Centacare Catholic Family Services
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?
During the recent crisis of the COVID Centacare’s FaRS, CaPS and FMHSS programs acted quickly to adapt their service delivery response. Working from home and unable to provide f2f support during the pandemic for several months we still delivered to the most vulnerable in the community.
Workers used online and telephone services and conference calls to link families to other services. Facebook groups, Virtual playgroups and story reading videos were also established to support those families who usually attend playgroups and community activities. This was utilised well in regional and metro areas of SA.
There was an increased need for therapeutic interventions for issues such as anxiety, uncertainty, job losses, family conflict and social isolation. Pre-existing underlying issues were also exacerbated by the Pandemic. No shows and cancellations overall significantly decreased during this time. However, for clients who were highly vulnerable with multiple and complex needs and little or no access to technology there was an avoidance of answering phone calls from workers which posed a significant concern as follow up home visits could not occur.
Challenges in service delivery also arose for couples where there were safety issues or where a confidential space was not available. Some clients engaged in counselling from their cars particularly for those experiencing domestic violence and high levels of family conflict.
For children and young people engagement levels also varied. For younger children who engaged via play and art therapies, some families chose to suspend service until f2f modalities returned because children struggled to engage online. Some young people also suspended telephone services where confidentiality and privacy was challenging in their home. With the shift away from f2f support, many clients from CALD communities struggled with the change in service delivery despite offering Interpreter services.
For the workforce they did not have access to appropriate technology to meet the demand of sudden changes to work conditions and service delivery expectations. This was also compounded by the complexities in maintaining admin requirements when administration and clinical staff were all working from home.
Into the future our workforce has become more confident in using tele-health type infrastructures which are more frequently implemented where appropriate for the service provided. Several workers have attended training in telehealth and are more informed how best to deliver services to both adults and children.
Technology continues to be rolled out and we are more prepared to respond for future crises. We are moving towards a paperless system that enables clients to access documentation digitally. However for those clients who did not have technology or wish to use technology, engagement will be an ongoing challenge. Additional funding will also be required to cover infrastructure costs to deliver it.
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?
Our programs provide services to many people who are struggling to have their more basic needs met, as per Maslow’s hierarchy of needs: water, food, shelter, sleep, clothing, personal security, resources, and health. Many of the proposed outcomes sit further up the needs hierarchy. And while we should always be aiming for all members of our community to reach these outcomes, external social, political and economic factors impact and lead to vulnerability, isolation and community disconnection. These outcomes are not supported by broader government systems. Issues such as unemployment, poverty and homelessness and belonging to a disenfranchised community will directly impact on people’s ability to move towards these outcomes. Combined with an erosion of funding to social and health care. Often our services are unable to address these larger systemic issues and there are very few, if any, generalised “case management” services that can assist people to navigate systems. This puts pressure on our programs to help families achieve these aspirational outcomes when many of their basic needs are not met.
Outcomes that could be considered include the importance of a strong, healthy attachment figure for people of all ages; increased ability to navigate other systems, as referred to above, in order to establish and maintain basic need; homes free of violence; basic parenting skills (routine, boundaries, attachment); theory of mind; and healing of trauma to minimize/prevent intergenerational trauma.
We acknowledge that not all of the proposed outcomes are appropriate to all cultures. For instance, many Indigenous and non-Western cultures do not value individual empowerment over family and community.
Question 3 – What tools or training would support you to effectively measure and report outcomes through the Data Exchange Partnership Approach?
Centacare has been reporting outcomes data through the Data Exchange Partnership Approach for four years and were active participants in the early roll out and training provided by the Department of Social Services. Since that time workers have become confident with entering the data and have adapted well to submitting additional data into new fields on request.
We have been fortunate to have had a stable workforce with a low turnover of staff who are committed to the DEX Partnership Approach as well as a Software Solutions team who support ongoing training and monitoring of data for all DSS programs. We have also established an internal DSS DEX Working group which is comprised of Workers and Managers. This provides a forum to disseminate knowledge, DSS updates and Q&A’s which supports capability building amongst our workforce. We have strong partnership with CCVT and have shared our DEX knowledge and resources together.
We appreciate that DSS has a range of resources available on the DEX website, including technical support through the Helpdesk, task cards and videos. However, for service providers such as ourselves who use a system-to-system communication system the task cards and videos are not always relevant to our processes of data entry and are designed to support service providers who use DEX as their primary CRM.
Opportunities for further DSS training, which was originally provided across the sector, would be a way in which we could continually provide upskilling to staff whatever system is used across Agencies. The training could be face to face or by webinars and would promote more robust understanding of the value of outcomes and evidence based practices within our programs.
If all service providers were required to report outcomes data through the Partnership Approach we would all, including DSS, have an opportunity to evidence the outcomes being achieved across the sector.
In regard to the use of SCORE there are questions on the reliability of the assessment. In a statistical sense, the norms have not been calibrated nor definitions clearly outlined. The way in which clients access services varies considerably; for example, it does not take into account age or cultural difference, whether this is an office based service or outreach, or a community event or playgroup. Measurement in this way is unreliable and open to statistical bias.
It also does not capture worker assessment for client suitability to a program. A tool to capture the missed data from this particular cohort who do not meet the program criteria and therefore are not captured in DSS data, but have utilized program time and resources would be welcomed.
We also suggest that a feedback loop from DSS to our services including how often the data is viewed, which data is viewed, how the data is used by DSS and it impacts decision and policy making would be highly beneficial and also assist us as service providers analyze our own data as part of internal evaluation.
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?
We have developed program logic models as well as explored assessment tools to record and score client outcomes. We are fortunate that we have had scope to develop this further and participated in several f2f workshops held in Adelaide by AIFS in 2018, which increased our knowledge and skill level in undertaking evaluations and developing Program Logic Models.
Since then opportunities for f2f training in this area has been limited, as well as compounded by the impact of COVID 19. We have however, been able to access webinars through Child Family Community Australia on evaluation and a range of helpful resources.
We currently have Program Logic Models for Family Relationship Counselling, Supporting Children and Youth (FMHSS), our CfC Programs and Family Connections Program (CaPs). The process of developing this was useful for frontline staff to advocate client voice into the overall aims of the program. It helped the team develop an understanding of the purpose behind what we do, and to bring this into client work. We have used the Program Logic Models more effectively over the last two years as a part of service delivery and as a visual representation between the program inputs, goals and activities, its operational and organizational resources, techniques and practices and expected outputs and effects.
As mentioned the CFCA research and evaluation practice guidelines as well as the Expert Panel project resources have provided valuable sources of information in this area but we still have a long way to go to be fully confident in applying this to our day to day work with clients.
In respect to evidence based approaches, we have embedded this within our Activity Work plans developed in 2020. Use of the Program Logic Model assists with outcome measurement as well using interventions within our practice which are based on numerous theories and models of intervention such as the Strengths and Difficulties Questionnaire in SCY and PEEM in the Family Connections Program. Effective evaluations do require time, funds and experience and ideally it would be good to be able to measure the work conducted with a client over time to see if the service has made any long term sustainable change or improvement in their lives or family circumstance. Once a case is closed, unless they are re-referred or self- referred back into one of our programs, our current practice of not contacting a client after case closure makes any type of long term longitudinal study very difficult and is an area that DSS may wish to explore with service providers as we go into the future.
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?
The SCORE approach works well for some of our clients, particularly when our clients are able to instigate change more easily and rapidly. Demonstrating gradual change through SCORE is more difficult when we work with families or individuals over some years and change is very gradual. Life events can cause fluctuation on the scale at any given time and this can make it appear a client is going “backwards” when they are likely to shift “forwards” again in the future.
Often the SCORE measures do not relate to the presenting issues of the client. Perhaps the outcome options could be provided and the client and worker create a goal and measurement scale based on individual need, capabilities and circumstances.
SCORE can be difficult in a group setting, particularly if the group is education focused and we are not hearing individual client’s narratives.
SCORE satisfaction doesn’t allow for anonymous feedback, as it has to be entered against individual clients. This can skew client feedback, as they may not want to say negative things about a professional they need to continue to work with. Or, it may prevent them from providing any feedback at all.
Program time is taken doing intake sessions with clients who we assess as not eligible for the program and refer on as appropriate, however we are unable to account for that time through the Data Exchange. This is also true for eligible clients who receive an intake session but do not return and therefore do not complete their DSS Registration form. It would be beneficial to be able to report this information through the Exchange.
We believe incorporating face-to-face meetings between Providers and DSS would allow DSS to gain a more holistic understanding of our service provision.
When we write our AWP Reports we are often having to refer back to the Data Exchange and repeating data from there into our report. It would be very helpful if the reports could be generated via a database, rather than a Word document, into which our data is automatically generated. Then we could provide the narrative around the data.
Question 6 – What does success look like for your service, and how do you assess the overall success of your service?
At Centacare we have a variety of ways we measure “success” and appreciate DSS’s stance that there are multiple ways of measuring the complex and nuanced notion of success.
At the frontline, our practitioners measure success on a small scale: the client who re-engages in a second session; the client who makes an appointment on time despite the multiple challenges in their life; the child and parent who hug during playgroup; a client who feels safe to disclose something difficult for the first time; the client who moves towards their goals; clients who develop the confidence to refer themselves to other support services.
At times we have clients who provide verbal or written unsolicited positive feedback to practitioners. Sometimes this feedback comes a considerable time after the client has engaged with our service. Word of mouth recommendations amongst the community are a strong indicator of client satisfaction, and therefore a measure of success for us.
In fact, many of our practitioners report that client satisfaction is their main indicator of success as opposed to a formal measure of achieving outcomes. A client who feels respected and heard, even if they only attend one event with our programs, is more likely to engage support in the future. In programs such as Child Protection, re-entry into the system is viewed as unsuccessful. In our services, re-entry into the system is often a sign of success: the client has felt respected and valued the service they have received. When they experience new or renewed adversity they are able to seek help based on prior successful engagement. They are able to recongise when they need assistance rather than waiting for their situation to worsen.
We provide each client the opportunity to provide formal written feedback to our service. Our response rate is fairly small, which limits our ability to formally measure client satisfaction. We speculate this may be due to issues such as literacy levels, the inability to provide anonymous feedback, and competing priorities.
Centacare keeps a register of all client feedback. It would be good if we were able to submit feedback from clients that indicate success to the Data Exchange, outside of the SCORE satisfaction. Some clients share with us beautiful words of their journey with our program, sometimes months or years after we have worked with them. The work we do remains with them as something they can draw on when they face challenges in the future, and this prompts them to get in touch at a later date.
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?
Centacare supports families, children and individuals who experience vulnerability, including those at risk of engaging, or who are already engaged, with the child protection system. Being able to promote our services to both the priority target groups as well the more universal participant as per the service agreement, means we are able to capture clients who have not identified themselves as ‘vulnerable’.
Flexibility regarding target cohorts enables early intervention, as per the Guidelines for many of our programs. Restricting service to only the most ‘vulnerable’ can result in us being a tertiary intervention service. There is already a paucity of early intervention services available, with many government funded/subsided programs only being for the more vulnerable. The ensuing result being that families who would benefit from early intervention are unable to receive a service until their situation deteriorates and they become vulnerable and therefore become a cost burden in terms of education, employment, mental health, child protection and incarceration. Often our most difficult tasks is turning away clients who are not “vulnerable enough” without adequate services to refer onto.
Medium to long term service delivery remains crucial in order to move clients towards the proposed Outcomes, particularly the vulnerable populations. Often these populations face significant adversity across all domains of the Outcomes diagram. Intergenerational trauma and disadvantage cannot be addressed with short-term intervention. We meet clients who have done their “6 sessions” with many other services and have then had to move on. Safe and trusting relationships with professionals are repeatedly broken, thus making it take longer to engage these clients.
We appreciate that DSS do not put a cap on the number sessions or a time-limit to service delivery (within reason). We would urge DSS to carefully consider any future plans to limit service delivery time to less than one year. Evidence in the trauma field indicates that change is likely to take over one year and requires a safe, trusting and stable relationship with a service provider. Cutting service intervention short in order to service more people is false economy. The clients cut off often haven’t resolved their vulnerabilities, thus decreasing the chance of clients reaching the proposed DSS outcomes, and entering into tertiary services as listed above.
Our Family Connections Program (CaPS) deliver a flexible service to meet the needs of local communities, consistent with a preventative and early intervention approach through the provision of a mobile outreach family support service to rural communities. Vulnerable families who would not usually access family supports are welcomed and supported by family workers and have opportunities to connect into their local community as well as access parenting support. FCP and SCY provide home visiting in regional areas where there is limited family suppor
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?
As CfC community partners delivering services within the community, Centacare has found this to be a highly successful way of engaging vulnerable families who may not otherwise access mainstream services as well as a way to collaborate with other organisations to provide holistic services for children and families. These families can often be “invisible” or reluctant to seek support.
Soft entry early intervention programs such as Centacare’s Family Connections Program funded through CaPs provides supported playgroups provide safe places for families to interact with others and become more connected into their local community. By providing a street level mobile resource service through play and chat sessions it works to: provide families with young children information about the range of support services and other family orientated resources within local communities; provide play and learn experiences to children at a street level within neighborhoods; provide increased opportunities for parents and children to access early learning opportunities for children’s cognitive, social and emotional development and to benefit and foster parent /child relationships and family functioning generally.
Like the universal services, place based programs also address issues before they become entrenched or escalate into requiring frequent and intensive support. We would like to see funding for such programs continue and be increased to enable at least 2-3 year funding rather than the current 1-2. Our Family Connections Program delivered in Mt Gambier under the CaPs funding collaborates with many local agencies including local Children Centres; Children’s Services Network and the Australian Early Development Census Action group.
In 2017 our CaP Service conducted a community needs assessment. AEDC data showed an increase of 9.5% in children who were developmentally vulnerable in 2 or more domains. Data from the Australian Bureau of Statistics showed that the community was more socio-economically disadvantaged than 77% of Australia. With socio-economic disadvantage having huge implications for child development and future outcomes, workers ascertained that additional early intervention support was needed in the area. From survey results and discussions with the community we established that a mobile toy library was of interest to the community. The Toy Library continues to service the area, providing access to educational resources, child development education, and access to child focused supports such as speech pathology, child mental health etc.
We reach the community by linking in with local businesses in small communities where we provide a Mobile Toy Library at the local store. This soft engagement approach has worked well, helping us to reach families who may otherwise not access family support services. If we were linked with a Facilitating Partner, we would hope that we could still collaborate with our current partnerships.
Question 9 – For all providers, are there other ways to improve collaboration and coordination across services and systems?
Centacare holds strongly to a socio-ecological model of community development with principles of non-duplication of services, integrated collaboration, partnership, resource sharing and prioritising the building of social capital. Our networks and partnerships are limited to other social services, but extends to grass roots community groups, businesses and key individuals within communities. This facilitates the effective work of programs and fits the reality of rural and regional practice. All strategies serve to provide effective and sustainable outcomes for clients and local communities over the longer term.
Sometimes variations in Service Agreement activity and target cohorts mean that programs have different priorities which can impact collaboration and coordination. The current competitive tendering may inhibit collaboration between local services and exploring other partnership service delivery models such as alliances or consortiums may be options to consider. Collaboration between DSS and state-funded services are challenged by the concept of “double-dipping” and therefore both parties being unable to record their time and resources for these activities.
In regards to the establishment of a consortium this may work better in regional areas where networks are generally smaller, easier to manage and are already functioning to make collaborative work possible to fill funding and resource shortages. Depending on the area that you deliver your service in there can also be many service providers and programs setting up collaborative opportunities that we may not always be aware of. In the first instance DSS could set up a register of collaborative groups that are organized by FaCS providers recorded in the DSS Data Exchange. This could be used as a service directory for workers and provide contacts and program information. Regular forums or workshops where DSS programs can meet and share information have been done at state level in the past and provided training and professional development for workers in those programs.
Centacare has also value added to the general benefits of networking by becoming a member of a Community of Practice group and have found that COP’s provide opportunities to share practice learnings, resources and information, connect workers outside their “silos” as well as develop new approaches to more holistic support for service users. Centacare has also successfully delivered programs in “Family Hubs” alongside other service providers delivering a range of support programs to families and children. By working collaboratively, supports to families are strengthened, referral pathways more easily navigated as well as the sharing of resources to develop and initiate new services for local communities. Strong collaborative networks lead to improved identification of service gaps and community need and coordination or responses.
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?
The capacity building support offered by DSS has been beneficial to a degree. A challenge we have faced is that despite organisations receiving this support, it often falls to Program Managers to implement the innovations such as research and evaluation. With the minimal time being available to Managers, taking on a task that is not often a part of their usual practice, can see such capacity building support having minimal impact. We wonder if the DSS could provide capacity support through partnering with Universities to provide agencies with research and evaluations as they are the leading experts in this area, with staff and students specially trained in these specialised and complex areas. We think there is a need to move from consultation and awareness raising to sector wide and materially supported mobilisation and implementation strategies.
Centacare supports the shift to outcomes measurement and evidenced informed practice. However, while this capability has been enhanced and supported, there is a concern that more time-intensive and outcome oriented practices can result in fewer clients being seen with the consequence that KPIs may not be achieved. The shift to outcomes and impact for clients, needs to be accompanied by a diminishing requirement on counting outputs as it places an often incommensurable work demand on frontline workers and program managers.
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?
We would like DSS to maintain its current consultative, supportive and flexible stance on innovation. We would appreciate more face-to-face opportunities with our grant funders to establish relationships for informal discussion about innovation.
We would like DSS to continue to fund the FRSA and their conferences as this generates space and inspiration for innovation.
While the current national expert panel has injected ideas into the sector, we would like to see this extend to state-base panels to foster more local involvement and relevancy of ideas.
Exploring ideas for a central DSS repository for sharing ideas/comments/resources may assist in innovation.
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 submit a response to the discussion paper.