Association of Childrens Welfare Agencies Conference 2006 Improving Care Through Accreditation- The Role of the NSW Children’s Guardian.

Association of Childrens Welfare Agencies Association of Childrens Welfare Agencies

Conference 2006Conference 2006

Improving Care Through Accreditation-Improving Care Through Accreditation-

The Role of the NSW Children’s GuardianThe Role of the NSW Children’s Guardian

IntroductionIntroduction

• Listening to what’s important to children and young Listening to what’s important to children and young

people in care- how kids experience the NSW OOHC people in care- how kids experience the NSW OOHC

system system

• Discussions with agencies participating in the OOHC Discussions with agencies participating in the OOHC

accreditation systemaccreditation system

• Data extracted from the Children’s Guardian Data extracted from the Children’s Guardian

information holdings after three years of operating information holdings after three years of operating

the accreditation and case file audit systemsthe accreditation and case file audit systems

Listening to children and young Listening to children and young people about what’s important in carepeople about what’s important in care

The importance of family The importance of family & social connections –& social connections –

Paul’s storyPaul’s story


The importance of having The importance of having a say in decisions that a say in decisions that affect you –affect you –

Marie’s storyMarie’s story


• Three key themes identified during discussions with Three key themes identified during discussions with

young people and agenciesyoung people and agencies

– ConnectednessConnectedness

– ParticipationParticipation

– Life recordsLife records

• Other areas identified through monitoring of OOHC Other areas identified through monitoring of OOHC

agencies:agencies:

– Residential CareResidential Care

– Health StandardsHealth Standards

– Educational SupportEducational Support

– ATSI ProgramsATSI Programs

• These identified as priorities for the Children’s These identified as priorities for the Children’s

Guardian over the next two yearsGuardian over the next two years

What’s important in careWhat’s important in care

• NSW NSW Children and Young Persons (Care and Children and Young Persons (Care and

Protection) Act 1998 Protection) Act 1998 founded on principles of founded on principles of

participation and connectedness.participation and connectedness.

• Since July 2003, agencies can provide OOHC Since July 2003, agencies can provide OOHC

services only if they:services only if they:

– Place children and young people in care Place children and young people in care

situations that promote the importance of their situations that promote the importance of their

families, communities and other significant families, communities and other significant

attachments.attachments.

– Actively promote the participation of children Actively promote the participation of children

and young people in decisions that affect and young people in decisions that affect

them.them.

Snapshot of the NSW OOHC SystemSnapshot of the NSW OOHC System– 30 June 2005– 30 June 2005

• 10,041 children and young people in all forms of 10,041 children and young people in all forms of

OOHC – an 8.3% increase over 3 years.OOHC – an 8.3% increase over 3 years.

• 6 in every 1000 NSW children and young people 6 in every 1000 NSW children and young people

are in OOHC.are in OOHC.

• 42.4 in every 1000 Indigenous children and young 42.4 in every 1000 Indigenous children and young

people are in OOHC – that’s 26.8% of the OOHC people are in OOHC – that’s 26.8% of the OOHC

population.population.

• 67.6% of children and young people in OOHC are 67.6% of children and young people in OOHC are

aged 5-14, 53.3% are under 10, and 20% under 5.aged 5-14, 53.3% are under 10, and 20% under 5.

Source: NSW Department of Community Services Source: NSW Department of Community Services

Annual Statistical Report 2004/05 (May 2006)Annual Statistical Report 2004/05 (May 2006)

What’s happening to children and What’s happening to children and young people in care?young people in care?

• OOHC placement arrangements:OOHC placement arrangements:

– Relative and Aboriginal kinship care – 5,031 Relative and Aboriginal kinship care – 5,031

(50.1%)(50.1%)

– Foster Care – 3,692 (36.8%)Foster Care – 3,692 (36.8%)

– Residential care – 300 (3%)Residential care – 300 (3%)

– Other (eg: supported accommodation, Other (eg: supported accommodation,

independent living) – 1,018 (11.1%)independent living) – 1,018 (11.1%)

• This preference for family based care has existed in This preference for family based care has existed in

NSW since the 1800’s.NSW since the 1800’s.

• Care arrangements shared between government and Care arrangements shared between government and

non-government agencies.non-government agencies.

Source: NSW Department of Community Services Source: NSW Department of Community Services

Annual Statistical Report 2004/05 (May 2006)Annual Statistical Report 2004/05 (May 2006)

Overview – the role of theOverview – the role of theNSW Children’s GuardianNSW Children’s Guardian

• Main functions:Main functions:

– Promotes the best interests of all children and Promotes the best interests of all children and

young people in OOHC.young people in OOHC.

– Accredits and monitors government and non-Accredits and monitors government and non-

government OOHC agencies.government OOHC agencies.

– Accredits and monitors non-government adoption Accredits and monitors non-government adoption

service providers service providers

– Authorises the employment of children under 15 in Authorises the employment of children under 15 in

specific industries.specific industries.

Overview – The Children’s GuardianOverview – The Children’s GuardianA strong and unique regulatory A strong and unique regulatory regimeregime• Independent statutory office under Independent statutory office under Children and Children and

Young Persons (Care and Protection) Act 1998Young Persons (Care and Protection) Act 1998..

• OOHC services regulated through a quality OOHC services regulated through a quality

assurance process (accreditation), rather than assurance process (accreditation), rather than

assessment of legal compliance with minimum assessment of legal compliance with minimum

requirements (licensing).requirements (licensing).

• Regulator of OOHC services is separate of the Regulator of OOHC services is separate of the

funder, supported by a strong legislative base.funder, supported by a strong legislative base.

• Regulates the market.Regulates the market.

How does the Children’s Guardian improve How does the Children’s Guardian improve practice and outcomes for those in OOHC?practice and outcomes for those in OOHC?

• Accreditation is “a structured means of achieving Accreditation is “a structured means of achieving

positive organisational change” (Council on positive organisational change” (Council on

Accreditation).Accreditation).

• OOHC accreditation improves outcomes for children OOHC accreditation improves outcomes for children

and young people because it:and young people because it:

– provides a framework for the independent provides a framework for the independent

assessment of the quality of care;assessment of the quality of care;

– ensures continuous quality improvement at both ensures continuous quality improvement at both

an agency and system-wide level.an agency and system-wide level.

• Identifies trends and issues where additional attention Identifies trends and issues where additional attention and research is required.and research is required.

• Raises concerns about individual cases with OOHC Raises concerns about individual cases with OOHC agencies and other relevant bodies.agencies and other relevant bodies.

““What is accreditation?”What is accreditation?”

How does the Children’s Guardian improve How does the Children’s Guardian improve practice and outcomes for those in OOHC?practice and outcomes for those in OOHC?

• Sets standards for OOHC providers.Sets standards for OOHC providers.

• Provides a “foundation system” for agencies to meet Provides a “foundation system” for agencies to meet standards:standards:

– an Accreditation Program – demonstrate compliance an Accreditation Program – demonstrate compliance with mandatory requirements and core, critical and with mandatory requirements and core, critical and significant standards. (51)significant standards. (51)

– a Quality Improvement Program (QIP) to help a Quality Improvement Program (QIP) to help agencies reach accreditation (by 2013).agencies reach accreditation (by 2013).

• Places conditions on OOHC agencies.Places conditions on OOHC agencies.

• Monitors performance of OOHC agencies, through QIP Monitors performance of OOHC agencies, through QIP and Case File Audits.and Case File Audits.

““The tools”The tools”

How does the Children’s Guardian How does the Children’s Guardian improve practice and outcomes for those improve practice and outcomes for those in OOHC?in OOHC?

AUTHORISING ENVIRONMEN

T• laws, regulations,• court decisions• OOHC Standards• resource allocation

OPERATING CAPABILITY

• accreditation & QIP requirements

• resources: people, skills,

PUBLIC VALUE• outcomes – eg

participation, connectedness, life records

• services appropriate to population needs

• trust & confidence in the system

How are we travelling after 3 years? How are we travelling after 3 years? The “foundation” OOHC accreditation The “foundation” OOHC accreditation system as at 30 June 2006system as at 30 June 2006

• 62 OOHC agencies:62 OOHC agencies:

– 18 accredited 18 accredited

(14 for 5 years; 3 for 3 years; 1 for 1 year). (14 for 5 years; 3 for 3 years; 1 for 1 year).

– 12 currently seeking accreditation (8 by 30 November 12 currently seeking accreditation (8 by 30 November

2006 and 4 by 30 June 2007).2006 and 4 by 30 June 2007).

– 32 participating in QIP. 32 participating in QIP.

• Accreditation not a barrier to new services being Accreditation not a barrier to new services being

established - 5 new agencies accredited.established - 5 new agencies accredited.

• In 2005-2006, the number of designated agencies In 2005-2006, the number of designated agencies

decreased but the number of accredited agencies doubled.decreased but the number of accredited agencies doubled.

• Rate of accreditation has accelerated since Accreditation Rate of accreditation has accelerated since Accreditation

Program introduced - this is expected to continue.Program introduced - this is expected to continue.

How are we travelling after 3 years? How are we travelling after 3 years? The “foundation” OOHC accreditation The “foundation” OOHC accreditation system as at 30 June 2006system as at 30 June 2006

Agency Status

16 19

15

12

1

9

18

36

32

47

0% 20% 40% 60% 80% 100%

30 June 2004(72 agencies)

30 June 2005(71 agencies)

30 June 2006 (62 agencies)

% of participating agencies

Agencies yet to decide which stream

Agencies in Quality Improvement Program

Agencies seeking accreditation

Accredited agencies

Monitoring the care of children and Monitoring the care of children and young people – Case File Auditsyoung people – Case File Audits

• Monitors practice against legislation and OOHC Monitors practice against legislation and OOHC

standards – evidence of carestandards – evidence of care

• Case File Audits commenced in July 2004/05.Case File Audits commenced in July 2004/05.

• 2005/06 audits covered 748 government and 2005/06 audits covered 748 government and

non-government agency case files – over 1,000 non-government agency case files – over 1,000

case files to be audited in 2006/07. case files to be audited in 2006/07.

• Progressively increasing the number and scope Progressively increasing the number and scope

of case files audited – extended to interim orders of case files audited – extended to interim orders

in 2006/07.in 2006/07.

• Compliance set at 80% (up from 65% in Compliance set at 80% (up from 65% in

2004/05)2004/05)

• Case files also provide children and young Case files also provide children and young

people with “life records”, linking them to their people with “life records”, linking them to their

past and helping to support identity and past and helping to support identity and

significant connections.significant connections.

Delivering outcomes for children and Delivering outcomes for children and young people in OOHCyoung people in OOHC

• In 2005/06, significant improvement in case files In 2005/06, significant improvement in case files providing evidence of children and young people (7 providing evidence of children and young people (7 years and older) invited to participate in placement years and older) invited to participate in placement reviews:reviews:

– Large agencies up from 50% to 71%;Large agencies up from 50% to 71%;

– Medium agencies up from 70% to 75%;Medium agencies up from 70% to 75%;

– Small agencies up from 66% to 76%.Small agencies up from 66% to 76%.

• In 2005/06, increase in:In 2005/06, increase in:

– carers participating in case conferences and carers participating in case conferences and signing planning and review documentation;signing planning and review documentation;

– recording of reasons why children and young recording of reasons why children and young people did not participate in case reviews;people did not participate in case reviews;

– recording and discussing the views of those who recording and discussing the views of those who did not attend the case conference.did not attend the case conference.

ParticipationParticipation


• In 2005/06, 85% of agencies compliant in recording In 2005/06, 85% of agencies compliant in recording following “connectedness” indicators:following “connectedness” indicators:

– history and development;history and development;

– family contact details;family contact details;

– contact arrangements with the mother; and contact arrangements with the mother; and

– reviewing contact arrangements with the mother reviewing contact arrangements with the mother and siblings.and siblings.

• In 2005/06 there was an increase in explaining the In 2005/06 there was an increase in explaining the placement of ATSI children and young people in placement of ATSI children and young people in accordance with the ATSI Placement Principles.accordance with the ATSI Placement Principles.

ConnectednessConnectedness

ATSI programsATSI programs


• In 2005/06:In 2005/06:

– 100% of accredited agencies reached Case File Audit 100% of accredited agencies reached Case File Audit

compliance benchmark for currency of reviews and file compliance benchmark for currency of reviews and file

content/structure;content/structure;

– court orders on files up 20% to 83%.court orders on files up 20% to 83%.

• In 2005/06, there was a increase in:In 2005/06, there was a increase in:

– the number of files containing current case reviews where the the number of files containing current case reviews where the

Minister had sole or shared parental responsibility;Minister had sole or shared parental responsibility;

– case files outlining the responsibilities of each person and case files outlining the responsibilities of each person and

agency;agency;

– planning in preparation for leaving care.planning in preparation for leaving care.

Case files – life recordsCase files – life records

How are we travelling? How are we travelling? Areas for further improvementAreas for further improvement

Percentage of agencies who have met one or more of the mandatory requirements or core standards

75%59%

75%

53%

0%

20%

40%

60%

80%

100%

Agencies seeking accreditation Agencies in QIP

Mandatory Core


• Mandatory requirements met:Mandatory requirements met:

– 28% of mandatory requirements met by those 28% of mandatory requirements met by those seeking accreditation.seeking accreditation.

– 10% of mandatory requirements met by those 10% of mandatory requirements met by those in QIP.in QIP.

• Applicable core standards met:Applicable core standards met:

– 32% of applicable core standards met by those 32% of applicable core standards met by those seeking accreditation.seeking accreditation.

– 8% of applicable core standards met by those 8% of applicable core standards met by those in QIP.in QIP.

– 21% of relevant agencies have met core 21% of relevant agencies have met core standards relating to foster carers.standards relating to foster carers.

– 9% of relevant agencies have met core 9% of relevant agencies have met core standard 2A (residential care)standard 2A (residential care)


• Applicable critical standards met:Applicable critical standards met:

– 59% of applicable critical standards met by 59% of applicable critical standards met by those seeking accreditation.those seeking accreditation.

– 18% of applicable critical standards met by 18% of applicable critical standards met by those in QIP.those in QIP.

• Applicable significant standards met:Applicable significant standards met:

– 75% of required number of significant 75% of required number of significant standards (5 of 11) met by agencies seeking standards (5 of 11) met by agencies seeking accreditation for 5 years.accreditation for 5 years.

– 19% of required significant standards met by 19% of required significant standards met by those in QIP.those in QIP.

Observations on compliance Observations on compliance – priority areas for improvement– priority areas for improvement

Mandatory requirements and core standardsMandatory requirements and core standards

• These have the lowest compliance rate, yet are the ones These have the lowest compliance rate, yet are the ones that focus on how children and young people experience that focus on how children and young people experience the OOHC system.the OOHC system.

Case file audit compliance ratesCase file audit compliance rates

• Mean Case File audit compliance rate for accredited Mean Case File audit compliance rate for accredited agencies was 69% - only one received a compliance rating agencies was 69% - only one received a compliance rating of over 80%.of over 80%.

• Mean Case File audit compliance rate for transitionally Mean Case File audit compliance rate for transitionally accredited agencies was 58%accredited agencies was 58%

Residential careResidential care

• Compliance with core residential care standards is lower Compliance with core residential care standards is lower than compliance with core standards for foster carers, than compliance with core standards for foster carers, identifying residential care as an area that requires greater identifying residential care as an area that requires greater attention.attention.


ParticipationParticipation

• Children and young people need to participate more in Children and young people need to participate more in

decision making (notwithstanding improvements).decision making (notwithstanding improvements).

• Only 6% of transitionally accredited agencies reach the Only 6% of transitionally accredited agencies reach the

case file audit benchmark for the area of participation.case file audit benchmark for the area of participation.

ConnectednessConnectedness

• Parents / carers need to be more involved in case reviews Parents / carers need to be more involved in case reviews

(decline in 2005/06).(decline in 2005/06).

Case files – life recordsCase files – life records

• Case files should provide children and young people with Case files should provide children and young people with

a history of their life in OOHC.a history of their life in OOHC.

• Where DoCS and an OOHC agency share case Where DoCS and an OOHC agency share case

management responsibilities, the responsibilities of each management responsibilities, the responsibilities of each

agency need to be more clearly defined. agency need to be more clearly defined.


ATSI ProgramsATSI Programs

• No transitionally accredited agencies have met mandatory No transitionally accredited agencies have met mandatory requirements for ATSI Programs, 27% of the OOHC population.requirements for ATSI Programs, 27% of the OOHC population.

Health StandardsHealth Standards

• No transitionally accredited agencies have met mandatory No transitionally accredited agencies have met mandatory requirements for Psychotropic Medication Policies/Procedures.requirements for Psychotropic Medication Policies/Procedures.

• Behaviour intervention and support practices need to be more Behaviour intervention and support practices need to be more formalised.formalised.

• Immunisation status of children and young people, particularly Immunisation status of children and young people, particularly those aged over 8 need further attention.those aged over 8 need further attention.

EducationEducation

• The educational progress of children and young people needs The educational progress of children and young people needs to be better monitored.to be better monitored.

SummarySummary

• The Accreditation, Quality Improvement and The Accreditation, Quality Improvement and Case File Audit Programs:Case File Audit Programs:

– provide evidence of considerable provide evidence of considerable improvement in the quality of court improvement in the quality of court ordered out-of-home care.ordered out-of-home care.

– identify seven key areas for the Children’s identify seven key areas for the Children’s Guardian to focus over the next two Guardian to focus over the next two years.years.

• Case File Audit results suggest accredited Case File Audit results suggest accredited agencies need to focus on maintaining agencies need to focus on maintaining standards after achieving accreditation.standards after achieving accreditation.

• QIP participants need to accelerate the rate at QIP participants need to accelerate the rate at which they are improving.which they are improving.

Association of Childrens Welfare Agencies Conference 2006 Improving Care Through Accreditation- The Role of the NSW Children’s Guardian.

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