Taking the Common Approach to Improve Child Wellbeing Webinar Presentation July 23 2013
Agenda Origins of The Common Approach Key findings from the formative evaluation What works to achieve results implementation best practice Examples: Implementation of The Common Approach in FMHSS Implementation for Interrelate Family Services
1. Advocacy 2. Supporting evidence based practice & policy 3. Translational research (focus on systems change) Our guiding principles Focus on prevention and lifepathways Work across sectors and disciplines Provide a neutral space for organisational collaboration Progress sustainable, evidencebased action Children and youth Practitioners and professions Researchers Collaborative hub of 2600 members Community and business Policy
Our focus over the last year Australia s 2 nd international comparative report on wellbeing of young Australians A national plan for child and youth wellbeing PLUS... What Works for Kids Evidence Reviews (100 to date) Football United s (FUn) Playing for Change project : improve social inclusion, wellbeing, and school / community engagement for refugee, migrant, CALD youth Communities that Care: a location-based prevention program (tested through numerous RCTs), designed to build local community & enhance wellbeing
... and continuing in 2013 right@home sustained nurse home visiting efficacy trial: Australia s largest ever trial of this best buy intervention Formative work on COAG social national marketing campaign to improve parenting efficacy: Engaging Families in the Early Childhood Development Story Upcoming conferences: Infant and early childhood social & emotional wellbeing conference (Oct 13) Linking Up for Kids: partnerships between health, hospital and education systems to enhance child & youth wellbeing (April 14) 2 nd Australian Implementation Conference (October 14)
What is the Common Approach?
What is the Common Approach? The Common Approach is a framework to help professionals in first contact with children better discuss families and children's needs. Its aim is to help identify needs early, recognise and build on families strengths and capacity, and enable a range of informal and formal supports that will improve the child s wellbeing. The ultimate aim is to prevent child abuse & neglect
Change in ability to concentrate Not making milestones Decreasing performance at school Change in ability to maintain friendships Missing lunchboxes, drinks, jumpers Weight loss, failure to thrive Self esteem issues, bullying Looking unkempt, unclean Tardiness or truancy Withdrawn from group activities Behaviour problems, aggression Continual illness, failure to treat minor illness
What the Common Approach isn t... NOT a risk assessment tool NOT an algorithmic tool (yes / no / go to step x) NOT solely focused on deficits / risks NOT focused on one aspect of wellbeing NOT for children and families already in crisis
Inputs Outputs Outcomes 1. CAARS Resource Kit, 2. Champions network, including: CAARS training for champions, Ongoing support Champions to be location, organisation or profession based. 3. Ongoing support / coaching for local area practitioners by the champions 4. Organisational / profession capacity building Practitioner outputs: 1. Appropriateness of use 2. Initiating conversation with clients on their needs and strengths 3. Action initiated by practitioner / family Organisational output: 1. Practitioner management support for use of CAARS approach 2. Ongoing support / coaching provided as required by CAARS champion 3. Ongoing data collection to ascertain the effectiveness of the CAARS approach Practitioner outcomes 1. Improved relationship 2. Increased awareness of role 3. Increased confidence and willingness in initiating conversations 4. Increased ability to identify families strengths and needs 5. Increased level of support and follow up with clients 6. Changes in referral patterns Practitioner outcomes 1. Increased collaboration 2. Increased use of common or shared language Short Term Child & Family outcomes 1. Improved relationship 2. Increased awareness of family situation 3. Increased understanding of assistance available and potential benefit 4. Increased use of services Long Term Child & Family outcomes 1. Increased empowerment and motivation 2. Reduction in incidence of child abuse & neglect 3. Improved wellbeing for children System outcomes 1. Increased number of practitioners identifying family / child needs earlier System outcomes 1. Increased number of practitioners preventing child abuse & neglect 2. Decreased demand child protection services
Where did CAARS come from? Inverting the Pyramid (2008) www.
Following "Inverting the Pyramid.. 2009 2010 The Australian Government (FaHCSIA) partners with ARACY CAARS Taskforce convened Tasked to develop CAARS approach Research, consultation and development of Toolkit Endorsed by the CAARS Taskforce in June 2010. 2011 Commencement of formative evaluation in 4 locations. 2012 Conclusion of formative evaluation. Move to implementation and outcomes evaluation 2013 Measured scale-up of CAARS with interested organisations
The Common Approach Toolkit The Wheel provides a visual and holistic view of a child s or young person s life. It covers six broad domains of wellbeing physical health, mental health and emotional wellbeing, relationships, material wellbeing, learning and development and safety. The young people s questionnaire is targeted at young people aged 12 and over. It is intended to act as a conversation prompt rather than a formal screening or assessment. The questionnaire for parents and carers asks respondents to think about the wellbeing of their children and also focuses on the six domains of wellbeing.
The 'wheel' For use during a conversation with a child/family. Reference points for practitioners include conversation prompts, e.g.: Does the child seem confident and comfortable with parents/carers? Does the child seem calm and peaceful? Does this child s immediate family seem to be coping? Do they appear to enjoy being a family? Do any parents/carers and siblings have a diagnosed mental health problem or symptoms?
Identifying an appropriate response Action the family can take Informal support Support from the community Support you can provide Other local services Formal referrals 17
Results from Formative Evaluation
Four trial sites 1. NSW Interrelate, Lismore Family dispute resolution, family counselling, parenting programs, schools, children s contact centre, family law solicitors, Brighter Futures, early intervention services 2. Victoria Gippsland Community Health Centre, Gippsland Maternal and child health nurses, intake, ChildFIRST, family violence, youth services 3. WA: Rockingham-Kwinana DGP (Perth South/Coast Medicare Local) Community nurses, psychologists, youth health service, young parents program 4. SA Northern Connections, Northern Adelaide Children s centre, Headspace, hospital social workers, schools, mental health clinicians, youth workers, child care, child and family health centre
Key process findings Highly visual engaging for clients Helps families identify own strengths and needs Puts the wellbeing of children at the centre of discussions Broadens the conversation Gives permission for practitioners to explore difficult topics When clients are distracted with their own story the CAARS tool is an important visual tool that helps the client focus on the child
Case Study You know, it is always about me, about my problems. I liked that this looked at it from the family, from the kid s view. It looked at things I can do to improve life for the whole family. It wasn t just about me.
Using system change theory to help implement CAARS
Barriers to implementation Systemic factors within practitioners workplaces, rather than CAARS tools themselves, which can prove a barrier to successful implementation. Use of systems change theory has also been applied to try to understand how the system in which CAARS operates may affect the implementation of CAARS. What is clear is a need for supported implementation and integration with existing systems and requirements. Just buying the tools doesn t work
Enablers to implementation Address as far as possible the structural factors and barriers to uptake, including supporting practitioners and organisations to build relationships and partnerships with other local services. Encourage & enable local cross-sectoral / professional collaboration; Allow time for the development of a shared approach, facilitating real culture change; Utilise the strengths of CAARS while still meeting the data collection and other requirements of organisations; Include simple rules for the implementation, encourage small wins and utilise systemic action research to build and maintain momentum and real learning.
Higher intensity coaching & support implementation model initiated
Fiona Hilferty, Research Fellow, Social Policy Research Centre Results from SPRC Evaluation
Trial sites NSW Interrelate, Lismore Family dispute resolution, family counselling, parenting programs, schools, children s contact centre, family law solicitors, Brighter Futures, early intervention services Victoria Gippsland Community Health Centre, Gippsland Maternal and child health nurses, intake, ChildFIRST, family violence, youth services WA Rockingham-Kwinana Division of General Practice (Perth South Coast Medicare Local) Community nurses, psychologists, youth health service, young parents program SA Northern Connections, Northern Adelaide Children s centre, Headspace, hospital social workers, schools, mental health clinicians, youth workers, child care, child and family health centre
Data Sources Monthly site reports submitted online to the CAARS Champions community; Observational data and recorded notes collected during teleconferences and other meetings; Interviews with site facilitators, practitioners using and not using the tools and key project staff from ARACY.
Practitioners views Highly visual engaging for clients Helps families identify own strengths and needs Puts the wellbeing of children at the centre of discussions Broadens the conversation Gives permission for practitioners to explore difficult topics When clients are distracted with their own story the CAARS tool is an important visual tool that helps the client focus on the child
Barriers to implementation Systemic factors within practitioners workplaces, rather than CAARS tools themselves, were often a barrier to successful implementation. What is clear is a need for supported implementation and integration with existing systems and requirements. Just buying the tools doesn t work. Some practitioners not willing to take on an expanded role in child protection actively avoided engaging in discussions of sensitive issues with children and families.
Key results Variable picture of implementation in diverse sites however feedback on materials was overwhelmingly positive, especially regarding the wheel. The trial highlighted great flexibility in use. Most frequently used as an instrument for initial internal assessment. Most frequently used by secondary service practitioners who felt competent in engaging families in conversations around support needs. It was most difficult to engage the health and school sectors. Use of CAARS by specialist staff in schools show creativity and promise.
Results relating to Logic Model Short Term Practitioner outcomes Child & Family outcomes System outcomes Increased awareness of role in prevention Improved relationship with practitioner YES Increased confidence and willingness in initiating conversations with clients YES BUT MAINLY SECONDARY SERVICES SOME EVIDENCE Increased awareness of family situation and how it impacts on children SOME EVIDENCE Increased number of practitioners identifying family/child needs earlier YES Increased ability to identify families strengths and needs YES BUT MAINLY SECONDARY SERVICES Increased level of support and follow up SOME EVIDENCE Changes in referral patterns SOME EVIDENCE Increased collaboration between practitioners & between services NO SUPPORTING EVIDENCE Increased use of common or shared language on holistic needs with other practitioners NO SUPPORTING EVIDENCE Increased understanding of assistance available and potential benefit of pathways offered SOME EVIDENCE Increased use of services/assistance to improve child wellbeing SOME EVIDENCE Long Term Increased empowerment and motivation to address children s needs SOME EVIDENCE Reduction in incidence of child abuse and neglect NO SUPPORTING EVIDENCE Improved child wellbeing NO SUPPORTING EVIDENCE Increased practitioners preventing NO SUPPORTING EVIDENCE Decreased demand for secondary and tertiary services NO SUPPORTING EVIDENCE
Driving The Common Approach Forward
Progress Moving away from CAARS to The Common Approach Implementation of The Common Approach in Family Mental Health Support Services How the Common Approach is working for Interrelate The Implementation of The Common Approach in the community sector
The Common Approach & FMHSS The Common Approach is currently being used in the Family Mental Health Support Services funded through the 2011 12 Budget Providers are using The Common Approach tools to facilitate conversations with families The reporting systems have been set up around the domains so that The Common Approach is completely integrated with all practice Practitioners are applying their experience to The Common Approach in lots of creative ways, including setting up play-based activities around the domains
Helen Isenhour, Director Operations, Interrelate The Common Approach and Interrelate
The Common Approach and Interrelate Interrelate has been a leading provider of quality relationship services since 1926. Community based, not-for-profit organisation with a network of centres across metropolitan, regional and rural New South Wales. Interrelate is currently implementing The Common Approach across all the organisation
Benefits for the Common Approach to Interrelate Recognised that, while the organisation had good talk, systems and old habits didn t always allow for good walk While participating in the formative evaluation, Interrelate saw the opportunity to align processes with core values The Common Approach gives a framework for better intake, better servicing internally and better referrals onward
Supporting agencies through effective implementation
Supporting Agencies through Implementation
Costs of implementation Initial training costs : $5000 to $8000 (depending on the number of participants.) Full implementation (12 months): $28,000 to $90,000 (depending on number of practitioners requiring training, the locations of practitioners and whether there are multiple sites, and the level of adaptation required. Ongoing costs: relies on site-based Champions, ongoing costs are minimal, starting from $4,000 p.a. Can be implemented at a larger scale (e.g. State / Local area etc.)
Top down bottom up approach needed The Common Approach is a promising practice at a local (service) level Maximum benefits to be gained through top-down and bottom-up approach: Professional groups, State Governments, peak agencies etc. can lead change via the Common Approach Matched by implementation at grass roots / local level