Question 1 – How have you adapted service delivery in response to the bushfires, floods and Coronavirus pandemic? When has it worked and when hasn’t it worked? How will this affect how you deliver services in the future? Have your service adaptations included better integration with other initiatives?
A greater demand for service was experienced following COVID restrictions (esp remote learning). This did impact upon wait times to access services. Our response to the pandemic, and associated increase in demand for services, included:
– Adapting service delivery to allow us to effectively provide telehealth appointments through Microsoft Teams
– Providing more frequent check-ins between sessions (via phone call)
– increased the flexibility of our approach – e.g. adolescent clients were better able to adapt to videoconferencing sessions than young children, so for young children the focus of service delivery switched to parent coaching to support child mental health.
– Making greater use of online/freely accessible resources that families/children could access at no or low cost
– Increased our knowledge of emergency relief and place-based support to better link in with our families when we couldn’t visit them ourselves.
– Accoras services a high cohort of CALD families – we worked hard to ensure they had access to important health and pandemic information in language they could comprehend (translated material or very simple English supported by infographics and other images)
We undertook a survey of FMHSS clients following the three month period of major lockdowns in Queensland. Results indicate our families and children felt supported and that they continued to receive a valuable therapeutic service through telehealth and phone-based service delivery.
We will retain the benefits/advantages we have discovered from adapting to the pandemic. This includes the ability to deliver telehealth sessions when meeting face-to-face is not possible (e.g. floods, transport difficulties, illness of other children in the household etc).
Question 2 – Are the proposed key outcomes for the families and children programs the right ones? Are there any major outcomes missing? How can we include strengths-based outcomes that focus on family or child safety?
The current outcomes data reporting could be improved by utilising program specific outcome measures to reflect client situation, intervention provided and progress made by clients. Time frames or intervals for SCORE reporting could be more clearly outlined to ensure all clients are having SCORES recorded at a consistent time in the intervention.
Outcomes measures that would be applicable to the FMHSS program may include
– Reduction of mental health symptoms
– Increase in coping strategies/ reduction of maladaptive coping strategies
– Increased engagement in education,
– Reduction in family conflict/ increased communication skills
– Increased interpersonal skills
– Increase in healthy relationships
– Increase in familial relationships and positive dynamics
– Increase in family’s ability to identify strengths
– Increase in parenting abilities
– Reduction of risk factors.
To support outcomes measures a number of psychometric tests with proven reliability and validity could be considered for use. These tests would be for the purpose of supporting case formulation and not diagnosis, however may support families in seeking further psychological intervention and diagnosis. Possible psychological assessments
– K10 (older cohort)
– Age & Stage Questionnaires
– ASQ to support ASD exploration
– Children’s depression inventory
– State trait anxiety inventory for children
– Assessment of attachment relationship with primary caregiver
It would be important for practitioners to receive training on use of any assessment tools to ensure consistency of use across programs.
Question 3 – What tools or training would support you to effectively measure and report outcomes through the Data Exchange Partnership Approach?
We would strongly support making reporting outcomes through the DSS Data Exchange Partnership Approach a mandatory activity for all funded programs.
To assist this, it would be useful for there to be consistency within each program re: how to record, when to record, and how to report.
It would be useful and informative to receive feedback on the outcome data provided to DSS – both for our own service, and for the performance of funded services across the country. Knowing we will see the results of outcome reporting assists with team member’s motivation to regularly input it.
In terms of achieving good client outcomes:
We recognise different organisations deliver their services in different ways, based on local needs. However there are some commonalities, and therefore some opportunities for sharing resources developed exists, e.g. “validated” tools, program guides etc. Where funding has been used to develop innovative approaches to achieving good client outcomes, sharing/providing access to these approaches should this be a requirement for services. This could be done through webinars, conferences, or sharing paper-based resources through email networks. Currently there are a number of services all expending resources to develop similar tools and client resources / service delivery approaches, which is not the most efficient use of funding dollars.
Question 4 – Do you already have a program logic or theory of change outlined for your program? Did you find the process useful? If you do not have one, what has stopped you from developing one? What capacity building support would assist service providers to develop program logics and theories of change?
Currently the program does not have a formal program logic or theory of change. There are however processes in place to ensure that intervention is needs and evidence based. This includes each client having a case formulation, regular auditing to ensure goals and intervention are congruent and continuous professional development. To have such a document or framework would be beneficial in providing the most appropriate intervention to the client group and ensure accountability of the program.
As our ability to evaluate the impact of FMHSS further develops (as opposed to outputs and outcomes), we will explore creating one to support evaluation activities.
It is our experience that a significant cohort of children accessing FMHSS have historical adverse events / trauma impacting their current mental health. Programs would benefit from a Trauma Informed Practice Framework to be able to appropriately support children and families from a trauma background (priority groups).
Question 5 – If longer-term agreements are implemented, how can the department work with you to develop criteria to measure and demonstrate performance? How can the Data Exchange better support this?
Accoras would encourage an increased focus on outcome and impact evaluation for FMHSS. Over time, Accoras has been building our internal ability to undertake impact evaluations of our service delivery. Our ability to fund this activity depends on how highly it is priorities by funders – are they willing to provide additional funds to support evaluation activities. Accoras would be very happy to share our experience in this area – how internally developed and implemented evaluation frameworks can strengthen service delivery and demonstrate outcomes and impact. A mix of qualitative and quantitative approaches can much better capture impact that what is currently in place with Data Exchange.
Question 6 – What does success look like for your service, and how do you assess the overall success of your service?
When thinking about individual clients:
– Success to us is having positive outcomes for goals that were client directed and client centred. Completing a review with a young person and their family and them being able to identify significant changes that have occurred through intervention provided and how this has impacted their daily functioning, ability to navigate through life and family functioning.
Currently our FMHSS program captures this type of progress through periodic assessment of psychosocial factors and goals by the client, family and practitioner. An increase in number on a Leichart scale and positive progression on identified goals are considered successes for the client.
Additionally, individual client success includes receiving positive feedback and the changes that have occurred based on FMHSS interventions. Positive feedback from other parties involved with the young person e.g. school staff. Low number of re-referrals of previous clients due to sustainable outcomes being achieved. When we are working with the right referrals in the early intervention space lowering the number of referrals up to a tertiary type support program (75% of our clients are able to exit the mental health system entirely). When we are working with young people who may have slightly more severe MH concerns, success is seen through building a strong working relationship, providing psychoeducation and supporting a warm handover with successful engagement to a tertiary support program.
This type of qualitative data is not recorded through DEX.
When thinking about program functioning:
– Achievement of quality outcomes is also demonstrated through repeated successful interventions concluding within an appropriate timeframe. Success is also measured through consistent ability to engage with clients’ families and support systems, to upskill them in supporting children and young people and improving mental health literacy.
Success can also be determined by strength of referral relationships and number of appropriate referrals received into program. The value and success of the program can be demonstrated by the consistent waitlist for service.
Question 7 – Do you currently service cohorts experiencing vulnerability, including those at risk of engaging with the child protection system? If not, how does service delivery need to adapt to provide support to these cohorts?
Accessibility of a timely service for vulnerable families is impacted by the geographical stretch of the programs reach. Currently over 100 schools and education facilities sit within the FMHSS GC coverage area, stretching over 70km and 75 suburbs. The logistics of covering such a large area consistently and distributing resources evenly can impact wait time for service and ability to target specific cohorts. A timely access to service reduces risk factors and is imperative to the early intervention model to increase mental health and improve child, young person and families’ trajectory.
Currently the program has a strong stakeholder and referral relationship with child protection-adjacent services who support vulnerable families and young people. This allows case collaboration and holistic family support between the two services. The organisation also has a place within the Child Safety-run Complex Needs Assessment Panel, which supports the most complex and at risk families on the Gold Coast. Presentations can include child protection concerns, contact with the youth justice system and complex mental health conditions.
The program makes use of trauma informed practice principles to support young people with trauma histories. This can include being flexible in service delivery, such as allowing young people to determine their safe place for sessions (home/school/ community)
The program currently supports external referrals to specific services that provide specialist support in the areas of DFV, CALD, housing and trauma services to ensure clients are met with the most appropriate support at the right time.
It is our experience that FMHSS service delivery can be beneficial for cohorts experiencing increased vulnerability. However this does require a nuanced understanding of early intervention, and how it can be holistically delivered within a systemic/ecological understanding of a client’s current functioning and resources. Further research on how early intervention mental health support can be successfully provided to children and young people who are / have experienced complex trauma would be useful in determining further appropriate support for complex presentations. Accoras believes every child and family can benefit from early intervention mental health supports. We do also recognise that families at risk of statutory intervention, or who are being reunified after statutory intervention, tend to have numerous complexities which require a longer-term intervention that is often clinical and/or safety-focused in nature. The strength of FMHSS is apparent when it can work in with other more intensive services, ensuring early intervention mental health family support does not get forgotten.
Question 9 – For all providers, are there other ways to improve collaboration and coordination across services and systems?
As the program works closely with schools and education facilities, a Department of Education contact or representative within the program at the corporate (State) level would be beneficial. This would assist in reducing barriers to entering some schools who are not open to external providers providing services within school premises. Often this is the safest space for young people to access services if they are in an unsafe/ unstable home environment.
This could also support the program in the understanding of schools expectations and allow greater collaboration between department of education and mental health support, specifically in areas of school refusal.
The ability to form strong relationships with multiple organisations, schools and education facilities is also impacted by the service area. Despite having established strong relationships with some schools and organisations, equal resources and relationships are not distributed to the majority of schools within the geographic program area due to logistics of a small team doing so over large geographic area.
Question 10 – The capability building support offered under Families and Children Activity programs has gone through several iterations. What works well? What do you think should change?
Having the Australian Institute of Family Studies available for evaluation assistance is very much appreciated, and we hope it will continue.
As impact evaluation becomes more of a focus, it will be important to provide training to practitioners to ensure measures and tools are being used consistently.
All FMHSS services should be trauma informed services, and training be made available to those organisations who have not historically had access to it.
Additional focus on what skills and knowledge practitioners need to deliver effective brief interventions to children 3 years and under, and their parents, would be beneficial.
Question 11 – Aside from additional funding, how can the department best work with you to support innovation in your services while maintaining a commitment to existing service delivery?
Greater opportunity to support innovation while delivering services and maintaining outcomes may come through opportunities for pilot streams of the program and anticipating reduced deliverables whilst in the planning stages of pilots.
For example, Accoras is piloting the delivery of Attachment and Biobehavioral Catch-up (ABC) to some FMHSS families. The introduction of ABC to the Queensland service community looks to be exceptionally valuable, however there is limited ability to incorporate the impact of such innovative activities in program deliverables.
However please note: the ability to access the Australian Institute of Family Studies for evaluation assistance has been very much appreciated.
A future opportunity could include a school refusal stream, in which practitioners, schools and parents work together closely, in line with the evidence for increasing attendance after refusal. This is an increasing presenting issue following remote learning and COVID restrictions.
Question 12 – Is there anything else you would like to share about the ideas and proposals in the Discussion Paper?
Thank you for the opportunity to contribute.