Transcript Early intervention approaches and service system reform

HSPIC Partnering Dialogue
Early intervention approaches and service system reform
Thursday 14 April 2011
Framing the discussion
Background
Last time we met, we spoke about client-centricity as a principle for how we deliver services. We identified
that service system reforms need to, at a minimum, include ways to:
•Enable clients to direct their own support responses;
•Engage with clients before a crisis and beyond a crisis to tackle causes;
•Build capacity to intervene early to reduce disadvantage;
•Attach funding to the client;
•Link client feedback systems to performance and outcomes;
•Provide consistent pathways into and through the system;
•Redirect resources that maintain silo structures to community and place based responses; and,
•Build partnership and community development functions into funded activities.
Dialogue objectives:
• A shared view of what early intervention means for the human services system.
• A shared view on where in the system we need to target early intervention approaches.
• A collaborative approach to generating greater investment in early intervention approaches.
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What are some of the questions we may need to consider?
At this HSPIC Partnering Dialogue we are looking at early intervention and what it means for us as a human
services industry. This document begins with a brief re-cap of the Department of Human Services (DHS)
reform story (how did we get here and why?), before posing a number of questions for you to consider prior
to the dialogue. The questions are designed to provoke discussion and commentary to inform future human
services policy, strategy and service delivery:
What do we mean by early intervention approaches in the context of a secondary
and tertiary human services system?
Where in the system would we target early intervention approaches to improve
client outcomes?
What changes could the community sector and DHS introduce separately and
collaboratively to foster early intervention approaches?
How do we promote greater investment in early intervention ?
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How did we get here and why?
The phases towards self management: moving away from a ‘residual welfare’ model
Great progress in service delivery has been made in limited programs and areas of DHS (such as in Disability support packages, Neighbourhood
Renewal and Bushfire Case Management), but we still focus primarily on supporting people at the stabilisation and recovery phases as our core
business. While these phases are important, they do not provide a pathway out of disadvantage towards resilience and self-management.
We do not fully engage in early intervention activities, which identify and address issues before they reach crisis point.
We also focus primarily on personal issues, under-playing the economic and community aspects of disadvantage. The social and economic costs of
delivering inefficient programs is high for both individuals and the state: individuals fail to live a fulfilling life and the State may exacerbate the
problem of dependency.
Primary focus of
human services
Resilience &
Self-Management
Capabilities
Recovery
Stabilisation
Early
intervention
Early
intervention
activities aim to
identify existing
or potential
issues and take
remedial action
early to
maximise the
prospects for
recovery.
Stabilisation
activities aim to
provide
immediate help
to people in
urgent need of
assistance, i.e.
crisis
accommodation
, rehabilitation,
child protection
actions.
Recovery
activities aim to
treat the causes
of an
individual’s
issues, i.e.
counselling for
drug and
alcohol or
violence,
ongoing
housing,
disability
supports.
Capabilitybuilding
activities are
those activities
that are
foundational
for moving
towards selfmanagement,
i.e. basic
financial
management
skills, help with
parenting
needs,
education and
training to help
with finding
employment.
• Clients
reaching their
potential
• Independence
• Social Inclusion
• Community
and economic
participation
• Selfmanagement
• Resilience
From a ‘residual welfare’ model to a contemporary approach
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The types of supports that clients need are a combination of the personal,
economic and community
The following diagram describes the inter-relationship of the three domains: the personal, the economic and the
community. Without addressing each of these domains, an individual may not be able to build the capability to become
independent or to self-manage, or they may remain socially excluded.
Personal: the client and the family
unit’s emotional and physical
wellbeing. Personal needs include
adequate and safe housing, support
services for clients who have
experienced physical violence and
sexual abuse, and support services to
assist with and maintain the emotional
wellbeing of the family unit. We assist
our clients to manage their
households and provide support
services to clients in order to maintain
functional and safe parenting and
family relationships.
Economic: this domain
refers to a client and their
family developing the skills,
attributes and experience to
gain and maintain
employment and contribute
to the Victorian economy.
Economic
Personal
Community
Community: all Victorians feel valued, have the opportunity to participate fully and contribute to the
vitality of their communities. People feel connected to their community, and can access a range of services
and facilities. People involved socially with people outside their family unit, children attending school and
participating in school activities and social events, families involved in sport and recreational activities.
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Client-centred practice in a service system continuum
“Given that many challenges and difficulties in the lives of vulnerable children and families are complex and interlinked, early
intervention initiatives are more likely to create benefits for children and families if they are firmly situated within a coordinated
service system of primary, secondary and tertiary intervention.”*
Intervention/Treatment
Designed to keep problems
from emerging
Aim: to reduce the incidence
of an identified
problem/condition
Population/sub population
level
Designed to reverse or reduce the
impact of known risk factors
Aim: to build individual capacity and
protective factors
Designed to reduce harm
Universal services for all
Examples:
• Nutrition/smoking programs
• Screening for developmental
disabilities, deafness
• Immunisation
• Books for Babies programs
Role of Gatekeepers
Focus on individual, family or both
with increasing recognition of social
& physical environmental issues
Targeted universal services for
place based disadvantage
Targeted eligible services for at risk
groups
Examples:
• Home visiting programs
• Parenting programs for parents of
preschool children displaying
aggression, etc.
• Programs for children identified at
school with signs of behaviour
problems
Collaborative practice intervention
Early Intervention
Collaborative practice intervention
Prevention
Aim: to provide most effective
treatment to achieve fullest
possible recovery
Individual level
Every where
Eligible individuals only
Examples:
• Clinical services
• Child Protection services
Role of Gatekeepers
How do we maximise the
interface between collaborative
practice interventions?
*Butler, K. (2009) ICPS – table modified to provide a generalist overview. Originally, the definition focussed on early intervention for children
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Principles for service delivery
INTERVENTIONS
Government plays a range of different
roles in responding to these types of
trends and outcomes across the
community.
Generally, universal services are
provided to support outcomes for all
families, with more targeted, or tertiary
services to assist families that require
additional support or assistance.
The diagram* illustrates the different
roles of Government in terms of
service/program delivery. This
illustrates that services generally
operate along a continuum – from
promotion and prevention, through to
protection.
Universal
programs
promote
positive
outcomes
All families
Specific
programs to
provide
support
Targeted
interventions
based on risk
factors
Families
experiencing
some
problems
At risk families
Prevention
Reactive interventions
to respond to crisis or
complex, ongoing
need/may also prevent
further deterioration
Families in
crisis
Protection
Promotion
CONTEXT
The types of services used by families along the continuum range from universal services (health and education) through to tertiary
services (public housing and family violence services).
The balance of universal and tertiary services is important to ensure that outcomes for all are maintained, whilst improving outcomes
for those that are faring worst.
Universal services also play an important role in supporting disadvantaged or hard to reach groups by providing a platform for engaging
in the service system that is accessible and understood, and without stigma. In addition, engagement with universal services provides
an opportunity to identify and refer families who require more targeted or tertiary services.**
* Diagram adapted from Prilleltensky et al.
** NSW Government, 2011, Early Intervention and Placement prevention Service Continuum: Framework for the service system realignment
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Early intervention opportunities are in many settings
Resilience &
Self-Management
Capabilities
Crisis
Recovery
Early
Intervention
–
Intake and
assessment
response
Stabilisation
Life stage /transition
interventions
• Maternal & child
health
• Parenting programs
• pre-school
• Schools / training
• Employment
participation
Hard to reach groups
interventions
• Mental health
• Alcohol and other
drugs
• Family violence
Basic needs
interventions
• Homelessness
supports
• Emergency financial
assistance
• Public housing
• Income support
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Barriers to major service delivery improvements
Government has signalled its intention
to confront the rigid and bureaucratic
silo approach to services.
Government wants to remove barriers
that exist across Government so that
individuals and families can access the
range of services necessary to address
their needs.
Although continuous improvements are made to
human service delivery systems, we are still structured
around individual programs. This has manifested in a
fragmented model, which limits our ability to make a
real impact on the long term outcomes for clients and
their families. As a result, we have little scope either to
address disadvantage in the broader community or the
disconnect with our service delivery partners and
other Government agencies.
There are three structural system areas that are
currently under discussion for reform. Applying an
early intervention filter to these areas would benefit
the discussion. These areas are: duplicated service
system entry points, rigid service models and
fragmented case management.
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Early intervention through an economist’s lens
“Evidence shows that for every dollar
invested in these early intervention
programs there can be a seven-fold
increase in benefits by the time the
children become adults.”
“Well-designed early childhood
interventions have been found to
generate a return to society
ranging from $1.80 to $17.07 for
each dollar spent on the program”
Australian Social Inclusion Board, 2011
Rand Corporation ‘Proven Benefits of Early
Childhood Interventions’ Research Brief, 2005
“Government’s investment in early
intervention also potentially avoids or
reduces the need to direct significant
amounts of public money in the future
toward the lengthy and expensive support
programs that are required to address
serious and ingrained problems.”
“One cannot assume that any
type of intervention in early
childhood will pay long-term
dividends. Some interventions are
more effective than others but,
importantly, some are more costeffective”.
Australian Capital Territory, Department of Treasury and
Finance,
Budget Paper No. 3, 2005-06
Australian Institute of Family Studies ‘The
Efficacy of Early Childhood Interventions’, 2005
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