- cognitive competence

- experience of self-efficacy - including hobbies

- reliance on faith and prayer

- hope and confidence in the future

    Source: The Children of Kauai, Werner, 1992

Whilst as helping professionals we can do little about innate temperament and inborn cognitive competence, we can facilitate the establishment of supportive environments.

What service responses will promote the conditions for resiliency?

Historically....

_ Professional groups have each traditionally responded to the problems arising from social change from the basis of their own values, understandings and expertise

• natural consequence of a dynamic biological or social system is expansion, diversity and increasing specialisation
  
• crisis-orientation and category-specific responses which focus on 'containment'

• tendency to assume 'my solution is best'

• consequence has been a plethora of unconnected services - "ships passing in the night'

• demand for information to enable choices

• demand for 'one-stop' shops - and seamless services

• withdrawal from services, except for crises
  - 'a plague upon all of your houses' - especially amongst disempowered
  

1. Conclusions from NCPC Home Visiting Consultancy

• home visiting is necessary but not sufficient to support families with young children

• home visiting can be a 'linchpin connecting the axle of the family to the wheel of community services'

• Therefore rebuilding a better integrated network of accessible, comprehensive, neighbourhood-based school-linked services through better inter-agency cooperation and collaboration and in partnership with neighbourhood residents is necessary.

• These services should be regarded as an investment in the social capital of neighbourhoods which promote the growth and development of healthy children and families, and not be seen as fixing up deficits.

• Investing in social capital is a legitimate activity of government
  'It takes a village to raise a child.'     (African proverb)
  

Barriers to service system changes...

• bureaucratic, hierarchical structure of government services

• fear of hegemony by one sector

• lack of rewards for people who work outside traditional departmental boundaries

• effective collaboration will need a reorientation of professional training and formation

• bureaucratic resistance to an approach based on partnership rather than control.

• proactive support of structures that strengthen families may be perceived as social engineering and interference with the private domain of family life - a new form of political incorrectness.

• increasing concern that the present system isn't working and not assisting in stemming the tide of social disintegration.

• helpful lessons from the experience of case management for people with special needs requiring complex mix of services

• growing recognition of the legitimacy of government investment in social capital

• success (and failures) of demonstration projects which implement collaboration overseas and in Australia

• growing awareness of the extent to which disempowerment is an underlying contributor to many of the problems faced by disadvantaged families and the fact that bureaucratic/professional solutions (prescriptions) often perpetuate this

• growing awareness that bureaucracies and professions must meet families and communities at their point of need and facilitate them finding their own solutions

• recognition that unless engagement with families occurs, professional help will be rejected. The development of trust in an individual who has learnt to mistrust is a prerequisite for successful engagement.

• the organising focus for primary care services needs to shift from a regional or statewide model to a neighbourhood level.

• the total range of primary care services - government, non-government, private for profit - needs to be involved in restructuring. This needs to be done in conjunction with members of the local community.

• the growth of telecommuting over the next decade is going to make it easier to work from home reestablishing the link between home and work which was a feature of preindustrial revolution life. This will raise the profile of neighbourhoods.

• the principles of primary care should be 'something for everyone and more for those in special need'.

• urban housing policies need to ensure that the growth of neighbourhood identities are facilitated by establishment of green-belt boundaries (eg european models).

• the network of primary care services should be backed up by a range of more specialised support services which serve a number of neighbourhoods.
  

What services are required for children and families?

What are the components of a network of primary care services (note not primary health care) for families with young children (birth to the end of primary school)?

A wide array of prevention, treatment and support services, delivered in an atmosphere of mutual respect, which focus where possible on the whole family and aim to achieve improved outcomes for children and families.

Services include:-

• primary health care services - including health visiting, general practice (acute illness care), immunisation, health monitoring of young children

• emotional and practical support for families (money is not enough!) Through home visiting and befriending, groups for parents and toddlers which address parents needs and skill and empower them in their role

• participatory case management for helping children and families with special needs. 'Case management is not merely service brokering, but a problem-solving partnership amongst practitioners and clients' (Melaville & Blank, 1991)

• early childhood educational experiences

• child care/respite care

• primary school with adequate staffing by counsellors to address psycho-socio-spiritual needs of staff, students and parents who request them

• youth development services - such as mentoring, community service opportunities, volunteer and leadership programs

• faith communities

• shops to meet needs experienced on a weekly or monthly basis

• community spaces for meeting - schools, faith communities, neighbourhood centres

• safe recreational areas

• adult education, including literacy training

• job training and employment services

• transport services

• flexible operating hours for many services

• information and referral

• other services

How should we proceed??

• What sort of structures are needed at the neighbourhood level to promote the development of this form of primary care services network? Examples of US models to promote intersectoral collaboration?

• Build on small scale experimentation and practical success

• Neighbourhood board of management? This might have community representatives, government (central and local staff), NGOs, churches. ?Elected or appointed. A huge group potentially - how could it be managed - would it be a form of neighbourhood government.'

• Approaches can be bottom-up (service delivery) complemented by top-down (system level changes), but ultimately must be joined - example of NSW regional coordination pilot project

• The role of the state and regional authorities is to facilitate collaboration at the local level, not impose it 'mandated coordination is unrealistic and paper-producing'

• Start with cooperation if necessary before proceeding to collaboration - build on success of more limited efforts

Figure 1: Service Models : A Vision of Communities Where Learning Can Happen

Figure 2: Child and Family Focused Services

Criteria for selection of neighbourhood service strategies

'What services and service delivery design are most likely to lead to a system that is:-

• comprehensive

• preventive

• family-centred and family-driven

• integrated

• developmental

• flexible

• sensitive to race, culture, gender and individuals with disability

• outcomes oriented?'

'Will the collaborative members and community residents sufficiently support this option for it to have a chance of success?'

from 'Together we can', 1993

Successful service integration initiatives...

• are school-linked

• are rooted in the community and closely connected to state government

• use place-specific service delivery prototypes to create systems change

• are data driven

• are financially pragmatic

• use new forms of interprofessional preservice and inservice education, training and leadership development

• use their influence to engage community members in making decisions about their economic and social well-being

• balance the political and technical dimensions of systems change

Two models of neighbourhood service collaboration

1. Regional Coordination Pilot Program..

In NSW the Premiers Department established a two year pilot study in Lismore and Dubbo - which has now been extended to cover all of country NSW - to facilitate a coordinated response by State agencies to key local and regional issues and to those communities most in need. The program is 'a response to the need for improved government service delivery in regional areas, and to emergent social justice issues which require new, creative and coordinated means of solution. The elimination of duplication and overlap, and the filling of service delivery gaps are being addressed through an integrated 'whole of Government' approach to service provision. The Pilot Program aims to deliver services in a way which meets the needs of individual clients and communities, and tackles pressing social issues, whilst making the best use of available resources'. The Premiers Department manages the program through a regional coordinator and secretary whose salaries have been met by a levy on the 17 participating departments. The program is project focussed and outcomes focussed.

One of the projects is the Children and Families at Risk program which aims to facilitate better coordination between services in the Lismore area working with high risk families. One arm of the project has been working on a community development approach in a housing estate and another on improving case coordination mechanisms for children with difficult problems. In an interim evaluation by John Hetherington and Rossi Lyons, the following outcome have been described:-

Outcomes of Lismore interagency case coordination model

• the process has lead to better interagency cooperation - greater sense of 'we are all in this together' and 'no-one has all the answers' and 'child protection is everyone's business'

• confidentiality issues could be overcome

• joint funding for a sessional child psychiatrist was obtained

• a class for severely emotionally disturbed children is being established in one of the schools

• but School Education staff are increasingly recognising that school-based solutions for emotionally and behaviourally disturbed children will not be effective unless family issues are addressed and some level of stability is achieved in the child's life outside school

• workers feel better supported by management

• case reviews and integrated case planning emphasised the need for an intersectoral approach - at the outset no one agency had all the information to develop a needs-based case plan

• DCS have begun to take a greater interest in responding appropriately to emotional abuse and neglect. 'Broken hearts and broken trust' may not have the same outcomes as 'broken bones'. They may be worse!

• Health has recognised that a centre-based clinic service delivery model is inappropriate

2. Interagency school community centres pilot project

This is a joint initiative of the NSW Departments of School Education, Health and Community Services and involves four two-year pilot projects in schools at Redfern, Curran (Macquarie Fields), Chertsey (Central Coast) and Coonamble aimed to develop and trial models of interagency coordination in supporting families with children five years of age and under with a view to preventing disadvantage at school entry. The project is characterised by community consultation and involvement in identifying needs and coordinating services and promotion of the school as a community centre. Each centre employs a facilitator who works closely with a community advisory group and local interagency management committee. Tasks for local projects have included

Summary

These isolated initiatives which aim to improve interagency collaboration are dependent upon recognition of the importance of a coordination infrastructure which is independent from service delivery and explicitly funded.

Unlike the US, there is no repository of information about such projects in Australia and the establishment of a clearing house such as is provided by the Family Resource Coalition or the Child and Family Policy Center and the National Center for Service Integration, would be a helpful strategy for service planners. Could this be yet another role for the Australian Institute of Family Studies?

Family Resource Coalition. Changing the way America works for families. FRC, Chicago, 1996.

Garbarino J. Raising children in a socially toxic environment. Jossey-Bass, San Francisco, 1995.

Melaville AI, Blank MJ. Together we can: a guide for crafting a profamily system of education and human services. US Department of Education and Department Health and Human Services, Washington DC, 1993.

NSW Departments of School Education, Health and Community Services. The Interagency School Community Centres Pilot Project. Department of School Education, Ryde, 1996.

NSW Premiers Department. Update on North Coast Regional Coordination Pilot Program November 1996.

Vimpani GV, Frederico M, Barclay L, Davis C. An audit of Home Visitor Programs and the Development of an Evaluation Framework. National Child Protection Council, Department of Health and Family Services, Canberra, 1996.

Werner EE and Smith RS. Vulnerable but Invincible: a longitudinal study of resilient children and youth. Mc Graw Hill, New York, 1992