Learnings from responding to quality of care concerns

1. Learnings from responding to quality of care concerns ACWA 2008 Conference Presenter: Steve Coventry, Quality of Care Coordinator, Barwon-South Western Region, DHS (VIC)

2. Who am I? • Social Worker • 26 years in child and family services • Community sector and public sector • 2 years in new position of Quality of Care Coordinator

3. Where do I work?

4. Where do I work? • 9 LGAs, 29,600 kms • Population of 355,000 (2005) • 46,000 people under 25 (2005) • 200 children in foster care (target) • 28 in residential care (target) • 180 in statutory kinship care (approx)

5. What will I be talking about? • How do we monitor children’s safety and wellbeing in care • What is a quality of care concern? • Brief comment on guidelines • Impact on carers • Data and learnings from 2006/2007 • References • Acknowledgements • Questions

6. How do we monitor children’s safety and wellbeing in care • Talking to children and their caregivers • Looking After Children Framework • Registration Standards • Charter for Children in Out of Home Care • Incident Reporting • Best Interests Planning • Quality of Care Processes

7. What is a quality of care concern? • Quality of care concerns range from minor issues through to allegations of possible abuse or neglect. • It includes (but is not limited to) concerns about hygiene, quality of diet, inappropriate clothing, poor levels of supervision, inappropriate behaviour management, carers engaging in criminal behaviour, not cooperating with the best interests plan, treating children in a discriminatory manner, medical neglect, physical abuse and sexual abuse.

8. What is a quality of care concern? • All parties in foster care share a responsibility to ensure that children and young people in placement are provided with quality care free from abuse. At all times the safety of the child or young person, and the foster family, is paramount. (Australian Foster Care Association, 2005)

9. What is a quality of care concern? • The great majority of children residing in out of home care receive good quality care from dedicated carers • Guidelines for responding to quality of care concerns in out of home care describe the approach taken in Victoria to responding to quality of care concerns

10. Overview of quality of care guidelines – guiding principles • There are clear guiding principles relating to children and young people, carers, parents, Child Protection and Out of Home Care services. • There is important information about what children and young people want during quality of care processes. • The potential impact of quality of care processes on carers is also outlined.

11. Overview of quality of care guidelines – cultural connectedness • maintaining cultural connectedness. • a culturally appropriate response to children and carers. • essential consultation with Aboriginal organisations. • Specific procedures and practice requirements.

12. Overview of quality of care guidelines – support for people involved • Nominated liaison people for children, their families and carers. • Support person for carers and children. • Support after quality of care processes.

13. Overview of quality of care guidelines – initial screening • All quality of care concerns reported to Child Protection are screened by the Unit Manager in consultation with the Out of Home Care Manager and Quality of Care Coordinator to determine the nature of the concern and the most appropriate response.

14. Overview of quality of care guidelines – screening outcomes

15. Overview of quality of care guidelines – formal care reviews • The majority of quality of care concerns should be managed by carer support and supervision. • Where there are significant or repeated concerns (not relating to abuse or neglect), a Formal Care Review (FCR) may be required. • When the safety, stability or development of the child is placed at risk by the concerns.

16. Overview of quality of care guidelines – investigation of alleged abuse • Investigation led by Child Protection, conducted in partnership with Out of Home Care services. • The Child Protection Unit Manager or Quality of Care Coordinator coordinates investigation. • An Investigation Planning Group is established comprising the Child Protection UM, OOHC Manager and QoC Coordinator.

17. Overview of quality of care guidelines - Possible investigation outcomes • Investigations completed within 28 days of the report of concern. • The Child Protection Manager must endorse any extension of timeline. • Investigation determines if the allegation is substantiated or not substantiated on the balance of probabilities.

18. Overview of quality of care guidelines – investigation finding • Safety of children paramount • Balance of probabilities • Briginshaw principle • Reliability • Relevancy • Consistency • Corroboration • Time elapsed • Opinions of witnesses and bias

19. Impact on carers • Distress • Disappointment • Shock • Anger • Helplessness • Guilt • Sadness • Reluctant acceptance • Philosophical • Critical reflection

20. Data and learnings from 2006/2007: allegations of abuse • 19 allegations • 15 physical (79%), 4 sexual (21%) • 9 foster care (47%), 6 residential care (32%), 4 stat kinship care (21%) • OOHC providers (3-7) • 7 children moved (and no return irrespective of substantiation)

21. Data and learnings from 2006/2007: allegations of abuse • 7 allegations substantiated (37%): 3 carers accreditation withdrawn, 4 children remained with additional support and supervision • 12 allegations not substantiated (63%): 6 NFA, 6 FCR, 2 resigned

22. Data and learnings from 2006/2007: formal care reviews • 45 FCRs • 22 inappropriate discipline/behaviour management (49%) • 5 carer not following case plan (11%) • 5 poor hygiene in carer’s home (11%) • 4 context of care – alleged abuse of another child (9%) • 2 poor quality of diet provided to child (4%) • 2 carer substance abuse (4%)

23. Data and learnings from 2006/2007: formal care reviews • 21 in foster care (47%), 10 in resi care (22%), 14 in stat kinship care (31%) • OOHC providers (5-14) • 8 children moved (and no return although concerns verified in all cases)

24. Data and learnings from 2006/2007: formal care reviews • 30 concerns verified (67%): 10 FCR action plans, 16 support and supervision, 3 disciplinary procedures, 1 carer accreditation withdrawn • 15 not verified (33%): 10 NFA, 5 other concerns (4 support and supervision, 1 FCR action plan) • 3 carers resigned • Most carers acknowledged and addressed verified concerns

25. Data and learnings from 2006/2007: egs of recommendations • Client and alleged perpetrator to be in separate sections of the house, with the exception of times they can be fully supervised by Carer. • The Regional Director endorsed a recommendation for the placement to continue. The case plan is for the children to return to their mother's care in the next few weeks. The carers were provided with reading material on positive parenting approaches. • The quality of care concern should be addressed by the Care Team continuing to support Carers to adopt a positive approach in responding to Client’s behaviour, and in promoting his safety, development and wellbeing.

26. Data and learnings from 2006/2007: egs of recommendations • Carers informed during the investigation that they are resigning as carers with this organisation. The carers were advised if they wish to recommence as carers a quality plan would need to be developed indicating how they would develop an enhanced understanding and management strategies of adolescent behaviour. • It was verified that Carer's estranged partner now has a significant care role and there were some issues with the management of Client's youth allowance. This to be addressed through support and supervision. Carer's partner to be trained and assessed as a Carer. Client's youth allowance was being paid into Carer's bank account - now will be paid into Client's bank account. • The context was that the child had punched another child in care in the head. The carer smacked the child in response to this occuring. The panel agreed that the smacking appeared to be an isolated incident and the matter is most appropriately followed up by OOHC through support and supervision.

27. Data and learnings from 2006/2007: egs of recommendations • Carer’s permission to be sought for a psychiatric report detailing her mental health diagnosis and prognosis, and the likely impact of the prognosis on other family members. • Child to be assessed by Take Two in relation to her concerning behaviour, • Case manager to see client weekly to monitor her safety and wellbeing.

28. Data and learnings from 2006/2007: changes to QoC process • Emphasis on support and supervision • Learning experience for Carers • Context and system issues • Best interests consideration • Cultural awareness • Formal inclusion of residential care and kinship care • Providing record of carer interview • Carer registration • Suitability Panel

29. References • Guidelines for responding to quality of care concerns – final working draft (DHS, 2007) • BSW Region Strategic Plan 2007/2008-2009/2010 (DHS, 2007) • Australian Foster Care Association Policy and Position Statement on Allegations of Abuse in Care (ACFA, 2005) • Charter for Children in Out of Home Care (CSC, 2007) • Standards for community service organisations (Victorian Government, 2007)

30. Web links for fact sheet and guidelines • http://www.cyf.vic.gov.au/every-child-every-chance/library/publications/fact-sheets • http://www.office-for-children.vic.gov.au/placement-support/library/publications

31. Acknowledgements • BSW Regional staff and management • BSW CSOs • BSW Carers • Child Protection and Family Services Branch • Quality of Care Coordinators

32. Contact Steve Coventry Quality of Care Coordinator Barwon-South Western Region Tel: 03 5226 4598 Mob: 0400 616 286 Email: steve.coventry@dhs.vic.gov.au