(See attached PDF file for full report)
March 2002
Prepared by Des Semple & Associates
DS&A
Alternative Care Report i
1 EXECUTIVE SUMMARY 3
2. BACKGROUND TO REVIEW 7
2.1 Review Context 7
2.2 Purpose of Review 10
2.3 Conduct of the Review 11
3 OVERARCHING ISSUES 12
3.1 Governance 12
3.1.1 Authority for Decision Making 12
3.1.2 Advisory Structures 13
3.1.2.1 Peak Advisory Body 13
3.1.2.2 Aboriginal Advisory Body 16
3.1.2.3 Local Aboriginal Committees 18
3.2 Relationships 19
3.3 Communication 21
3.4 Environment 22
3.5 Lack of Diversity 23
4 ROLES AND RESPONSIBILITIES IN MANAGING
ALTERNATIVE CARE 23
4.1 Department of Human Services 23
4.1.1 Functions and Structures 23
4.1.2 The Alternative Care Unit 26
4.1.3 Funding for Alternative Care 32
4.2 Family and Youth Services 35
4.2.1 Functions and Responsibilities 35
4.2.2 Increased Demand for Alternative Care Placements 37
4.2.3 Early Intervention Services 41
4.2.4 Case management 44
DS&A
Alternative Care Report ii
4.2.5 Services for Aboriginal Families 49
4.2.6 FAYS Future Role in Alternative Care 51
4.3 Alternate Care Service Providers 54
4.3.1 Anglicare SA 56
4.3.2 Anglican Community Care 57
4.3.3 Whyalla Centacare/Port Pirie Central Mission 58
4.3.4 Port Lincoln Aboriginal Health Service 59
4.3.5 Aboriginal Family Support Service (AFSS) 60
4.3.6 Waltja Piti Aboriginal Care Program 61
4.4 Carers 62
5 FUTURE SERVICES 66
5.1 Distribution of Services 66
5.2 Future Service Models 67
6 SUMMARY OF RECOMMENDATIONS 70
BIBLIOGRAPHY
APPENDICES
DS&A
Alternative Care Report 3
1. EXECUTIVE SUMMARY
Alternative Care services in Australia and overseas are experiencing increasing
difficulties in attempting to adequately respond to families under stress and the
increasing numbers of children requiring Alternative Care placements. The Alternative
Care system is almost entirely reliant on family carers, who receive subsidies for what is
primarily a voluntary service - 97% of South Australian placements are in family care -
higher than any other State in Australia.
The profile of children and youth requiring Alternative Care services are those who are
at significant risk of harm and abuse, have frequently suffered significant deprivation
and may present with extremely challenging behaviours. In view of the increasingly
difficult and complex needs of the children requiring care, and the extremely high
reliance on a primarily subsidised volunteer family care workforce it is not surprising
that the system is under significant pressure.
South Australia, like the rest of Australia and overseas, are developing new approaches
that require a more diverse range of placements and models of care to respond to
children and young people with more complex needs. These new models require
specialised skills and higher remuneration than exists with traditional family care. It is
important that these developments occur in a way that does not devalue the contribution
of existing family carers. It is also important that existing and future family carers
receive accessible, accredited training that provides them with the necessary support to
deal with the current children in care as well as the opportunity to increase their skills to
respond to more complex cases.
The 1997 restructure of Alternative Care in South Australia created significant change
and difficulties in providing services for Government and non-Government agencies.
Despite a well-developed and thorough planning process the restructure, predicated on
the separation of purchaser and provider roles, caused many negative unintentional
consequences that have not been appropriately and systematically addressed.
DS&A
Alternative Care Report 4
Different stakeholders assumed responsibility for their part of the system without
sufficient regard for the roles and responsibilities of other parties and their
interdependence. Relationships have deteriorated and a culture of blame has developed
between different stakeholders. This culture was evident during the Review.
The Review acknowledges and addresses the interdependency between Government and
non-Government in the provision of services and has made a number of
recommendations to improve relationships between the Department of Human Services
(DHS), Family and Youth Services (FAYS), Alternative Care Service Providers
(ACSPs) and carers. Fundamental to constructive and collaborative relationships, is the
need to clearly define, understand and respect the differing roles, responsibilities and
authority for decision-making. The current lack of openness and partnership has
undermined trust of Government’s usual role and authority in decision-making.
Currently there is no formal consultative structure for joint problem solving or to assist
with regular communication between Alternative Care stakeholders. The Review is
aware that there are within DHS a number of advisory structures, including the
Children's Interest Bureau, which assists in the policy and planning on children's
matters. These structures are most useful in providing advice on overall policy and
planning issues, however do not have the level of detailed understanding of the specific
matters that need to be addressed within the Alternative Care program. A major
weakness identified by the Review is the lack of implementation of a large number of
important matters that had been identified in earlier reviews and/or working parties. It
is therefore proposed that a Alternative Care Advisory Committee be established, with
representation across all relevant stakeholders, to advise on policy directions, service
development and communication strategies and to assist in the implementation and
monitoring of recommendations of the Review.
The majority of the Review recommendations address the significant improvements
required in practice and service delivery standards. The implementation of standards
for all service providers, appropriate training for workers and consistent application of
policies and practices in Alternative Care would result in substantial, immediate
improvements in relationships and case management. Lack of change management, and
DS&A
Alternative Care Report 5
failure to implement recommendations from previous reviews, has been a systemic
weakness and contributed to some of the deterioration in relationships between the
sectors.
Consultations with both the Government and non-Government sectors reinforced the
need for an incremental change management approach. While all stakeholders
recognise the need for change, service providers including carers, indicated that radical
system level changes would be counter-productive and result in the probable withdrawal
of services by a number of critical providers.
Many submissions indicated the difficulties of providing increasing demands for
flexible and innovative services within existing limited resources. The current contract
allocation to agencies for family placements and family preservation services provides a
set budget amount for a variable demand. This arrangement is not consistent with
standard Government funding policies that vary the resource allocation according to the
number and complexity of cases. It also makes the budget process difficult, as it does
not relate to any unit costing. Recommendations have been made to address this issue.
DHS provides an important opportunity to ensure that children and youth in Alternative
Care have improved access to services across the portfolio. The Review strongly
endorses the view that all of DHS, not just FAYS, has responsibility for the improved
delivery of Alternative Care services in South Australia. The creation of the
Alternative Care Unit in DHS establishes the separation of program management from
service provision by FAYS and ACSPs. The Unit’s responsibilities to provide quality
assurance, monitoring and evaluation across the sector were strongly supported by all
stakeholders.
The Review has made a number of recommendations relating to improvement in the
services provided by FAYS. These address standards of practice, the need for a culture
change to improve relationships with the non-Government sector and more emphasis on
early intervention as an integral part of Alternative Care services. Residential care,
provided through the Community Residential Care units, should remain an ongoing
responsibility of FAYS and be more integrated with other Alternative Care services.
DS&A
Alternative Care Report 6
ACSPs need to work more closely with FAYS and DHS, to incorporate strategies to
improve the recruitment and training of carers to maintain the higher level of skills
required to support the young people currently requiring placement. The Review has
not proposed radical change for the provision of existing family based care, but there
are number of recommendations regarding additional new models of care and the need
for a policy framework to manage the increasing number of Individual Packages of Care
(IPCs).
Family based carers will continue to be the main service providers for Alternative Care
in South Australia. As in other states of Australia, carers are under significant stress in
attempting to manage increasingly difficult children and young people.
Recommendations have been made to provide SAFCARE with more resources to
represent carers in ongoing policy and practice developments as well as providing peer
support. Carer recruitment and training are also addressed. The Review recommends
further examination of a range of financial and other initiatives to enhance children's
placements and life opportunities including Special Needs Loadings, Brokerage and
Respite Care.
Relative care is significantly under utilised in South Australia compared with all other
states. Recommendations for increased early intervention would improve the current
assistance available to support these placements.
Aboriginal children are over-represented in Alternative Care in South Australia. The
Review recommends a number of structural and practice changes to affirm the
Aboriginal Child Placement Principles and ensure more attention is placed on kinship
care and other culturally appropriate placements. In addition, an Aboriginal Family
Advisory Committee should be established, as well as additional structures at local level
to increase the involvement of local Aboriginal communities in developing services for
families.
DS&A
