1 Brighter Futures: Experiences and lessons learnt. Presented by Matthew Solomon and Kerry Gwynne ACWA Conference, Sydney 2010.

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Brighter Futures: Experiences and lessons learnt.

Presented by Matthew Solomon and Kerry Gwynne

ACWA Conference,

Sydney 2010

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Outline of presentation

1. Context of work in early intervention support for vulnerable families

2. Description of model of practice

3. Lessons learnt 1: Service Structure

4. Lessons learnt 2: Program Components

5. Lessons learnt 3: Organizational

6. The worker experience

7. The family experience

8. Conclusion

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Context - Brighter Futures

Operational by 1/1/2007 (Northern Sydney)

TBS is Lead Agency in 8 regions (metro and rural/regional)

One of 14 Lead agencies across NSW

targeted support to vulnerable children and families with children aged under 9 years

or families who are expecting a child

aim to help prevent problems from escalating to crisis point

up to 2 years support

complement and build on existing service networks in communities to support

families showing early signs of child protection issues.

Each region develops local response and service model

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Context: Referral criteria

PARENT CHILD+Lack of parenting skills

Substance abuse

Difficult child behaviourLack of family/social supports

Domestic violence

Parental Mental health

Parental learning disability

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Model of practice

Partnership with parallel teams

Dalwood Spilstead Model:

Single governance with integrated services provided by the one team.

Team case management.

Integration of 3 evidenced based modes of intervention:

1. Family support and home visiting.

2. Intensive child development focus including early intervention preschool.

3. Parent / child attachment interventions.

Routine outcome measurement regime integrated into clinical practice.  

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EarlyYears Centre

Child D

evelopment

Family support

Par

ent-

Chi

ld R

’shi

pPlay Therapy

Speech Pathology

Home-based ECE

Occupational Therapy

EI Preschool

Father’s Program

Volunteer Hom

e Support

ATS

I support

Counselling

Financial advice

Welfare &

Housing

Parenting Programs

Parent-Child Interaction Interventions

Supported playgroups

Home visiting

Art Therapy

Dalwood Spilstead Model

The Team

1. Family Workers: SW, Psych, Early Childhood Nurse. 2. Father’s Program Co-ordinator.3. ATSI Family Worker2. Early Childhood Educators 3. Clinical Psychologists4. Speech Pathologists5. Occupational Therapist6. Art Therapists7. Special Education Consultant8. Home Volunteer Support Co-ordinator.9. Admin & Manager

client engagement and retention

case planning and management

efficiency of service delivery

measurable outcomes for families

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Lessons learnt: Service Structure

Client Engagement and Retention Creating an “easy to engage service” rather than focusing on “difficult to engage clients” .

Attrition rates: SPRC May 2009 Interim Evaluation Report - 20% of cases closed as “Goals Achieved”.

Our experience for same period:

Clients Referred 117 % Closed Cases 44 %

Assessed as low need 16 12% Moved out of area 1 2%

Unable to contact 3 2.5% Transferred to Child Protection 4 9%

Declined 3 2.5% Not Engaging 1 2%

Entered program 96 79% Became un-contactable 2 4.5%

Moved out of area prior to contact.

5 4.3% Completed with Goals Achieved 36 82%

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Comprehensive family-centred assessment and goal setting

Parallel parent and child approach.

Team case Management

Combination of interventions:

Family support and home visiting for parents.

Child development early intervention services

Parent - child attachment interventions.

Continuum of services form drop-in / home-based support to therapeutic interventions.

WELFARE SUPPORT SPECIALIST THERAPY

Case Planning and Case Management

Efficiency of Service DeliveryThe sum is greater than the parts of a diverse team.

• Range of parent programs:• Individual counselling and professional home visiting• Referral, advocacy & welfare assistance• Parent education programs: Triple-P, The Incredible Years, TIPS.• Parent support groups, life skills and leisure skills groups.• Adult education on site in partnership with local TAFE • Grandparent support group.• Financial mentorship. • Father’s Program• Volunteer Home Support: 2 hours of goal oriented support in the home.• Parent In Action Group: Building capacity via self determination.

• Intensive children’s EI services:

• Early Intervention preschool with 1teacher to only 5 children.

• Regular individual Speech Pathologist , OT, Play therapy,

• Clinical Psychologist on the team.• Parent – Child Attachment interventions: Supported Playgroup programs,

PCIT, WWW, Steep, Marte Meo.

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Measurable Outcomes

Regime of measures built into routine practice.

Family and child functioning; client and clinician rated

Administered prior to program entry, routinely and at exit.

• The Parent Stress Index

• The Being A Parent Scale

• The Child Behaviour Checklist

• The Northern Carolina Family Assessment Scale.

• The ADST and Brigance Developmental Screen

• Norm-Referenced Speech and Language Assessments

• Goal Attainment Scaling

Figure 1. Comparison of Mean Results on Northern Carolina Family

Assessment Scale. n=38 families. p<0.0001.Sample includes families who attended Spilstead Brighter Futures services for a minimum of 12 months during 2007-2008.

A score of 0 = adequate family functioning.

13Environment ParentingCapacity Family Interaction Child Safety Child Well-Being-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

PRE

POST

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Brigance Developmental Testing.Sample included all children between 12 months – 6 years who received a combination of children’s services for at least 12 months during 2007-2008. n= 33. Figure 4. Pre-Post Means on Brigance Child Development Testing Effect Size: (Cohen’s d) = 0.6 Moderate (p<0.001)

Figure 6. Improvement on Brigance Testing for Children Initially

Identified in the Clinical Range of Delay n=14.

151 SD or More 2 SD or More > 2 SD

0%

10%

20%

30%

40%

50%

60%

70%

80% 72%

43.%

29.%

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Lessons learnt: Program Components

quality children’s services

parenting programs

home visiting services

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Quality Children’s Services First Goal of the 2005-2008 Guidelines: 1. promote healthy development in children.

SPRC evaluation of 2008-2009 BF almost 30% of children rated by carers as having a medical condition or a developmental problem. 42% moderate, 20 % severe.

Our Experience:

70% under 5 years demonstrated delays on norm-referenced screening.

95% of these children demonstrated speech and language delay.

70% demonstrated social/emotional disorders.

Speech Pathology and other therapy services is essential.

Spilstead Preschool modelled on Highscope has been achievable. 1 teacher ; 5 children plus volunteer teacher’s aide. 12 mths – 6 year old children, 2 days per week Maximum group size of 10. Relationship based model of attachment with teacher. Intensive allied health intervention. Individualized special education programming.

Group programs: Incredible Years including Child-Led playgroup. Triple P TIPS Practical “hands on” approach Supported infant playgroups. Thematic playgroups with parent education followed by play session.

Individual programs: PCIT Watch, Wait and Wonder Marte Meo Steep Seeing is Believing.

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Parenting Programs

Professional Family support in the home.

Early Headstart Early Childhood Educator Home Visiting

Volunteer Home Support

Individual parenting programs in the Home

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Home Visiting

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Lessons learnt 3: Organisational

service establishment,

community partnerships,

recruitment and retention of staff

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The Benevolent Society experience

SPRC findings

8 regions

Rural vs metro

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The worker experience

Reflective journeys of practitioners

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“The integrated team approach to the Brighter Futures program really ensures a secure, cohesive and stable base for both families and workers and provides opportunities for more intensive support and better outcomes.”Kathryn Prowse, Social Worker

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“Working alongside family counsellors, occupational therapists, psychologists, teachers, and art therapists provides me with a real knowledge of the child’s needs and factors that may be impacting on their learning. Working in the intensive preschool with teachers allows us to group together children with similar needs. This allows us to treat many more children”. Lynn Shakenovsky, Speech Pathologist.

“Its been great to see how we can involve fathers from the start (even when they are in separated relationships) when a whole team of people values their contribution and role. Regular case conferencing is the key’

Jesse Wynhausen, Psychologist and Father’s Program co-ordinator.

The family experience

What is one of the most valuable things about this service?

• Professional advice given by experienced people.

• Speech pathology has given my child a very valuable service I otherwise could not afford.

• Everyone is so down to earth and treats you like a normal person.

• Care, case worker being interested in you and your family. Helping you step forward in life.

• Ongoing company from family worker providing ideas, networks, help an encouragement. Parenting courses, incredible years and Triple P.

• Play group, counsellor, pre-school, speech therapy.

• When I need help I can ask for it, when I want to try things on my own I am encouraged to do this.

• Providing services for families that can't afford to pay for private therapies.

THE FAMILY EXPERIENCE

•Connection to Aboriginal community and support services.

•Someone who I trust always listen to me. I feel good and feel comfort because of my family worker.

•For me helping me realize, I myself deserve to feel a good sense of worth for myself which then reflects on relationships with my kids ( in good ways) encouraging a bit more love than ever before.

•The respect of the staff. I feel I can trust them with the safety and security of my children.

•I have been given direction, encouragement and support through some of the worst times of our lives. Tracey is always just a phone call away.

•Bernie is just an appointment away.

•That no one is judgmental.

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THE FAMILY EXPERIENCE

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Fay, T and Carr, F, ‘‘Tailoring Early Intervention Programs to the needs of families: Illustrative case studies from an Integrated Parent-Child centre.’’ Developing Practice Journal number 25 Autumn/Winter 2010

References:Gwynne KD, Blick B, Duffy G, “Pilot evaluation of an early

intervention program for children at risk.” Journal of Paediatrics

and Child Health, 2009, Vol 45. Issue 3. pp 118-124.

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