CRADLE TO KINDER Performance and Impact Report August 2020
Research, Outcome Measurement & Evaluation (ROME) Unit, Family Life
CONTENTS
Executive Summary 3 Introduction 4 Program Description 5 Program Overview: A window of opportunity 5 The Model 5 Methodology 6 Aim of the report 6 Data collection process 6 Limitations 6 Profile of C2K families 7 Complexity of issues 8 Service Delivery 9 How much did we do for our families? 9 How much did we engage our families? 10 Quality of Service Provision 11 Trauma-Informed Practice 11 Attachment Theory 12 An Ecological Approach 13 Complexity of the strategies used to support our clients 13 COVID-19 Context 14 Impact of the C2K program 15 Quality Case Study: The families behind the stats 20 Families’ Voice: Reactions to the program 21 Conclusion 22 Acknowledgments 22 References 23
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Cradle to Kinder - Performance and Impact Report | August 2020
EXECUTIVE SUMMARY
Unprecedented times challenge us all. Where existing family equilibrium is already destabilised by experiences of trauma, marginalisation and disadvantage, the consequences can be devastating. In recent times Family Life has drawn on our years of knowledge and experience partnering with vulnerable families and collaborating with the broader service system to ensure that children and families remain seen, heard, resourced and supported to meet both anticipated as well as unprecedented challenges. Our Cradle to Kinder (C2K) program is a case in point. Since 2017 Family Life has provided this service to 97 vulnerable young mothers (under the age of 25) and their families. The C2K program provides targeted intervention through a whole-of-family service approach, with early intensive, wrap-around and preventative long term assistance, including intensive and specialised early parenting support to strengthen the relationship between parents and their children. In this way, we assist parents to meet the health, development, safety and wellbeing needs of their infants and young children. In addition, the program helps parents to build their own self-reliance and sustainability through empowerment to access education and employment. Overall program objectives include: • I ncreasing connections with culture and community;
This report demonstrates our journey in supporting families to realise the C2K objectives. We highlight: • T he profile of the families accessing the C2K program: a high number of Aboriginal and Torres Strait Islander families receive support through the C2K program, through our partnership with the Victorian Aboriginal Child Care Agency; • T he key vulnerabilities experienced by families, which include experiences of family violence, mental health issues, financial hardship and developmental concerns for children; • T he complex, intersecting issues experienced by families, including the overlay of intergenerational trauma, marginalisation and isolation from community; • T he quality of service provision: practice is informed by theory and research related to trauma, attachment, cultural knowledge and awareness and ecological systems theory; • H ow Family Life “leaned in” to the COVID-19 challenge and managed to keep families connected and engaged. The program is testament to the rapidly growing body of research highlighting the necessity of intervening early in life, and early in the life of the problem.
• Strengthening parenting capacity; • P romoting positive parent-child relationships and attachment; • P romoting the family’s financial and social self reliance; • S trengthening parent’s mental health, problem solving and communication skills; • Promote child safety and stability; • I mprove child health and optimise child development and well being from pre-birth up to four years of age.
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INTRODUCTION
Family Life is a specialised child and family services organisation with a wellestablished footprint across the south eastern suburbs of Melbourne through fifty years of service delivery. To achieve our vision of capable communities, strong families and thriving children, we provide holistic, therapeutic and practical services, support and community connections. Over 247 volunteers enhance the value of 188 staff. Our long connection to the local community has enabled an extensive network of community partnerships and connections are leveraged to enhance outcomes for clients. Family Life knows that children thrive when they grow up in families where parents are able to actively promote their positive growth and development. It is often difficult for families to do this important work without support and additional resources. We also know that childhood experiences, both positive and negative occuring in the context of family, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. Adverse Childhood Experiences (ACEs) have been linked to risky health behaviors; chronic health conditions; limited access to opportunities for education, employment and personal development; and early death1. Parents and children referred to the Cradle to Kinder (C2K) program have experienced a range of ACEs. For example, children referred have particular vulnerabilities in relation to: • E xposure to and/or direct experiences of family violence, parental mental health and/or substance use; • Unstable accommodation;
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1 https://www.cdc.gov/violenceprevention/acestudy/resources.html 2 KPMG (2016)
• L imited exposure to opportunities for healthy development, for example, learning through developmentally appropriate play, stimulation through music, being read to and access to relevant support services to address developmental concerns. During the phase of late adolescence and young adulthood, individuals begin to expand their capacity for empathy, to think and plan for the future, and develop a sense of identity2. Experiences of, or exposure to violence during this critical phase of their life has the potential to negatively impact on their transition into further education, employment, independent living and establishing healthy relationships. Violence and other adverse childhood/adolescent experiences also contribute to conditions such as depression, anxiety, alcohol and drug abuse and obesity. Parents of children in the C2K program (often individuals in late adolescence and young adulthood), have the opportunity to transform their ACEs through targeted C2K support, and prevent the intergenerational transmission of trauma. Family Life successfully applied to deliver the Cradle to Kinder program. From July 2017 to June 2020, we have worked with 97 families. This report aims to provide an overview of the performance and impact of the C2K program in the families we have supported.
Cradle to Kinder - Performance and Impact Report | August 2020
PROGRAM DESCRIPTION
Program Overview: A window of opportunity The Cradle to Kinder (C2K) program provides a targeted antenatal and postnatal support service that offers intensive and long-term family and early parenting support to vulnerable young mothers (under the age of 25) and their families. Families can commence the program during pregnancy and continue until the child is four years old. Young mothers who are known to find it difficult to maintain engagement with services are priority3. These include for example, Aboriginal women, women who are or have been in out-of-home care, and women with a learning difficulty4.
The Model The service provides a combination of individual and group, centre/community and home-based interventions and supports. The program’s model is based on a whole-of-family service with early intensive, wrap-around and preventative long term assistance for vulnerable families. Intervention includes information provision on topics such as maintaining a healthy pregnancy and targeted
education around child development and parenting techniques (e.g. sleeping, feeding and routines). It also provides intensive and specialised early parenting support to strengthen and relationship between parents and their children. This assists parents to meet the health, development, safety and wellbeing needs of their infants and young children. The program also helps parents to build their own self-reliance and sustainability through access to education, vocation training and employment.
The C2K program’s objectives align with Family Life’s overall purpose of supporting children to thrive through strengthening families in the context of building and supporting capable communities. Our deep community footprint, robust collaborative, sector wide relationships and suite of wrap around child and family services ensure an enhanced response to meeting the C2K objectives.
Alignment of the C2K Program Objectives with Family Life Outcomes Framework Program Objectives Strengthen the parent/carer’s mental health, communication and problem solving skills Increase the family’s connection to their culture and community
Strengthen parenting capacity Promote positive parent-child relationships and attachment Promote the family’s financial and social self-reliance
Promote child safety and stability Improve child health and optimise child development and wellbeing from pre-birth up to four years of age
Family Life Outcomes Framework Capable Communities
Strong Families
Thriving Children
Adults, young people and children learn and participate within supportive communities
Families experience positive wellbeing and strong and respectful relationships
Children and young people experience optimal development and are safe from harm
3 Victorian Government (2017) 4 Victorian Government (2013)
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METHODOLOGY Aim of the report This report aims to provide an overview of the performance and impact of the C2K service provided by Family Life and will focus on the following aspects of the program: (1) Quality of service provision for the target group: vulnerable young mothers and their families; (2) Capacity to respond to the complex needs of the families we support; (3) The extent to which the program achieves its overall objectives.
Data collection and analysis process A mixed methods approach, combining a range of qualitative and quantitative methods, was used to obtain a detailed picture of the C2K program and allow for triangulation of information to confirm and support findings5.
Limitations While the methodology aimed to capture the perspective of a diverse group of stakeholders, limitations need to be acknowledged and should be considered when reading this report: • M onitoring data: Sample size varies per variable. This could be due to lack of data available to the
practitioner and/or due to the field not being a mandatory field. • S napshot surveys of clients: Response rates vary from 30% to 61%. During the last snapshot, a different survey was used to reflect Family Life’s updated Theory of Change and the COVID-19 pandemic situation. • I nternal families progress reports: Level of depth was limited to the data available. Qualitative analysis was conducted only for one year of the service. • O utcome measurement tools: Limited sample size and lack of consistent data during the time of the service. Not enough families have completed their service yet. Data compares progress at different stages of the service and is not the same for each family. Possibility of bias during the first time the data was collected as parents might be scared of losing their child if they rate themselves low, particularly on the “keeping your children safe” domain. There was a change of the measurement tool on April 1st 2019. • F ocus groups with practitioners and case study: the possibility of bias is acknowledged regarding participants’ own involvement in the service.
Content analysis of internal families progress reports To understand complexity of family needs, service delivery and impact of the service
Descriptive analysis of monitoring data To understand families’ profile and service delivery
Thematic analysis of snapshot surveys of clients Completed every 6 months by C2K families to hear their voice regarding quality of service delivery Thematic analysis of focus groups with practitioners To understand the key elements of the service, effectiveness of the service delivery and impact
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Data collection and analysis process
Descriptive and statistical analysis of outcome measurement tools To understand the impact of the service
Case study Application of trauma-informed evidence based intervention to practice
5 Monitoring data: 2017-2020 (n=97 families; n=430 individuals); Internal families progress report: 2019-2020 (n=36 current families); Outcome measurement toolFamily Star Plus: ( n=9 which represents 25% response rate - with an average time between time 1 and last data collected of 15 months per family); Snapshot surveys of clients - only qualitative data was included: 2017-2020 (April 2018 (n=10); October 2018 (n=17); April 2019 (n=17); October 2019 (n=16); May 2020 (n=22); Total= 82 and average response rate of 45%); Case study: (n=1); Focus group with practitioners: 2020 (n=5)
Cradle to Kinder - Performance and Impact Report | August 2020
PROFILE OF C2K FAMILIES Since July 2017, the Family Life C2K service has provided support to: Mother in Out of Home Care
90% 97 families
(430 individuals) during both the case management and group work.
33% Yes 67% No 58% are first time mothers. 149 children under the age of 4.
of these families had a young mother under the age of 25.
63 people who identified
as an Aboriginal and/ or Torres Strait Islander person, representing
14%
of the individuals we have supported in this service.
*n=48
This data reflects success in engaging Aboriginal and Torres Strait Islander people. This is significant, given the over-representation of Indigenous children in child protection and out-of-home care services, compared with non-Indigenous children. It is hoped that early engagement with culturally sensitive family support services such as the C2K program may reduce the numbers of Indigenous children entering child protection and out of home care services. This suggests the need of continuous improvement of mainstream service provision.
Families’ Housing Tenure
Families’ Household Status
Renting public housing
23% 23%
Renting from private owner Transitional housing/boarding Occupied rent free arrangement Purchasing a house
8% 2%
44%
37% have single/lone parent status 25% are couples with children 17% live at home with other family members 22% are in other family/household arrangements
*n=52
*n=65
Highest Level of Education Attained by Mothers
20%
Primary education or below
1%
Bachelor degree
Families’ Source of Income Government pension/benefits *n=69
17%
Vocational Education & Training Course 6 Australian Institute of Family Studies (2020)
Partner or carer
62%
Secondary education
Child support maintenance Employment (Full or part time) No source of income
23% 6% 3% 1%
67%
*n=70
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Families are referred to the C2K program for different reasons. Internal family progress reports related to primary support needs were coded using an inductive approach7. All families currently receiving a service were included in the analysis. The main identified themes were: Develop work and/or educational skills
Parenting issues and skills - includes out of home care
Community support and accessing support services
Mental health issues
Understanding developmental needs
Housing
Material aid and financial hardship
Alcohol and drug use
Family violence
Relationship concerns
Self-esteem, self-worth and confidence
Physical and intellectual health and wellbeing
(72%)
(50%) (42%)
Emotional support
(28%)
(53%)
(69%)
(50%)
(47%) (14%)
(47%) (31%)
(36%)
(25%)
Boundaries and behaviour issues
(17%)
These findings echo previous research on the Family Life C2K program8 which suggests that our clients experience vulnerabilities such as domestic violence and abuse, physical and intellectual disabilities, limited educational attainment, substance use problems, chronic or recurrent homelessness, poverty and/or lack of economic independence, lack of access to supports, refugee status, social and institutional effects of racial discrimination, and long-term intergenerational effects of colonisation.
Complexity of issues Families in the C2K service have multiple and complex needs9. For 70% of our current families more than 5 support needs were identified; for 25% current families and between 3 and 4 support needs were identified. Between 1 and 2 support needs were identified for only 5% of our families. This complexity was confirmed by C2K practitioners during the focus group. They pointed out that parents commencing the service may experience issues related to attachment, trauma, mental health, family violence, and unhealthy relationships (with partner and/or parents). They may struggle to prioritize their children’s needs over their own, when they themselves are adolescents with their own adverse childhood experiences. Furthermore, neuroscience demonstrates that their brains, particularly the areas responsible for reasoning and abstract thinking, are not yet fully developed.
“Society expects them to parent but they are teenagers - normal development for teenagers is to only think about themselves.” 8
An example of a family accessing the C2K service with a complex situation... Relationship concerns “<Fer> wants to have a good and working marriage without any conflicts.” Using AOD “<Fer> wants to keep her family home safe and free from the overuse of Alcohol and drug use.” Material aid “<Fer> needs a bed to feel comfortable and not being a trigger for her.” Parenting issues “<Fer> has expressed she would like <her child> more regularly in her home.”
An inductive approach aims to generate findings emerging from the data - without a theory to test. Cook, et al. (2019) Analysis of the the internal families progress report
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Understand developmental needs “<Fer> has agreed to have an Ages and Stages Assessment done on child to check his word vocabulary.” Community support “The children to be familiar and comfortable with their own culture.” Mental health “MH issues.” Emotional support “Due to the children coming back to her care. She would like them to have an independent person to talk about the impact this has on them.”
Cradle to Kinder - Performance and Impact Report | August 2020
SERVICE DELIVERY How much did we do for our families? From July 2017 to June 2020, we have provided...
11,000
113
Hours of support Hours per family to our families (average)
1408
2926
visits to families at their home
visits to families at other locations
2973
2340
Calls
Contacts using email, phone messages or video conferences
We provide this service for clients from 69 different suburbs from across Victoria. However, our clients are mainly located in the Family Life catchment area (Frankston - 35%; Mornington Peninsula - 22%; Kingston - 12%; Glen Eira - 5%; and Bayside - 5%).
According to the practitioners who participated in the focus groups, a key successful element of the C2K service delivery is the timeframe for the program which provides time to build trust and rapport, engage in psychoeducation and skills development for parents, offering meaningful and timely strategies for parents. This creates consistency of engagement and opportunities to repeat and consolidate intervention to support positive interaction between parents and their children. Practitioners expressed that these are the elements that contribute to long-term and sustainable outcomes for both parents and children. Constant, ongoing service provision is less damaging and disruptive than having to go through multiple programs a number of times.
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“Shorter programs focus mainly on crisis, C2K dives deeper and <families> can reach more goals...there is time to build autonomy and resilience within the families.” “Length of program is beneficial for children too... consistency of having a reliable person <worker> in their life.” “I have seen massive long-term change in multiple areas… young mums going back to study, getting jobs, getting their licence; children entering childcare/kinder; going to school...a lot of growth and insight into their trauma.” (Focus group participants’)
How much did we engage our families? Practitioners suggested that engagement in the C2K program is achieved as families build trust in their workers. Families do not need to tell their story multiple times and practitioners can refer them to skills previously learned. This resonates with the families, see quote below:
“Family Life is an amazing organisation which doesn’t limit the lengths to which they help their participants and families. It’s rare in my life where I feel like I can turn to someone and just know for certain they’ll try to help. I know that with <my worker> and family life - have been the only continuous support and friend I’ve had in years and I’m eternally grateful that <my worker> and the organisation came into my life when they did - <my worker> saved my life. And I’ll be forever trying to be as good of a person as she is! Thank you.” (participant of the snapshot survey May 2020, more than 1 year in the service)
Time in the service & reasons for disengagement
Current families
n= 36
40% 26%
Previous families
n= 59
40% 31%
20%
24%
11% 1-5 months
5% 6-11 months
1-2 years
More than 2 years
Family moved from area -36% Family did not engage - 22% Family withdrew - 14% Family ceased contact - 10%
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1-5 months
6-11 months
1-2 years
More than 2 years
Family completed service - 8% Family referred to other agency - 8% Client attending school - 2%
Cradle to Kinder - Performance and Impact Report | August 2020
QUALITY OF SERVICE PROVISION Family Life’s C2K practice framework is grounded in principles of trauma-informed and attachment focussed practice, responding to trauma in a way that emphasises physical, psychological and emotional safety and creates opportunities to rebuild a sense of control and empowerment in relational context. Evidence demonstrates these approaches are critical to effectively respond to the needs of vulnerable children and families.
Trauma-Informed Practice Family Life’s C2K program works with infants and their families where the infant has been exposed, or is at risk of exposure, to toxic or chronic stress - exposure can occur from conception- such as family violence and/or parental mental health concerns and substance misuse. These experiences can trigger a trajectory of child protection involvement, removal of the child from parental care and placement in state-funded out of home care settings. Monitoring data10 suggests that 70% of the total number of individuals we work with have had previous child protection history when arriving to the service. From those, almost half are over 18 years old; 41% are under 18 years old and 9% are unborn.
The C2K program aims to interrupt this trajectory through intervening early in the life of a child. Internal families progress reports11 suggest that trauma-informed practice is used with C2K families:
“We don’t “do” for the client, we work alongside them and let them be the drivers of their own lives.” When children experience abuse or neglect, their capacity for regulation and coregulation is diminished. The C2K program at Family Life is informed by the Neurosequential Model of Therapeutics, which enables us to support the regulation and development of areas of the brain where functioning has potentially been compromised as a result of trauma. Our intervention supports healthy development across the functional domains of sensory integration, capacity for relationships, regulation and cognitive development.
78%
Empowerment and support
Creating safety
35-25%
Strategies to cope Education/information provided
Understanding needs
22-14%
Strength-based approach Self-care strategies
“C2K is a unique program in Victoria that is able to use trauma-informed practice. Because of the length and complexity of the trauma, we are able to create safety for the families, and provide them with the space to start healing… we walk alongside them.” (Focus group participant’)
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Monitoring data from the service (n=176) Internal families progress reports notes (current families n=36) of the 2019-2020 period related to the strategies we use to support our clients were coded using a deductive approach following key elements of trauma-informed service delivery and the theoretical basis of trauma informed models of care (Wall, Higgins & Hunter, 2016).
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Attachment Theory Trauma, whether current or historic, can interfere with the capacity of parents and carers to provide attuned, timely and appropriate responses to infant cues. The inability of a caregiver to read a childâ&#x20AC;&#x2122;s signals and respond appropriately has been linked to a number of poor outcomes later in life12. The C2K program offers therapeutic interventions aimed to repair ruptured attachment relationships between infants and their parents. The aim is to support parent/infant interactions where parents provide a secure base for infant exploration and development as well as a safe haven for comfort and protection when the stress response is activated. The internal families progress reports review suggests that positive attachment strategies have been used with 17% of current families during their individual sessions during the 2019-20 period. However, we have been also providing attachment informed interventions13 such as:
Best Interests Case Practice Model Used with every single client to develop assessments based on the developmental needs of the child, identifying where parents need support and creating a Family Action Plan Group work with mothers who have experienced family violence Mothers bring their infants and connect and interact with volunteer support Infant massage Supporting parents to connect with their infants through positive touch
Attachment Theory
Parent-child Mother Goose program To strengthen attachment by introducing them to the pleasure and power of rhymes, songs and stories together
Baby music group
Dozier, Stovall-McClough & Albus, (2008) Infant massage: One of our staff members has been trained in and has provided training to participants; Circle of Security group: This group has been running each term since the beginning of 2018 and alternates between running from Sandringham and Frankston each term so that clients from across the catchment have capacity to attend; Group work with mothers who have experienced family violence: A specific group was created to support mothers with infants who had experienced, or were currently experiencing, family violence. This group ran from September 2018 to mid 2019; Parent-child Mother Goose program: Two of our staff members have been trained in Mother Goose facilitator training and have run this for two terms out of Mordialloc Community Centre; Baby music group: This group has been running since mid 2019. 12 13
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Circle of Security group Supporting parents to provide a secure base and safe haven for their child
Cradle to Kinder - Performance and Impact Report | August 2020
An Ecological Approach The Family Life C2K program creates rich ecosystems around infants and their parents and ecological theory forms one of the core theoretical underpinnings of the model. This is lived through strong partnership which brings together key parts of the system to provide connected, and best practice service. Strategies informed by ecological systems theory, utilised by our C2K practitioners, to support the complex needs of our clients include- as per the internal families progress report and the focus groups with practitioners:
Interagency collaboration & referrals E.g. speech pathology, occupational therapy & mental health assessment & review
Encouragement to participate in community activities
75%
92%
Complexity of the strategies used to support our clients During the 2019-2020, the internal families progress reports review suggested that due to the complexity of the vulnerabilities of our families, a variety of strategies were used to support them: 50% of our families were supported using at least five different strategies; 42% were supported using three or four strategies; and 8% were supported using between one and two strategies. These strategies reflect the integration of trauma and attachment informed approaches and the ecological systems approach.
Assertive outreach “It is a very hands-on role: outreach going to their homes, going with them to appointments, etc...lots of clients don’t have driver’s license”
Active participation in the child’s care team “We work with the whole family. It is a holistic approach” The families are part of the group of people involved in directly supporting the child and the family
An example of a family supported by the C2K service using more than 5 strategies...
Interagency collaboration “<Ana> was linked in with a psychologist at Family Life commencement for mental health support. <Ana> has identified various challenges that require support and would like support to access relevant support services.”
Create safety “<The worker> to continue to support <Ana> to develop safety measures to lower the risks of family violence. <Ana> to contact the police if required.”
Encouragement to participate in activities “<Ana> was linked into Frankston House Sanctuary of Learning and Goodstart Early Learning Centre for childcare.”
Education & information provided “<The worker> provided <Ana> with the contact details of community services that can support with food and material aid within the community.”
Empowerment & support “<The worker> and <Ana> attended Salvocare and Orange Door to investigate possible housing support options for <Ana> and the children.”
Skills building “<The worker> to provide ongoing psychoeducation on the characteristics of family violence. Worker and <Ana> to create a budget to support essential financial needs.”
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COVID-19 Context Family Life’s proactive response to the disruption caused by COVID-19 included a literature review, identifying how community based services have effectively responded to pandemics in the past. This review identified the need for a safety planning guide to effectively engage families on a weekly basis. This assisted the risk assessment process and enabled the creation of a current but flexible self-determined plan of action, taking into account diminished visibility of clients and potential stress associated with restrictions on movement. From the week beginning on the 6th of April until the date of this report, there have been 354 contacts with families; this represents on average, 30 families being contacted weekly. The main risk safety concerns identified by practitioners during the safety planning process include: Mental health issues Child wellbeing concerns
28% 26%
Family violence Relationship concerns Drug and alcohol related issues Isolation Disability Pregnancy/unborn child
10%
41% 38%
5% 3% 3%
The Research and Evaluation Team also developed an online survey to understand further support needed during the pandemic. In total, 22 individuals (61%) responded to the survey. On average, respondents mentioned three challenges. The main challenges mentioned by families include: Mental health and wellbeing Access to services Having additional carer responsibilities Financial constraints Safety Access to technology
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During the Focus Groups, practitioners acknowledged that the current situation puts families at risk by having to be at home with their children all the time without the strategies to manage, entertain and stimulate their children. Unfortunately, due to the restrictions, practitioners have not been able to provide the same intensive support (including access to material aid). To deal with this situation, and keep connection with our families, the C2K team was creative and flexible. For example, they are (1) using technology to engage with families; (2) created activity/care packs for families purposely made for parents to do activities with their children to build their parenting skills, promote positive attachment,
18%
23%
36%
44%
55%
64%
and support child development, and (3) make sure children are safe by following up with other services such as childcare.
“COVID-19 can be a stress for parents but also bring families together to stop and reflect and re engage with their children…families I work with have come far more resilient than anticipated. They share what is happening in their lives with videos and photos and bring the kids on the video and we do fun activities over the phone.” (Focus group participant)
Cradle to Kinder - Performance and Impact Report | August 2020
IMPACT OF THE C2K PROGRAM
What would be the risk for vulnerable families with complex needs not having the support of a program like C2K? During the focus groups, practitioners identified that without the support of the service, families would be negatively impacted on issues such as:
Having child protection involved
Affecting their confidence in accessing support services
Having their child removed from their care
47%
Reached their goals fully or substantially
40%
Almost reached their goals partially
13%
Did not reach their goals
“Becoming a parent in general is tough with all the support and resources available, so imagine having complexities and being a teenager.” In total, 59 families have finalised their service with us, including those who didn’t engage, disengaged or were transferred to another program.
Having to go through the system a number of times
For those who engaged long enough to set goals (n=38), at least 87% reached part of their goals.
Family Star Plus is the outcome tool Family Life uses to support practitioners and the families they work with on their journey to improve life for both them and their children. The tool has 10 areas of life with a ten-point scale that measures how the client feels, how they are coping, and what they are doing to address difficultes (physical health, wellbeing, meeting emotional needs, keeping your children safe, social networks, education and learning, boundaries and behaviour, family routine, home and money, and progress to work). At Family Life we use this tool to assist practitioners setting goals with clients, clients reflecting on their journey, and measuring outcomes. Overall, from families currently receiving the service, the data suggests that at the beginning of the service
they mainly needed support in the following areas of the Family Star Plus tool: wellbeing (median=4); boundaries and behaviour (median=5); and progress to work (median=4). These scores suggest that families are concerned with, and struggling in, these areas. The data suggests that the service had a positive impact on these domains. On average, after 15 months from the first data collection, all areas improved between two and three points on the measurement scale. This improvement could be translated into families finding ways of meeting theirs, and their children’s needs, but still needing support. These families are still in the service so these results reaffirm the need for the length of the service.
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What are the benefits for the C2K families?
Legend
To understand the impact of our C2K service, different methods were used (see methodology section). Triangulation14 of the data was done to confirm and support the findings. The presentation of the findings are based on the program’s objectives and data source (see Legend image)
Qualitative analysis of internal families progress report
Focus groups with practitioners
Outcomes Star: Family Star Plus data
Monitoring data
Increase the family’s connection to their culture and community
Social connection/participation in community activities was achieved by 39% of families (n=14)
Increased cultural connection by providing culturally appropriate services Individuals who identify as ATSI are assigned to an Aboriginal worker to ensure their needs are appropriately identified. Practitioners have consultations with VACCA to provide a culturally appropriate service. People who want to be part of VACCA are referred
Practitioners encourage individuals from CALD communities to engage more with their community - if safe to do so; and use interpreters, when needed, to ensure families receive the information accurately
“A young mum from <a CALD> community who was experiencing family violence and was in a transitioning house...there were many barriers (e.g. cultural differences, making sure she actually understood, lots of repetition)... now she is engaged in her community and with her extended family, she is undertaking further education and her child is full time”
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Triangulation refers to the practice of using multiple sources of data or multiple approaches to analysing data to enhance the credibility of a research or evaluation study.
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Cradle to Kinder - Performance and Impact Report | August 2020
Promote positive parent-child relationships and attachment
Caring for children/ understanding their needs (n=11, 31%)
Increase in attachment-promoting behaviours
“Parents learn what attachment is as they might not have that experience from their own childhood - for example, eye contact” Increase in skills to promote positive parent-child relationships. They achieve this during home visits, role modeling, demonstrating behaviours and linking them with services that could provide more guidance
“Teaching parents how to play with children...parents enjoying interacting with their child. For example, there is a father who didn’t acknowledge his children or speak nicely with them...now he is engaging in activities with the children like reading to them and talking in a lovely manner”
Strengthen parenting capacity
Self-esteem and confidence/ independence improved (n=5, 14%)
Supporting skill development, empowering them, and building their confidence
“Mum wasn’t confident in parenting, doubted herself, had a child with needs and didn’t want to get support for him. Through reflection on her parenting and working with her, she got support for her child. She was also empowered to move out of area by herself (normally wouldn’t have done that before) due to a family violence situation”
There was an improvement on the “boundaries and behaviour” outcome domain of 2 points (from a median of 5 “trying” to 7 “finding what works”)
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Promote the family’s financial and social self-reliance
44% of our current families were provided with material support (n=16) during the 2019-2020 period
Practitioners supported families in building capacity in basic life skills such as cooking, managing finances, getting their driver’s license etc.
Parent’s participation in education or employment improved (n=11, 31%)
They have seen growth over the years in these areas
There was an improvement on the “progress to work” outcome domain which had a median increase of
2 points
(from a median of 4 “accepting help” to 6 “trying”)
Improved finance skills and how to manage their finances (n=5, 14%)
Strengthen parent/carers’ mental health, communication & problem solving skills
Families improved their communication skills and relationships (n=5, 14%)
Families have become more confident in accessing services and understand how to advocate for themselves
Improve child health and optimise child development from pre-birth up to four years of age
Families are accessing care (n=22, 61%) Children are participating in childcare/kindergarten (n=9, 25%)
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Same as internal families progress report
There was median improvement on the “wellbeing” outcome domain of 3 points (from 4 “trying” to 7 “finding what works”) This increase is statistically significant (p=.03) from the first time and the last time the tool was used with families (on average, 15 months difference)
Cradle to Kinder - Performance and Impact Report | August 2020
Promote child safety and stability
The length of the program is beneficial for children as it provides them with consistency of having a reliable person (worker) in their life
The program promotes child safety and a stable environment (n=13, 28%) 40% of those who reported alcohol or other drugs reduced their intake
Complexity of the impact More than 5 outcomes
Children are less likely to be removed as parents get the support to develop parenting skills and create safety
27 referrals to antenatal services 75% of those mothers with
a history of out-of-home care, currently are not in that situation Practitioners have supported families with, and during, Child Protection involvement
Based on the internal families progress review of the 2019-2020 period, families achieved (self-reported or noted by their practitioner):
25%
Further impacts are likely as families are stepped down into other wrap around services (in average 2 per family) such as: mental health support, housing and financial counseling, family violence counselling or Men’s Behaviour Change Program, speech pathology, occupational therapy, parenting education and support, disability support and AoD support.
Between 3 and 4 outcomes
36%
Between 1 and 2 outcomes
25%
An example of a family supported by the C2K service with more than 5 outcomes... Improved relationships “<Louise> now has all her children living with her…<the youngest> is really enjoying having his older siblings with him.”
Social connection “The family come together for any cultural events which may be happening in the community at times.”
Safe and stable environment “<Louise> is no longer in her marriage... all concerns around having a safe home environment have been addressed, as <Louise> doesn’t have alcohol on a regular basis.”
Confidence & independence improved “<Louise> still sees her GP and sometimes will get there herself...She doesn’t rely on <the worker> to get to the appointment.”
Practitioners mentioned that achieving these outcomes is outstanding and reflects on the resilience of these young parents and their willingness to support their children.
Participating in education “<The older kids> are both linked into the same Primary School and both have expressed how much they are enjoying their new school…<Louise> is making sure the two older ones attend school regularly and <the little one> has quality time with her when the older two are in school.”
“They have the ability to manage multiple young children, have history of Family Violence and trauma, and still be able to attend appointments. It is inspiring.”
Reduced use of AOD “<Louise> is attending her local gym regularly and finds this is helping towards not isolating herself and not being reliant on marijuana.”
(Focus group participant)
Since 2017, 105 child reports have been made to Child Protection
Accessing care “<Louise> sees a GP close to her if it’s about <the little one> not being well or needing follow-up vaccinations...She has agreed to have an Ages and Stages Assessment done on <the little one>, just to check with his word vocabulary...if he needs further assessment, <Louise> is happy for this to happen…<the older kids> have been accessing counselling sessions.” Improved wellbeing “<Louise> has a regular eating routine now and has shared some of her cooking delights with <her worker> and is expressing how much she is enjoying doing meal planning for herself and the children...going to her gym on a regular basis has also helped with her energy levels and mental health issues.”
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CASE STUDY: The families behind the stats
Charlotte was born at 25 weeks gestation and is currently two years of age. Her parents, Caitlin and Steve, have a history of marijuana, ice and alcohol use. Due to severe prematurity Charlotte was not held for the first 6-8 weeks of life. Even after it was possible to hold Charlotte, her parents would only visit for an hour each day. Initially when Charlotte was discharged from hospital she was cared for by her mother and father with the support of Sandra, her maternal grandmother who they were residing with. When Charlotte was 6 weeks of age Sandra asked that Charlotte’s father leave the home due to family violence. Following this Caitlin struggled to care for Charlotte and her mental health declined. Charlotte still has oxygen at night. Charlotte also has hearing aids which she is only now starting to wear for short periods of time. Charlotte struggles to focus for very long on one activity. She reaches out to her mother and maternal grandmother but is not happy if approached. Charlotte gags when full and struggles with chunky foods. She is very clumsy and falls or runs into things. Charlotte does not engage in eye contact except with Caitlin when they sing ‘row row row your boat’. She can understand commands and directions but does not make many sounds herself. When told ‘no’ she will head bang on the wooden floor. Due to her health concerns and low immunity Charlotte has not been able to go to childcare or interact with other children.
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Note: Names and identifying details have been changed
How did the C2K program support Charlotte? Charlotte’s practitioner requested an NMT metric for Charlotte. Intervention based on the NMT recommendations included: • L inking Caitlin in with community supports such as childcare and playgroups once Charlotte was able to be around other children; • L inking Caitlin with other services such as housing, drug and alcohol services, basic healthcare services and counselling in an attempt to assist her to resume her role as the primary caregiver; • R eferring Caitlin and Charlotte to Family Life’s Children’s Contact service so that they could spend time together in a safe and supported environment; • S upporting Caitlin to implement a self care routine; organising regular care team meetings with the services involved with the family including disability services and the child care; • W orking with other services to provide psychoeducation around trauma and the impact this may have on Charlotte’s behaviour and functioning.
Cradle to Kinder - Performance and Impact Report | August 2020
FAMILIES’ VOICE: Reactions to the program Across snapshot surveys completed on five different occasions between April 2018 and May 2020, families had the opportunity to tell us what is working well in relation to the service provided. In total, 82 responses were received across the surveys. Across the surveys, participants expressed high satisfaction levels between 94 and 100% of participants were either satisfied or very satisfied with the services provided.
Families’ levels of satisfaction with the program
100%
94%
100%
94%
95%
October 2019
May 2020
What is working well in relation to the service provided? In total, there were 70 comments provided to this question. Seven of those indicated that “everything” was working well. The remaining 63 responses provided specific comments. These comments were analysed using a thematic analysis to identify aspects of the service families are happy with.
Support and empowerment provided “Emotional support in every way possible. It can be normal for some to feel uncared about or always insecure when they’ve only ever been treated like that. Cradle to Kinder helped eliminate my weak areas, and promote and flourish my strengths”
April 2018
October 2018
April 2019
Constant communication “I appreciate the phone calls to check in between face to face visits”
Practitioners’ attitude “Having a wonderful, caring and deeply compassionate worker made it easier to connect and communicate with”
Material aid provided “I really appreciate the material items <my worker> organised for my family that I would have struggled to buy my own”
Being understood “I feel like I am understood and always have an encouraging person who can encourage me to keep going with my school or when I am having hard time with my kids” “Having my cultural needs taken into account”
How can we improve the service? There were 46 responses to this question and 60% of the comments indicated that nothing needed to be improved as they were satisfied with the service. Suggestions provided include: making the service longer than four years; running more playgroups; linking more young mums in; role play activities; increasing the number of cars available to staff; and opportunities to see their workers (this due to the Covid-19 restrictions).
“Services need zero improvement. I am entirely satisfied with the help and support I have received. Thank you so much!”
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CONCLUSION
ACKNOWLEDGMENTS
The C2K program is a key earlier intervention service and forms an integral part of the Placement Prevention system. The program provides targeted intervention to young mothers and their families through a whole-of-family service approach, with early intensive, wrap-around and preventative long term assistance. The current evaluation demonstrates that the service has provided this support to vulnerable families with complex issues - around 70% of our families have more than 5 support needs. Key aspects of the success of this program include: the timeframe for the program, the complexity and concurrent use of strategies used to support the families. Key strategies identified included the integration of trauma and attachment informed approaches with an ecological systems approach. Integral to the programs efficacy has been staff experience in the provision of developmentally relevant interventions for infants and children.
The ROME team would like to acknowledge the support and contributions made to this report:
The findings suggest that the C2K program has achieved the program objectives. Families have moved from being concerned and struggling with their needs to finding ways of meeting theirs, and their children’s needs. Many identified that they are still needing support, a possible future direction for evaluation and program design. Currently the families reporting the need for continued support are still in the service so these results may reaffirm the need for the length of the service. These findings translate into parents being empowered and independent, connected with their community and keeping their children safe and at home. Overall, almost all families in the service are satisfied with the service provided and appreciate the support and empowerment provided, their practitioners attitude, efficient communication, material aid provided, regular checks, and being understood. We know that long term impacts of adversity include a range of physical and mental health conditions, including depression, anxiety, alcohol and drug abuse and obesity.16 Negative outcomes also include “intergenerational transfer of violence against children: juvenile delinquency (for those who were abused as children); adult criminality homelessness and prostitution.”17 This report highlighted evidence informed approaches to interrupting this trajectory through building connection and resilience, restoring hope and building pathways for healing, recovery, growth and wellbeing. Recent modelling suggests that when children are diverted from placement in out of home care through early intervention programs such as C2K, cost savings could represent up to $1,99B of net savings in system costs over 10 years. 18
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Deloitte Access Economics (2019) Deloitte Access Economics (2019, p. 1) SVA (2020)
16 17 18
• T he C2K clients who participated in the different online surveys, for so generously giving their time and sharing their personal experiences. Family Life acknowledges the bravery, determination and ability to drive change that has presented in those we serve during their C2K journey. • T he C2K practitioners for contributing to data collection and measuring outcomes, for being transparent and honest during the team focus group, and for being very caring with all the families they support. • T he partnership organisation VACCA, for contributing their respective skills and expertise to the ongoing support of our Aboriginal and Torres Strait Islander clients. • T he Funder and Leadership group for their commitment to such a necessary service.
Cradle to Kinder - Performance and Impact Report | August 2020
REFERENCES Australian Institute of Family Studies (2020), Child protection and Aboriginal and Torres Strait Islander children: CFCA Resource Sheet. Retrieved from https://aifs.gov.au/cfca/publications/child-protection-and-aboriginal-andtorres-strait-islander-children Cook, K, Albury, K, Savic, M, Zirakbash, F, Al Mahmud, A, Ahmed, A, Martin, J, Fordyce, R, Mackelprang, J, Bano, M, & Schneider, J (2019), Doing better for vulnerable young parents and their children: an exploration of how technology could catalyse system transformation. Melbourne: Swinburne University of Technology. Deloitte Access Economics (2019) The economic cost of violence against children and young people Advocate for Children and Young People. Retrieved from https://www2.deloitte.com/au/en/pages/economics/articles/economic-cost-violence-against-children-youngpeople.html Dozier, M., Stovall-McClough, K. C., Albus, K. (2008), Attachment and psychopathology in adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (p. 718â&#x20AC;&#x201C;744). The Guilford Press. KPMG (2016), The economic cost of violence against children and young people Advocate for Children and Young People. Retrieved from https://www.dss.gov.au/sites/default/files/documents/08_2016/the_cost_of_violence_against_women_and_ their_children_in_australia_-_summary_report_may_2016.pdf SVA (2020) Keeping families together through COVID-19: the strengthened case for early intervention in the child protection and out-of-home care system [webinar, 6 August 2020] Victorian Government (2013), Victorian Cradle to Kinder and Aboriginal Cradle to Kinder: Practice Guide. Retrieved from https://providers.dhhs.vic.gov.au/sites/default/files/2017-06/Victorian-Aboriginal-cradle-to-kinder-practiceguide.pdf Victorian Government (2017), Cradle to Kinder and Aboriginal Cradle to Kinder. Retrieved from https://services.dhhs.vic.gov.au/cradle-kinder-and-aboriginal-cradle-kinder Wall, L., Higgins, D., Hunter, C. (2016), Trauma-informed care in child/family welfare services, Child Family Community Australia, CFCA Paper No. 37
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