). In May 2010 it was expanded to further 3 locations (two metropolitan and one country). 15 Given that six (or 15%) of the 40 families cultural background is unavailable, this data should be interpreted with caution. 30

31 All families had been subject to a Tier 2 notification and just over a third, to a Tier 1 Neglect was most common type of alleged abuse (88%) All families had been subject to a child protection investigation with abuse confirmed in 72% of cases Most families had not had children placed in care prior to the IPP referral NCFAS data indicated a higher level of risk at intake compared to TEIS families. Services provided by IPP: Families in the program received a wide range of services, with a third receiving six service types and a quarter, four Parenting skills development was provided to 92% of families, followed by counselling (75%) and school/education children services (58%) The average duration of support (for 18 closed cases) was 119 days. Outcomes of support: At the time of data collection, 18 cases were closed The most common reason for closure was recorded as engagement issues (around 40% of cases) Three cases were closed due to successful completion of the program, with no renotifications reported for the two families for which data was available NCFAS closure information is inconclusive due to the small number of cases for which this data is available. 31

32 2.2.1 Referrals A total of 41 referrals, involving 40 families (one family was referred twice) and 105 children, were made to IPP services. IPP services attempted to engage with 34 families 16 (85% of those referred) and reported successful engagement with 16 families. Since inception, 18 cases had been closed17 (Figure 6). Figure 6: Program statistics number of families referred to IPP attempted to engage with successful engagement case closure Regional distribution of service referrals 18 The IPP was initially available in 3 Families SA Offices (Elizabeth, Port Augusta and Salisbury), which referred all 41 cases considered in this report (Table 18). In May 2010 the program was extended to another 3 locations (Metro North East, Gawler and Whyalla). 16 Engagement information was available for 34 out of 40 families referred. 17 This number includes 9 of the unsuccessful engagement cases. 18 Two maps of the Distribution of SFSC Programs and Service Providers are attached as Appendix A-1 and Appendix A-2. 32

33 Table 18: Number of referrals made by each Families SA Office Families SA Office Number of referrals % Elizabeth Port Augusta Salisbury Unknown Total Anglicare SA had received the majority of the referrals (n=29); Catholic Diocese Pt Pire, in partnership with AFSS, received 7 referrals 19 ; and the remaining 5 referrals did not include service provider information Characteristics of families and children at intake Age and number of children in households Seven families (17.5%) 21 and approximately 25% of children (23.8% n=105) were Aboriginal and/or Torres Strait Islander. The average age of children was 6 years (median 5 years), with the majority (68.5%) under 10 years old (Table 19). Table 19: Age of children by cultural background Age groups Indigenous Non-Indigenous Not stated Total n % n % n % n % Not stated Total It is important to note that referral numbers are impacted by the level of funding, agreed targets, and geographical coverage of the service. Families SA offices do not chose which NGO to refer to but refer to a designated NGO service provider for the local area. 20 The total number of clients with culturally and linguistically diverse (CALD) background is not large enough to allow reporting. 21 Given that six (or 15%) of the 40 families cultural background is unavailable, this data should be interpreted with caution. 33

34 The number of children in referred households ranged from one to nine (Table 20). Table 20: Number of children in each household Number of children in the household Number of households % Not stated Total Household and accommodation characteristics Half of all families in the program were headed by a sole parent (Table 21). Close to half (42.5%) were in public or community housing; and 2 families (5.0%) were in arrangements indicative of homelessness (e.g. rent free or boarding house). Table 21: Household and accommodation characteristics n % Household type household containing a mixture of family and non-family members household containing family members only household containing non-family members only not stated or inadequately described Household family composition one parent family female caregiver couple family - natural parents not stated or inadequately described couple family - step/blended parents other relatives/kin as primary caregivers one parent family male caregiver Accommodation type public housing rental private rental not stated community housing rental rent free accommodation boarding house other Total

35 Disability status of children and carers 22 Six families (15%) were reported to have at least one child with a disability (Table 22), including four with an intellectual or learning disability, one a sensory or speech disability, and three physical disabilities. 23 Thirteen (32.5%) carers were reported to have a disability (Table 22), including eight with mental health problems, four an intellectual or learning disability and one a physical disability. Table 22: Disability status of children and carers Number of families (N=40) % Children No notable disability Having a disability Unknown Carers No notable disability Having a disability Unknown Child protection and placement history of referred cases Twenty-five of the 40 families were successfully matched with Families SA client data to assess previous Families SA history. All of the 25 families had attracted previous Tier 2 notifications, and just over a third a Tier 1 notification (Table 23). Neglect was the most common abuse type alleged (88%). All 25 families had been the subject of a child protection investigation and abuse was confirmed in 72% of cases. 22 A family may include children or carers with more than one type of disability. 23 It should be noted that this data represents disability as reported by NGO service providers it is not known if the disability had been clinically assessed. The severity of disability was not reported. 35

36 Table 23: Contacts with child protection system prior to IPP referral* Contact with child protection Number of families (n=25) % Type of notification Tier Tier Tier Notifier only concerns (NOCS) Type of alleged abuse Neglect Emotional Physical Sexual Outcome Investigation Substantiation *A family may have more than one type of contact with child protection system. Most families had not had children placed in care prior to the IPP referrals (Table 24). Table 24: Alternative care placement history prior to referring to IPP Alternative care placement Number of Families (n=25) % No placement Emergency month order Respite from foster placement VCA or Parent/Guardian authorisation Respite from birth family GOM Service delivery information Engagement Data was available on engagement for 34 of the 41 families referred to the program (Table 25). Overall, the data suggests considerable problems with engagement, with less then half the families (16 or 47.1%) successfully engaged. Those who failed to engage included a very high proportion of Aboriginal and/or Torres Strait Islander families. Only one Aboriginal client was reported to have 36

37 successfully engaged. The majority of families with a prior Tier 1 notification (8 out of 9) failed to engage. Table 25: Engagement in IPP by cultural background Indigenous Non-Indigenous Not stated Total n % n % n % n % Successful Unsuccessful Total The inability to keep appointment was reported as the main barrier to engagement (Table 26). Table 26: Barriers to engagement* Barriers to engagement Number of referrals % (n=34) Inability to keep appointments Carer(s) is/are distrustful of or lack understanding of child protection system Carer(s) lack of awareness of need for change Parental mental health Domestic violence Unresolved parental alcohol and/or drug misuse Unable to locate carers/ child(ren) Not stated * More than one type of barriers can be identified Support services offered Service providers offered a range of support services to the 12 families for whom data was provided 24 (Table 27). The most frequently provided services included parenting skills development, counselling and children services/ school/education related supports. 24 Of the 16 families reported as successfully engaged, support services information was not recorded for four families. 37

38 Table 27: Support services provided* Support Services Number of families received services (n=12) Parenting Skills Development Counselling Children Services/School/Education related Housing/Homelessness Links to Community Networks and Services Mental Health Support Therapeutic Service Interventions Financial Support Medical support Practical and Structured In-Home Assistance Brokerage Family dispute interventions Domestic/Family Violence Interventions Drug and/or Alcohol Support *A family may receive more than one type of support service. % The number of support services offered to an individual family ranged from 2 to 10, with a mean of 5 (median 5) (Figure 7). Ten out of the twelve families received four or more types of services. Figure 7: Number of support services offered to families number of families number of family support services 38

39 2.2.4 Closure information Duration of support The IPP program is designed to provide an intensive and time limited support to families in crisis. It is anticipated that generally families will remain in the program for less than four months. 25 By the time of data collection, 18 cases (43.9% n=41) had been closed. For these, the average duration of support was 119 days (range = 12 to 259 days). Eight of the 18 cases had received less than 100 days of IPP support, with 2 less than one month. Five cases had remained engaged with IPP for more than 200 days Reasons for case closure Only three of the 18 cases were closed due to the successful completion of service (Table 28). The most common reason for case closure was recorded as engagement issues (38.9%). Four cases were closed because children were placed in care and parental mental health problems were identified for three of these parents. Table 28: Reasons for case closure Reasons for case closure Number of cases % Engagement issues Child placed in care Successful Case Completion Increase risk or incorrect referrals Other Total Stronger Families Safer Children Practice Guidelines December These figures are indicative only as the available data is limited and reflects the early stages of the program implementation. 39

40 2.2.5 Case outcomes Families problems at intake NCFAS assessment scores at intake were available for only 16 families, or 40% of the 40 families referred to IPP. Consequently, the following results are indicative only. In each of the 8 domains, a noticeable proportion of families was assessed as having problems (Figure 8). Figure 8: Percentage of families with mild, moderate or serious problems at intake percent of families environment parental capabilities family interactions family safety social/ community life child wellbeing selfsufficiency family health Compared with TEIS, those families entering IPP with problem scores (i.e. mild, moderate or serious) were more likely to be rated as having a moderate or serious problem. This suggests a higher level of risk compared to TEIS families Families problems at case closure NCFAS assessment scores at closure were provided for 12 families. Half or less than half were rated in the problem range (mild, moderate or serious problem): child well-being (50.0% in problem range at closure) environment (41.7%) 27 The case outcomes analysis for IPP focused on the first eight domains of NCFAS. 40

41 parental capabilities (33.3%) family interactions (33.3%) family safety (33.3%) self-sufficiency (33.3%) social/community life (25.0%) family health (16.7%). Overall, the outcomes were mixed and therefore difficult to report. Only three cases were closed due to the successful completion of service, making it impossible to further explore changes in the domain scores and outcomes as a result of the IPP Subsequent child protection contacts Data on subsequent notifications and placements was available for only 12 of the 40 families in the program. Of those, seven cases had been closed for more than 6 months. Given the small numbers, it was not possible to calculate re-notification rates. Of the 12 families, four families had attracted at least one notification after case closure, including one Tier 1 notification two families had the subject of Tier 2 notifications and Notifier Only Concern reports two families had been the subject of an investigation of alleged child abuse, with abuse substantiated in both cases one family had a child placed in care following case closure. Families SA child protection data was available for two out of the three families who successfully completed IPP. At the time of data collection, both cases were closed for between 3 and 4 months and neither had been the subject of any renotifications to the child protection system. 41

42 2.3 Reunification Support Services (RSS) Key findings Between 1 April 2009 and 14 July 2010 a total of 123 families (with 203 children) were referred to the Reunification Program. Reporting on RSS is significantly limited due to the quality of data. The findings on this aspect of SFSC are indicative only and should be treated with caution. Client profile: Of the 80 families with reported cultural background information, about 25% were Aboriginal and/or Torres Strait Islanders Sixty percent of children were aged between 2 and 9 years of age The majority (65%) of children were on a 12 month Guardianship Order and a large proportion (53.1%) was placed in relative or kinship care Over 90% of families had three children or less. Services provided by RSS: The average duration of support (for closed cases) was 150 days Outcomes of support: At the time of data collection 52 cases were closed Successful reunification was reported for 18 (35%) of the closed cases Eleven closures (21%) were due to unsuccessful reunification, with children returned into or remaining in alternative care NCFAS assessments were conducted for 42 families. Results for the 12 closed cases were mixed. Reunification data was provided from services to the Research Unit in paper format, with a considerable amount of data missing. The data included not only SFSC RSS clients but also clients of other (preexisting) reunification services, with no identifier available to distinguish between the different programs. Consequently, the analysis in this section includes all program data, RSS and from other reunification program funding. 28 That is, some NGOs recorded funding for their reunification program for SFSC together with 28 One family was excluded from the data due to their first date of contact with a service being before April 2009 when SFSC commenced 42

43 other pre-exiting reunification programs funded through Families SA. Table 29 summarises the split of NGOs reunification program funding between RSS and other Families SA funding as well as the number of referrals of all reunification clients in the data collection period. Table 29: Number of reunification referrals made to each NGO and funding for RSS NGO service provider Number of referrals % of funding for RSS % of funding for other programs Centacare 43 73% 27% Anglicare % 0 ACCare 17 48% 52% UnitingCare Wesley Port Pirie 14 49% 51% AFSS % 0 Total 123 In addition, about 90 percent of RSS records did not include an intake number, making it impossible to link the RSS data with NCFAS data sets Program statistics Between 1 April 2009 and 14 July a total of 123 families (with 203 children) were referred to one of the five RSS service providers, ACCare, AFSS, Anglicare, Centacare and UnitingCare Wesley Port Pirie for reunification services. Fifty-two cases were closed during that period Child and parent demographics The average age of children was 6 years, with the majority (77.8%) being under 10 years of age (Figure 9). 29 Two maps of the distribution of SFSC Programs and Service Providers are attached as Appendix A-1 and Appendix A-2. 43

44 Figure 9: Children by age groups 40.0% 35.0% 36.5% Percentage of children 30.0% 25.0% 20.0% 15.0% 10.0% 17.7% 23.6% 13.8% 6.4% 5.0% 2.0% 0.0% Not stated age group The number of children in each household ranged from 1 to 5 (Table 30). Table 30: Number of children in each household Number of children in the household Number of families % Total Cultural background information was provided for 80 families (65.0% of total). Of these, 21 families (26.3%) identified as Aboriginal and/or Torres Strait Islander. (In comparison, recent statistics indicate that 25.8% of children in out-home care in SA were Aboriginal and/or Torres Strait Islander. 30 ) Court order and placement information at referral Of the 146 children for whom information was available, 65.1% were currently on a 12 month Guardianship or Custody Order; and approximately 15% were on a Voluntary Custody Agreement. Where placement details were available ( Australian Institute of Health and Welfare 2010 Child Protection Australia Child welfare series no. 47 Cat. No. CWS 35. Canberra: AIHW 44

45 children), over half (53.1%) were placed in relative and kinship care, 16.8% had been placed in interim emergency care and 15.9% were placed in foster care Service delivery and closure information Engagement Engagement information was available for 52 families (42.3% of the total). Of these, 46 were described as successfully engaged (88.5%) Closure information Seventy one cases were still open at the time of analysis. Thirty one (43.7%) of these referrals were made before December Fifty-two cases had been closed. The average duration of support was 150 days, with a range of 6 to 348 days (Table 31). About 20% of families had received services for less than 100 days, with 3 families remaining in the program for less than one month. About 10% of families had participated in the program for more than 250 days. 31 Table 31: Duration of support Duration of support (days) Number of families % Not stated Total Eighteen cases (34.6%) were closed due to successful reunification (Table 32). Eleven closures (21.2%) were due to unsuccessful reunification with children being returned to or remaining in alternative care. Seven (13.5%) cases were closed due to engagement issues. 31 These figures are indicative only as the available data is limited and reflects the early stages of the program implementation. 45

46 Table 32: Reasons for case closure* Reasons for closure Number of families (n=52) % Successful reunification Other (not specified) Children return into alternative care Family has disengaged for an unknown or another reason Family has been supported for 12 months post-reunification * A family may indicate more than one reason for closure Case outcomes About 90 percent of RSS records did not include an intake number, which made it impossible to link the RSS data with NCFAS data sets. Case outcomes analysis in this section is therefore based only on NCFAS data. NCFAS assessments were conducted for 42 families; twelve of these families had exited the program. Reunification clients were assessed using the North Carolina Family Scale for General Services and Reunification (NCFAS-G+R) which includes, in addition to 8 domains contained in NCFAS-G, two other: caregiver/child ambivalence readiness for reunification Families problems at intake In each domain there were over 60 percent of families (n=42) rated in the baseline/adequate or above range (i.e. baseline, mild and clear strength) at the time of intake. This suggests that the families referred to RSS presented with a lower level of risk and higher level of readiness for reunification, making them suitable candidates for the program Changes in family functioning NCFAS closure scores were available for 12 families. Figures 10 and 11 show the level of change across the 10 domains at the time of closure. There were no clear trends in the results, with the most common scoring assessment being no change. Results are difficult to both report and analyse - for example families 46

47 could improve in some domains, but decline in others. Of the total of 112 domain scores recorded for the 12 families: 34 scores were positive change 27 were decline 46 were no change. Of the domain scores which did not demonstrate any change at closure, more than half were rated in the problem range at the time of intake. Figure 10: Changes in Families recorded NCFAS Scores at Case Closure (Domains of Environment, Parental Capabilities, Family Interactions, Family Safety and Child Wellbeing) 32 (n=12) 7 6 Number of families or more no change or more Environment Parental Capabilities Family Interactions Family Safety Child Well-being 32-1 or more: deteriorated one or more scale intervals; +3 or more: improved three or more scale intervals 47

48 Figure 11: Changes in Families Recorded NCFAS Scores at Case Closure (Domains of Social/Community life, Self-Sufficiency, Family Health, Caregiver/Child Ambivalence and Readiness for Reunification) (n=12) Number of families or more no change or more Social/Community life Self-Sufficiency Family Health Caregiver/Child Ambivalence Readiness for Reunification 2.4 Conclusion The analysis of the program and related data presents a mixed picture. In the 15 months between program inception and data analysis, 426 families with 1005 children were referred to the Stronger Families Safer Children program. Many of these families had entrenched, complex issues often with extensive histories of concern related to child safety and wellbeing. Aboriginal children and families were well represented in referrals to the program and country locations appeared to have utilised the TEIS program especially well. Some families have clearly benefited from program support, as indicated by NCFAS results for TEIS families and the successful closure of cases. Even where cases were closed with an unsuccessful outcome, involvement with the service may have provided a clear direction for future planning and the long term safety and stability for children. However, the data also points to significant problems with engagement, particularly in the IPP program and for ATSI clients. Not surprisingly, families with more extensive child protection histories and complex issues were harder to engage. Of particular concern is that only one Aboriginal family had been engaged 48

49 successfully in IPP. Inability to keep appointments was frequently identified as a barrier to engagement. This suggests a need for a more proactive and persistent strategy. Hard-to-engage, chaotic and resistant families are the target group for the program and should be a priority area of focus. Although it is difficult to quantify given the quality of the available data, inappropriate referrals may have contributed to high drop out rates post referral. This may reflect the reported tensions between Families SA and NGO service providers in the early stages of the program regarding the suitability of clients for the program (see qualitative evaluation reports). Of some concern are the relatively small numbers of families exiting the program as a result of successful completion (about a third of TEIS and RSS closures and only 17% of IPP s). Engagement issues were again identified as a significant problem. It is not possible to assess the broader impacts of the program, particularly on the child protection system, at this early stage. This question will be explored in more detail through analysis of data in the second stage of the evaluation. Finally, data quality was an issue across all program streams, most significantly the RSS, and this impacted significantly upon the evaluation. More robust data is required for better and more meaningful analysis. 49

50 50

51 3 Qualitative findings: Families SA staff 3.1 Methodology Families SA has 18 Offices across South Australia, nine in the metropolitan region and nine in country locations. All supervisors of Child Safety and Family Support Teams (n=31: metro=19, country=12) were invited to participate in the evaluation via a telephone interview. Prior to interview, supervisors were provided with a series of questions and asked to take these to their teams for discussion. The evaluation team then re-contacted supervisors for their feedback on these questions. The notes of these interviews were analysed to identify themes, similarities and differences according to each of the key focus areas of the evaluation: Service expectations and performance Service effectiveness Working relationships Impact on Families SA. The ability of some workers to comment on different aspects of the initiative was constrained by their limited contact with the program (for example, having referred only one or two clients). Additionally, some supervisors were only recently appointed to their position and had limited knowledge of the program s development. 3.2 Findings Implementation to date - overall assessment According to the information gathered from FSA informants, there has been much success to date in the roll-out of the SFSC program. The program has addressed a clear service gap, and has been widely welcomed. In many places strong 51

52 relationships have been developed between SFSC services and FSA; processes appear to be working well; and there is a high degree of enthusiasm from FSA about what the program has to offer. However, this response was not universal. Responses were received from 14 Families SA offices and of these, 7 were largely positive, 5 were mixed, one was strongly negative, and one office essentially could not comment (because of their lack of experience with the program). Many offices are working with more than one service provider or program element (e.g. TEIS and IPP); and the mixed nature of responses was often due to the different views and experiences of the programs/providers, or else individual workers in the NGO. Country/regional areas had both the strongest positive comments, but also the most negative (strongly negative at two locations). In both these cases, feedback was focused on worker skills. In several responses, issues were raised about supervision and support mechanisms for workers in regional areas. Overall, feedback suggests that there is room for program improvement and particularly in certain locations or with certain service providers. The major issue identified by informants was the perceived skills level and approach of the SFSC workforce in some services and locations which influences every aspect of the program (the working relationship, processes, services provided etc) What is working? There were many comments from FSA informants which indicated that the key elements of success for program implementation (collaboration, clear roles, effective processes, interventions, skilled workforce, family-centred/childfocused) were in place. Flexibility, negotiation and a strong relationship and communication between the sectors; a shared focus and understanding with regards to child protection; clarity of roles and the ability to work as a team with families; and the skills and approach of the individual SFSC workers; were the clear themes repeatedly referred to where things were working well. The TEIS is the one I have referred to a lot. This service is working very well. One of the most important aspects I have found is the development of good relationships with the service. I have found that flexibility and a willingness to 52

53 negotiate around the referral criteria has been very important. I think that it is not really early intervention cases that we are always referring. Some of them are in fact quite chronic in terms of need, not so much in terms of safety. I think this was inevitable as we do not investigate the lower end cases so we would be unable to refer them. Both services have been excellent. The working relationship between FSA and the services has been brilliant. We have spent time on establishing good working relationships. FSA has an open door policy with workers, they often have discussions about cases, how and when they should notify when there are concerns; they work out together how they will proceed with the case, if an investigation is required there is lots of work done to protect the source of the notification in order to preserve the working relationship between the clients and the services. Workers have shown real commitment and care about their clients. They get in and do the work. The TEIS is excellent in engagement and perseverance with families. Referral processes have been smooth, we've found the worker to be very goal orientated and able to challenge families respectfully and keep them on track. We are satisfied at the way it is going. There is a lot of contact with the SFSC worker and a lot of respect for her work. The prior worker and the current one have a good understanding of statutory child protection work and that has helped significantly. Families SA and IPP met with the family at the beginning and the goals were clearly established. The IPP worker went out of her way to engage the family, attending at the home very early in the morning to assist in teaching the mother how to get the child dressed and fed when needed and persisted when the family were avoiding her. The monthly reports were detailed and helpful and addressed all of the goals. The IPP worker worked collaboratively with Families SA by arranging joint home visits, s to update when there were any concerns and by visiting the FSA office to discuss progress and concerns whenever required. Another key success is the very real service gap which SFSC has addressed. Amongst respondents there was widespread appreciation that 'at last we have somewhere to refer to'. We finally have a service that does the work that's needed to be done so the work is not falling back on us. We are finally able to refer out to another service provider and that service has been good. The particular value of having the model based in the community (NGO) sector was identified by several respondents that is, the perceived capacity of the service provider to engage in a different way with the family. This was seen as an important and helpful adjunct to the statutory child protection role. 53

54 We have found that utilisation of the SFSC program has been a safer way to build relationships with resistant families. They are more likely to trust TEIS workers and others from NGOs than FSA. 3.3 Emerging Issues In any program implementation there are always issues that emerge the aim of a first stage evaluation is to identify these issues and promote opportunities for program improvement. The issues discussed in this section must be seen in this context. It must be emphasised that by no means were these issues universal, and they generally related to specific service providers or localities. However, these issues do have the potential to limit or threaten program performance and outcomes Targeting and referral criteria - TEIS Service criteria and eligibility have been key issues in the implementation of TEIS and are still, in some areas, unresolved and a source of frustration. This essentially relates to the complexity/nature of cases which can and should be referred to TEIS, as well as to the meaning of early intervention. Families SA workers expressed a need for a service which was able to deal with complex cases. In general, offices reported that they do not see families with lower levels of need, with those who encounter the child protection system already having compounded and difficult issues which call for skilled and child-focused interventions. It's difficult to find the right families for the service. Most of the families being seen by FSA are difficult and hard end they have lengthy child protection histories, mostly we're looking at Orders and removals. We don't get too many cases that can be worked without an Order. Successful implementation necessitates FSA and NGOs agreeing on the target client group, including service eligibility and entry criteria. Families SA feedback suggests this has been resolved successfully in some areas, but not in others, and also with different outcomes. It appears that in some areas FSA have modified their expectations (which was often for a service which would 54

55 work with higher-end clients) and are now referring lower risk families; whereas in other areas TEIS are accepting and reportedly working well with higher-need cases. Some clients that fit the IPP criteria are being referred to the early intervention because we do not have IPP and it is needed here. In other areas, it appears a lower need threshold applies, with this being an ongoing source of tension between the sectors. The capacity of the workers does not fit with what work is required. We have had to be very selective in relation to the families we refer We are only referring the lower cases, the medium risk cases. Several offices were disappointed by the program due to the limited capacity to deal with more complex cases. We did expect that they would take higher risk cases. There were also a small number of examples of significant disagreement about eligibility. Best outcomes were achieved when both SFSC and FSA were flexible and willing to negotiate referral criteria, and were open about potential referrals and what could realistically be achieved. The TEIS has been the most effective due to the willingness of the service to be flexible around referral criteria and also the skill of the workers. Where this was not in place, misunderstandings and different service expectations have caused, and continue to cause, tensions Working together There were many examples given of high quality practice in 'working together' and by far the majority of responses indicated strong working relationships. There has clearly been investment in this area by many offices: Great, we have an open door policy, they come and visit regularly, we have healthy conversations, we are a professional group of people aiming for the same thing. I know that it's not the same with other DC's and the (SFSC) workers have talked to us about different experiences with other DC's but they have said they like our approach and we are happy with it, we kind of made it up as we went along but it seems to be working. Excellent, hasn't always been easy and we had to work through initial issues, but collaborative work has been worthwhile. We have had regular meetings with our co-agencies and discussed how things are going and have worked through any differences of focus for the families we are referring. We have identified the benefit/need for joint training for FSA staff and the 55

56 agencies as this would aid in the understanding of each agency's perspective of how we approach the issues. Having the SFSC worker at our staff meetings has helped to open communication channels between the NGO and FSA. Features of the positive relationship were openness with each other, strong and regular communication, and collaborative work practices. However, relationships are not all strong and positive. At the extreme end was: Our workers have not really had the opportunity to build relationships with the SFSC worker. They said that they have never been successful in contacting them. My workers were frustrated that they could not get in touch with the worker. There were also mixed views about partnership meetings some were described as 'working well'; but responses also suggested some uncertainty or disagreement about the focus and role of the meetings. The monthly meetings have been really helpful. We use them to discuss cases and brainstorm cases; they are almost like a supervision session in some ways because we offer ideas around strategies and services. Mixed views about the partnership meetings some find it quite tedious to discuss cases where things are going well, however, where things aren't going well the information is very useful. We have monthly meetings, but I don't want to have my time used up for a couple of hours talking about cases which for FSA are closed. I don't mind talking with them and having meetings about referrals and families on our books that might benefit from the SFSC, but not closed cases. For these cases, they need to have the autonomy and confidence to work through issues, to assess, to rely on their supervisors and, if they assess the children are still at risk, to notify and have the notification assessed via the normal process. The above comments reflect tensions between FSA staff wanting to limit their involvement at partnership meetings to cases of relevance to their work and NGO staff wishing to consult more broadly. Considering the need for capacity building and skills development in the NGO sector, partnership meetings could be considered as an opportunity and a worthwhile long term investment Workforce issues Feedback often directly linked service performance with the skills, experience and attitude of workers. The program is doing quite well, but it is the workers that are the key. We have terrific SFSC workers. 56

57 Overall the program is a good one, but there are problems with individual workers. It's highly variable, dependent upon the service provider and the workers involved. When it's good, it's good. Workforce issues raised by respondents included workers without proper training and qualifications (especially in regional areas where recruitment has been a challenge). The reality is that workers are unskilled and untrained. The workers have no understanding of FSA work, a developed training pathway is non-existent and workers have no skills in family assessment. In some instances, the adequacy of supervision (for the SFSC worker) was raised as an issue, especially in regional areas and where workers were relatively isolated. It is time consuming for FSA workers as SFSC workers need high levels of monitoring and supervision. They rely on FSA to provide supervision due to their own organisation not having the capacity to do so. SFSC in my area needs a clearer leadership. They need to be clinically supervised. In response to concerns about worker capacity, FSA had modified their expectations and referrals; and also indicated that they were sometimes highly directive in cases. We have to prescribe tasks to the SFSC workers and monitor them heavily. They rely on FSA supervisors and not the senior members in their own organisation to sort things out or to ask questions. Basically, all they can do is to work with parents on how to keep the house clean. They do not even address parenting skills and, due to most of the services being provided when children are at school, they do not even address parent-child interaction, and there is not any child focus. Some respondents also indicated a 'working together' approach, to address workforce and training/skills concerns. I have been really open with (the SFSC) about the issues. We are working together to try to improve staff skill and professionalism. There is open communication from management to management about the SFSC workers, who are really unprofessional in their communication and who have a real lack of knowledge about FSA and where their service fits in... However, I think it is a unique problem here as the SFSC workers specific to our area have insufficient skills. The problem is that there are not enough people who applied for the positions and they were employing workers who did not even meet the baseline criteria. 57

58 The nature of SFSC work demands a highly skilled and professional workforce, able to engage and work with families struggling with many complex issues, including drug abuse, mental health, violence and entrenched poverty. The skills and capacity of the workforce must be a major focus for service improvement Family-focused child-centred practice To be successful, SFSC services must work from a family focused child centred' model of practice. This will include having a strong child protection knowledge base; being able to engage and work with families whilst maintaining a clear focus on the safety and wellbeing of the child; and the ability to address 'tough' issues. A partnership approach between FSA and the NGO and community-based services is also essential. Much feedback indicated success in this area: IPP and RSS were the most effective, worked closely with Families SA but also fulfilled their role in working with the family; had clear goals and provided detailed regular feedback. They were child focused in their work; the work with parents is to provide a safe environment for the child. However, some responses also raised issues of concern. What I've observed is that there is a real lack of professionalism. The workers become over-involved with the parents to the extent that they are their mates rather than the workers. There are real issues around professional boundaries. They over-identify with the parent and lose sight of the child and the child protection issues. They can't have the hard conversations and they close too soon and too easily. Clients can use reunification workers to vent about the department and if the worker is parent focussed rather than child focussed it can cause difficulties in case planning. These comments suggest opportunities for improvement, in particular to ensure that services have a clear family-centred and child-focussed approach; and can work collaboratively with Families SA, across the tensions and boundaries that can easily emerge in statutory child protection Engagement and "persevering" Persistence and assertive engagement are vital in family and child services in order to engage 'hard to reach' families as well as involuntary clients, and also to encourage and support change in the face of protective services' involvement. Most feedback in this area was positive. 58

59 The services are excellent in persevering, in trying to engage families. A (reunification) family was very negative towards FSA. SFSC has built a really good relationship with the family and trust and they connected the family with FSA. The clients have since become more open with FSA and more truthful. They have even been forthcoming with issues and problems even before they come to our attention. Some respondents, however, raised concerns about the willingness of SFSC to persist with families that is, to engage them in the service, and then also to keep going with them through difficult times. 33 It was suggested that (in some regions) services did not try hard enough to engage with services, and were too eager to close. I thought there would be more time taken to try to engage difficult families. IPP will close a case after the client has rescheduled and/or missed a few appointments. The least effective has been the reunification service, which is not intensive. I have found that this service has not had success engaging our clients and they give up quite quickly if clients miss appointments. My observation is that workers are not skilled in engagement. IPP was the least effective service. They seem to struggle with working with involuntary clients. This becomes evident when they are unable to engage a family and will simply report to the DC that they made a phone call and the client did not return their call. It is then up to the DC to push the IPP workers to go out and do home visits and basically increase the pressure for the family to make contact with them. These comments indicate some tension between FSA and SFSC concerning engagement and closure decisions, as well as concerns regarding the skills of some program staff Model and service capacity It is widely recognised that the increasing complexity of at-risk families calls for a highly skilled workforce, and also the capacity to provide a range of specialised services. There were not many responses which discussed the services actually being provided to families by SFSC and their 'fit' with the needs of the client group. In general, as previously noted, feedback on SFSC was strong. The intensive casework is beneficial to families. 33 This is borne out by the data (see section in the Quantitative analysis chapter). 59

60 The most effective aspect is its flexibility in terms of program and the hours that workers can spend with families; the structure around the homebuilder s model is good and communication is generally open and effective. Some respondents reported that the service had exceeded their expectations as to what could be provided by the worker: Our worker has extended her services to families when necessary and provided additional supports when families ask for them. For example, some of the parents have needed one-to-one counselling and the worker was able to provide that. A couple I know of were reluctant to access outside counselling services so that was really good that the SFSC worker was able to fill the gap until these mums have the confidence to connect up with other services. Intervention which focused on parent-child relationship was critical to success: Most effective is the service delivery in the home when the children are there. There is a combination of parent-focused, child-focused and integrated family work. The worker visits the families after school when the children are there. However, some concerns were also noted about the model and its capacity, including the nature of service provided (practical rather than therapeutic or clinical) and the intensity and length of intervention that was available. SFSC works pretty well with practical stuff, but it needs to be better integrated with therapeutic work to ensure a more holistic in-home service. SFSC workers would benefit from training in specialised areas, such as alcohol, drugs, domestic violence, mental health, etc. The SFSC service is quite good, but it has a task focus and not too good theoretical approach. There is no understanding of attachment issues and no therapeutic base. They need to [go] back to the parent's own childhood and explore the impact that has on current levels of attachment with their own children. They need training to integrate therapy in the work done in the homes. Timeliness' is another critical component of the service model, especially for intensive family support and reunification services. Sometimes the take-up of the cases has been a little slow - it is important that the service meets the client quite quickly and is able to engage quickly before momentum is lost. The hours of work were a concern in some areas: The programs are funded to work after hours, including weekends, but they don't. They work nine to five on weekdays and most of their visits are done during school hours so they're not even seeing the kids or working with the kids and parenting. the services are not intensive, particularly TEI, and they're not there for the time they are meant to be. They only visit for an hour a week, if that. Several respondents raised concerns about SFSC not seeing or working with children suggesting the need to clarify the program s role in this critical area. 60

61 3.4 Outcomes and impacts A qualitative evaluation is not designed to assess outcomes. Feedback is inevitably anecdotal. In addition, data collection was conducted relatively early in the program's functioning with only a small number of cases being closed (which means that individual respondents commenting on case outcomes for their own team have had limited opportunities to observe outcomes). However, indications were generally positive, both in terms of outcomes for families and impact on FSA. Positives include that it has reduced our workload, enabled better relationships between FSA and families and reduced subsequent reports for most of the families involved. The reunification program has had some very good results with children returning home. In a couple of instances, respondents identified the benefit from SFSC services even if children were placed in care. We feel TEIS has been successful in diverting clients away from the statutory system and where they haven't they have effected more amicable removals of children. Although they haven't been operating long enough yet, it would appear there has been a reduction in re-notifications, we're never going to make these families 'ideal' families but able to get them to a point where the risk is manageable "good enough" parenting. Many respondents identified positive impacts, not only for clients, but for FSA, enabling them to 'get to more cases; as well as, in some cases, positively impacting on work practices and knowledge. Services have helped broaden FSA knowledge of other services available within the community. We know that there is a service that can be provided almost immediately to a family in such an intensive way, with a short waiting time. Many other services have limitations to what they can provide or when they can provide it this service has been essential. However, on the down side, a minority of respondents reported a negative impact on their workload, and were less optimistic about outcomes. The services are not having a high success rate. Cases are being closed without positive outcomes being achieved, and therefore they are coming back to FSA. It has increased our workload. When they close cases we have to re-open, and that's a real capacity issue for us. It has also increased our workload because we have to attend more meetings, do the referrals and follow up with the cases. 61

62 It has not reduced our workload. The team said it had increased work due to doing referrals, assessments and goals with families that were not accepted or not engaged. Paradoxically, cases that would have previously been closed by FSA now need to be investigated and assessed if thought suitable for TEIS. If a family says 'no' to the SFSC service, then FSA are stuck Quantum of services Respondents identified issues relating to the quantum of services available in their area either wanting 'more of the same', or else a higher level service (such as the IPP). IPP will only work with clients for four months. Given that they are given higher risk clients than TEIS (who work with clients for 12 months) this does not appear to be sufficient time to make genuine changes in the family. There is often a waiting list for reunification services and the length of the reunification service provision 4 months is not long enough when working towards reunification. We try to refer, but we only have a 0.5 allocation to the SFSC program. This means it is a bit of a hit and miss process to get a family referred. We need more TEI services in particular, more capacity. We need an IPP service. Our client base is at the high to very high risk end. The current service (TEIS) does not suit what we need. 3.5 Summary Responses from Families SA supervisors suggest variable results in the roll-out of SFSC. Generally, the program has been welcomed as meeting a very real servicegap, and satisfactory working relationships and partnerships have been established between the NGO sector and Families SA. However, there are areas in which the working relationship is poor and where there are also concerns reported about service quality and outcomes. Most commonly, these issues have arisen from concerns about workforce skills, capacity and values. Continued attention therefore must be given to developing capacity and skills within the SFSC workforce. 62

63 The responses have indicated other areas in which there are opportunities for improvement, and where attention needs to be given to ensure program performance. These include: referral and eligibility criteria and processes, particularly for the early intervention service engagement and persistence with clients mutual expectations of the sectors in regard to each other's roles and responsibilities relationship and collaboration between the sectors compatibility of the service delivery model in each of the program s streams to specific clients needs and program objectives. 63

64 64

65 4 Qualitative findings: NGO stakeholders The responsibility for conducting the qualitative component of the evaluation was split between the Research Unit, DFC (reporting from Families SA staff) and an independent consultant (reporting from the NGO sector). This section presents a summary of the findings from the NGO sector. This summary and the full report were prepared by Dr Paul Aylward, Division of General, Practice, University of Adelaide. This report details findings from a formative qualitative evaluation of South Australian stakeholder NGOs engaged with the Department for Families and Communities Stronger Families, Safer Children initiative. The initiative seeks to prevent children from vulnerable families from entering or becoming entrenched in the child protection and care system. NGOs are funded through this initiative to provide access to a wide range of support services to achieve the outcomes of stabilizing and supporting families to help care for children in a safe environment. There are three streams of the program: Targeted Early Intervention Family Support Services (TEI); Intensive Placement Prevention (IPP); and Reunification Support Services (RSS). The work is being undertaken in partnership with Families SA (FSA) District Centres. Seven focus groups of program workers were conducted, one for each of the NGO stakeholder agencies. The stakeholder NGOs in this project were: Centacare Catholic Family Services; Uniting Care Wesley Port Pirie; Nunkuwarrin Yunti of SA Inc; Aboriginal Family Support Services Inc; Centacare Port Pirie; Anglicare SA and Anglican Community Care (ac.care). The focus groups were conducted in several sites around Adelaide, and in Murray Bridge, Port Lincoln and Kadina. Participants attending these sessions worked broadly across South Australia including Coober Pedy, Port Augusta, Ceduna, the Riverland, Port Lincoln, Mount Gambia and Whyalla. Four of the NGOs ran more than one stream of the program with one running all three streams. 65

66 4.1 Overview The effective operation of the program across each of the three streams is predicated on establishing a sound working partnership between the NGO service provider and the DCs responsible for directing initial referrals. This has varied greatly across the program and within program streams; where partnerships appear to be working effectively this has generally taken some time to establish. Whilst a range of additional difficulties were identified for NGOs operating in rural regions there were few patterns emerging which identified the conditions under which these partnerships operated effectively; even within a single NGO stream, workers experiences of partnership and program operation differed considerably. Despite some specific concerns emerging for each stream, a number of contextual, socio personal and strategic issues emerged which influenced partnership development across the program. Interagency partnership appears to be most influenced by: DC workload, working practices, and staffing continuity; the extent to which DC staff are aware and supportive of the program; and existing or developing inter personal relationships between individual staff from the two agencies. The efficacy of program guidelines (whose clarity was broadly acknowledged) stipulating referral procedures, program implementation and partnership arrangements was premised on these factors. Strong collegial partnership between the service provider NGO and individual DCs have, from the NGO service provider perspective, generated a range of beneficial client outcomes which are detailed in this report. Because these varied within streams all NGOs reported positive outcomes for many families. All NGOs strongly supported the program and emphasised the high level of need. The benefits of early intervention and a tailored family focused service including the flexibility to apply brokerage funding were broadly applauded; extending brokerage funding to the Reunification stream was advocated. The flexibility of the program to respond to contextual and local concerns raised was highlighted as a strength, and the role of Community Connect in this was particularly applauded. The program was generally considered inclusive and responsive at all levels and the State wide meetings were broadly appreciated. Where NGOs have had the opportunity to liaise with each other through partnership meetings with District 66

67 Supervisors or through efforts made by NGO managers this has enhanced collegiality and mutual support. Training provided through the program was broadly praised with some suggested improvements. Written guidelines were considered clear and Community Connect s efforts to help implement them by addressing referral issues and raising program awareness among DCs was broadly appreciated. However, the extent to which this translated into routine practice appears to vary greatly across the program leading to broad calls for these efforts to be supported by more authoritative ( top down ) directives to the DCs. The program impact has been diluted by both a tendency for low referral rates and inappropriate referrals from the partnering DCs and this has been particularly the case for Aboriginal families. While NGOs reported improvements across the program this has nonetheless been an enduring problem for the majority of stakeholders. NGOs reported accepting unsuitable cases due to: a lack of alternative service provision for families in the area; the perceived need to demonstrate competence to the DC and to allay possible threats to the evolving partnership; concerns to meet accountability requirements regarding recording attempts to engage; and concerns to enact the program where client capacity had not been attained. Potential strategies suggested for enhancing and extending referral pathways are presented below. For three NGOs the program appears to be steadily strengthening as it matures. Flexible on going inter agency liaison which has included program promotion activities and the documenting e mail exchange to monitor client progression has enhanced this. However a range of potential improvements were identified by all NGOs culminating in the compilation of suggested enhancements to consider. It is also the case that three NGOs, which taken together delivered all three streams of the program were very critical of current inter agency arrangements and this was particularly evident for Aboriginal families. 67

68 4.2 Targeted Early Intervention Recruitment to the TEI program is reliant on the capacity of the FSA to: efficiently respond to notifications concerning potentially suitable families and arrange initial investigation/assessments; and to liaise with the NGO to conduct an initial meeting with the family. From the perspective of many of the NGO service providers, problems have been identified in each of these areas. Whilst these have been partly addressed by the introduction of new guidelines, at the time of writing several NGOs expressed frustration at their persistence. District Centres were broadly considered to be overworked, under staffed and operating in crisis mode. The focus of the FSA was considered crisis intervention with potential Tier 1 families rather than early intervention. It was asserted that the DCs through necessity tended to prioritize workload accordingly resulting in a number of families who were considered to be most suited to early intervention missing out on the TEI program. It was asserted that closing cases without notifications being investigated by the DCs was common and that families often required several notifications before being visited for assessment. In these cases NGO stakeholders asserted the potential for family issues to deteriorate into crisis as a result of delayed action with these cases re emerging as notifications at a later date. In this regard the DC assessment requirement of the program recruitment process appears to have impeded efficient early intervention. Collaboration between the DCs and NGOs to regularly review notifications was advocated as a possible means to help alleviate this problem. Where families were identified by the DCs as potentially suitable for referral to the program, Several NGOs complained of difficulties coordinating the initial home visit leading to delays in instigating the program for some families. Allocating specific DC workers to the program was advocated and broadly supported as a means to enhance inter agency coordination. There has been a broad tendency for DCs to refer unsuitable high need families to the TEI program; this has eased as awareness of the program and its guidelines has grown in the FSA and confidence to refuse inappropriate referrals has developed among NGOs. However, these improvements appear to be inconsistent across localities and persist most 68

69 notably for referred Aboriginal families where the TEI has been partly acting as a proxy for the IPP. Whilst these families were considered to benefit from participating with the program, this was currently facilitated by the number of clients being below capacity allowing more resources to be directed toward them. The quality of the service for these more needy families would decline if full quotas are reached. Some NGO inter agency partnership agreements have enabled small numbers of these clients to be directed from the TEI to the IPP stream where they operate in the same vicinity. Referrals of Aboriginal families have generally been low across both the TEI and IPP and this has frustrated NGOs, particularly those who specialize in Aboriginal service provision. This was attributed to community reluctance to engage with government services (due to historically located concerns about child removal and stigma issues) which combined with a referral process which stipulates the initial requirement to do so. Despite recruitment issues, from the perspective of the NGOs the program has been working well for the large majority of clients but particularly for those for whom the project was designed. The value of the program was broadly championed and in the view of these workers has brought about substantial and sustained changes for families including: connecting families with communities and their services, imparting parenting skills and engagement of parents with their children, building resilience to cope and reengaging children with schooling. The program was broadly asserted to have prevented the removal of children from their families. However, it was widely felt its optimization was shackled by a sole reliance on the FSA for referrals and this was particularly emphasized in the case of Aboriginal families. The need to establish alternative referral pathways for non Aboriginal and Aboriginal families was broadly held and strongly expressed. For some specialist Aboriginal NGO service providers, a range of other programs were concurrently run for Aboriginal communities; while program clients could be referred to these, clients who were known to be suitable for the TEI program cannot under the current referral process be referred from these programs unless they are redirected to the District Centre. Similarly, other families who were aware of the specialist Aboriginal service self presented for help which could, in the view of those who provided the program be well met by the TEI. In these cases, it was felt that the existing relationship and engagement established with 69

70 Aboriginal families and the reputation of the specialist service with the broader Aboriginal communities were underutilized and restrained by the requirement to contact the FSA for referral. In this situation, the established benefit of accessibility provided by the specialist Aboriginal service for those in the community was considered to be undermined by the program s referral procedure. The extent of client family problems (and related suitability for the early intervention) was sometimes revealed only after the program workers had engaged with them over several weeks. This was most commonly expressed in relation to mental health issues. Building NGO capacity to identify clients with mental health issues and to make informed decisions concerning suitable interventions was advocated. In some cases workers were unsure of procedures to follow in the event of new suspicions of abuse arising with engaged families; this requires clarification. 4.3 Intensive Placement Prevention As with the TEI stream, NGOs running IPP have experienced problems in receiving suitable referrals from the DCs. This has been partly attributed to FSA staff turnover and the need to raise awareness of the program. In one case the IPP program received no referrals for a four month period following staffing changes in the DC. Another NGO increased referral after widening the constituency of DCs. There were broad calls to expand the IPP particular to address unmet need for Aboriginal families. Where relationships between the NGO and DCs have been established the program appears to be working well with collaborative partnership encouraging good client outcomes. However where these relationships have not been established referral and liaison difficulties persist. NGO service providers also reported accepting IPP cases with long standing and multifaceted issues. Many of the problems faced by some non Aboriginal and Aboriginal families were considered so entrenched that the relatively short intervention, whilst valuable was not adequate to fully address their needs. In some cases the IPP was extended but the scope for doing this varied between program localities highlighting a 70

71 degree of inconsistency across the program. There was support for the development of a step down program to address this identified gap in service provision and to allow identified IPP families to continue to receive support and have their family goals monitored. There was also an identified reluctance of Aboriginal families to participate with the program. This was attributed to a lack of consultation with the communities from the outset, historical influences/fears and concerns about stigma. Avoiding government services and stigma was considered to camouflage genuine desire for change for some Aboriginal families. This is being addressed by some NGOs enlisting Aboriginal workers to connect with communities and promote the service. Additionally pseudo volunteers have emerged as families seek admittance to the program in order to avoid other consequences without really wishing to engage with it. The importance of potential clients acknowledging the need to change was advocated as a recruitment criterion and the use of family care meetings to encourage this appears to be a beneficial (currently optional) strategy which needs further monitoring. 4.4 Reunification Support Services Successful referral to the Reunification Stream and outcomes for families engaged with it appear to be influenced more by inter personal relationships between workers across agencies than the establishment of program systems; the corollary here is that where the program operates effectively this is vulnerable to staff turnover. However, where families have been united through the program the personal rewards of job satisfaction from positive client outcomes for staff was clearly expressed. Referrals have varied across the programs but appear to be particularly poor (given the number of effected cases) for Aboriginal families. This was attributed to several overlapping factors: some DCs generally considering the large majority of families to be unsuitable for the program; a reluctance for DC staff to change existing working practices; a reluctance to accept the possibility of genuine change occurring within families, and a related rejection of the concept of reunification ; a lack of awareness of the program, 71

72 referral criteria and the application of assessment tools, and a distrust of the NGO service provider credentials and aptitude. In some cases NGOs have attempted to address these issues by promoting the program to individual DCs and progress was reported. In other cases however, where referrals have been made to the Reunification stream, delays in starting the program was considered to soften its impact. A range of acute problems were raised concerning: unequal partnership, inadequacies in case planning, and unattainable goals being set for Aboriginal families. The extent to which NGOs and recruited families could contribute to case plan development was unclear for some workers possibly due to differences between IPP and Reunification stipulations in the guidelines; in the latter case several workers reported little input to case plans which were sometimes considered inappropriate and unrealistic. Despite program stipulations, it was also asserted that in some cases the NGO service provider workers were being used to collect family information which was selectively presented by the DC in court to prevent reunification occurring; several workers expressed the wish to present supporting information directly to court. Several workers questioned the FSA commitment to the program highlighting difficulties for DC workers who were instrumental in removing children from families to accept changes had occurred to allow their return. These problems have led to a number of NGO workers feeling disengaged and devalued. Negative outcomes for Aboriginal clients following the raising of false expectations were asserted. 72

73 4.5 Suggested responses to enhance the program Dr Aylward prepared a list of suggested improvements to the program, based on information provided by the NGO service provider staff. In consultation with the participating NGOs and DCs: 1. Consider establishing alternative direct referral pathways to the TEI program including: SAPOL, Housing Trust / Housing SA, School counsellors / DECS, Health, and self referral. 2. The need to build up the Aboriginal family case load across all streams of the program was widely asserted. Confining referrals of Aboriginal families solely through the FSA was considered to have restricted access and resulted in inappropriate referral to the TEI and IPP. Consideration of self referral and enabling alternative referral pathways which are more closely linked to Aboriginal communities were strongly advocated. Potential avenues may include: Aboriginal education workers (and partnership with DECS), Doctors and hospitals, and other specialist Aboriginal services or programs. 3. Working with Families SA Management, explore new and enhance existing strategies to raise and sustain awareness of the program streams among DC staff, promote their benefits, clarify referral criteria, encourage routine consideration of program suitability for new and existing FSA clients and emphasize partnership arrangements and responsibilities. 4. Explore mechanisms to encourage DC s who engage with the program to establish contingencies for referral process continuity in the event of staff turnover or absence. 5. Consider establishing an allocated FSA worker to be responsible for the TEI and IPP programs at each DC in order to: enhance prompt response to considering notifications for the program; more efficiently coordinate first home visits; provide a known first contact with which NGO workers can liaise where necessary. This worker could also assist in promoting the program at the DC level. 73

74 6. Consider establishing procedures for specific NGO workers to regularly and collaboratively review notifications with their allocated District Centres in order to identify suitable candidates for referral more efficiently and optimize early intervention. Where notifications have been made but where the DC does not intend to investigate, explore alternative strategies for potential recruitment of these families to the TEI stream. 7. Build TEI service provider capacity to more efficiently identify and gauge the extent to which mental health problems may impede project engagement and family progress in order to enable earlier decisions concerning recruited client suitability to continue with the program and appropriate avenues for help including alternative or supplemental intervention. Possible strategies may include provision of training for current service provider staff and/or enlisting professional expertise in mental health as part of the intervention team for TEI. 8. In partnership with FSA, stipulate/highlight procedures to investigate TEI worker suspicions of family abuse. 9. Encourage documentation of e mail exchange between District Centres and the NGOs to be included in client case notes as an aid to monitoring case progression. 10. Promote opportunities for NGO providers to share information, experiences and approaches; where this has occurred through partnership meetings with District Supervisors or through the instigation of particular NGO managers, staff reported collegial benefit and learning synergies. 11. Consider formalizing pathways to efficiently facilitate the transfer of appropriate TEI clients to the IPP stream where this is possible and in the best interests of the recruited family. 12. Consider viability of establishing a step down program for the families completing the IPP stream where appropriate. 13. A broad unmet need for the IPP was identified by service providers with this tending to result in inappropriate referrals to the TEI stream. In this light, consideration to expanding the IPP stream to more locations is warranted. 74

75 14. The process and impact of using Family Care Meetings to encourage engagement of families on the IPP Stream should be monitored where this has been introduced with a view to further promoting and extending this current optional strategy across the program. 15. Service providers reported a lack of referral of Aboriginal families to the Reunification stream. The reasons for this are unclear and warrant further exploration with the FSA. Strategies to promote the Reunification stream for Aboriginal families in order to optimize recruitment to the program appear necessary. 16. Explore the need and potential to build DC capacity concerning models of change in relation to families who are considered for the Reunification stream and the effective application of existing/new assessment tools to aid referral. 17. Current guidelines stress the importance of prompt referral to the Reunification stream in order to capitalize on the family s sense of crisis. However in some cases delays in referral to the program may dilute this. Whilst time stipulations are provided in the guidelines for the first meeting once a referral is accepted, the time taken for the process leading up to families starting the program was considered to impede its effectiveness. Consideration as to how to streamline the process may be warranted. 18. Stipulations for developing case plans differ between IPP and Reunification streams. Strong concerns about the adequacy and appropriateness of case plans for Aboriginal families on the Reunification stream have been raised and the influence of the service provider and families in their construction and the setting of goals queried. There is a need to clarify the respective roles of stakeholders in the design, evolution and application of case plans for Aboriginal families on the Reunification stream. 19. There is strong evidence that collaborative working relationships between the FSA and service providers addressing Aboriginal families on the Reunification stream are considerably strained and have encountered difficulties which have limited program effectiveness. This was particularly evident in the southern region where 75

76 the commitment of the FSA to the program and partnership has been strongly questioned and the reunification goal considered undermined. There is urgent need to explore this problem further and to examine constructive means to reestablish the collaboration on which program success is premised. 20. Consider procedures for establishing a mechanism to enable the NGO to provide accurate supporting information and/or recommendations concerning families during court appearances. 21. Consider the viability of establishing an FSA reunification team with separate responsibilities from those charged with the removal of children from Aboriginal families. 22. Consider establishing a brokerage fund for the Reunification stream. 23. Adapt the training program to reflect skill and experience levels at which specific sessions are pitched. 24. Consider the need to include the time taken for family program engagement in calculating workload where families contacted do not subsequently commence with the program. 76

77 5 Summary and conclusions 5.1 Quantitative data analysis Over a 15 month period (between April 2009 and mid July 2010) the SFSC program provided services to a significant number of families and children: TEIS: IPP: 263 families and 697 children 40 families and 105 children RSS : 123 families and 203 children 34. Far fewer families were successfully engaged in the services compared to the numbers referred for both TEIS and IPP. Inappropriate referrals and difficulties in engaging families were the major factors recorded by SFSC services as contributing to this result. Aboriginal and Torres Strait Islander families were well represented in the referrals to the program. Whilst no difference was noted in relation to engagement rates between Aboriginal and non-aboriginal clients in TEIS, this was not the case for the IPP with only one Aboriginal family successfully engaged. The IPP program on the whole had poor engagement rates, with less then half of all referrals (47%) successfully engaged. SFSC services identified a major barrier to engagement as the inability of families to keep appointments, followed by families distrust and lack of understanding of the child protection system. The analysis of data suggests that harder to engage families were generally more complex, with more entrenched child protection issues. Families referred to TEIS and IPP were mostly single parent households (usually headed by a mother), with high rates of disability reported for both children and 34 Numbers of families and children provided with the reunification service under the SFSC program are not clear as the RSS data included not only SFSC clients but also clients of other (pre-existing) reunification services, with no identifier available to distinguish between them. Consequently, exact number of families and children provided with the SFSC RSS services are not known. 77

78 carers. The majority resided in rental (mainly public) housing. Large families were common in the TEIS stream but less so in the IPP or RSS. All families had previous involvement with Families SA, in some cases quite extensive. NCFAS scores at intake indicated (appropriately) higher level of risk for IPP in comparison to TEIS families. Families in TEIS and IPP were provided on average with 5 to 6 service types, with parenting skills development the most common service type. For IPP clients, this was followed by counselling and, for TEIS, by links to community networks and services. The average duration of service (for closed cases) was 4 to 5 months (156 days for TEIS, 119 for IPP, and 150 for RSS). At the time of data collection, 35% of TEIS and RSS, and 45% of IPP total referrals, were closed. Of these, successful outcomes were recorded for 32 TEIS families (35% of closed cases), 3 IPP families (17%), and 18 RSS families (35%). Problems with engagement were identified as the most common reason for case closure in IPP (40%) and TEIS (24%). Post closure, notifications had been received in relation to 28% of all TEIS families who had exited. Abuse was substantiated in 6 cases (7.3% of families), 5 families had at least one child removed from their care and placed under a 12 month order and children from 3 families had been placed under a long term order. Notifications of abuse were also received in relation to 23% of families who successfully completed the program. However, none of the families had these allegations substantiated or children placed in care. Of the three IPP families who exited the program following successful completion, post exit Families SA data was available for two, with no re-notifications reported. NCFAS data at closure (available for 30 TEIS families only) indicated positive results. Very few NCFAS results were available for IPP and RSS clients, and no outcome analysis could be conducted. The available data suggests that longer term outcomes were generally positive for clients who had engaged with a service (e.g. 72% of TEIS families who 78

79 successfully engaged with the program have not been re-notified to the child protection system at the time of data collection). However, firm conclusions about outcomes cannot be drawn due to the small client numbers and the relatively short timeframe since case closures. This will be a major focus in the next stage of the evaluation. 5.2 Qualitative data Families SA Responses from Families SA informants suggest variable results in the roll-out of the SFSC. Generally, the program has been welcomed as meeting a very real service gap, and satisfactory working relationships and partnerships have been established between the SFSC services and Families SA. However, there are locations in which the working relationship is poor and some concerns have emerged about service quality and outcomes. Most commonly, informants related these to workforce skills, capacity and values amongst the SFSC service providers. Areas for program development and improvement emerged, including: SFSC workforce capacity and capability clearer referral and eligibility criteria and processes, particularly for the TEIS the capacity of services to engage with complex, hard-to-reach and resistant families (who constitute a large part of the client group) the relationships and collaboration between FSA and SFSC services, including governance and collaboration structures and mechanisms (such as partnership meetings) and expectations and understandings of roles and responsibilities the appropriateness of the models and components of service delivery, as are currently being delivered by NGOs, to the needs of clients - that is, whether the services being offered, and the way in which they are offered, are the most likely to meet client needs. The need for a child-focused-family-centred approach was also emphasised. 79

80 5.2.2 SFSC service providers Overall, there was a strong support for the program amongst SFSC service providers. The benefits of early intervention and family focused approaches were emphasised. The flexibility of the program, its overall management and the role of Community Connect, DFC, were applauded. Training provided to staff was generally praised. However, there were also suggestions for improvements and indications that the program was not working work well in some areas. For example, sound working partnerships between SFSC services and FSA were not always present. Informants attributed this issue to Families SA workloads and working practices, staff turnover, the level of awareness and support for the program within FSA, and inter-personal relationships between individual staff. Low referral rates and, at times, inappropriate referrals were reported, particularly for Aboriginal and Torres Strait Islander families. Informants also identified a need for more intensive services in locations where the IPP was not available. It was also proposed that it should be possible to have a gradual withdrawal of services, particularly for families with complex issues. A range of possible improvements were suggested, including: alternative entry pathways into the program, particularly for Aboriginal and Torres Strait Islander families mechanisms within FSA offices to improve service coordination, provide for continuity in the event of staff turnover, and maintain the program s profile amongst staff collaborative processes for reviewing notifications and considering referrals to the program opportunities for sharing knowledge and experiences between local agencies improvements to the service delivery model, including establishing pathways between different program streams and establishing a step down program extension of the IPP model to all locations to ensure an appropriate fit between client needs and the level and intensity of service 80

81 improvements to case planning practice, with a more collaborative approach and greater clarity of goals and responsibilities. 5.3 Emerging issues The first stage of the evaluation aimed to identify emerging issues and areas for program improvement. Across the three streams, some clear themes have emerged. These - discussed below should all receive attention to guarantee optimal program performance Referrals and eligibility criteria There are on-going tensions regarding referrals and eligibility criteria, particularly to the TEIS program. This essentially relates to the complexity and nature of cases which can and should be referred to TEIS, as well as the meaning of early intervention. Families SA workers were united in calling for services able to deal with complex cases the extent to which this can or can t be met through SFSC is still creating tensions across the program, including at a local level. This issue needs to be examined at a governance level, as well as locally and between the program partners, with different solutions perhaps appropriate for different areas. There are also some concerns about the level of referrals that is, whether sufficient referrals are coming through from Families SA (especially for TEIS). It is clear that there has been enormous variability between Families SA offices in referral rates and practices. Barriers to higher referral rates include: the characteristics of the families with whom Families SA work (ie, Families SA offices only see/work with families who are more advanced in the child protection system and have complex needs their suitability for the TEIS program is a matter of contention) and the additional work demands on Families SA staff, in an already very stretched work environment, in identifying and referring suitable families. These issues must be explored further, particularly with Families SA, to ensure a steady and appropriate rate of referrals either through FSA or through other pathways. 81

82 5.3.2 Engagement rates Data from all components of the evaluation indicates that engagement is a significant issue, both in terms of initial service up-take and in retention within the program. This is particularly the case for IPP and Aboriginal and Torres Strait Islander clients. The very nature of SFSC services is that they target complex, hard-to-reach, resistant and chaotic families. It is of concern that client s inability to keep appointments is consistently identified as the major reason for program drop-out and failure to engage these characteristics are almost a given for many in the target group, and the capacity to effectively engage and work with such families is fundamental to the program s success. Strategies must be developed to improve engagement and retention rates, including persistent and assertive outreach; developing workers skills and confidence; and identifying successful approaches. Processes at the time of referral must also be considered, including the timeliness of initial assessments and referrals as well as the clarity and consistency of messages conveyed to families by SFSC and Families SA staff. In all this, Aboriginal families must be a priority Effectiveness The relatively short time frame since the program s implementation limits the conclusions that can be reached about outcomes and effectiveness. However, early data suggests that, while many positive outcomes have been achieved, there are also many who exit the program prematurely or without achieving improvements. This is particularly evident in the IPP and RSS streams. Addressing problems with engagement would go some way towards increasing success, however other factors, such as the suitability of the service models (including the length, intensity, nature and focus of intervention), and the professional skills and training of staff, should also be considered. 82

83 5.3.4 Workforce skills, capacity and values A highly skilled workforce is essential to the program s success. Staff need to be child focused, culturally competent, persistent, able to effectively engage clients and deliver practical and therapeutic support. It appears that there is considerable variation across the programs in values, professional background and training and as well as skills and knowledge base. The existing training program for SFSC staff was widely applauded by the service providers. However, a range of strategies and approaches are required to address varied needs in particular contexts and locations, some of which may be outside of the formal training program. For example, partnership meetings provide an opportunity for sharing information, experiences and perspectives. Their role in facilitating learning is recognised in the Practice Guidelines but not always accepted or applied at a local level. Closer collaboration between SFSC and Families SA staff provides an opportunity for sharing of knowledge and experience and developing a common understanding of issues and expectations Working together The importance of positive and cooperative relationships and a positive dialogue between SFSC services and Families SA cannot be overstated. Where there is a strong collaboration, problems are generally resolved quickly and effectively. Whilst a strong partnership was evident in some locations, this was not always the case, and in some areas major problems were evident. A number of elements are essential to effective partnerships, including strong leadership, trust amongst partners, a common understanding and knowledge base and the capacity to focus on overarching and shared priorities. These elements are not always in place. Different priorities and perspectives, heavy workloads and frequent staff changes are also not supportive of an effective partnership. Consideration therefore needs to be given to building partnership, relationship and collaboration, particularly at a local level, and addressing or minimizing the factors that impact negatively on the partnerships and program performance. 83

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85 6 Appendix A: Maps Map 1: Map 2: Distribution of SFSC Programs and Service Providers Distribution of SFSC Programs and Service Providers 85

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