HSPIC Partnering Dialogue Early intervention approaches and service system reform

1. HSPIC Partnering Dialogue Early intervention approaches and service system reform • Thursday 14 April 2011 • Framing the discussion

2. 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. Background

3. 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 ?

4. 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 phasesas 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. Resilience & Self-Management • Clients reaching their potential • Independence • Social Inclusion • Community and economic participation • Self-management • Resilience Capabilities Capability-building activities are those activities that are foundational for moving towards self-management, i.e. basic financial management skills, help with parenting needs, education and training to help with finding employment. Recovery 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. Stabilisation Early intervention Stabilisation activities aim to provide immediate help to people in urgent need of assistance, i.e. crisis accommodation, rehabilitation, child protection actions. Primary focus of human services Early intervention activities aim to identify existing or potential issues and take remedial action early to maximise the prospects for recovery. From a ‘residual welfare’ model to a contemporary approach

5. 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. Economic 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. 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. 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.

6. 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.”* Collaborative practice intervention Collaborative practice intervention 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

7. INTERVENTIONS Reactive interventions to respond to crisis or complex, ongoing need/may also prevent further deterioration Universal programs promote positive outcomes Specific programs to provide support Targeted interventions based on risk factors Families experiencing some problems At risk families Families in crisis All families Protection Prevention Promotion CONTEXT Principles for service delivery 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. 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

8. Early intervention opportunities are in many settings Crisis Resilience & Self-Management Capabilities Recovery Early Intervention – Intake and assessment response Stabilisation • Basic needs interventions • Homelessness supports • Emergency financial assistance • Public housing • Income support • 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

9. Barriers to major service delivery improvements 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. 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.

10. Early intervention through an economist’s lens “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” Rand Corporation ‘Proven Benefits of Early Childhood Interventions’ Research Brief, 2005 “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.” Australian Social Inclusion Board, 2011 “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.” Australian Capital Territory, Department of Treasury and Finance, Budget Paper No. 3, 2005-06 “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 cost-effective”. Australian Institute of Family Studies ‘The Efficacy of Early Childhood Interventions’, 2005