Good Beginnings Australia response to FSP consultation 

Until there are effective “whole-of-governments” strategies to support families with children we will continue to be plagued by duplication and dysfunction with the service system mirroring the dysfunctional characteristics of some of our most vulnerable families.  In fact the language of the first program requirement relegates the role of State Government instrumentalities to “other relevant stakeholders”.

Serious consideration needs to be given to governance structures that will facilitate collaboration.  Please have a look at the Children’s Trust’s model in the UK and consider how this may be adapted for the Australian system where there are three, not two tiers of government.

For EG at present in NSW Commonwealth programs overlap with Families NSW, Brighter Futures, and in areas where Communities for Children have operated, there has been some  evidence of better collaboration between these tiers as a result of the actions of the precursor programs to FSP.

The FSP reflects a narrow definition of programs that support families. There are various examples of more comprehensive conceptual frameworks to be explored.

EG. A key resource document to emerge in recent years concerns the Total Environment Assessment Model of Early Childhood Development (TEAM-ECD) developed by the World Health Organisation’s Commission on Social Determinants of Health Knowledge Hub on Early Child Development (Hertzman et.al, 2007). The TEAM-ECD was developed as a means of framing the types of environments (and therefore experiences) that are integral to healthy early child development and of linking these to the biological processes with which they interact to shape children’s outcomes. The model builds on several diverse sets of literature and many past frameworks that address early child development and social determinants of health more broadly speaking.

(Good Beginnings can provide more information on this framework)

 Moving towards effective integrated approaches to service delivery requires systemic changes at the highest level as well as within local communities. A key element to support effective integration is the development of processes within government. The consultation document does not articulate any processes the government may be considering to work towards more effective integration within government departments.

The best approach would be to ask the fundamental question “What do young children need to thrive?” and “What can all the players – families, communities, service agencies comprising people from multiple disciplines and skill bases from NGOs, faith-based organisations and local and state government agencies, and the commonwealth government – do to provide these ingredients and how can we facilitate their working together.”  These questions need to be asked at a national, state, regional and local level.  Learning from the international experiences in the UK when the Blair government came into power in the late 90s these questions were asked and underpinned the development of a range of whole of government strategies such as Sure Start.  Responsibility from key human service ministers and agencies was locked in at the top and mirrored in local level governance arrangements.

One cannot build flexible service models with improved service pathways whilst agencies continue to work in isolation at the community level. It is important for Children’s health services to be around the table particularly if links are to be made with universal groups.

Good Beginnings supports the importance of an holistic approach taking into account the particular needs of the Local community. The attached model Appendix A) is referred to as ‘The Model’ but is only one of many models and there may be others that are suggested as  ‘one size does not fit all’. This model is being piloted between Good Beginnings and The Smith Family in Townsvillle.  

Flexibility is most necessary to deal with issues of access, equity, quality with particular attention given to how to attract hard to reach families, models that support access in rural and remote locations and relevant to population groups such as indigenous families, CALD families, families where a member has a disability etc

If the focus of services is based upon the needs of the child then the services around this can be provided from both an universal and targeted approach – pending the identified needs This is not clearly explained here . We need some universal services for all children and families and Government in consultation with other stakeholders need to examine the research evidence and decide what these should be .Perhaps having Governments define what they believe are the universal programs and evaluate if they actually are and if the research supports this as key service for all children and their families. Particular attention needs to be given to how to involve hard to reach families.

EG. in some areas it may be lack of transport in another the lack of staff with appropriate skills or the program which is oriented to the mainstream and so excludes others.

Good Beginnings supports a model of integrated services which could include a range of services

EG it could be a child care centre with a supported play group, parenting programs including dad’s groups, maternal and child health, therapists such as speech pathology.

There is no common agreement on the model but it also takes time to break down the existing silos and the new FSP should support an integrated approach. This is not included in the discussion paper and in the future funding should support more integration than currently exists whilst assisting services to start making the changes over the next two years. Achieving real integration takes time. Most organizations move slowly from discrete stand alone service through to more collaborative networks and then full integration. Depending on their current service systems, many organizations would not be able to achieve this within the 2 year timeline identified in the paper.

It would be an idea to look at creating one stop shops for families with young children – at present this idea seems to be lost in territorial disputes between Education and FaCHSIA with respect to where they should be located.  Being based in schools is a good idea, but generally schools alone shouldn’t run them.  Children’s centres need to be backed up by local and regional and statewide governance arrangements that engage the key stakeholders, including parents.  This is where the notion of the UK’s Children’s Trusts and Safeguarding Children’s Boards that are concerned with a whole of community approach to child protection have merit.

It is suggested that reference be made to the recent reports of the Senate of Canada on the importance of addressing social determinants of health and wellbeing and in particular their review of the Cuban approach to facilitating early childhood development. Their polyclinics could be renamed child-parent centres and clearly offer a platform for a range of services being brought together.  This agenda seems to be missing from the FSP framework.

A. Polyclinics

A key player in the country’s successful approach to maternal health and early childhood development is what Cubans call “Polyclinics.” The role of the polyclinics is far more extensive than that of a health clinic as Canadians would understand that term. These local establishments ensure integration of science, knowledge transfer, parent education and community mobilization, in addition to providing primary health care.

The polyclinics are multidisciplinary. They focus on prevention, regularly undertake universal screening initiatives and strongly encourage immunization. They also serve as a site for both medical training and education. In addition, polyclinics work closely with teachers in early child development, preschool and elementary schools. Regular meetings (every six months) are held to discuss the overall mental and physical health of the children in the community. Moreover, they serve as a resource for data collection, scientific research and a conduit for scientific advances (knowledge transfer). For example, staff regularly participate in population-wide prevalence studies designed by scientists working in different ministries.

The intimate connection between the staff at the polyclinics and the population they serve creates a health system where, at the street level, every aspect of the human condition is addressed – from maternal health care to teaching seniors to act as counsellors for grandchildren.”

There is a serious need for state governments to get common regional boundaries agreed by their human service agencies.  The Commonwealth and States could consider working together on this.  Incentives for the states to do this might be helpful.  Without this we will continue to have problems with all of our governance arrangements.

EG South Australia 30 years ago had CURB boundaries and state government agencies were required to organise themselves along these lines (or sometimes with collation of several adjacent CURB areas).  These areas need to make sense geographically and functionally.  NSW Area Health boundaries may in some instances be a bit big, but provide a model for consideration – but they aren’t the same as DET or DoCS.  Within those boundaries, regional clusters can be defined.  It is important to remember that there is a gradient effect – not all disadvantage resides in the bottom quintile, and in fact, the distribution of some outcomes is such that better penetration of programs to those who are vulnerable would be achieved by programs that might target 40-60% of the population. It needs to be noted that all communities have children/families who could benefit from FSP.

The major factor should begin with the needs of the community and from this the range of services and natural boundaries would become more prominent. It would be best to utilize a mapping process what already exists. This would avoid overlap and duplication and then prioritise the needs - taking into account what research shows can make a significant difference to child well being and family functioning. Things like the AEDI will also provide useful information to guide priority setting in communities. Government can provide ‘top down ‘guidelines, but local family and community participation is required in defining service needs and programs based on existing resources and building on existing strengths. Whichever approach is used there needs to be flexibility.

In relation to Non Governments delivering services some important questions need to be asked:

What do NGOs offer over government agencies?  Under what circumstances should they be preferred?  Under what circumstances could state government agencies be preferred? How  do they best work together?  These are serious questions particularly in an environment where in the previous government  commonwealth government investment has arguably seen greater fragmentation, lack of sustainability of programs, non-engagement of state government agencies running complementary services in the same area.

This issue is all about timing. Funding being spread over the longest time possible will assist with achieving results. This time frame needs to include a wind down phase minimum of one years clarification that funding is going to cease – not within the two weeks of the beginning of the financial year. If funding is based on outcomes determined by Governments then communities need to be monitored to identify change

EG: change from families with young children to an aging population, or a suburb changing because it becomes trendy so housing costs rise and the poor move somewhere else; inner city suburbs of large cities.

These changes should be known over time. Monitoring of research is critical as it may show a significant change is needed in the programs offered, evaluation of the programs themselves against outcomes but both quantitative and qualitative data is required. Good Beginnings is most keen to explore an implementation trial of ‘outcomes based accountability’ for the transition period of the FSP.

Universal provision should be funded for extended periods - at least 10 years - even if there are changes made to the program to reflect current knowledge. This requires an all political party ‘sign up’ which is one of the first steps that were taken in the UK and consolidates children being the future of the country regardless of political leadership

EG: home visit for all babies would look different over the years but the service would still be guaranteed.

Other funding could be for a one off event

EG: a special training program, development of resource material.

If others are to be funded for periods such as 3 or 5 years then a clear decision on the future needs to be made and a transition communicated at least one year with a 6 months transition of the two programs.

The key issue around distributing timely resources is continuity and timely notification of any funding changes. This includes regular and timely releases of funds against deliverables including mobilization or start up funds if required to commence a new program

Good Beginnings is mindful that the FSP has not increased its funding level but increased to include older children. A point to be made is the importance of the early years and how this should continue to be the focus. Unfortunately the current suggestion means less funds available for early intervention and prevention with young children prior to school.

The importance of integrated services and the key role of children’s services in the model as shown by the research are not reflected in the discussion paper.

EG: The importance of child care as an intervention strategy. Of all the single strategy interventions, high quality child care is the most effective in improving child outcomes for disadvantaged groups.

“The positive relation between child care quality and virtually every facet of children’s development that have been studied is one of the most consistent findings in developmental science’ (Schonkoff & Phillips).

The emphasis is and needs to be on program quality. When programs are of poor quality, children from these families are places in double jeopardy. The government has responsibilities through the national accreditation system to ensure programs offer good quality experiences.

When high quality child care is accompanied by programs for parents and/or communities, the gains for children are greatest. The FSP needs to focus on the role of schools and the UK Full Service Extended Schools Model and evaluation is useful.

The funding for the FSP does not represent new money. Australia currently is near the bottom of the OECD table in the amount of money provided for this area. Societies that have the most successful policies and programs in this area spend approximately 1.5-2% of GDP per year and Australia spends less than this. There are now very strong arguments emerging from the economics of human capital formation that support the cost benefits of early investments.