Charles Darwin University response to FSP consultation 

The FSP identifies six key requirements in the discussion paper. These are:

1. Strengthening collaboration between and amongst providers and community and Government
2. Improving access to relevant services
3. Ensuring services link families and children with other relevant community support services
4. Offering more flexible and responsive service delivery approaches
5. Operating within an outcome based accountability framework
6. Improving business environment for providers

All of these factors are important to support the more effective delivery of FSP services. In the context of the Northern Territory, where the Let’s Start program is delivered, coordination of services could be improved. With the introduction of the Northern Territory Emergency Response (NTER) there are a number of services being delivered in remote communities. From our experience, many services arrive in the community unannounced and compete for the same client groups. The FaHCSIA GBMs might potentially play a key role in coordinating these services. However, their capacity to assess the value of services, and to effectively coordinate them may be limited, particularly when number of different agencies are flying in and out and if they themselves lack expertise in the area of evidence-based programs.

Building capacity within the communities to engage local people in delivering programs may help embed programs and improve prospects for sustainability. Strengthening collaboration between and amongst providers, community and Government is also pivotal. However, collaboration based on ‘good will’ alone is not sustainable. If service providers are to collaborate, these networks need to be formalised. Programs operating with limited resources, in a high need, high cost environments such as remote NT will default to focusing on individual program delivery without an overarching strategic framework. According to the national evaluation, the Communities for Children framework in the NT has in this respect produced mixed results.

From a quantitative accountability perspective, fly in/fly out services may report that they have had ‘client contact’. However, the quality of contact also needs to be taken into account. Establishing relationships and trust and a basis for professional and ethical service provision in Indigenous remote communities takes time. With the number of programs available, there is a risk that families will experience program fatigue and will not access the programs of most benefit.

In setting up the Let’s Start program in one remote community, a new site for the program, the team spent six months visiting the community prior to direct program delivery. This involved regular meetings with the school principal, GBM, identifying a suitable venue and engaging with women and elders in the community. For four months of this work, the community was only accessible by light aircraft. There is a risk that outcomes based accountability frameworks would not measure the process of program set up, which is crucial to the success of a family support program.

Finally, evaluation design needs to be built in to the service provision as part of project design. There needs to be evidence of effectiveness. There is no way that “outcomes” can be inferred from intent to deliver a service, or even fa tual service delivery based on numbers participating and the usual accountability indicators: in service delivery for indigenous children and families, implementation needs to be subject to rigorous evaluation, and contextual adaptation needs to be tested through evaluative research using appropriate measures.

Recommendation:
That accountability frameworks measure the quality of relationships that are established with communities and families, and acknowledge that process is as important as, and in many respects defines outcome, particularly in regard to indigenous engagement.

That research and evaluation design should be built-in components of program design and implementation, particularly for social-emotional interventions for Indigenous families, parents and children.

To build flexible service models and improve service pathways, time for strategic planning and establishing links with other agencies and government organisations needs to be built into next phase of program delivery. This includes having the time to reflect on learnings from delivering program over the past four years to ensure continuous improvements. In our case this requires consideration of evaluation findings, materials and resource development and project redesign to ensure that program development is supported by evidence and appropriate resources and methods.

A flexible service model is where families can easily access support, preferably early before problems escalate. Schools are often viewed as a place where problems are identifies and families can initiate access services. However, relying on teachers to make referrals to different support agencies places a great deal of pressure on their time. Having a case manager (ie psychology/social work trained) on site at schools to facilitate referrals into FSPs could relieve some of this pressure. These professionals would have specific training in having the difficult conversations with parents about accessing support – it should not be an expectation that teachers fulfil all roles for children and families. It may not be appropriate to have family support programs run from schools either, so identifying suitable venues that protect the privacy of families should be an important consideration when engaging universal and targeted clients.

Flexibility may be needed in funding arrangements to ensure that appropriate collaborative arrangements can be achieved to suit local circumstances. The link between targeted and universal services in many community settings requires careful attention to decision-making pathways (in health, education, special services) and referral networks and linkages between them. Personnel may need to work together in ways that cut across the usual practice “silos”. This may require purpose-built partnerships that recognize genuine, not just grafted-in capacity. The flexible service model approach takes too much for granted in terms of the appropriateness of interventions and services for Indigenous people. Some programs in areas such as nutrition and household management training may be straightforward and really entail a focus on engagement, rather than re-design and adaptation. However, in other areas, “evidence-based” program designs, particularly in the field of early intervention in developmental health, social-emotional wellbeing, parenting, etc. simply can not be taken “off the shelf” and “rolled out”. Their implementation needs to be accompanied by regard for social and cultural context, professional/ethical accountability, and based on well-designed evaluation of effectiveness.

Recommendation:
That appropriate regional delivery frameworks are available to ensure that families can access high quality support services across their regions.

That partnerships between community agencies and providers are established in consultation with the research sector to ensure that the implementation of interventions in developmental health and social-emotional wellbeing for indigenous people are not implemented without appropriate evaluation of accountability and program effectiveness.

While promising in theory, the ‘no wrong door’ seamless approach to FSP service delivery may be difficult to achieve in practical terms. In terms of privacy and confidentiality, families may choose to provide information to service providers that they have established trust and developed a rapport with, but that they might not necessarily consent to this information being shared with other services/organisations. A way that this challenge could be addressed is by consulting with families about what information they would consent to be shared across FSP services. This may be basic information, i.e. names, address etc. However, families accessing early intervention services may object to information being stored as part of a larger service system. Families have expressed to us that they do not wish outcomes of a aprticualr program to appear on their child’s school record for example. It would need to be made clear to families that services are part of a broader Family Support Program under FaHCSIA as part of this consent process as they may not be aware that the individual program is part of a broader strategy.

Recommendation: That consultation is held with families to determine appropriate information sharing between FSP services.

From our experience of linking in with other agencies, over the past four years there are a number of challenges in developing referral pathways, particularly between Let’s Start and NT government. The Let’s Start evaluation highlights that the future sustainability of the mainstream Let’s Start program would depend on a greater degree of embedding and routinisation of the referral and promotion process within the school systems of the NT. This would require the support of senior management in education and the development of policies and guidelines to specify referral pathways to the program. It may also involve the inclusion in governmental staff job descriptions a requirement that they participate in family support program delivery. This would assist in reducing the silos that have developed between government and non government agencies and promote cross agency collaboration at the frontline.

Using Let’s Start as an example, although the main participating agencies have supported the program through cash and in kind inputs and high and regular consultation, their participation has not met the threshold which could achieve the “embedding’ of the program’s processes in departmental practices sufficient to secure a steady flow of referrals or to free up practitioners to work as group leaders in program delivery on a regular and predictable basis. Given the success achieved despite these limitations, however, it seems that appropriate agency ”buy-in” will lead to greater sustainability of the program. Engagement with a range of paediatric and developmental services and with child health providers in primary health care is a current focus. The development of promotional and referral processes in child protection in the context of the NT Emergency Response, and in terms of improving general referral of individual families in need has been initiated.

It is important, to consider the impact of any mandated participation in an early intervention family support program by families under welfare supervision. This can undermine engagement in these services if families feel ‘forced’ to participate. In terms of a group work program such as Let’s Start this could negatively affect group cohesion and reduce benefits to participants, if not handled appropriately.

The building of collaborative networks, referral pathways and exchanges of resources, personnel and information, and the alignment of specific early intervention services with relevant policy and service frameworks across sectors is a process that requires significant investment of effort. It requires a commitment to scale and to appropriate timelines for program development, and the achievement of commitments from multiple stakeholders/agency partners that can be translated into effective action.

Recommendation:
Clear guidelines need to be established to establish referral pathways, case management and agency responsibilities for making referrals between FSP services. Services do not necessarily identify as part of a common government strategy beyond that they are all funded under the same broad policy heading. Coordination between services could only be achieved if there are both commonalities and drivers: these need to be identified and highlighted.

Demographic and epidemiological research and some representation of service-level administrative data would need to be conducted in determining the range of FSP services required for a region or community to identify population characteristics such as age groups, growth, needs. However, by itself, this may be an insufficient basis for decision-making. Consultation with communities, families and community organizations can also contribute to identification of the needs of community or region. Families may be more likely to engage in services if they have been involved in the planning and development of programs, from the beginning. The Northern Territory Emergence Response has created an environment where many programs have been ‘imposed’ upon indigenous communities, in some cases producing counter-productive reactions.

More generally, funder-driven consultative processes, including some of those under the former Stronger Families and Communities Strategy have often produced superficial assessments of need and local capacity that have lead to fragmented, patchy and sometimes even frankly trivial program delivery and capacity-building outcomes. The assessment of options for program development needs to be based on appropriate consultation and investigation. The job should not be simply assigned to sole organizations lacking the capacity by themselves to deal with the whole challenge of family support on a regional basis. Partnerships between organizations, including research organizations need to be established to achieve effective and sustainable outcomes at a regional level.

Recommendation:
The implementation of the FSP needs to be accompanied by investigation of 1) family and community population profiles and needs 2) capacity to benefit from particular approaches and minimum entitlement to services 3) and capacity to deliver services to the regional population, whether from “hubs” or single communities.

Funding security for providers can be better achieved not only through extending grant periods, but by notifying providers well in advance of the expiry of their funding agreements if funds are to be extended. Staff working in FSP projects support vulnerable families. To do their job properly, program staff need to feel supported and secure in their positions. As mentioned above, building trust with indigenous communities and families is crucial to the success of our program. With a high staff turnover this trust is impossible to maintain. By providing security to program staff, we will better support vulnerable families and children. We will also reduce costs in regard to recruitment and training.

Performance indicators are a useful way of measuring performance, as long as process is assessed as well as outcomes. These indicators should be negotiated, by the funder, with individuals programs as part of the funding agreement to ensure they are realistic. If there concerns about the performance of a particular FSP program, FaHCSIA should play a role in supporting that program and clarifying what targets that program needs to achieve within specific timeframes. This should not be simply a monitoring role, as government has a responsibility for building capacity in the non government sector. If a program continues to underperform following a period of being on ‘special measures’ , it would be important to consider the needs of the families accessing that service and for them to be streamed into an alternative support program if a decision was made not to continue funding.

Recommendation: That FaHCSIA notify programs of funding, at least three months in advance of funding agreement expiry. That a system of ‘special measures’ be established for underperforming programs so programs are clear of funder expectations and targets.

Let’s Start was developed as an action research program. It has been supported by existing service delivery frameworks through the general support provided by schools and teachers and has entailed a large commitment to community engagement and service development by the Let’s Start team. The work involved in primary promotion of the program, direct engagement of teachers and parents and the building of processes of referral, have limited the research program. However, as a research trial, Let’s Start has clarified the potential for further research and development into effective early intervention with Indigenous children and families.

Investment in evaluation and research of programs to develop a solid evidence base for the Family Support Program is paramount. Research into the efficacy of preventive interventions aims to understand causal pathways, change mechanisms and treatment outcomes, ideally using valid standardized measures and randomised or matched controls. This may not be achievable for some areas of service development and program implementation. However, evaluation design has to be considered early in program design, both from the standpoint of rigour in program adaptation and fidelity in implementation and from the standpoint of evaluations that deliver genuine evidence of effectiveness, not superficial administrative accounting of expenditure and participation. The existing approach to implementation in the family support area, particularly in underserviced remote, rural and urban areas affecting indigenous people has been inadequate. Where community service provider organizations and NGOs lack the capacity to implement some or any evidence based programs there needs to be additional support. Evaluation tenders let after program commencement, at both local and national levels, have often provided poor support to program development and to date have contributed little if anything to the evidence base on program effectiveness. Implementation research needs to be a feature of service delivery from the design phase onwards. The research sector needs to be brought into partnership with service provision in family support both on a regional basis and at initial program design.

Recommendation:
That FaHCSIA redesign regional implementation strategies in consultation with the research sector both in order to provide effective support to community organizations to deliver evidence-based programs, and to ensure that there is genuine research evidence produced through its evaluations.

Extended Funding Cycles

Funding projects in the NT needs to take into account the higher operating costs of delivering services to remote communities and the medium and long terms strategies needed to build capacity. It also needs to reflect the challenges of attracting and retaining qualified multi-disciplinary teams needed for delivering complex services to vulnerable children and families.

For example, to form the current Let’s Start team, staff were relocated from interstate to build capacity and expertise in the team to the point at which it can now deliver a high quality, research evidence-based, professionally supervised treatment program based on thorough and sensitive engagement with Indigenous communities and families. This capacity has been built only in part through the core grants from FaHCSIA: it has also required leveraging of significant additional grants from agency and research funding partners.

Core funding from the federal government is an important component of attracting additional funding. The current funding offered under the transition to the FSP is inadequate and the two year time frame is insufficient to secure significant partnership funding from nationally significant third party sponsors.

The current two year transition to the Family Support Program needs to support detailed investigation of the capacity to build and deliver necessary evidence-based services across regions and jurisdictions, and partnership funding models for expansion with extended timeframes for eventual implementation need to be explored.

In our experience, while the existing partnership funding models, such as Communities for Children, have led to some improvements in capacity in underserved regions of the NT, they can be significantly improved through strengthened partnership arrangements, improved program design and less reliance on single facilitating partners or consortia if they are to help build service provision arrangements that are effective at both population and community levels.

Recommendation: The transition to FSP should quickly develop frameworks for negotiation of partnership grants to expand and sustain strategic evidence-based family support intervention programs and services in regions of the NT.