Measuring Client Outcomes in Disability and Out of Home Care Services - Research Paper Example

Client Outcomes Framework E.W. Tipping Foundation (Large Non-profit Provider) Purpose Meet the need of a large non-profit providerproviding care and support service to Out of Home Care for children, and for disability clients Target Audience Senior Management of E.W. Tipping Foundation (Large Non-Profit Provider) Background: Out-of-Home Care and Disability Out-of-Home Care has been defined by the Australian Institute of Health and Welfare as “alternative accommodation for children under 18 years of age who are unable to live with their parents, where the State or Territory makes a financial payment or where a financial payment has been offered but declined.” This definition does not include children who are living in Out of Home Care outside of the child protection system. On the other hand, children with a disability/disabilities are those children who suffer an impairment in their health, communication, movement or learning, which adversely impact their social engagement and education (Australian Bureau of Statistics, 2012). Identification of National Standard of Quality Outcomes Model Out of Home Care Program for Children and Young People Ideally, the Best Outcomes Model was conceived to specify the best possible results for the Out of Home Care program for children and young people. While it is preferable and is even possible at the institutional level, as of this writing the Best Outcomes for Out of Home Care has not yet officially been specified for the national level. Efforts, however, are underway for the determination of the National Standards for Out of Home Care, which is in its consultation stage under the auspices of the Australian Government Department of Social Services. The aim of the National Standards for Out of Home Care is to “drive improvements in the quality of care so that children and young people in care have the same opportunities as other children and young people to reach their potential in all the key areas of well-being.” These key areas of well-being referred to for children, young people and the disabled include health, safety, culture and community, spirituality, emotional development, learning and achieving (Australian Government DSS, 20 Aug 2013). The National Standards aims to identify the key factors in the delivery of care that directly impact upon the positive outcomes of quality of care for children and young people. Presently, there are 13 standards which comprise the National Standards for out-of-home care, and measures have been identified by which outputs could be gauged against these standards. The hope is that measurable standards will be defined and set at the best practice level, to ensure that all legal jurisdictions in Australia are aimed at driving improvements consistent with each other. These factors that may form the bases for standard setting include (Australian Government DSS, 20 Aug 2013): Stability of placements and relationships Regular health and well-being checks Transition planning that involves children and young people (i.e. into during and existing care) Appropriate carer assessment, screening, training and support By setting the standards and defining the best practices, the goal of defining the desired outcome for children in care, in a manner that is identifiable, measurable and therefore capable of objective assessment, becomes possible. These desired outcomes for children in care, herein identified according to their respective areas of well-being earlier specified, include: Health, both physical and mental Attain and maintain good health Develop effective coping style Safety A stable environment that is free from physical, emotional and/or sexual abuse Develop social connections Learning and achieving Achievement of developmental milestones Participation and achievement in education Emotional development Stability in behaviour Positive and supportive relationships Culture and community Cultural identity and ethnic pride Participation in community Spirituality Positive sense of identity Connection to family or significant others and land/ country. The consultation literature indicates that the above list is not exclusive, and there is an opportunity to expand or limit the list of desired outcomes for out of home care for children and young people. Care for the Disabled There are eight areas of universally relevant outcomes, also known as quality of life domains, which essentially focus on the broad-level needs of people with disabilities. The aim of the outcomes is to improve care for the disabled for them to lead enriched lives in spite of their impairment. These quality of life domains and their specific outcomes are enumerated by Schalock, et al. as follows (PWC 23): Interpersonal relations Affiliations Affection Friendships Intimacy Interaction Physical well-being Health care Mobility Wellness Nutrition Self-determination Choice Personal control Decision Personal goals Social inclusions Natural supports Integrated environments Participation Barrier-free environments Emotional well-being Safety Stable and predictable environments Positive feedback Material well-being Ownership Possessions Employment Personal development Education and habilitation Purposive activities Assistive technology Rights Privacy Ownership Due process Implementation Plan Component 1: Practice Development Step 1: Assembling of a regional senior management group which is vested with the overall responsibility in the implementation of the framework. Step 2: Develop an operating plan that includes joint information sessions and training for participating individuals (practice leaders including regional representatives) Step 3: Establish the capacity for collaborative practice leadership and the development of this capacity to support complex cases. Step 4: Maintenance of an “issues log” where issues of concern are recorded, for the purpose of addressing these issues. The log serves as documentation that shall be referred to the central programs for policy discussions across divisions. Step 5: Maintenance and management of a register for individuals with a disability or for children in out-of-home care, to provide timely and updated information on these individuals Step 6: Conduct of an annual audit of children and young people with disability or in out-of-home care who are entered in the register. Step 7: Monitoring and periodic reporting of collaborative activities and any joint training programs conducted regionally, for the purpose of addressing issues pertaining to the system and, but more importantly, to improve the outcomes for the children, particularly those who are included in the regional register. Component 2: Practice Support and Tools Step 1: Regular meetings of practice leaders for both programs (i.e., individual children with disabilities and their families, and children and young people in out-of-home care) will meet on a regional basis, for the purpose of supporting staff who are working on complex cases. Step 2: Regional practice forums may be developed particularly to support children with a disability on the out-of-home care register. They may likewise be included in cross-program practice based structures existing per region. Step 3: Practice based opportunities may be developed on an ongoing basis for individual children with a disability who are either in out-of-home care or who may be at risk of coming into care. These may be carried out through different means such as via secondary consultation and/or joint case conferences. Step 4: Opinions may differ between Disability Services and Child Protection practitioners concerning support of a shared client, in which case the workers involved should thoroughly explore common areas where there is agreement and disagreement, with the effort at directing resolution of the issue towards the child’s best interest and welfare. Where disagreements cannot be resolved, then the matter should be settled through the senior management group. Component 3: Practice monitoring, review and learning Step 1: Key areas where collaborative efforts are pursued between Child Protection and Disability Services should be monitored, and activity outcomes should be ascertained in terms of service provision, as well as the number, characteristics, and the relative well-being of children and young people with disabilities as a result of the activity. Step 2: Collaborative reporting shall be done quarterly and on a regional basis particularly in the implementation of the quality of care operating framework. Step 3: An annual audit shall be conducted that would track the current service response in the individual cases of identified children with disabilities in and out of home care, such as those included in the regional registers. Review process Component 1: Data collection and reporting system Collaborative activity between the workers attending to children with disabilities and children and young people in out-of-home care shall be the subject of a quarterly report issued at the regional level for the purpose of the implementation of the new framework. Measures to be included in the report are the number, nature and impact of collaborative activities that were undertaken during the course of each quarter, so as to address system issues and improve the outcomes for groups of children with disabilities in out-of-home care; Reports should also include the number, nature and impact of training sessions for workers attending to children with disabilities, and workers attending to children and young people in out-of-home care in the previous quarter, differentiated by the number and type of participants. Component 2: Data capture and analysis on client outcomes for Client Outcomes and Service Improvement (COSI) trending (adapted from the Child, Youth &Families – Disability Services Operating Framework, Nov. 2012) In the course of accomplishing entry of groups of children or young people in the disability or out-of-home care register, the following data categories shall be included: Name Registration number Date entered in the register / date out-of-home care commenced Date removed from register / date ceased to be in out-of-home care Reason removed from register: Family reunification permanent care left for more independent living youth justice custody other – please specify Date of birth Sex Aboriginal (yes/no) Disability type Under 6 with developmental delay Under 6 with other disability Above 6 with intellectual disability Identified by Child Protection (CP) Identified by Disability Service (DS) Identified by both CP and DS Above 6 with other disability Out of home care funding source Child & Young People and their Family Services only Disability Service only Joint Other – please specify Voluntary Child Care Agreement status: Not applicable – court order Yes – too early for CP review Yes – CP review required CP review in progress CP review up to date – no concerns CP review follow up required CP follow-up in progress Out of Home Care (OOHC) type: Foster care Kinship care Family options CYF funded residential care Lead tenant DS funded adult residential unit DS funded respite facility Other OOHC – please specify Disability service status Below 6 years Never referred based on DS advice Never referred other reason - please specify Never referred – unknown reason Target group assessment (TGA) in progress Assessed as not in target group In target group – no service required In target group – awaiting service response Receiving service from DS Receiving service from a DS funded agency Pre-school / School enrolment Too young for pre-school Mainstream pre-school Specialist early intervention program only Pre-school age not enrolled pre-school or EIP Mainstream school Special school School age not enrolled Post-secondary education Below 16 and left school Pre-school / school participation: Regular Poor attendance Pre-school or school age – no participation Not applicable due to age DS involvement in leaving care planning Not applicable, under 16 years Not applicable 0 DS funded care Yes / No Regional comments (free text) Component 3: Data capture and analysis on client outcomes for Client consultation (adapted from the Looking After Children Assessment and Progress records) Essential Information Record (EIR), which contains vital information concerning a child or young person to whom carers and the care manager provide good care. Factual information is maintained that is of the nature that those responsible for the care of the child or young person will necessarily require for ongoing reference over the long term. Requires information such as: Parents’ names and contact information Date of birth Medicare numbers School details Professionals’ contract information Current and historical information (i.e., schools attended) The facts to be entered are those with historical significance to the child or young person, and matters which shall always remain true, such as the fact and period of hospitalization, the birth of a sibling, etc. As such, the best practice in maintaining the EIR necessitates continuous updating and processing to keep factual information about the child current. All members of the care team must have access to a copy of the EIR. Information must also be updated at every meeting of the care team, and subsequent to any review of the Care and Placement Plan. Care and Placement Plan (CPP), which identifies the needs of the child through the fundamental life areas, while also describing the manner these needs will be met for the duration the child is in out of home care. Needs that arise from the child’s strengths and aspirations must be identified as well as those reflecting problems and difficulties. The purpose of the description of the child’s needs is to provide the care workers an idea of the issues and questions that must be considered within any particular area, thus those areas which are not relevant need not be fully described. The CPP documents for each area the following: The child’s or young person’s needs How these needs will be responded to Who shall respond to these needs When the needs shall be addressed The role of the parents Planned outcomes The first CPP should be accomplished within the first two weeks after the child has been placed, and it should focus on how the child has made his/her transition to the new living arrangement. This entry must include what action are required, and which party is required to take these actions, so that the adverse impact upon the child/young person is minimized. This includes confirming arrangements for family contact and communication, for school, and other measures to ensure the happiness of the child as far as is practicable. The next and subsequent plans should be more comprehensive and must address the child’s needs over the next six month. DS providers may also have to develop a specific health care plan for individuals living in department funded disability accommodation services. Also, children may require a comprehensive behaviour support plan to address specific behaviours. These should be referenced in the CPP. Review of Care and Placement Plan (RCCP) is a workbook that provides guidance to the care team in developing a new CPP. Each of the sections addressing the Looking After Children life areas from the last CPP is reviewed to evaluate: Actual outcomes of the planned actions Whether previously identified needs have been met What new information has emerged On the basis of the assessment on past developments, new needs and actions are identified and recorded in the RCPP, the results of which constitute the new plan. According to best practice, undertaking the RCPP should be done whenever circumstances change for the child/young person, after the completion of each Assessment and Progress Record, and at every six months, consistent with the Looking After Children framework. Assessment and Progress Record (APR) is the tool that enables the care team to monitor how the child/young person is developing, and identifies the needed follow-up actions. Existing within the framework are six age-related records, three of which are relevant to disability service providers: the 5-9 years, the 10-14 years, and the over-15 years records. The APR should be completed by a member or members of the care team who see and had been able to observe the child most often. The information reported in the APR is obtained through observations and a series of conversations with the child/young person, as well as with various care team members over a six-week period. The APR should be incrementally prepared over time; in no case should it be completed in one sitting merely to complete the form for compliance. The first record should be started as soon as the first CPP is completed, and should be updated on a yearly basis. Component 4: Benchmarks The establishment of measures and standards by which to benchmark future shall be undertaken with the guidelines issued by the government, such as the Child Protection and Out-of-Home Care Performance Indicators, which describes the current performance indicator framework used in Australia. Service performance is assessed in terms of efficiency and effectiveness, supported by data culled from a variety of sources and the different states and territories by the Productivity Commission as Secretariat for the Review of Government Service Provision. Eight performance indicators are specified per state or territory: substantiation rate, substantiation rate after decision not to substantiate, re-substantiation rate, safety in out-of-home care; stability of placement; placement with extended family; children aged under 12 in home-based care; and placement in accordance with the Aboriginal Child Placement Principle. Inasmuch as each state and territory has its own legislation, policies and practices, therefore the indicators for the state of Victoria shall guide the establishment of benchmarks for this particular framework (Australian Institute of Health and Welfare, 2006). Star Outcomes Framework The Star Outcomes framework may prove useful in providing a scale by which each of the aspects of development may be assessed. The Star Outcomes diagram below shows each of the aspects divided into a ten-point scale. The points are determined, and then connected to provide a picture of the status of the particular case. Source: http://www.outcomesstar.org.uk/star-versions/ Legislation Affecting the Out of Home Care & Disabilities Outcomes Framework The following list of statutes and their description were adapted from the E.W. Tipping Foundation Practice Leader Framework Guideline 2013. Federal Privacy Act 1988 – Australia’s national law protecting the privacy of personal information when such is in the custody of Federal and ACT Government Agencies. The 2001 amendments to this law increased the scope of coverage to private sector organisations and health services. Under the principles set forth in this law, basic rules were established observing privacy in the handling of personal inflation, while encouraging full disclosure and openness among agencies and organisations concerning what and how they collect information and their purpose for doing so. Information Privacy Act 2000 – A law establishing a framework governing the collection and use of personal information in the Victorian public sector. Under this law, individuals are provided rights to access information about them which are held by the service, and to have information about them amended. The collected information must be relevant to the functions discharged by the agencies, and individuals may compel the disclosure of the agencies’ purpose for collecting the information. The Act encourages the free flow of information affecting the interest of the public, but protects the privacy of personal information. Finally, it seeks to promote correct information handling practices within the public sector. Health Records Act 2001 – This law establishes a framework by which the privacy of individuals’ health information may be protected. Under it, health information may be gathered to ensure the provision of safe and effective treatment. Every individual is assured of the right to access their personal health information, and the collection and storage of such information is regulated. The Act covers public hospitals, health and extended care services, public community and residential care services. Child Wellbeing and Safety Act 2005 – This Act creates a legislative framework to encourage and support a shared commitment to the welfare of children in Victoria. It promotes the development of services benefitting children and their families pursuant to the principle that the promotion of a child’s safety, health, well-being, development and education shall be accorded the highest priority. Child Youth and Families Act 2005 – The goal of this law is to provide a framework that promotes the well-being of all children in care in Victoria, consistent with the principles governing the ‘rights of the child’ and serving children’s best interests as the cornerstone philosophy in child welfare. The purpose of the CYF Act 2005 is to provide guidance to community services in support of children and their families, to provide protection and support for children charged with or found guilty of an offence, and continue the provisions to the Children’s Court of Victoria. Disability Act 2006 – Provides for greater effectiveness in the response by government and community to the needs and rights of persons with disability. It establishes a framework for a high standard of services and support for individuals with a disability/ies and their families. The Act also provides for an improved complaints and review systems, by mandating that disability service providers must: provide a clear process for managing complaints about their services; ensure that people who avail of their services are aware of how to make a complaint; and report yearly to the Disability Services Commissioner concerning the number and status of complaints they receive and how they are managed. Victorian Charter of Human Rights and Responsibilities 2006 – The Charter sets out the freedoms, rights and responsibilities of the citizens of Victoria. It protects the civil and political rights of all people in Victoria based on the principles that all people are born free and equal, and compels the Victorian Government and public authorities and their employees to always act in accordance with the principles embodied in this Act. Charter for Children in Out of Home Care 2007 – The creation of a Charter for children and young people in care is required by the Children, Youth and Families Act 2005. The Charter creates a framework for the promotion of the wellbeing of children in out of home care. The Charter was developed by children in out of home care, guided by the office of the Child Safety Commissioner. It explains the rights of children and young people, and is a guide for workers and carers when assisting them. Best Interests Framework for Vulnerable Children and Youth 2007 – Developed for family services, child protection and placement services. This creates a common understanding and concerted approach among different services to ensure that the child’s best interests are served and that the best practices are being adopted. The responses are guided by the key outcomes of the safety, stability, and development of the child, the family and community in a holistic context. It considers the age, gender, stage of life, and culture of the child in the assessment, planning and action taken in administering the service. Outcomes are thereafter monitored, analysed and evaluated against the goals set for the child’s welfare. Looking After Children Framework 2010 – A joint initiative of the community service organizations across Victoria who deliver out of home care services for children and young people, in collaboration with the Department of Human Services. It considers the child’s needs and outcomes in seven life areas, namely health, emotional and behavioural development, education, family and social relationships, identity, social presentation, and self-care skills. Office of the Child Safety Commissioner Child Safety Policy 2010 – This policy states that every child has the right to grow learn, develop, play, and be safe in the community. The office is committed to the well-being and safety of all children, and employees and volunteers of the office should reflect this commitment in discharging their activities, particularly those requiring close contact with children. Department of Human Services (DHS) Standards 2012 The Victorian DHS has integrated its program standards and independent reviews to a single set of quality standards for service providers. There are four DHS Standards, namely: Empowerment, whereby people’s human rights are promoted and upheld; Access and engagement, whereby people’s rights to access transparent, equitable and integrated services is upheld; Wellbeing, whereby people’s right to wellbeing and safety is promoted and upheld; and Participation, whereby people’s right to choice, decision-making and to actively participate as a valued member of their chosen community is promoted and upheld. Future Development The process of establishing a workable and effective framework for the assessment of program outcomes is a constantly evolving process due to the changing needs of the child/young person in out-of-home care or with disabilities, as well as the advancing methods and techniques in engendering the best results possible. Observations and ideas coming from care providers and care teams concerning improving the framework may be undertaken through discussions in regular meetings. Proposals may be circulated through other teams and proposed to the proper organisation in charge of standardisation, if warranted. The principal criterion is the usefulness and effectiveness of the proposed changes in attaining the desired results regarding the ultimate safety, health, well-being and happiness of the child/young person with a disability or in out-of-home care. References Australian Bureau of Statistics, Australian Social Trends, June 2012: Children with a Disability. Retrieved 27 September 2013 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Jun+2012 Australian Government, Department of Social Services. National Standards for Out of Home Care – Consultation Paper. (20 August 2013). Retrieved 27 September 2013 from http://www.dss.gov.au/our-responsibilities/families-and-children/publications-articles/national-standards-for-out-of-home-care-consultation-paper?HTML#f_n_1 Australian Institute of Health and Welfare (AIHW). Child protection Australia, 2011-12. Child Welfare Series No. 55. Australian Government. Canberra: AIHW. (8 March 2013). Retrieved 27 September 2013 from http://www.aihw.gov.au/publication-detail/?id=60129542755 Australian Institute of Health and Welfare(AIHW). Child Protection and Out-of-Home Care Performance Indicators. Child Welfare Series Number 41. Cat. No. CWS 29. Canberra: AIHW (2006). Retrieved 27 September 2013 from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455297 Children, Youth and Families and Disability Services. Operating Framework. Melbourne: Victorian Government Department of Human Services (2012). Retrieved 27 September 2013 from http://www.dhs.vic.gov.au/__data/assets/pdf_file/0004/717097/Disability-and-CP-Operating-Framework-Nov-2012.pdf Council of Australian Government. Families and Children: National Framework for Protecting Australia’s Children 2009-2020. Australian Government, Department of Social Services. (April 2009). Retrieved 27 September 2013 from https://www.fahcsia.gov.au/our-responsibilities/families-and-children/publications-articles/protecting-children-is-everyones-business?HTML Council of Australian Government. Protecting Children is Everyone’s Business: National Framework for Protecting Australia’s Children 2009-2020. Commonwealth of Australia (2009). Retrieved 27 September 2013 from http://www.dss.gov.au/sites/default/files/documents/child_protection_framework.pdf Department of Human Services (DHS). Looking After Children framework for children and young people living in out-of-home care arrangements: A guide for disability service providers. Melbourne: Victorian Government Department of Human Services (2012). Retrieved 27 September 2013 from http://www.dhs.vic.gov.au/__data/assets/pdf_file/0006/703239/1_disability_look_after_children_oohc_guide_0312.pdf Department of Social Services. National Standards for Out of Home Care – Consultation Paper. Australian Government, Department of Social Services. (20 August 2013). Retrieved 27 September 2013 from http://www.dss.gov.au/our-responsibilities/families-and-children/publications-articles/national-standards-for-out-of-home-care-consultation-paper?HTML#f_n_15 E.W. Tipping Foundation. Practice Leader Framework Guideline. E.W. Tipping Foundation. Disability Quality of Care – Performance Measurement System Holzer, P & Lamont, A. Australian child protection legislation. Australian Institute of Family Studies, Resource Sheet No. 14, (October 2009). Retrieved 27 September 2013 from http://www.aifs.gov.au/nch/pubs/sheets/rs14/rs14.html Pricewaterhouse Coopers (PWC). Disability Expectations: Investing in a Better Life, A Stronger Australia. (2013). Retrieved 27 September 2013 from http://www.pwc.com.au/industry/government/assets/disability-in-australia.pdf Schalock R. L., Brown I., Brown R., Cummins R. A., Felce, D., Matikka L., Keith K. D. & Parmenter T. Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: Results of an international panel of experts. Mental Retardation, 40(6), p. 457–470 (2002) Read More