at a glance

With a desire to shift service delivery from outputs to outcomes OzChild has moved to implement a suite of evidence based programs (EBPs).

These programs include SafeCare, Functional Family Therapy – Child Welfare (FFT-CW), Functional Family Therapy (FFT) Treatment Foster Care Oregon (TFCO), Multi Systemic Therapy Child Abuse and Neglect (MST CAN).

This journey has required a commitment to high quality implementation with fidelity including close consultations with program developers to customise the models to an Australian context and support a new way of working for staff and community. Find more info on OzChild’s evidence based services.

‘Child protection reports are growing each year, with a high proportion of repeated reports occurring, Child First was struggling to meet client demand and address the complexity of client needs.’

The Challenge

OzChild observed that increasing numbers of children and young people were being placed in out-of-home care, including a growing over representation of Aboriginal and Torres Strait Islander children and young people entering the child welfare system, not only in Victoria but across the country.

OzChild also observed limited availability of out-of- home care placements. This was recognised as a challenge that required innovative solutions backed by evidence.

The challenge for OzChild was to determine how to transform its services to meet the needs of client safety, wellbeing and permanency, including which evidence informed approaches would work best.

‘It’s important to give children, young people and their families what they need and what the evidence says works.’

Lessons Learned

  • Importance of sustainability — Consider sustainability at the outset- long term goals and long term planning.
  • Adequate planning time — Devote significant and sufficient time to planning and model selection to ensure it is appropriate for the identified need.
  • Effective implementation support — High quality implementation leads to outcomes. Systematic and ongoing implementation support is critical from the agency and model purveyors throughout the program.
  • Model fidelity — A commitment to fidelity is essential to EBPs, monitoring adherence to the model and applying a continuous quality improvement and learning lens is critical. Still, despite the ‘non-negotiable’ core elements of most EBPs, there is still flexibility and creativity in the way practitioners can deliver the programs.
  • Strong stakeholder engagement — (internal and external) – Critical to attract ‘buy in’ for the programs and to develop a strong referral pipeline.
  • The use of Data — use all available data to understand what is working, what are the challenges and what barriers need to be addressed.
  • Engagement, participation and cultural responsiveness — Critical to success, facilitated across all programs through partnerships, specific leadership roles, collaborations and an openness to feedback.
  • Relationships with model purveyors — Maintain strong relationships with model purveyors and develop joint understanding of the operating context.

The Journey

During 2015 OzChild began a journey of seeking out the most relevant and impactful programs available for vulnerable children, young people and families. Programs that could be successfully transferred into the Australian cultural context.

Looking abroad

The team looked internationally for examples of programs backed by high quality research that would be effective for their clients in Victoria. This included undertaking a study tour to New York City (NYC) to learn more about the implementation of EBPs for children, young people and families experiencing vulnerability. The study tour showed that the strong prevention program delivered by NYC services, including EBPs, contributed to a marked reduction in the number of children in out-of-home care over a 15 year period. Additionally:

  • The New York City workforce was highly motivated, skilled, flexible and enthusiastic
  • There was clarity around the goals, Intervention

    and outcomes of the programs being delivered

  • The models were strengths-based and incorporated the workers own knowledge, skills, values and experience
  • Interventions were intentional and considered
  • Staff were highly visible and accountable

Choosing the right

OzChild developed a selection criteria tool to ensure the selected models were compatible within an Australian context. The criteria were categorised into essential, important and desirable.

Subsequently, OzChild used the National Implementation Research Network (NIRN) Hexagon Tool to evaluate new and existing interventions against six broad categories: needs, fit, resource availability, evidence, readiness for replication and the capacity to implement.

Implementation

OzChild identified three programs to trial and self-fund; SafeCare, Functional Family Therapy – Child Welfare (FFT-CW) and Treatment Foster Care Oregon (TFCO). Key activities for implementation involved:

  • Establishing a cross functional implementation team; representatives from human resources, IT, finance, quality and risk, marketing and communications and program staff.
  • Translating staff experience and qualifications; a significant part of bringing EBPs to Australia from the US.
  • Introducing EBPs and engaging with stakeholders; to ensure the models were well socialised before officially launched. OzChild organised agency visits with US organisation and disseminated information on the EBPs through information sessions, webinars and staff presentations. OzChild held meetings with the Department of Health and Human Services (DHHS), Child First, Maternal Child Health Services, The Victorian Aboriginal Child Care Agency (VACCA) and other local Aboriginal Community Controlled Organisations (ACCOs).
  • Setting up outcome measures, an evaluation framework, and a new client information system;  to collect data, oversee the quality of practice and measure outcomes.
  • Customising practice manuals to the local context; together with the developers to revise language to better suit the Australian context.
  • Establishing robust referral pathways; to ensure clarity about the cohort of families who would be best served by which program.

Early implementation: one of the busiest phases of their journey.

‘There was a lot of work around ensuring staff were set up for success and barriers that were identified were being cleared by Managers not the staff delivering the programs… trying to free up staff up as much as we could so they could just focus on delivering the program with intention and fidelity.’

To aid this process OzChild welcomed staff from the New York Foundling to Melbourne for one month post launch and staff participated in weekly consults with the US based model purveyors improving their confidence and skills to deliver the programs with fidelity.

Working with Aboriginal and Torres Strait Islander Families

OzChild is working collaboratively and respectfully with ACCOs, peak bodies, local Elders and the broader community through the inclusion of seconding Aboriginal staff from ACCOs and have identified new Cultural Advisor roles to enhance the cultural responsiveness of the EBPs.

In NSW, where OzChild has a larger footprint with EBPs they have been able to explore this in greater depth and are undertaking a full customisation of TFCO to ensure its responsiveness for Aboriginal children and young people.  This has included extensive consultation with the Aboriginal community.

 

The Outcome

In the 2017–18 financial year, 273 families completed programs in OzChild’s Evidence Based family preservation services.  The programs tracked safety indicators using various measurement tools all of which showed improvement on average over the course of the year.

All programs also measured a broad range of outcomes that relate to child and family wellbeing, including family functioning, emotional and physical health, and social and cultural connections. Pre- and post-program data available showed levels of positive change across wellbeing indicators between intake and closure.

In the domain of Permanency, FFT-CW has shown great success in preventing children entering out-of-home care. In Victoria only 4% of families OzChild worked with were placed in out-of-home care and in NSW this figure was 7%.

The Future

OzChild has identified key activities to enable the sustainable delivery of the EBPs and to continue to improve the outcomes that are measured. These include:

  • Ensure the programs continue to be delivered to fidelity – high fidelity is linked to successful outcomes as determined through the research.
  • Gather and continue to use data at a practitioner, team, site, state and organisational level. This is an important driver in continuous quality improvement and an important implementation factor that supports effective decision-making at various levels.
  • Working with model purveyors, ACCOs and the Aboriginal community to ensure the programs are culturally responsive and any customisations of the programs are articulated and evaluated.
  • Ensuring effective referral processes are in place to ensure families receive the appropriate service at the right time (EBPs won’t always be the best option for a family).
  • Identifying ongoing training and development needs for practitioners.
  • Continuing to build a highly qualified and skilled workforce with staff engagement, retention and development at the forefront.