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?
Karitane responded swiftly to the COVID-19 global pandemic by pivoting the entire service within two weeks ensuring ease of access for families seeking parenting support in these challenging and unchartered times. During the COVID-2019 period, Karitane transitioned all services to Telehealth platforms, this included: Virtual Home Visits for up to 2 hours with a Karitane Child and Family Health Nurse, Virtual Residential Stay, Toddler Behaviour, virtual parenting groups and webinars, virtual social catch ups, virtual play groups and virtual perinatal infant mental health services . Karitane was able to maintain the continuum of care for families in need from early intervention to tertiary support services. This transition to 100% virtual care fulfilled Karitane’s commitment to supporting vulnerable and isolated families during the COVID-19 pandemic.
As the effects of the pandemic have eased somewhat, Karitane has strategically decided to retain elements of the virtual services for a number of reasons. Familys’ access to services was not limited by geographical boundaries, transportation, difficulty accessing services, caring responsibilities for other family members or fear of leaving the house due to community transmission anxiety.. A blended model of virtual and in-person services offers flexibility, client choice of care modality and ongoing flexibility of access to a service should period geographical lockdowns continue
A blended, virtual model also has the potential for greater collaboration with other services supporting families without the challenge of timing, travel and geographical limitations.
Following Karitane’s shift to virtual care during COVID-19 on the background of virtual care expertise since 2017, The NSW Department of Communities & Justice`sought support from Karitane to support NGOs to roll out telepractice service models and assist other organisations to build their workforce capacity to deliver high quality virtual care services
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?
Karitane welcomes the comprehensive change to measuring key outcomes for families. This is more reflective of the socioecological model (Bronfenbrenner, 1979) and demonstrates the interrelated nature of relationships and their impact on health and wellbeing and outcomes for families. The challenge of measuring outcomes is the longitudinal nature of impacts and the difficulty of measuring this within program delivery but no less important. It is noted that this has been highlighted in the document.
An ongoing challenge for measuring outcomes is the cultural adaptability and cultural sensitivity of available tools. This can be significantly challenging for families with low literacy as often the questions within the tools do not translate culturally particularly with Aboriginal and Torres Strait Islander families. The timing of measuring outcomes can also be challenging if families are not contactable, it can be overwhelming for some families to participate in lengthy questionnaires and as noted in the discussion paper, data is significantly low.
In our experience, the translation of the outcomes data into SCORE especially under “Circumstances” may not be objective and are open to interpretation and subjectivity by the professional submitting the data. Whilst Karitane acknowledges the need to record outcomes data we agree with the elements highlighted in the document for further consideration.
Current outcomes measures for the Karitane CaPS and C4C funding does not allow for rich qualitative data to be recorded. Storytelling (which can be culturally appropriate) and sharing moments of significant change and shifts in constructs, contribute to measuring the impact of programs for families. We recommend that a mechanism for storytelling and sharing moments of significant change that can be built into programs would be helpful to consider.
Question 3 – What tools or training would support you to effectively measure and report outcomes through the Data Exchange Partnership Approach?
Authentic family engagement is critical and this should be considered when measuring outcomes. For families that have been engaged with child protection services may experience difficulty developing trust with service providers and therefore measuring positive engagement should be considered. Programs focussed on family restoration should be well coordinated with a focus on parent child relationships.
Often parents are “mandated” to attend evidenced based parenting programs-attending these courses in isolation will not be as effective or strengths based if there is limited opportunity for a parent to implement strategies/concepts at visitation meetings and build their skills which enhances the safety of children.
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?
Karitane has been participating in the partnership approach with both our CaPS and Communities for Children programs for over 7 years . It would be helpful to consider the tools available to measure outcomes and their appropriateness for some cultures and populations. We recommend:
– further training on using the translation matrix to adapt other outcomes measures
– involving families in the consultation process of how they think outcomes can be measured.
The foundations for family engagement at Karitane are underpinned by the principles of the Family Partnership Model – supporting families to be engaged in their case planning and increasing successful outcomes. The Family Partnership Model developed over the last 25 years has become an internationally recognised exemplary evidence-based model of care. Karitane would encourage service providers to have team members complete this training as it is evidenced based and assists with ongoing engagement with families and increases participation in outcome measures. It also allows the professional and family to assess their partnership and how they are working together to achieve outcomes. It is a strengths based model of communication. http://www.cpcs.org.uk/index.php?page=about-family-partnership-model
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?
Karitane has developed program logics for CaPs and Communities for Children programs and uses program logics across all service models within Karitane. The process of developing program logics is very useful and allows for clarity in identifying the program intentions (what problem are we trying to solve) and articulating outcomes from short term to longer term outcomes.
Program logics also allow for a complete summary of activities with associated appropriate resource allocation (inputs). It would be helpful if Facilitating Partners have one standardized template for program logics as recommended by the Department. As a community partner with multiple activities, we reognise that consistency is crucial and builds confidence and capacity of staff developing the program logics.
Question 6 – What does success look like for your service, and how do you assess the overall success of your service?
A shared understanding of the uniqueness of each program and the desired outcomes that are articulated in the program logic and activity work plan (AWP). Program outcomes will be specific and individual to each program and may not be measured at the same time or in line with predetermined reporting timelines.
As a community partner with multiple relationships with facilitating partners, consistency for the facilitating partners’ reporting obligations and relationship management would provide clear expectations for community partners. It also provides consistency of service delivery across areas- facilitating partners may have increased demands on community partners that impacts service delivery.
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?
– Success for Karitane includes: Meeting all key deliverables in contracts
– Recognition as a trusted and capable service provider
– Provision of safe, efficacious, evidence based care with tangible reported outcome measures, including client experience
– Feedback from families on a positive experience whilst using our services
– Adoption of outcome-based funding models
– Proficiency with program logics & DEX reporting
– Meaningful, trusting collaborative partnerships with other NGO service providers
– Recurrent longer-term funding to secure a stable workforce model
– Achieving a positive, values-based culture with excellence in team work & collaboration
Question 8 – If you are a Children and Parenting Support or Budget Based Funded service provider, do you currently link with a Communities for Children Facilitating Partner or other regional planning mechanism to understand what other services are provided in the community and what the community identifies as their needs? How does this work in practice? Would you value the increased support of being attached to a local Facilitating Partner?
Karitane’s physical services have a strong presence in South West Sydney with other integrated care models established in regional areas where families are experiencing vulnerabilities. Parents in South West Sydney (SWS) experience vulnerabilities including lower levels of education, higher levels of unemployment and lower levels of income compared to the state average. There are more than 76,000 children aged 0-4 years in SWS and Children living in Fairfield, Campbelltown, Liverpool and Bankstown had the highest proportion of children that are developmentally vulnerable on two or more AEDC domains (e.g. lower physical health and wellbeing and lower social competence) which is higher than the NSW state average.
Karitane provides support across the continuum of care from early intervention to tertiary support services for families with a high degree of complexity and at higher risk of engaging in the child protection system. Access to services and between services needs to be seamless for families with respectful sharing of information to avoid families have to tell their story numerous times dependent on which services have been engaged. Families need to be actively involved in their care, experience shared decision making and transparency that builds trust. Greater collaboration between government and non-government organisations is required.
Question 9 – For all providers, are there other ways to improve collaboration and coordination across services and systems?
Karitane’s Talking Realties Program is a CaPS funded program. As Karitane has several Communities for Children programs we have the advantage of having strong, collaborative relationships in the community. This enables knowledge sharing and educational opportunities amongst service providers and allows for input in exploring and understanding the needs of the local community. When there is a shred collaboration, the whole community benefits and service providers become a trusted entity in the community .
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?
Karitane welcomes and supports an integrated care model where local services take a placed-based approach that benefits vulnerable children and families where joint planning between services occurs to address vulnerabilities and develop a more coordinated response. All services working collaboratively would gain a more comprehensive understanding of trauma and how it can affect important transitional points, for example starting school and that trauma can occur at different life stages. A framework for a partnership approach to working with families could be developed by these services and implemented at important transition points that include planning, support, and referral pathways including linkages to other services for both short term and long term intervention so that the best possible outcomes are achieved for the child and family.
Karitane has begun this work in some of our other services in regional areas such and Taree and Shellharbour. Collaboration in an integrated care model has benefits to families and improves access to support.
Karitane welcomes incentivsing for evidence based programs and the use of outcome based funding models.
Incentivising collaboration and the use of structured, collaborative practice models (such as CAFÉ) would also be welcomed
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?
With Families and Children Activity, it would be helpful to bring together the CFCA and AIFS in one place. There is overlap and connectedness which is essential however new service providers without local knowledge may assume these entities are completely separate.
Karitane would welcome alerts and notifications that Family and Children communicates on their website. The CFCA mailing list is very useful for understanding changes that may be occurring, advertising of education opportunities, changes to programs and practice. This ensures all service providers are well informed and aware of alerts.
Question 12 – Is there anything else you would like to share about the ideas and proposals in the Discussion Paper?
The opportunity to innovate, develop and enhance existing programs is essential. It could be helpful to consider and review outcomes and data at agreed milestone points in the program this will help inform if program changes are necessary. It also allows the opportunity to review engagement with families and if the programs remain relevant for the community.
Facilitating Partners should be encouraged to seek, share, showcase & benchmark models of care delivered by others to ensure that other locations and jurisdictions can adopt and adapt similar models.
An industry/sector benchmarking framework should be established for providers similar to the Health Roundtable and Ability Roundtable to review efficiency & effectiveness across service providers.