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National evaluation (2004–2008) of the Stronger Families and Communities Strategy 2004–2009

5. Communities for Children sector outcomes: service coordination and collaboration

5.1 Service coordination and collaboration successes
5.2 Facilitators and barriers to effective service coordination
5.3 Conclusion

The logic model of CfC indicated that outcomes for children and families depended not only on the number and type of services delivered in the community, but also on how services and activities were coordinated. A major aim of CfC therefore was to improve local service coordination and collaboration.

The CfC model transformed the way early years services are delivered. Prior to CfC, early childhood services were often narrowly focused and rarely coordinated. CfC provided a new approach to government-funded service provision for services focusing on 0 to 5 year olds. Qualitative and quantitative evaluation methods found significant increases in service coordination and collaboration throughout the initiative. This was commonly described by Facilitating Partners and service providers as a 'culture change' within CfC sites.

The findings on service coordination that follow in this section are based on the Service Coordination Study, a survey administered in two waves (2006 and 2008) which elicited 744 responses from service providers, and from the 222 interviews with stakeholders across the 10 CfC sites in 2006 and 2007.35

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5.1 Service coordination and collaboration successes

There were significant increases in coordination and collaboration between staff from different agencies in CfC communities between 2006 (Wave 1 of the Service Coordination Study) and 2008 (Wave 2). A select purposive sample was used for this study and therefore findings can be generalised. However, response rates differed by CfC sites and so the broad findings may not be indicative of the outcomes for all individual locations. The response rates are representative for eight of the 10 SFIA CfC sites.36 These findings are also collaborated by the qualitative interviews in the SFIA areas.

Of the total 744 responses to the survey from stakeholders (442 in Wave 1 and 302 in Wave 2), only 86 responses were repeated and identifiable across both waves of the survey. Since this number is fairly small, information is provided in the following tables about this 'repeated' sample to observe changes in paired organisations over time, and about the sample of 'all agencies' to make use of the full sample across both waves and provide the broadest picture of service coordination across communities in each of the two waves of the survey. Appropriate statistical tests are used in each instance to test for significant changes or differences, and are reported in the following tables.

In 2006, only 34 per cent of agencies (who responded to the survey in both waves) agreed that staff from different services worked closely together most of the time. This had increased significantly to 66 per cent by 2008 (p<0.001; Table 5). By the same token, in 2006, 21 per cent of agencies knew little about each others' work, but by early 2008 this had decreased significantly to only 4 per cent (p<0.001). Similar improvements occurred across all agencies that completed the survey, suggesting that the improvement trend was more widespread (Table 5).

Table 5: Collaboration between staff from different services
Staff from different services... All agencies(a) Repeated agencies(b)
Wave 1 (%) Wave 2 (%) Wave 1 (%) Wave 2 (%)
Work closely together most of the time 35 60 34 66
Work closely together occasionally 50 35 45 30
Know little about each other's work 16 5 21 4
n 376 302 71 71
(a)     p<0.001—results highly significant (Chi Square test).
(b)     Each response was paired across the two waves, and McNemar test for repeated observations returned highly significant values (ranging from p<0.001 to p<0.002).
Note:     All columns add to 100 per cent except in cases of rounding error.

In 2008 (Wave 2), survey respondents were also significantly more likely to report that services worked in a coordinated manner than in 2006 (Wave 1; p<0.001; Table 6). In Wave 1, only a small percentage of agencies reported that services in their area worked as a well-coordinated team (15 per cent of all agencies and 10 per cent of those who completed the survey in both waves, that is, repeated agencies), compared with almost half the agencies in Wave 2 (over 40 per cent in both samples). Similarly, while one-quarter of the repeated respondents (25 per cent) described the service network in their area as separate and uncoordinated in Wave 1, by Wave 2, only 6 per cent believed that.

Table 6: Level of coordination between services
All agencies(a) Repeated agencies(b)
Wave 1 (%) Wave 2 (%) Wave 1 (%) Wave 2 (%)
A well coordinated team of services 15 44 10 46
A partially coordinated team of services 68 47 65 49
A group of separate, uncoordinated services 17 9 25 6
n 387 299 72 72
(a)     p<0.001—results highly significant (Chi Square test).
(b)     Each response was paired across the two waves, and McNemar test for repeated observations returned highly significant values (ranging from p<0.001 to p<0.002).
Note:     All columns add to 100 per cent except in cases of rounding error.

It is not possible to attribute these positive changes only to CfC, as other factors may have also contributed. However, the qualitative interviews conducted in 2006 and late 2007 corroborate the survey findings indicating that CfC made a substantial contribution to improving service coordination and collaboration.

In the interviews CfC stakeholders reported that the number and strength of networks had increased in their communities between 2006 and late 2007, and that the nature of the relationships between service providers had changed for the better, largely as a result of CfC. Trust and respect increased and service providers became more willing and open to working together as time progressed. They said CfC helped break some of the silos that previously existed in the early years service sector. Collaborations also helped service providers to solve problems, upgrade skills, increase capacity, identify the best providers for different service delivery areas, and minimise the duplication of services. The improvements in service coordination and collaboration in CfC sites were so marked that a number of stakeholders interviewed described the occurrence as a cultural change. Given the implementation challenges discussed above, this is a significant finding which indicates the strength of the CfC model.

Coordination activities

Service collaboration can involve joint activities (for example, multi-agency working groups), sharing infrastructure (for example, collocation of offices), or common financial arrangements (for example, cost-sharing for services) (Sullivan, Gilmore & Foley 2002). The Service Coordination Study revealed that there was some collocation within CfC sites, and that the funding allocations of CfC had also resulted in some cost sharing. But most of the collaboration within CfC occurred around activities, although to varying degrees depending on the activity, for example, planning, service delivery, sharing information, professional development. All of these coordination activities were found to be quite useful (Table 7).

Agencies had been coordinating a range of activities from the early days of CfC. For example, in 2006 (Wave 1), 86 per cent of all agencies were involved in referring clients, 85 per cent in exchanging information, 83 per cent in interagency meetings, and 73 per cent in joint service delivery or case management.

There were smaller proportions of respondents conducting joint planning (71 per cent), interagency staff training (57 per cent) and collocation (45 per cent). This is understandable because these activities take relatively more time to establish because they require the investment of resources and need activities such as joint meetings and relationship development to take place before they can be implemented.

By 2008 (Wave 2), there had been increases in all these activities (except for joint service delivery/case management and exchanging information which remained stable). Some of these changes were statistically significant, namely changes in the proportions of all agencies (that is, the repeated agencies plus those who completed only Wave 1) that were referring clients (from 86 per cent to 92 per cent, p<0.05), and of those conducting interagency staff training (from 57 per cent to 73 per cent, p<0.001). Both of these factors also increased in the case of those agencies who completed the survey in Waves 1 and 2, that is, the repeated agencies alone (85 per cent to 91 per cent and 59 per cent to 71 per cent respectively), although these increases were not statistically significant.

Referring clients is a fairly simple activity to coordinate, but the increase in referrals is still a very positive outcome for CfC. Referrals are critical for increasing people's access to services based on needs and directing them to the most appropriate providers. Referrals between services were found to especially benefit families who were disengaged from service networks. In many cases, a family's engagement with a child care service may be the only connection they have to service networks. For this reason, referrals between early childhood service providers and other support services are crucial. Referrals from informal services were also found to be important for introducing families to more formalised, specialist services.

The increase in interagency staff training was beneficial for maximising resources and building the capacity of service providers and organisations. Service providers recognised the value of training by rating the helpfulness of this activity highly (Table 7). However, training was helpful only if it was of high quality and relevant to service providers. That some training may have been of poor quality or of little use to service providers is indicated by a slight decrease between Waves 1 and 2 in the ratings of its helpfulness, both by all agencies and by the repeated sample.37 For programs like CfC in the future, this reinforces the importance of not only working towards conducting activities cooperatively and collaboratively, but also ensuring that the quality of these activities remains high and is beneficial to agencies.

Although not statistically significant, there were increases in other activities as well. Taking all the agencies that completed the surveys, they were slightly more likely to be conducting joint planning at Wave 2 than at Wave 1 (71 per cent to 76 per cent), to be having interagency meetings (83 per cent to 86 per cent), and to be collocated (45 per cent to 49 per cent). Looking only at the repeated group, there was an increase in interagency meetings (87 per cent to 89 per cent), and in collocation (48 per cent to 55 per cent), while joint planning remained at the same consistently high level at 83 per cent.

The proportion of agencies exchanging information remained equally high between the waves (85 per cent) for the all agencies sample, but it increased for the repeated group (82 per cent to 92 per cent). Information exchanges involved agencies learning about each other, sharing service delivery and client engagement strategies, swapping resources and joint problem solving.

Approximately seven in 10 agencies reported being engaged in joint service delivery and case management throughout the evaluation. Joint service delivery was also reflected in the CfC progress report data. For the period from July 2006 to December 2007, 89 per cent of activities were being conducted in partnerships between organisations or groups and 76 per cent of services reported being involved with at least one other partner. The report data indicate that these partnerships were successful, with a strong positive relationship between partnerships and outcomes (p<0.01).

The most helpful coordination activities for agencies were joint planning, exchanging information and referrals. Joint planning and exchanging information showed the largest increases in reported helpfulness between Waves 1 and 2, both for all agencies and for the repeated group. Agencies' scores on the five-point scale for joint planning increased significantly from 4.0 to 4.2 for all agencies (p<0.05), and from 3.9 to 4.3 for the repeated group (p<0.001). Exchanging information increased from 4.0 to 4.2 for all agencies (p<0.05), and from 4.0 to 4.3 for the repeated group. Finally, joint service delivery and case management increased from 2.9 to 4.0 for the repeat group (p<0.001). Thus, agencies perceived that they were benefiting substantially from planning and delivering services together and from exchanging information. In the case of referrals, respondents consistently rated them across both waves as one of the most helpful activities (4.2 for the repeated group in Waves 1 and 2; from 4.1 to 4.2 for all agencies).

In the case of the reported helpfulness of the various activities, there were some decreases despite the fact that helpfulness tended to increase overall. Interagency meetings were perceived as less helpful in Wave 2 than in Wave 1 for the repeated group (from 4.1 to 4.0). The helpfulness of staff training and the collocation of services also decreased for the repeated group (from 4.1 to 3.7 and from 4.2 to 3.9 respectively) and remained similar for the all agencies group from 4.1 to 4.0 and 4.0 to 4.1 respectively). The decreases were not statistically significant and the ratings of helpfulness for each of these activities remained very high. Future programs, however, should monitor the relevance and effectiveness of coordination activities to ensure they are mutually beneficial and worthwhile for agencies.

In most cases, there was an increase both in the proportion of agencies undertaking coordination activities and in the helpfulness of those activities, indicating positive effects of the CfC program. The findings also indicate that some of the more complex service coordination activities may take longer to develop, and the time between the two waves of the Service Coordination Study may have been too short to capture significant changes in such activities.

Table 7: Interagency involvement in various activities (%) and average helpfulness score
All organisations(a) Repeated agencies(b)
Agencies involved Average helpfulness Agency involved (%) Average helpfulness (1–5)
Wave
1(%) 		n Wave
2 (%) 		n P-value
(Chi-Sq 		Wave 1
(1–5) 		n Wave 2
(1–5) 		n P-value
(T-test Indep.) 		Wave
1 (%) 		Wave
2 (%) 		n
(both waves) 		P-value
(McNemar) 		Wave 1 Wave 2 n
(paired samples) 		P-value
(Paired obs.
T-test)
Joint planning 71 417 76 293 0.148 4.0 285 4.2 222 0.000*** 83 83 80 1 3.9 4.3 46 0.023**
Referring clients between agencies 86 427 92 293 0.017* 4.1 345 4.2 266 0.531 85 91 81 0.359 4.2 4.2 59 0.907
Joint service delivery or case management 73 425 72 293 0.607 3.9 298 4.0 210 0.312 72 71 79 1.000 2.9 4.0 37 0.000***
Exchanging information (about clients, projects, funding sources) 85 423 85 293 0.894 4.0 346 4.2 249 0.010** 82 92 78 0.268 4.0 4.3 53 0.116
Interagency staff training 57 416 73 293 0.000*** 4.1 227 4.0 211 0.116 59 71 78 0.233 4.1 3.7 25 0.161
Interagency meetings 83 432 86 293 0.207 4.0 342 4.0 253 0.415 87 89 82 0.824 4.1 4 59 0.903
Collocation 45 415 49 293 0.352 4.0 179 4.1 143 0.150 48 55 79 0.522 4.2 3.9 21 0.666
(a) *** Results significant at 0.000 significance level (Chi Square test); **Results significant at <0.05 significance level (Chi Square test); * Results significant at <0.1 significance level (Chi Square test).
(b) *** Results are significant at 0.000 significance level (each response was paired across the two waves, and McNemar test for repeated observation used); ** Results are significant at <0.05 significance level (McNemar test for repeated observations); * Results are significant at <0.1 significance level (McNemar test for repeated observations).

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5.2 Facilitators and barriers to effective service coordination

The CfC model was designed to support service coordination. Based on the 222 interviews with CfC stakeholders, networking, collaboration and coordination were effective within CfC sites because of the:

Although some services were already willing to work together, or had in fact been doing so prior to CfC, the support provided by CfC translated willingness into practice and provided a structure and support to strengthen pre-existing networks. Some of these issues are dealt with in more detail in Section 7 of this report in relation to the CfC model, but they are worth mentioning briefly here to highlight the facilitators and barriers to service coordination.

Funding

CfC funding specifically assigned for coordination activities was critical, as was the key role played by Facilitating Partners in making this funding effective. For example, between 2004 and 2008, the 10 SFIA sites spent almost $1.5 million on activities related to 'families and children's services working effectively as a system'. This accounted for 9 per cent of the funding for the period. Funding spent on activities within other priority areas also often had a collaborative focus or component. In fact, according to available data within the CfC progress reports, the majority of CfC sites undertook activities with at least one other partner (76 per cent), and only 11 per cent of activities had no partner involvement.

In most cases, CfC was the only coordinating program in the community. Where other coordinating programs existed, CfC was often the only initiative with substantial, or indeed any, funding for coordination. Coupled with the place-based nature of the initiative, this meant that most Community Partners were willing to collaborate and to allow the Facilitating Partner to take the lead. It is unlikely that CfC would have succeeded without funding for collaboration activities (especially if there were other legitimate candidates for leading early years collaboration in the community).

Common goal and the CfC Committee

Service coordination also worked within CfC sites because the model brought people together in a collaborative way around an important community issue—early childhood. Having a shared focus and aim helped NGOs to work beyond past atmospheres of silos and competitive tendering.

Organisations worked well together as a result of the Facilitating Partner consultation process and CfC Committee. Open discussions in the committee about the community's resources, current assets, skills and capacity of existing services, and the needs within communities, were important in getting agencies to work in a complementary manner, rather than competing with each other. Unsurprisingly, some 'turf wars' reportedly continued, with a minority of service providers remaining reluctant to share information and resources.

Facilitating Partners

The Facilitating Partners were instrumental in improving service coordination and collaboration. They not only established transparent and effective consultation and communication processes, but also helped services to work through disagreements over the course of the program. They also provided links for service networking by printing out and distributing shared resources, and assisting services to set-up and maintain formal and informal communication. In many cases, they also initiated interagency training and facilitated learning networks and joint problem-solving.

Having formal structures in place for coordination and collaboration was important, and Facilitating Partners assisted service providers to implement formal processes. But despite the fact that some services worked actively together, there were some cases where no formal structures were in place even towards the end of the evaluation. Failure to establish formal structures poses a risk to the sustainability of collaboration because, without formalised policies and processes, the success of coordination efforts depends solely on individuals.

Pre-existing networks and coordination

Service coordination was significantly facilitated by pre-existing networks (in addition to other factors). Where networks existed prior to CfC, substantial time was saved in starting and developing relationships, and joint activities were able to begin sooner. This meant that sites could focus on consolidating and enhancing service networks, and this was especially beneficial because of the tight three to four year timeframe.

Communities that did not have pre-established networks were at a distinct disadvantage. They could not be expected to develop high levels of collaboration in such a short time period.

While pre-existing early years networks were sometimes strengthened by the arrival of CfC, there was also some concern expressed about duplication of effort when both were running concurrently. There was also concern about the additional time required for collaboration. This reinforces the importance of assessing coordination and collaboration activities for their focus, their relevance and the benefit they have for all parties.

Geography

Coordination and collaboration worked most effectively in urban and regional areas because of the relatively large number of services available. However, coordination was very difficult in some rural areas and in all remote areas because of the limited capacity and resources for service delivery.

Because of its focus on service coordination, CfC may therefore be better suited for urban and large regional areas that have numerous service providers, rather than for rural and remote communities. The model is expensive, cumbersome and burdensome in communities with very few services. In such communities it would probably be more beneficial to spend time building the capacity of the local service provision and encouraging lower level coordination like referrals and information-sharing, before developing mechanisms such as the Facilitating Partner and CfC Committee which require high levels of commitment, sophisticated planning and greater resources.

Professional backgrounds

A wide range of services in the CfC areas was engaged in networking and interagency collaboration. However, some professions in the early years sector seemed difficult to integrate into a service network. This applied particularly to child care workers and some maternal and early-childhood nurses, and was probably a reflection of the time constraints of their jobs.

Government

The SFCS 2004–2009 was an Australian Government-driven initiative with minimal formal engagement with state and territory governments. However, Facilitating Partners were given flexibility to work with a range of stakeholders at regional levels, including state and territory governments as well as local government. Collaboration with other levels of government increased in each of the fieldwork sites, but it happened on an agency-by-agency basis, and was most likely to occur with local councils rather than state or other Australian Government departments.

Facilitating Partners had little impact on the large state government agencies, except where individual state government officials were interested in participating in CfC. This limited CfC from truly transforming early years provision. There was no marked change in engaging state government departments for the majority of sites between the first and second rounds of fieldwork, although the few relationships that did exist between government departments and CfC were perceived favourably both by Facilitating Partners and by government officials. For example, one CfC site had successfully engaged a state government health department, and this not only resulted in increased early years programs being implemented by the department, but also in a change in the way the department was working with the site's local community. Collaboration with state governments worked particularly well where services were provided at the neighbourhood level, for example, the CfC-initiated community centres on public school grounds. This depended on the willingness of school principals to participate.

The overall limited coordination with state and Australian Government departments was one of the weaknesses of CfC. Standard government processes, such as budget allocation and spending based on financial years, and the formal and contractual nature of working relationships, presented barriers to service coordination.

Traditional tensions relating to federalism also presented barriers. These included:

Local councils were much more likely to be actively involved in CfC than their state government counterparts. Councils were valuable in providing and sharing resources and services and co-funding CfC activities. The local councils were easier to engage because the communities were within their major remit. However, there were still barriers in some places where local councils were traditionally responsible for early childhood service provision.

Future programs should incorporate plans on how to effectively engage and collaborate with state, territory and local governments on community-level programs. State, territory and local governments, where appropriate, need to be much more integrated into the process of developing, designing and implementing major community-based funding models.

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5.3 Conclusion

CfC positively changed the service sector in CfC communities by increasing the focus on the early years and significantly improving service coordination and collaboration. Service networks and coordination continued to strengthen throughout the evaluation. Overall, service coordination improved in tandem with the rising profile of the CfC program. Service providers were more aware of other agencies' activities, generally perceived collaboration and cooperation to be helpful, and were engaging in these activities to a higher degree. The improved service coordination and collaboration generally strengthened service provision and capacity.

It is important to point out that, irrespective of the successes in service coordination and collaboration, relationships took considerable time to establish and partnerships were not always conflict-free. They required a significant investment of time and resources and a commitment to both formal and informal processes and policies.

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