Intensive Family Support Program Review

Transcription

1 Intensive Family Support Program Review A Summary of the ARTD Consultants Final Report to Ageing, Disability and Home Care, NSW Department of Family and Community Services Intensive Family Support Program Review by ARTD Consultants 17 January 2011

2 Document approval The Intensive Family Support Program Review A Summary of the ARTD Final Report to Ageing, Disability and Home Care has been endorsed and approved by: Peter De Natris Executive Director, ADHC Approved: December 2011 Signature on file Document version control Distribution: Document name: Version: Document status: File name: Authoring unit: Public Intensive Family Support Program Review A Summary of the ARTD Consultants Final Report to Ageing, Disability and Home Care Summary Final Intensive Family Support Program Review Summary Community Access Directorate Date: December

3 Table of contents Executive Summary The IFS program and scope of the review The IFS program Strategic context Program theory and evidence base Aim of the review... 6 Program logic Methods Review program documentation Review of monitoring data Service provider interviews Workshop with ADHC regional managers Client survey Client interviews Workshop with service providers Review findings Stakeholders are satisfied the referral and assessment processes are working reasonably well Referrals have grown steadily over the past four years How could the referral process be improved? Are clients being effectively engaged? Client numbers have grown in most local planning areas The program is reaching key target groups Planned service targets are not being met Is the service being delivered as intended? Most clients receive a mix of practical and therapeutic services The average service duration is longer than planned Not all families received or required an intensive service Are families benefiting from the IFS program? Most clients feel more supported and better resourced, but not as many feel better connected Most clients feel more able to care for their children What do stakeholders value most about the program? IFS is contributing to strategic objectives to varying degrees Key issues Segment client service needs and consider a second or third service option Support evidence-based practice through monitoring and measurement Develop stronger links with child protection services Develop service guidelines Appendix 1 Characteristics of preservation services

4 Executive Summary Intensive Family Support (IFS) is a program funded by Ageing, Disability and Home Care (ADHC), Department of Family and Community Services NSW. The Intensive Family Support Program Review Summary presents the key findings of a review undertaken by ARTD Consultants in The content and findings of the full ARTD report to ADHC are retained in this summary however references to specific organisations that contain sensitive information and data have been removed. Key findings The IFS program is an intensive, time-limited service to support families at risk of family breakdown where children are at risk of being placed in out-of-home care. It is intended to be a flexible and highly targeted intervention involving a mix of practical and therapeutic services. The ARTD review found that the IFS program, although operating under capacity, is being implemented largely as intended and is very successful in engaging clients from priority target groups. An appropriate mix of services is being provided and from a client and service perspective the program is benefiting families. The review highlighted that the service is being offered to families with a wide range of needs and that not all families who need a service may need the level of intensity provided by IFS. The review proposes more detailed segmentation of client service needs with consideration of additional program streams based on different intensity and durations. For example, a service with reduced intensity could be delivered over the same period for families just entering into difficulties and a less intensive and longer term service could assist clients who need ongoing support whether to prevent them getting into crisis or to maintain family functioning following an intensive case management intervention. The review also made recommendations about eligibility criteria, improved program monitoring and data collection, the use of structured case planning and review tools and developing a set of service guidelines. The ARTD review made the following recommendations for ADHC: 1. In consultation with providers, segment the service needs of clients and consider a second or third service option. 2. In consultation with service providers, implement a program monitoring system that provides information about service delivery and client outcomes. 3. Consult with providers about the option for a shared goal setting/case planning tool such as the Supporting Children and Responding to Families (SCARF) tool, North Carolina Family Assessment Scale (NCFAS) or similar. 4. Regional staff to report on existing partnerships between the IFS program and local child protection services and develop a strategy to increase appropriate referrals to the program i.e. for clients who are not under the care of the Minister for Community Services. 5. To use the information from the report to inform the service guidelines for the IFS service. 3

5 1 The IFS program and scope of the review 1.1 The IFS program The IFS program was established in 2005/06 to provide a time-limited, intensive, homebased intervention to assist families of children with a disability to better manage the challenges they face. The program targets families of children and young people who are finding caring for their child difficult and who are at high risk of being placed in out of home care and/or experiencing family breakdown. The program has four main intended outcomes: Families at risk of voluntarily placing their child with a disability in out of home care are able to identify and access the support they need at critical times. Families are better able to manage stress with a reduced risk of their child with a disability being placed in long-term out-of-home care. Families using the service have an improved sense of well-being. There is increased confidence and capacity within the family to manage the impacts of future stresses. The program funds nine non-government organisations that provide a total of 16 services across NSW. Three of these services target clients from culturally and linguistically diverse (CALD) backgrounds and four provide specialist support to Aboriginal families. All IFS services are required to meet the needs of both CALD and Aboriginal families Strategic context The program was developed as one of four initiatives in the Supporting Families Care for Children and Young People with a Disability Framework (2005) which has five objectives: 1. Expanding support options and networks for families. 2. Providing better support to families to reduce the incidence of children and young people in out-of-home care. 3. Supporting families to provide the best outcome for both the child with disability and the family as a whole. 4. Providing support to children and young people who in rare circumstances are unable to live at home and who require short or long-term voluntary out-of-home care placements including alternative family placements and small group care arrangements. 5. Assisting young people leaving care to transition into appropriate living options. 1.2 Program theory and evidence base The IFS program is a family preservation service that is based on crisis intervention theory and strengths-based practice which proposes that families can engage with services positively, learn new behaviours and build their capacity to manage at a time of crisis. The program has adapted the Homebuilders model 1 to provide families with support and information and link family members to appropriate supports. The research indicates that the most effective approaches to supporting families of a child with a disability include 1 The Homebuilders model was developed in 1974 through the US Institute for Family Development as an alternative to unnecessary out-of-home placements. The model has been developed within a child protection context where the risk of children being relinquished or removed presents such a crisis. 4

6 providing flexible, home-based interventions which involve all family members and build formal and informal resources and capacity to manage stress. Such approaches enable families to access appropriate services and develop ongoing support networks involving friends, other family members and people in the community. A report on family preservation services in the Australian context has found that the common adjustments to the model include longer duration of services, pathways into less intensive and long-term support, and different therapeutic components such as group work and in-office counselling. Evaluation of the services in Australia has pointed to the need for longer interventions for Aboriginal families who are often dealing with more entrenched and complex family issues. The broader literature includes some limited evidence that longer interventions may be more effective for some families 2. A study which assessed 14 different family preservation services against a list of 16 identified components in the Homebuilders model found that the four programs which adhered to at least 13 of the criteria had significantly fewer subsequent placements and reports of maltreatment 3. The 10 services in the study that did not closely follow the criteria produced no significant effect 4. A literature review of family preservation services undertaken by the Centre for Parenting and Research found similar evidence. The 16 criteria of the Homebuilders model are listed below Imminent risk of placement hours a day 7 days a week (24/7) availability for intake. 3. Immediate response to referral. 4. Service in a natural environment e.g. home, community setting. 5. Intensity of service, therapists typically see 18 families a year, serving 2-3 families at a time. 6. Brevity of service, duration of service is limited to a maximum of six weeks, with an option for service extension hours-a-day, 7-days-a-week availability for clients families per therapist. 9. Services are provided by a single service provider. Therapists operate in teams of four to six therapists and a supervisor. 10. Organisational support, flexible time and at least forty hours of training from recognised experts hour consultation, therapists have 24/7 access to their supervisor. 12. Engagement and goal attainment outcomes tracked during the case and in followup interviews/questionnaires with the family to ascertain placement prevention outcomes. 13. Flexibility and responsiveness of services e.g. session lengths and appointment times tailored to the family s needs and goals and include appointments on weekends and evenings. 14. Interactive assessment and goal setting. 15. Services involve a teaching/ skills-based approach. 16. Provision of concrete and advocacy services. 2 Tully, L 2008, Literature Review: Family Preservation Services, Centre for Parenting and Research, NSW Department of Community Services. 3 Miller, M 2006a, Intensive family preservation programs: program fidelity influences effectiveness-revised, Washington State Institute for Public Policy. 4 Tully, L Miller, M 2006a; Tully, L

7 1.3 Aim of the review The ARTD review assessed the IFS service model and its implementation. It identified opportunities to improve the model and inform the development of IFS service provision guidelines. In particular, the review: Assessed the effectiveness of the referral process, and issues in relation to eligibility criteria and assessment. Examined the implementation of the program, including take up and engagement of key client groups, service duration and intensity, and types of services provided. Examined the extent to which families appear to benefit from the program and the extent to which the program contributes to strategic objectives in the Supporting Families Care for Children and Young People with a Disability Framework (2005). Identified key issues and proposed how these could be addressed. Program logic ARTD developed a program logic diagram in which the IFS program is expressed as a hierarchy of outcomes (see Figure 1.1). The program logic focuses on the intended outcomes at different levels of the program and aims to show the causal links between them. The review examined whether outcomes at different levels of the logic have been achieved or can be demonstrated. The long-term result for more children and young people to remain at home was not included in the review due to limited availability of data. Figure 1.1 Program logic 6

8 2 Methods The review methodology was designed to assess the extent to which the IFS program is being implemented as intended; is achieving its intended outcomes, as expressed in the outcomes hierarchy; and to identify key areas for action and development of the service. 2.1 Review program documentation A review of available program documentation included the Request for Quotation for IFS Review, Information Package and Application Form, Aboriginal IFS Program Description and the Intensive Family Support Programs: Keep children with a disability safely in their families Report. The latter is a research study undertaken by the Centre for Gender- Related Violence Studies by the University of New South Wales (UNSW) which provided evidence of client benefits and identifies a number of program implementation issues. Documentation from one ADHC region was also used to inform the review. 2.2 Review of monitoring data The review analysed service data on 682 clients for the period 1 July 2006 to 30 June 2010 and looked at the following information for all services: Number of clients per service Client demographics Waiting period and length of service Use of brokerage funds. Referral data Data about referral sources, dates and the reasons for eligibility/non-eligibility was available in three out of six ADHC regions which revealed differences in the recording and collection processes between regions. 2.3 Service provider interviews ARTD conducted semi-structured interviews with each of the nine service providers. Interview data was used to inform review questions about the IFS model and its implementation. The interview data covered the following key issues: Service targeting, reaching high need groups including Aboriginal and CALD clients. Referral process. Perceived impact of the service activities on clients. Perceived strengths and weaknesses of the IFS model, policies and implementation. Perceived client satisfaction and outcomes. 2.4 Workshop with ADHC regional managers ARTD held a focus group with ADHC staff involved in panels from four regions to collect their views about the effectiveness of the IFS model and the implementation process. The data informed the analysis relating to eligibility, referral processes, operation of the panel, use of brokerage, the role of ADHC caseworkers and priorities to be addressed in the ongoing implementation of the program. 7

9 2.5 Client survey A survey was sent to 276 families who commenced in the program from 1 July 2009 of which ARTD received 73 responses, representing a 26% response rate. Of the 73 survey respondents: 23% spoke a language other than English at home 15% identified as being Aboriginal 42% indicated they lived in a rural or remote location 35% indicated their family included more than one child with a disability. The data sample includes some caveats, it is not known how representative the sample is of the IFS service client base and the data categories are not mutually exclusive. It is not known what influence factors such as language, socio-economic situation or complexity of needs may have had on the sample. For example, families with more complex needs may have been less likely to complete the survey. The data provides a sample of the client perspective about the program and its implementation. The findings have informed the analysis of the referral process, the service length and intensity and service benefits. 2.6 Client interviews ARTD aimed to interview eight clients including two from each of the key target groups, Aboriginal, CALD and rural/remote families. ARTD contacted 16 families but only five families consented to be interviewed including three from CALD backgrounds and two from rural areas. The interviews aimed to collect data on issues such as timing and intensity of the services. 2.7 Workshop with service providers A workshop with 18 participants representing seven service providers was held in early November 2010 to seek further input in relation to key policy issues and areas of identified service development. 3 Review findings For the referral process to IFS to be effective, referral agencies must be made aware of the service, understand criteria and make appropriate referrals. 3.1 Stakeholders are satisfied the referral and assessment processes are working reasonably well. A panel consisting of ADHC regional officers and IFS service providers is established in each region to manage referrals to the program. The UNSW study reported a number of problems in the early operation and establishment of the panels. Panel members and service providers reported placing great effort into developing service delivery and communication processes to implement the service. Most panels have been proactive in making changes to panel processes to meet local needs, for example, to the frequency of meetings or assessment processes, and ADHC and service stakeholders indicated that local panel processes currently work well. The panel process appears to work well where an effective partnership-style relationship has been developed between ADHC and service provider panel members. In these cases there was shared decision-making and a collaborative approach evident. 8

10 Service providers commented that panels provide an independent and objective forum for assessing and prioritising referrals and that the processes involved (including the criteria and assessing priority) are clear and professional. Stakeholders indicated that where there are multiple providers in a region this helps make panels efficient in allocating referrals. Service providers from each region indicated their panel used an eligibility assessment tool which may provide a good example from which a common tool, potentially with differential service pathway outcomes, could be developed. The frequency of panel meetings to assess referrals varies by region and local planning area. Panels most commonly meet on a monthly basis but in some rural areas panels meet less frequently according to need. Meeting frequency ranges from every six weeks to every four to five months and most panels meet to process referrals outside regular meeting times if needed. A small number of providers were less positive about the panel process. One noted that, on occasion, an ADHC panel representative had identified a family as a priority independently of the panel process or some families were not prioritised because all other options including ADHC services had not been exhausted. Another provider commented that the lead role of ADHC on panels can undermine the independence and impartiality of the panel process. One of the strategies attributing to an effective and collaborative relationship between the agency and providers is where the lead role is shared with service providers. 3.2 Referrals have grown steadily over the past four years The available data from three regions indicate that over the last four financial years the total number of referrals for these three regions has steadily grown from 84 in 2006/07 to 216 referrals in 2009/10. Referrals are mostly through IFS service providers A separate client dataset of 709 records containing information about the source of referrals in three regions showed that almost all clients were referred from either an NGO (most commonly one of the IFS service providers) or ADHC. Very few referrals from other agencies were recorded and some of the data was missing or the referral source was recorded as unknown. Referrals are generally assessed within four weeks Between 2006/07 and 2009/10 the average time between referral and assessment was 26 days among the three regions. Most referrals are assessed as eligible The majority of clients (79%) referred to IFS were eligible for the service. Demand may be a contributing factor but the most common reason clients were not eligible related to the fact that essential or priority criteria was not met which suggests that the criteria needs to be clarified. Clients wait an average of two months from referral to the start of the service Between 2006/07 and 2009/10 the average time from referral to commencement of service was 57 days and the time varied widely between service providers. 3.3 How could the referral process be improved? While stakeholders are satisfied with the way the referral process is working, further action or consideration is proposed in five key areas: timing of the service, eligibility, use of waiting lists, assessment, benchmarks for panel processes and guidelines for service provision. 9

11 The level of crisis and timing of the intervention could be clarified Working with families as early as possible has implications particularly for case loads, service numbers and the service model. Families receiving an early intervention are unlikely to require the intensity of service provided in the IFS model which is based on caseloads of 2-3 families per staff and is designed for families facing more complex and intensive challenges. All service providers interviewed indicated that most families face some risk of family breakdown and fewer families were at risk of either statutory or voluntary relinquishment of their child. Aboriginal IFS service providers were more likely to work with families where there is a risk of the child being placed in out-of-home care and only two services indicated working with families of children in temporary care. Seven of the 34 survey respondents who answered the open ended questions made reference to their situation at the time of the IFS service as struggling or experiencing some form of difficulty which indicates that the IFS service is provided to families at a time of difficulty however no families indicated that they would consider not being able to care for their children at home. One client stated that the IFS service was offered too late, we needed the service some years earlier before the crisis crunch...it was too hard when we received it to come back to a workable point. Stakeholders saw the requirement that clients be at risk of family breakdown and/or need for out-of-home care as creating a service-dependent mentality, in which difficulties compound as they wait to exhaust all other service options. Many service providers suggested that the need to represent the family as in crisis undermines the strengths-based approach on which the program is based. One service provider commented that, families can feel as if support will not be available to them unless they are in crisis... this can breed the mentality that unless I am having a crisis and unable to cope I cannot access services or service will not be available. This is in conflict with the program ethos, which requires service providers to use a strengthsbased approach in the hope of building family capacity and resilience. According to these stakeholders the definition needs to be clarified or revised so the service can be provided to families at any point of crisis including when they first experience a crisis event. For some families this may be at the time they first receive a diagnosis. Eligibility criteria should be amended to allow more families to access the service Flexibility around the requirement for formal diagnosis to be provided with an IFS application. One service provider suggested greater flexibility around the criteria that a child must have a diagnosed disability as some families who are referred to IFS services, particularly Aboriginal and CALD families, do not have a diagnosis due to barriers in accessing diagnostic services. ADHC staff indicated that evidence of a diagnosis is collected as part of the reporting process by service providers to ADHC and so it is not required at the time of application. Some regions indicated flexibility in supporting referrals from a variety of professionals. It would be useful to clarify the requirement of a formal diagnosis in future service guidelines which should also address what would happen if a family is accepted to IFS and then it is determined that a child does not have a disability under the NSW Disability Services Act 1993; a transition plan should be developed for these families. 10

12 Include children under temporary protection orders. The IFS service criteria require children and young people to be living in the family home with family members providing support and legal care but some services have worked with children or young people under temporary care orders where there was a case plan goal of restoration. All providers and ADHC staff consulted support this approach and the service should explicitly include this client group. Include refugees with temporary protection or humanitarian visas. One region indicated clarification is needed to determine if non-australian residents or those with refugee status are eligible for an IFS service. In some case these clients are included as eligible on the basis that service providers have wider discretion to service these groups. Services should find other pathways for families on IFS waiting lists Waiting lists are not often used in family preservation services due to the acute, crisis nature of the service however over half of the IFS services have a waiting list of eligible families. The number of families on these lists varied between one to six families with waiting periods from four weeks to six months. Service providers indicated that where an IFS service could not be provided due to lack of capacity, referrals to other supports were made. Four service providers (representing six services) do not keep waiting lists because families were waiting too long. Future service guidelines should provide a common response and practice in this area. Where families are not eligible or there is no capacity to provide them a service, either ADHC or the provider should locate alternative services, as is commonly occurring already. Panels could accept the application at a subsequent panel meeting if there is still a need for the service. Several providers noted that having multiple IFS services in their region on the same panel helped to allocate referrals and manage demand which is useful for planning any future expansion of the program. A standard priority assessment tool should be considered Most regions use an assessment tool developed by the panel to assess and prioritise applications and stakeholders reported that this process is working well. Having a common tool across all panels could provide fairest access to the service, particularly if the tool is used to direct families into different service streams. The tool would provide common priority criteria such as: Family willingness to engage. Breakdown or significant stress in family relationships. Requesting or at risk of requiring an out-of-home care placement. Concerns about child neglect and/or abuse in the home. Significant change in physical or emotional health of family members. Complex family situation with significant change in request for services. Increase in effects of difficulties on siblings. Panels would assess applications against standard criteria and the tool and/or guidelines could use case study examples to illustrate eligibility against these criteria. If there were more than one service option the assessment tool could be also used for streaming purposes. 11

13 Benchmarks for panel processes should be provided One of the characteristics of intensive services is that families receive an immediate response to a referral however the average wait time for an IFS service is 57 days between assessment and commencement of service. It was not clear what was driving the timeframes especially in the context of lower than planned service outputs reported in Section 4.3 and the lack of capacity to meet demand. Regular monitoring of panel processes, service outputs and duration will inform future decision-making. Monitoring of panel processes should be based on a set of benchmarks introduced to guide practice and assessment time thresholds around: How often the regional panel meets to assess referrals. The time from referral to assessment. The time from assessment to commencement. Service guidelines will clarify policy uncertainties and promote a common approach to the operation of panels and the referrals process ADHC and service stakeholders welcomed the introduction of service guidelines and a number of suggestions to improve the referral process included: Roles and responsibilities of ADHC and providers at each stage of the referral process. Case study examples to help illustrate and build a shared understanding of eligibility. A process map outlining key responsibilities and steps in referral and assessment processes. Clarification on eligibility criteria. A policy position/ process for wait listed families. Benchmark timeframes for panel operations. Promote collaboration through shared responsibilities and decision-making. Some flexibility within regions to apply processes to meet local needs e.g. frequency of panel meeting times. 4 Are clients being effectively engaged? 4.1 Client numbers have grown in most local planning areas The total number of clients across NSW has grown from 88 in 2006/07 to 232 in 2009/ The program is reaching key target groups Service data showed that the program is reaching CALD and Aboriginal client groups but additional strategies are needed to engage these key client groups. A total of 26.8% of families in the program are reported as being from a CALD background. Of these families 85% are supported by four providers of which three target families from a CALD background. Between 2006/07 and 2009/10 Aboriginal families represented 21% of all IFS clients. Four services target and provide a service exclusively to Aboriginal families 12

14 working with between 10 and 21 families each. Several other services worked with a large number and/or proportion of Aboriginal families. The Aboriginal population was more widely distributed across the services than the CALD population with most services having worked with at least one Aboriginal family in the reported period. 4.3 Planned service targets are not being met The IFS program was still in a development phase for most of the reporting period. As a result the number of clients per service against the planned targets show that in 2009/10 ten services operated at less than half of their planned capacity. Some providers reported that local agencies took time to learn about the service and who was eligible. This suggests that a more effective approach to monitoring and supporting providers is needed. Additional strategies help with engaging key client groups Service providers promoted their service through presentations at schools, ADHC offices, disability and early intervention service providers and relevant agency forums and disability expos. According to providers interviewed, the main strategy used to engage families from target groups was face-to-face contact with the family and the referrer to explain the service. Two Aboriginal IFS services said that it was important to engage the wider Aboriginal community as part of the strategy for engaging families. Additional ways of engaging the Aboriginal community include: Attending community and cultural events and arranging barbeques and other social activities to help communities learn about IFS and that it is a voluntary service. More formal processes of consulting with Aboriginal Elders and service providers to ensure the services are welcome by the community. Employing Aboriginal workers is an important strategy for engaging Aboriginal families. Service providers reported the following challenges to engaging families from a CALD background: Difficult to find appropriately skilled and available interpreters Some families including refugee families have experienced trauma and need specialist services The cost of interpreters The stigma associated with disability in some cultures and unfamiliarity with the service system. Closer monitoring of service outputs is needed Service data is not regularly available to inform service providers and ADHC about program outputs. The lower than planned number of families and lengthy average wait time for the service suggest there may be a need to further review service targets and capacity. More comprehensive monitoring would enable trends in client numbers and length of service to be more closely assessed. 13

15 5 Is the service being delivered as intended? 5.1 Most clients receive a mix of practical and therapeutic services The research shows that family preservation programs are considered effective because of the combination of practical and therapeutic supports provided. The ARTD review collected evidence about the range of supports families received through IFS services. Service provider interviews and client surveys indicated that a balance and mix of services is provided to families. The client survey listed eight service types and families indicated which service type they had received. The results of the survey are as follows: Families receive a mix of services with 71% of families receiving service referrals and help with parenting and counselling services. Families from a CALD background are less likely to receive counselling (53% compared with 71%) which may be a factor contributing to the shorter service these families receive. 26% of the families interviewed indicated that assistance was received in making their home a safer care and play environment. 46% of families reported the IFS program helped to connect their family to community supports. About one quarter (26%) of the survey sample received help with purchasing household equipment. Families in rural areas received slightly less help (17%) and Aboriginal families received slightly more help (38%) with household equipment. Most services focused on providing support to assist families through the crisis that led to the referral which in some cases followed initial diagnosis. The range of support included helping families develop and maintain routines, informal counselling, connecting families to services, arranging and accompanying families to medical and other appointments. The practical supports included liaising with Centrelink, paying for driving lessons, and assisting newly arrived refugees and Aboriginal families relocating to apply for social housing. An important aspect of the IFS service delivery is that information and education about disability and disability services is provided to families. For CALD families this includes having relevant information translated and using interpreters. Some services offered parenting training and role modelling for parents to better manage their child s behaviour while other providers helped families to implement behaviour plans that had been developed by other agencies, including occupational therapists and psychologists. Some services support siblings and parents through connecting them to recreation activities and support groups. For example a group of Aboriginal fathers had a weekend away fishing and formed supportive friendships. While all services have at least some contact with schools some have had a considerable role in engaging the school by: Advocating for the child with disability to re-enter school after a period of suspension often due to behavioural issues and sometimes related to lack of educational support staff and/or programs in the school. Encouraging continuity between the child s home and school through the implementation of the behavioural strategies and/or plans. Engaging therapists. Advocating for increased resources for the child with a disability. 14

16 Transport to school and purchase of school uniforms. One service emphasised the need for and benefit of ongoing, complementary supports, for example supported playgroups and other activities. Some clients received assistance through brokerage funds IFS services also offered practical support through the use of brokerage funds to purchase household items, such as a new fridge, dining room table or washing machine, and play, sensory and other equipment for the child with a disability. The use of limited flexible funds was seen as an important component in family preservation and other similar programs 6. The data indicated that over two-thirds of all clients received some amount of brokerage funding and the amount varied widely between client, service and year. The average amount across all clients over the four years was $1,039 which varied substantially over the four years. Service providers reported high levels of satisfaction with the discretion in using the funds as it allowed timely and flexible use. A small number of service providers have used the brokerage funds to purchase respite care, which includes after school and holiday care, and therapeutic services for families where there are long waiting lists for such services especially in rural areas. One Aboriginal IFS service suggested that brokerage funds could be used for community engagement activities as having effective community links was an important part of the program. One service provider said that it is important to get the funds at the beginning of the year so that they can be used as required. Some stakeholders reported support for having separate service guidelines that include the purchase of respite and therapy services. Others reported that while purchasing respite is useful to achieve short-term goals, plans for long-term use will require sustainable arrangements. Most services have used the Family Assistance Funds Business Rules (FAFBR) as a guide for the use of brokerage funding although the FAFBR do not allow funds to be used for respite. Two services stated that there is a need to clarify the use of brokerage funds and that any service guidelines should remain flexible and discretionary. 5.2 The average service duration is longer than planned The IFS service is intended to last between six and twelve weeks but the data indicated that the average service was 15 weeks for the 2006/07 to 2009/10 period. The average number of days from commencement to exit of the program has declined over the last four financial years from 114 days (16 weeks) in 2006/07 to 95 days (14 weeks) in 2009/10. CALD clients generally received a slightly shorter service in some services Overall clients from a CALD background received a slightly shorter service than all clients. The average service duration for CALD clients across all years was 86 days (14 weeks) and the average length in 2009/10 was 97 days (12 weeks). Aboriginal clients receive a slightly longer intervention The planned service length for Aboriginal families is six to 16 weeks. The data indicates the average number of days from commencement to exit for Aboriginal families over the four operating years was 118 days (17 weeks). Two of the services working exclusively with Aboriginal families had longer than planned interventions over this period at 32 weeks and 18 weeks. In 2009/10 the average length of service for Aboriginal clients was 104 days (15 weeks) which is one week more than the average service length for all families in the same year. 6 Disney, H. & Morgan, E 2006, Latest Research Evidence on Integrated Programs for Young People at Risk, Morgan Disney & Associates. 15

17 The increase in the number of clients has no impact on service duration Although the number of clients had increased from 88 to 217 across all outlets between 2006/07 to 2009/10 the average duration of service remained stable over this period. The service should remain at current lengths but other service options might reduce the average length, and closer monitoring is needed The length of service should remain the same. The length of service varied widely across different providers and locations. When a service went over the timeframe, this resulted in fewer families being able to access the program. Service providers noted that ADHC approval to extend the period of service delivery for individual families was commonly sought. Some providers suggested that future service guidelines should reflect the longer period of service being delivered however most providers agreed to the 6 to 12 week timeframe and 6 to 16 weeks for Aboriginal families with the option to extend. Additional client groups may need a longer intervention. The IFS policy for Aboriginal families is a six to 16 week service which is up to four weeks longer than other clients. Service providers identified additional client groups requiring a longer intervention such as carers with an intellectual disability or with particularly complex or mental health needs. While CALD clients received a shorter service overall, in some services these families received a longer than average service. Some providers stated that CALD families often needed a longer intervention due to the complexities of working with interpreters. The review recommends that the IFS program maintains the service duration but a longer service option of 8 to 16 weeks is considered for carers with intellectual disabilities. Consider options for post-ifs support. Services reported that IFS includes a progressive reduction in intensity as families move toward exiting the program and towards the end of each intervention families and caseworkers develop a transition plan. This recognises that some families require ongoing support beyond IFS. The review suggests that the IFS service could be extended until a case manager can be identified and appropriate service arrangements are in place. Most providers supported the concept of a post-ifs component in the form of a less intensive service provided over a longer period of time, six or twelve months. The service length could be better monitored. The majority of generalist providers reported that the support provided is usually between 8 and 12 weeks. The discrepancy between this perception and the data indicates a need for greater monitoring of the program. The review has found that case duration is not a reliable indicator of intensity of service provision and other indicators such as total service consumption and monthly service consumption would provide a better picture of service provision. The review proposes that ADHC develop a monitoring system for the IFS program so that the number of outputs required by providers can be reviewed to determine whether current targets are realistic or enhanced funding is needed to meet demand. 5.3 Not all families received or required an intensive service The IFS program tender documentation describes intensive family support as working intensively...to address (families ) immediate situation and help them develop sustainable family routines and ongoing supports. Intensity is defined as the small caseload of two to three families per worker, the 24 hour on-call and after-hours availability of the service and to some extent by its short-term, time-limited nature. 16

18 The client survey asked families to indicate the average number of hours and days of support per week they received from IFS caseworkers and therapists while in the program. Although the response rate to the survey was 26% the data below provides some evidence about the intensity of the service from a client perspective. Most clients saw their worker one to two days per week A total of 57% of survey respondents reported having contact with workers once or twice a week, 27% indicated having contact three to four days a week and 16% reported having contact five to seven days a week. Aboriginal families were less likely (30%) to report seeing their worker only one to two days a week, with most (70%) reporting contact with their worker three to four days per week (a more intensive intervention). Most clients received one to four hours of service per week The survey asked families approximately how many hours per week their IFS caseworker or therapist spent with members of their family. A total of 72% of all families, including families living in rural/remote areas, reported between one and four hours per week, 17% indicated five to ten hours per week and 11% reported more than 10 hours. Of the Aboriginal families surveyed 55% reported spending one to four hours per week and 36% reported spending five to ten hours per week with their caseworker or therapist. A total of 88% of CALD families reported spending one to four hours a week, 6% reported five to ten hours a week and one CALD family reported spending more than 10 hours a week with their worker. Not all families may need an intensive service The evidence suggests that not all families using the service may need an intensive service. All five families interviewed indicated they had received a visit from their worker once a week for one to two hours and one family reported that it reduced to one visit per fortnight. Two families indicated they had expected to spend more time with their worker. Service staff at the provider workshop indicated that they spend a significant amount of time on non-face-to-face client related work. An average of six to twelve hours per week with each client includes face-to-face, follow-up, information gathering and referral activities with an hour of face-to-face service involving hours in follow-up work. Service providers reported that many families are time-poor and can only see their worker for a limited time each week and while these families have met the IFS eligibility criteria because they demonstrate that they are facing difficulty they may not require the level of service intensity provided through the IFS program. A flexible, targeted IFS style-service option could better meet the needs of these families. This is discussed in Section 7. 6 Are families benefiting from the IFS program? The IFS program aims to benefit families in several ways, in particular by: Increasing their confidence and sense of well-being. Increasing their use of formal and informal supports. Improving their capacity to manage. 17

19 6.1 Most clients feel more supported and better resourced, but not as many feel better connected Families were asked about the impact of the support they had received through IFS and the extent to which the support had made a difference to their family life. The survey recorded that these families: Feel more supported 75% of the survey respondents agreed they feel more supported as a result of the IFS program and 57% agreed a lot. A total of 22% of rural/remote families agreed and 67% agreed a lot. Feel less stressed many families felt less stressed with 45% who agreed a lot and 65% of CALD families agreed they felt less stressed. A total of 18% of families disagreed and another 18% disagreed a lot. Have better contact with friends, family or people in the community less than two-thirds of the families interviewed indicated they feel more connected as a result of the program. 6.2 Most clients feel more able to care for their children Families were asked whether they felt more able to care for their child as a result of the IFS program. Over 75% of the respondents agreed they felt more able to cope in the shorter term and almost half agreed a lot. A total of 70% of the respondents agreed they felt more able to cope with their child s care in the longer term. All service providers reported that the majority of families are achieving their goals and the broader outcomes of the program. Examples of outcomes reported by providers include: Preventing a child from suspension, help with transition to high school and integrating children into local schools. Arranging kinship care with the service s support. Helping prepare a family to accept a child s need for walking support. Helping families become involved in their community to reduce isolation, make use of services and gain support. Accepting services back into their lives. Assisting families with diagnosis. Linking newly arrived families into essential services, including schools and paediatricians. For rural families the main barrier to achieving goals has been family isolation, lack of access to services (many of which have long waiting lists) and lack of transport. Families can face other difficulties such as financial and family relationships which can impact on the capacity of families to achieve their goals. 6.3 What do stakeholders value most about the program? Service providers value the flexibility it brings to their work with families Service providers emphasised the benefits of the flexibility and highly targeted nature of the IFS program. Providing individualised support to family members enabled the family to build resilience and capacity to communicate and to manage family life. Clients value the flexible, informative and supportive nature of the program Of the 73 survey respondents a total of 34 provided open comments about the IFS program. The feedback was generally very positive and some families commented that 18

20 the support was beneficial, had helped the whole family and provided ongoing effects. The comments respondents provided around the program s impact included: Great source of information. Builds up my confidence, empowered me to look after my child. Could share feelings, talk to someone non-judgemental who listened. Helped me to understand myself/my child. Helped me develop ways to cope, how to deal with changes. Created positive energy to deal with crisis. Flexibility of service, worker had plenty of time to help us. The IFS program was unsuccessful for some families Some families reported less positive feedback about the program outcomes because it did not provide the support they needed and in some cases this was because these families needed more ongoing services or respite services. The feedback received included: Need more ongoing support. Did not meet our needs for overnight respite. Great but not enough and not the answer; not long enough and feel it is a bandaid. One respondent was particularly dissatisfied with the service they received when they complained to their provider. The review recommends that ADHC s Complaints Policy is provided to all families and a reference is included in future service guidelines. 6.4 IFS is contributing to strategic objectives to varying degrees The IFS program is contributing in varying degrees to four out of the five strategic objectives in the Supporting Families Care for Children and Young People with a Disability Framework except for Assisting young people leaving care to transition into appropriate living options. The opportunities to strengthen the program s connection to the framework included: 1. Enhance the focus on connecting family members to wide community supports and networks; and 2. Greater links at the regional or service level between ADHC and Community Services so that eligible families who are risk of a statutory placement are able to access the service. 7 Key issues The ARTD review highlighted the following issues for consideration and/or action. 7.1 Segment client service needs and consider a second or third service option The review highlighted that the service needs of families varied widely. Many of the families for whom IFS is designed need an acute period of intensive support in order to get on top of issues that may result in the children needing to go into out of home care. These families may also need less intensive, ongoing support for up to twelve months following IFS. There are also many families who would be able to exit the IFS program 19