The notion of quality in the human services

Although professional ethics and demands for accountability have meant that human service organisations have always paid attention to notions of quality in the provision of services, the emphasis on quality has strengthened as a result of managerialism. However, quality is a socially constructed notion that changes according to the particular perspective adopted (Pollitt 1998). Debates and discourses on quality in the human services have been influenced by competing paradigms. In particular, two different paradigms based on different values and priorities have emerged: the professional/managerial paradigm, and service users' discussions or discourses (Beresford et al. 1997: 63 and 71).

We contend that government and/or management are not always in the best position to determine the full range of factors that contribute to the development of a quality service. As Beresford and his colleagues (1997) point out in their work in the United Kingdom on the role the service user has in the design and delivery of personal social services, definitions of quality emphasised by service users are quite different from those of professional or service agencies. Service users are interested in what services can do to help them and how services are delivered. Professionals or service agencies are more likely to be interested in the efficiency or effectiveness of the service delivery system. Professional or business approaches may be limited because their views on determinants of quality are based largely on the cultural and professional assumptions of the purchasers or providers of services, not on the perspectives of those who use the services (Beresford et al. 1997).

Other work has emphasised the importance of using quality factors identified by service users as a basis for developing questions to assess recipients' perceptions of service quality and their satisfaction with a program (Herman 1997). However, in our view it is not sufficient to think only in terms of 'service user satisfaction' tools as the primary evaluative method. Rather, it is important to explore what it means to service users to talk about quality services - to get below the level of satisfaction to explore what is actually valued. An evaluation study undertaken in Norway by Noess and Woerness focused on rationality and management issues in public care services. These researchers caution that a managerialist approach focuses on what the consumer wants rather than what they need, which is not necessarily the same thing. Rather than a managerialist approach, they argue that an approach based on the characteristics of good care is necessary in order to achieve better quality (1997).

There have been numerous evaluations of family support services, and the difficulties in undertaking evaluations, especially focussing on outcomes, have been widely acknowledged. In particular, there has been little research to date on social and community service user views. By drawing on perceptions of service users, the study at Anglicare Victoria provides some useful insights into aspects of services which are most valued, providing possible directions for future service development.

Service users' perceptions of quality

The Anglicare Victoria study explored the perceptions of a number of service users concerning aspects of service provision which they most valued. This was done by interviewing service users - some individually, some in focus groups - in both urban and rural settings.

The process of this form of qualitative research is time-consuming and requires careful consideration of various ethical and professional issues, including how to access service users for interview. The various family support teams were relied on to approach service users to participate in the study. This meant that the sample was biased in that it involved the most confident of the service users and those whom the family support workers believed it was appropriate to approach.

In all, 29 service users were interviewed. All but one were women and all were seeing a family support worker individually or were a member of a group facilitated by a family support worker. Length of contact with the service ranged from one week to four years, although the majority had had contact with the service for between one month and two years.

The service users had been referred to the family support service from a broad spectrum of community services. Typically, the women were experiencing difficulties in parent-child interactions - often associated with histories of disadvantage, abuse, loss - and the majority were also experiencing socio-economic or environmental difficulties such as inadequate housing. A number felt marginalised from mainstream society, were isolated, and often tied down with the care of children. In three families the children were the focus of protective concerns.

Among other things, the service users were asked what they valued about the services provided. A major theme in the service users' responses was the companionship and friendship, and for some the fun and humour, offered by the service - either from the support worker or from the support group facilitated by a worker. In particular, the relationship with the family support worker was valued because it was this person who provided acceptance, humanity, caring and time. The following example provides a sense of this.

'Odette's' experience

Often when service users are referred to family support, they have little or no sense of what to expect. This was certainly the case for "Odette" who knew nothing about the agency or the program when she was referred by her doctor. This service user had significant emotional and physical health problems, was isolated from friends and family, unaware of local community services, experiencing relationship difficulties, and was struggling to care for adolescent children.

After a long period of involvement with the family support program, Odette reported that the impact had been life changing. She now talks enthusiastically about how her confidence and self-esteem have grown, how she has lost weight and made new friends. Her current goal centres on learning to read and write. She now embraces and enjoys life, whereas before she was severely depressed, even suicidal. This service user attributes this remarkable change in her quality of life to the worker assigned to her through Anglicare's Family Support Program.

The service worked for this woman, in her view, because of the inherent quality of the interaction that occurred between the service user and the worker. There was something about the quality of the transaction that enabled her to examine herself in relation to others and to explore how she could change in ways that were comfortable for her.

So how might quality have been experienced by this service user? Perhaps it was having someone who believed in her and who believed that change was possible. Perhaps it was the reassurance and support. Perhaps it was the interest shown, the listening without judgement, or the absence of a script about what she should do and how she should live her life. Perhaps it was something to do with the reliable and dependable contact she had with her worker. Perhaps it was about trust or the fact that the worker really took time to get to know and understand her. Perhaps it was the offer of practical assistance and help with the children.

Clearly it is something in the way the service is performed that is crucial to the outcomes from the point of view of the service user.

Relationship between practitioner and service user

The comments from the service users indicate that the relationships and friendships, and in particular the way in which a service is provided, combined with practical assistance of various kinds, are key factors for the service users. This is consistent with the findings of a recent study in the United Kingdom by Beresford and his colleagues (1997), where a range of service users were asked what they valued in their contacts with social service workers.

The single most important factor of a good quality service was the relationship between the individual worker and the service user: 'So often it was the style of the way services are delivered rather than the service itself which produces a quality service . . . Beyond the basic skills, [this] empowering experience comes from the quality of relationships' (Wiltshire Users' Network in Beresford et al. 1997: 77)

Nor is quality just about the transactions that pass between the worker and the service user. It is about the ability of the client to access resources from the broader community. Developing coherent and consistent policies that facilitate the wellbeing of families is essential. Complimentary policies need to exist between income, employment, housing, education, transport, health, industry, community infra-structure planning and community service delivery.

It is important that policies recognise the needs of the individual, promote a family's capacity to provide optimal care for its members, enhance the status of parenting, ensure access to information about child development, parenting skills and community resources, promote the ability of the local community to support families' child rearing function, promote a family's opportunity for interaction with a social and generational mix, and promote personal and physical access to services.

Conclusion

Personal support services play a crucial role in strengthening the most vulnerable families and providing them with the resilience to 'keep going' and, ultimately, to make significant changes in their lives.

The aspects of services particularly valued by recipients may be seriously put at risk by current government trends towards purchasing short-term, time limited, targeted services for families. Policy imperatives and service specifications of organisations providing family support services need to provide a framework which will allow for the provision of services that are relevant to the actual needs and circumstances of families and not just confined to what programs can 'legitimately' offer.

The rules and expectations that govern the delivery of services to the community and families have changed irrevocably. The influence of economic rationalism and managerialism has had wide ranging implications that have penetrated deeply into the psyche of the human services. Our investigation into what shapes a quality service affirms the importance of the service user role in offering valuable feedback and insights for organisations about what actually works. The key is in understanding more about what features of the relationship succeed when a practitioner works with a service user.

While organisations need to address those determinants of quality as specified by their principle 'customer', that is, the service purchaser, they have a responsibility to set their own unique standards or measures of quality. We suspect that crystallising those interpersonal elements of a quality service will invariably link back to the value base that underpins the work of human service agencies and the helping professions.

Individual rights are at the very heart of community life in Australia. To disregard or overlook the perspectives of service users undercuts their right to respect and empowerment.

The preliminary findings of the research undertaken within Anglicare Victoria suggests that a program like Family Support works because quality relationships are built with service users that enable the emergence of real growth and change. Such programs need to be given space and permission to continue this important work. Australia's social policy context needs to support the development of a diverse range of services targeting the many needs of families. Family support alone is not the answer. There is no one program that can do it all. We need supportive social and economic structures and well designed support services that are culturally sensitive to affirm and strengthen all families and community life.

References

AIHW (1997), Australia's Welfare 1997: Services and Assistance, Australian Institute of Health and Welfare, Canberra.

Beresford, P., Croft, S., Evans, E. & Harding, T. (1997), 'Quality in personal social services: the developing role of user involvement in the UK', in A. Evers, R. Haverinen, K. Leichsenring & G. Wistow (eds) Developing Quality in Personal Social Services: Concepts, Cases and Comments, Public Policy and Social Welfare Series, vol. 22, Ashgate, Aldershot.

Department of Human Services (1996), Family Support Program: Service Standards and Quality Improvement Program, Family Support Unit, Youth and Family Services, Victorian Government Department of Human Services, Melbourne.

Gledhill, M. (1996), 'Family resource programs: strengthening families and communities', Children Australia, vol. 21, no. 4, pp. 4.10.

Herman, S. (1997), 'Exploring the link between service quality and outcomes: parents' assessment of family support programs', Evaluation Review, vol. 21, no. 3, pp. 388-404.

Noess, S. and Woerness, K. (1997), 'Rationality and management in public care services', in A. Evers, R. Haverinen, K. Leichsenring & G. Wistow (eds) Developing Quality in Personal Social Services: Concepts, Cases and Comments, Public Policy and Social Welfare Series, vol. 22, Ashgate, Aldershot.

Pollitt, C. (1998), 'Improving the quality of social services: new opportunities for participation?' in G. Flösser & H. Otto (eds) Towards More Democracy in Social Services: Models of Culture and Welfare, Walter de Gruyter, Berlin.

The People Together Project (1998), Turning People into Commodities: Report of the Public Hearings on Competitive Tendering in Human Services, The People Together Project, North Carlton.

Wolcott, I. (1989), Family Support Services: A Review of the Literature and Selected Annotated Bibliography, Bibliography Series, Australian Institute of Family Studies, Melbourne.

This article is an extract from a paper delivered at the Sixth Australian Institute of Family Studies Conference in Melbourne, November 1998. The full paper may be read on the Institute's Web site at: http://www.aifs.gov.au/institute/afrc6papers/allan.html

Early intervention programs like home visiting are one way of supporting parents. Home visiting services have a long history in Britain and Europe and are becoming increasingly popular in the United States and in Australia as a strategy to address some of the difficulties faced by today's families.

Focus of Good Beginnings

In each area, an experienced professional coordinator becomes responsible for selecting, training, supporting and supervising volunteer 'community parents'. Community parents are carefully screened, usually in their own homes, before any training begins.

A team of approximately ten potential community parents undertakes six weeks of training at one time. Ultimately, each coordinator will supervise approximately 30-40 fully trained community parents. New parents hear about Good Beginnings through hospitals, general practitioners, child health nurses, community organisations and word of mouth. The program is available to all parents of children up to 24 months of age.

New parents are introduced to a community parent who will visit the family as required - generally once a week for an hour or two. This will continue for up to 12 months unless the new parents decide to leave the program.

Coordinators keep in touch with new parents by visiting occasionally along with the community parent. Should the new parents decide, for any reason, to ask for another community parent, the coordinator will make alternative arrangements. The same applies if a community parent seeks a change.

How children benefit

When parents are calm relaxed and confident, free of anxiety and stress, their children are usually far more contented. Their physical needs are met, they feel loved and worthwhile, and they can trust and depend on those who care for them. These are the basic necessities for any child to grow into an emotionally, physically and spiritually healthy young adult.

How parents benefit

Learning that they are not alone is the first and perhaps most important step for new parents. With a community parent to guide them through difficult times, congratulate them on their successes and relax into the role of parenting, a new parent's self confidence grows. There is a real sense of achievement as they discover a new pleasure and pride in parenting.

Parents develop a sense of belonging to the community, learn to access community services, share the load and give their children a sense of loving security. In return, most children will become happier and easier to care for.

How government and non-government agencies benefit

Good Beginnings encourages partnerships with professionals to ensure that families are able to access the resource they need in their own community. As recommended by all state and territory governments, these partnerships facilitate the development of strong links and trust between agencies and families.

The Good Beginnings Volunteer Home Visiting Program is a universal service provided free of charge to parents with babies or small children. Families who choose to use the program and who meet the criteria are linked to trained volunteers known as community parents. The volunteers are drawn from the local geographic area and are parents themselves. Once linked to a family, the volunteers visit regularly to offer support, information and friendship. A coordinator recruits, trains and provides support and supervision to the volunteers.

Four Good Beginnings Volunteer Home Visiting Programs were established to test the effectiveness of volunteer home visiting in enhancing parenting skills for families with new babies and young children in distinctly different but disadvantaged communities. The pilot programs are located in inner western Sydney (New South Wales - urban), Katherine (Northern Territory - remote), Hobart (Tasmania - remote urban), and Moe (Victoria - rural).

An external evaluation has been carried out by Rosemary Cant from Social Systems and Evaluation. The evaluation shows that the program has been successfully implemented at all pilot sites and, even at this early stage, has demonstrated very positive outcomes for families and local communities.

Parents have been assisted

Parents participating in the Good Beginnings Volunteer Home Visiting Program were typically isolated, lacking support networks and often highly stressed. They hoped for guidance, support and companionship from the program.

Nearly all had their hopes met. Mothers spoke about 'having found a friend' and gained a 'little bit of sanity'. For many mothers Good Beginnings broke down the isolation they felt by providing companionship and 'someone to talk to'. They were supported, reassured and encouraged by the volunteers. Having a volunteer visit made a difference to the way the mothers (or fathers) coped with day-to-day parenting and home routines.
Apart from general help and support, parents also acquired parenting skills. In many instances the volunteers acted as mentors to parents. They worked on sleeping problems, they helped parents tackle behaviour problems in older children, they modelled playing and reading to the children, they showed mothers that going to the park can be fun, and they introduced them to local amenities.

Referring agencies confirmed that Good Beginnings had had a positive impact on the families that they had referred. Many workers saw as an important aspect of the Program that it provided 'someone there for the parents' and there were stories of significant personal growth as a result. Workers also corroborated that the program had provided parents with information about relevant services and had linked them to services such as playgroups and child care that they may not otherwise have felt able to access.

While the Good Beginnings Volunteer Home Visiting Program works with fathers as well as mothers, although not as frequently, there is a dearth of programs that address parenting issues for fathers and prospective fathers. The Moe and Hobart Volunteer Home Visiting Programs are testing initiatives for men in their role as parents and carers, which are showing promise.

Different and complementary service

Concern is sometimes expressed about using volunteers for programs like Good Beginnings. This concern appears to be based on the apprehension that they may be used inappropriately to provide a service that should be provided by professional paid staff.

Good Beginnings works in close collaboration with local agencies that provide services to families with babies and young children and the evidence is that it provides a different but complementary service to them. It has freed professionals from having to take on a 'befriender' or support role that they considered inappropriate for themselves. They welcomed it as providing additional support to the professional support they provided. The parents saw the volunteers as friends.

Quality, flexibility and cultural sensitivity

Good Beginnings has worked in four diverse sites - urban, isolated urban, rural and isolated. While the program has remained fundamentally consistent, there have been subtle adjustments that have enabled it to respond to local needs.

The training, support and supervision of the volunteers are of a very high standard. The training program has been designed for the Australian context and volunteers found it comprehensive and relevant to their role as home visitors. Policies, procedures and the training program are well documented.

Good Beginnings is piloting a program for Vietnamese parents to test the appropriateness of Good Beginnings Volunteer Home Visiting in this cultural context. Funds have been received to pilot the program in an urban Aboriginal community. In each case there has been extensive prior consultation, and Good Beginnings has been sensitive and responsive to cultural issues.

Community connectedness and social capital

Evidence is already emerging of improved community support networks for families and increased social capital in sites as a result of the Good Beginnings Volunteer Home Visiting Program.

The impact of Good Beginnings on Clarendon Vale, a particularly disadvantaged community, is likely to be very great both as a result of the Good Beginnings sponsored Clarendon Connect Program and of Good Beginnings itself. The empowerment of local women who worked together on a Good Beginnings committee has already been noticed by agencies in contact with them.

Sustainability

As well as creating and testing models of best practice (including volunteer home visiting), the Good Beginnings National Parenting Project has been testing whether programs like the Good Beginnings Volunteer Home Visiting Program can become self-sustaining. At the National Office level, Good Beginnings has been very successful. Current fund raising has virtually ensured that the National Office will be able to continue beyond the year 2000, and well over half a million dollars has been raised to expand the Good Beginnings Volunteer Home Visiting Program to new sites.

The process of achieving sustainability at the pilot sites has been slower as local management committees have had difficulty coming to grips with the expectation placed on them for fund raising. However despite a slow start, local management committees are now beginning to put in place fund raising strategies. Nevertheless ti is still unclear whether self-sustainability is achievable at all pilot sites within the next twelve months.

Conclusions and recommendations

The evaluation has demonstrated very positive outcomes for families and communities form the Good Beginnings Volunteer Home Visiting Program. It is now set to expand and should be supported to do so.

In view of the difficulties that disadvantaged communities face in fund raising, the evaluation recommended that the Commonwealth Government subsidy to existing Good Beginnings Volunteer Home Visiting sites be extended to three years.

Reference

Perry, B.D. et al. (1995), 'Childhood trauma, the neurobiology of adaptation, and 'use-dependent' development of the brain: how 'states' become 'traits', Infant Mental Health Journal, no. 16, pp. 271-291.

For further details contact the Good Beginnings National Office, Suite 32, 8-24 Kippax Street, Surry Hills 2010. Phone: (02) 9211 6767. Fax: (02) 9211 3775.

It may be reached on its Support Line (02) 6292 9164.

The aims of this group are to:

An information site is provided on the Web: http://millennium.fortunecity.com/jamestown/470/

Evidence suggests that there is much scope for improving the State's success as parent and family to children in the public care. For example, the monitoring of health, educational and social wellbeing, which is routinely carried out by ordinary parents, tends to be neglected in the public care system, and already disadvantaged children are thereby further disadvantaged. As a consequence, the eventual outcomes for such children are less beneficial than they should be.

Looking After Children was developed as a response to these shortcomings, as a practical tool for monitoring and promoting the health and wellbeing of such children, and as an aid in sharing caring responsibility among different people with a stake in a child's wellbeing. In its most essential form, Looking After Children is a series of age-related booklets called the Assessment and Action Records, which enables universally applicable outcome measures to be recorded across seven key developmental spheres: health, education, identity, family and social relationships, social presentation, emotional and behavioural development and self care skills.

A number of agencies providing placement and support services both in Australia and around the world have been following closely the development of LAC in the United Kingdom, and have been concerned to introduce the system into their own agencies. Within Victoria, a perceived need for a more long-term focus on caring for children and young people, and greater consistency in the standard of care provided during placement, were the catalyst for incorporating the Looking After Children system on a 12-month trial basis. Considerable overlap in the principles underpinning the Victorian and British child welfare legislation, and similarities between the cultures of the two countries, further validated the suitability of the materials for use here.

Pilot program

The Children's Welfare Association of Victoria initiated a 12-month pilot in the Eastern Metropolitan region of Victoria involving DHS staff and some non-government agencies. The overall aim of the Victorian trial was to improve outcomes for children and young people in 'out of home' placements through implementation of the Assessment and Action materials. To this end, the pilot was also to examine the most effective way of introducing Looking After Children in the Victorian system, and to suggest ways of adapting the materials for use in current case-management, case-contracting and case-planning systems.

The Victorian pilot commenced in 1996, and 51 clients of placement and support services from the target region, ranging in age between a few months and 17 years, were involved in the trial. These children were selected on the basis of their age, and on the basis that they would remain in 'out of home' care for the duration of the pilot.

AIFS evaluation

The Australian Institute of Family Studies supported the trial by conducting an evaluation of the effectiveness of 12-months implementation of the Looking After Children materials in improving children's developmental outcomes and assisting carers, practitioners and other stakeholders in caring for children during placement.

The Institute's evaluation involved monitoring health and wellbeing, and the initiation of remedial action in respect of all children and young people involved in the trial, to enable a before and after contrast of outcomes. The perceptions of carers and children about the experience of implementation and the benefits of the approach were also recorded during interviews and focus group discussions to help measure the influence of Looking After Children on developmental outcomes. Information was also collected about the utility of the Looking After Children approach as a means of sharing responsibility for the care of children among different people during placement, and for promoting the involvement of children and young people in decisions that affect their lives.

The Victorian experience paralleled the experience of implementation in the United Kingdom, pointing to the need for a careful and well-supported implementation process. The small scale of the Victorian pilot, compounded by staff turnover, changes of placement, the demands of day to-day practice and other events in children's lives, made it difficult to completely adopt the approach to practice outlined by the 'Looking After Children' materials in all cases.

Despite these problems, the evaluation revealed that the principles that lie at the heart of Looking After Children were acceptable to those concerned with the implementation, and that the materials require very little adaptation, and are culturally sensitive. Despite some difficulty engaging children and young people and their families in the implementation process, Looking after Children also proved to have considerable promise as a tool for planning interventions on behalf of children, and sharing information and responsibility for caring for children among different stakeholders.

Information collected during the evaluation indicated that Looking After Children was effective in promoting the developmental progress of children and young people concerned. A comparison of all indicators of developmental educational progress, emotional and behavioural development, social and family relationships and physical health outcomes used in the evaluation revealed modest improvements along all of these dimensions after implementation of the program.

These improvements were also apparent for children and young people irrespective of their age, family background, care history, placement type and reason for admission, suggesting that implementation of Looking After Children may have benefits for the range of clients that receive placement and support services.

White Balloon Day is a child abuse awareness campaign, which originated in Queensland two years ago. The first Day in 1997 consisted of the founding family and six others handing out free white balloons and various written information to passers by in the Brisbane City Square.

The 1998 White Balloon Day attracted a $25,000 grant from the Department of Family Services for the purchase, printing and packaging of white balloons which carry the message 'Break the Silence on Child Abuse'. Support was also attracted from Amcal, Foodlink, Canon and some other organisations.

Advocates for Survivors of Child Abuse (ASCA) is hoping for financial support to hold another White Balloon Day on Tuesday 17 August, this year. ASCA is a community based, non-profit, national organisation whose members incorporate survivors, parents, friends, partners, professionals, and who share the desire to reduce the incidence of child abuse.

ASCA is hoping to:

The program

In 1995, a parenting program was run in Risdon Prison. Response from the inmates was so enthusiastic that an application was made to the Commonwealth Department of Family and Community Services for help in implementing parenting programs on a regular basis. Consequently a grant was received to employ a project officer and cover program expenses. The program began in April 1998.

Negotiations about the benefits of the program for inmates and their children were held with Corrective Services management, and also with uniformed staff within the prison complex. Meetings were held with welfare/program staff about the integration of parenting programs with other programs offered, and with inmate representatives to publicise the program and tailor its content to their needs. Guidelines were set up for inmates' children to attend Dads' Day.

Many male inmates had lost contact with their children. The longer the sentence, and the more frequently parents were jailed, the more likely it was that relationships would have become strained between partners. This impacted on the frequency of contact with children. A great deal of family mediation as to the best interests of the child was required to facilitate regular contact with the incarcerated parent.

Issues of safety were always considered. In some situations, the project officer assisted in transport for contact visits especially when one parent (usually the mother) did not want her whereabouts known to the incarcerated parent.

Now a set feature within the prison calendar, Dads' Days allow children to spend three and a half hours with their inmate parents about every three months, and many inmates are initially drawn into participating in the program for this reason. Before the program began, there were only limited facilities in the main prison complex for contact visits. This meant most children had to talk through a screen to their parent without being able to touch or hug them.

Skilled community workers who are familiar with prison work and who are experts in their field run sessions on: Effective relationships; Fathering from prison; Expectations of fathering - ages and stages of development, and play; When the going gets tough - difficult times; Expectations about returning home - coping on the outside; and Dads' Day - time to put learning into practice. Craft sessions have been run to make Christmas gifts for children.

Responsibility and non-violence are reinforced throughout the program. The focus is on building on existing skills, looking for and reinforcing success through shared experiences rather than a didactic teaching approach. A non judgemental approach is essential and reframing skills important. Some participants have never attended a group before and would be most unlikely to talk about parenting matters with other men on the outside.

Participation is totally voluntary for inmates, partners of inmates and children. Because of the need to keep children's safety paramount, the program is not available for persons in prison for sex offences. Also with children's safety and wellbeing in mind, where family violence was previously an issue, extra care is taken in preparation for Dads' Days.

Important principles

A number of important principles have been identified.

Future success of the program could be fostered by inputs into prison officer training on the issues/hardships faced by children and families of prisoners as a means of fostering links between inmates and community service providers, as well as integrating community services into the prison.

Community involvement

Community service providers have generously donated worker time to run the groups in the prison, and several agencies have donated toys and equipment for Dads' Day. In addition, prison staff have assisted in making these occasions very successful. City Mission and government organisations from Launceston have assisted in transporting children to Hobart from the north of the state, while volunteers from the Risdon Visiting Centre have been available so that parents and children have a safe place to wait at the beginning and end of the Day.

Negotiations and implementing the present program have fostered networking between agencies focusing on the needs of inmates and their families and has aided client care. This is particularly important in Tasmania as there is no one easily identifiable agency that works exclusively with this population.

Issues addressed via individual client contact

Individual client contact facilitates the following issues:

• tracing children for re-contact through government agencies;
  
• access visits for children where mothers did not want contact with inmates;
  
• support/protection for mothers where violence was an issue in the family;
  
• assistance with letter writing to children;
  
• negotiating letters from inmates to be sent to their children via schools;
  
• arranging counselling for children of inmates;
  
• negotiating the prison system for family members;
  
• linking and facilitating communication between family members and prison staff;
  
• advocacy regarding contact visits in Hobart and Launceston prisons;
  
• cleaning toys in visitors' waiting area at Risdon;
  
• renewing toys in visiting areas;
  
• support for partners of inmates;
  
• inmate support/counselling on family issues;
  
• information and resource links;
  
• family reintegration;
  
• home visits to post-release prisoners and families to aid adjustment;
  
• family mediation regarding access visits, letters, presents for children;
  
• advocacy for drug and alcohol program;
  
• communication clarification between partners;
  
• negotiations with family support agencies for visits to prison by state wards to see incarcerated parents.
  

Inmates have increased or resumed contact with children, are more relaxed in their interactions with children and partners, and show more readiness for involvement in family mediation. They have improved knowledge of child development and expectations of age appropriate behaviour, and greater desire to be involved in decisions such as children's education. They are more aware of the impact of violence or drug use of adults on children, and are more motivated to address drug/alcohol problems impacting on family life. They are more aware of the difficulties family members face on the outside, and have greater involvement in prison courses/work activities to earn income to help pay for children's activities (parenting from inside).

An unforseen benefit is increased peer support in the prison yard and readiness to share/discuss family matters. Each group creates a mini-support group within the prison context where the men talk openly about family matters. Usually inmates are reticent about sharing any information of a personal manner, fearing the information would render them vulnerable.

Even in the short time the program has been operating, the benefits of personal empowerment have had positive results. Overall, inmates seem to have greater self-confidence. One inmate from the initial group in the maximum security section is now peer leader not only for this program but for other groups run in the prison. He has gained sufficient confidence and trust to go out into schools to talk with at-risk youth, and has expressed the desire to develop a career in this area after release.

Prison inmates are generally suspicious of welfare agencies and often will not use services even when needed. By bringing community agency representatives into contact with inmates, barriers are broken down and referrals facilitated.

Likewise it has been easier to provide support for families on the outside. The program fosters trust enabling either direct requests from inmates or referrals for the programs project officer to visit family members in the community for support and referral where appropriate. Trust is a significant issue for this client group. Family members are very suspicious of government, especially welfare agencies and may not seek assistance needed if they feel under scrutiny. It has been important for the project officer to be seen as independent from state government agencies although able to link people into services as needed after trust has been established. The independence provided by federal funding has helped foster acceptance of the program outside of prison to the point where families will now self refer from information received through word of mouth.

A unique aspect of the program has been the ability to advocate for children to have access to both parents even in situations where the children's parents are in conflict. Knowing that the absent parent is safe helps children cope with the separation imposed by family disruption and incarceration. Workers and parents report the children are better adjusted and more settled after contact with an incarcerated parent. This has been very helpful for children who had witnessed violence between parents or whose parent had 'disappeared' and were not told where that person had gone.

The Dads' Days have proved particularly beneficial as they have enabled fathers and their children to interact in more normal ways than through a screen (non-contact visits) or sitting around a table in an enclosed space (contact visit). Risdon Prison management has agreed to continue this activity on a regular basis for all inmates (maximum security) who attend the parenting course.

Contact between inmates and their children has helped foster greater responsibility towards parenting. Inmates report having a new purpose in their lives and feel more motivated to work towards rehabilitation after being re-united with their children. Several fathers have negotiated with child support agencies to take over full responsibility for their children once the prison sentence is complete. Some of these children had been made state wards and had lost contact with their fathers prior to this program.

Lessons learned

The program has highlighted the need for:

In addition, as more than half of inmates come from the north or north west of Tasmania, means of assistance is needed for families trying to maintain family cohesion from a distance. First, there is the financial burden for families of travelling to Hobart. Second, the costs to both families and inmates of STD phone charges can be prohibitive - by the time inmates have paid for their daily necessities out of their modest wages there is little money left for long-distance telephone calls.

New pre-release procedures, at present in the development phase by Correctional Services, include family reintegration. There is scope for the training and support of a team of volunteers to assist in home visits - an activity which could be linked to the present program should funds be available.

Finally, there is a need for increased public awareness about the impact on children of having an incarcerated parent, as well as promoting and fostering parental responsibilities from prison.

Where to from here?

Now that the program has been successfully established, its long-term viability is essential as the client group is one of high need and extremely limited power. Many find accessing services difficult because of the stigma they feel because of their circumstances and association with prison. The project officer has been actively seeking ongoing funding. Corporate sponsorship is one option.

Inner Worlds - Outer Realities is a collection of papers by team members of the Society's Centre for Children's Early Intervention Programs. The book is a rich source of information and insights on practice issues in child abuse prevention. Being practice-oriented, it would be particularly useful for social workers, clinicians, therapists and workers with high risk families and infants, and the description of individual intervention programs provides information for those wanting to learn from, or replicate the programs. The book also deals well with issues of administration, use of intervention workers, training of volunteers for home visiting, and working with parents with substance abuse problems and with adult survivors of child sexual abuse. Case studies and personal insights into the helping relationship from both therapists and clients provide informative and interesting reading.

The following is a description of some of the chapters.

Introducing the book

Suggesting that there is still a long way to go to understand fully the extent of abuse and neglect in the population, the Benevolent Society's CEO Adrian Ford introduces the book by arguing that the numbers of children at risk of all types of abuse and neglect are still vastly under-reported. He describes the wider and important trends in society which impact on children, such as structural violence in the form of unemployment; substance abuse; changing family structures and increasing rights for adults; and an increasing focus on services for the aged. The need to work with the maltreated child to prevent the cycle of violence is discussed, particularly in terms of appropriate funding of children's services and the need to focus on the child and not the parents. Challenges of prevention work are identified and four quantitative measures developed by the Benevolent Society described. A plan for early intervention is briefly outlined, with the emphasis on home visiting and the need to involve parents in the process of healing.

Prevention programs

In the chapter 'Prevention through early intervention in the Benevolent Society, Centre for Children's Early Intervention Programs', Judith Edwards describes how programs - the Families Together Program, the Infant-Parent Program, and the Home-Start Program - have been designed to complement the work in the Early Intervention Program. Their aim is to give children a better start in life by supporting parents who are experiencing extra stress during pregnancy and their child's early years, and by developing relationships with other professionals and community organisations to advocate for children.

Early Intervention Program

In 'The early years of the Society's Early Intervention Program', Beulah Warren discusses the background to the Early Intervention Program, the context of its germination, and the model 'Invitation to the Family' which was its framework. Beulah's involvement as part of the intervention team is outlined, providing details on management and administration. Evaluation of the Program is considered and the ways in which it encouraged the development of similar programs outlined.

The chapter by Elke Andrees and Belinda Keatinge, 'Seeing with different eyes: the knife edge between inner worlds and outer realities', gives an overview of what the clinicians and workers in the Early Intervention Program believe to be the fundamental framework in working with high risk families and infants, and explores some of the issues of the work, highlighting the difficulties of seeing with different eyes - the eyes of the therapist, of the parent and of the infant.

'Grappling with the issue of child protection in early intervention: one worker's perspective' presents Melinda Hughes' perspective as a social worker in the Early Intervention Program. She describes the context of the 1980s: the initial Program protocol, the denial surrounding child abuse, the struggle around notification; the extent of abuse which society is prepared to tolerate, emotional abuse, and systemic denial of emotional abuse.

In the Benevolent Society's early intervention programs, 50-60 per cent of women in the families involved have a history of childhood sexual assault and in the Early Intervention Program and Families Together, this number is consistently 80-85 per cent. The chapter by Judith Edwards discusses how pregnancy, childbirth and motherhood affect this group, and presents an overview of appropriate intervention strategies, focusing on the safety of the baby and facilitating positive attachments between mother and child.

The problem of the social isolation of some mothers in the Early Intervention Program is addressed in a chapter by Justine Spurrs which discusses how the Program identified this need and established a play group in 1995, offering it as a free service to clients. The aim of the group was to help parents focus on and play with their children, break down social isolation and encourage parents to join other groups in the community.

The process of supervision of students in counselling and psychotherapy is discussed in a chapter by Karen Asgill, which focuses on some of the special aspects of training students through the Early Intervention Program and addresses the complications of working therapeutically on the relationship between parents and their infants in the home setting, particularly when there are concerns for the safety of the infant.

Home visiting

The role of home visiting in the Benevolent Society's early intervention services is discussed in the chapter by Judith Edwards and Elke Andrees which examines some of the advantages and difficulties that accompany home-based clinical practices. Engaging harder-to-reach clients, empowerment of clients, and providing an individualised service are listed as advantages while difficulties include difficulty in worker containing feelings, harder to maintain a frame to work within, and missed appointments.

Primary Maternal Preoccupation is a state of emotional vulnerability seen in mothers following the birth of an infant. The chapter, 'Facilitating the development of empathy in parent-infant relationship', by the Early Intervention Program team, describes how the aim of early intervention is to strengthen and enhance the relationship between parent and infant so that all aspects of the child's development are facilitated and distortions in the interactions, which may put the child at risk, are minimised.

Families Together program

The Benevolent Society received a two-year grant from the National Mental Health Project to trial a program called 'Families Together' to work specifically with families where a parent has a long-term mental illness and who are expecting a child or have young children. This chapter by Jane West, Judith Edwards, and Sharyn Moses describes the program, outlines its basic principles, and discusses the importance of evaluation as an ongoing part of the program.

The nature of art therapy using an Object Relations approach is described by Belinda Swan. This program aims to assist in facilitating the attachment process between parent and infant.

Home-Start program

Home-Start, a volunteer home visiting program which offers practical and emotional support to families with additional needs, is described by Maria Bourke and Eva Gloker in a chapter which outlines the objectives and history of the program and discusses issues such as: the use of volunteers in Home Start; profile of volunteers; volunteer training and selection; matching volunteers with families; and support and backup of volunteers. The importance of clearly defining the role of the volunteer is stressed and case studies illustrating the need for clear boundaries, multiple births, and multicultural issues are presented.

Therapeutic relationship

'Struggling for a space' is an account of Belinda Keatinge's two years of working with a very chaotic family. The first visit is described, the ambivalent relationship between the mother and author discussed and the difficulty in finding a space to think is addressed. Attitudes of both the author and the mother to the relationship which developed and to its termination are examined.

Role of administrative officers in early intervention programs

This chapter by Suzanne Donnolley is a collection of thoughts and observations resulting from her experience of nine years as an administrative officer in early intervention programs. Some of the aspects of her position specific to the client group of families with young children from 0 to five years who are considered to be at high risk of neglect and abuse, and their workers, are explored, putting forward the notion that the administrative role contributes to the smooth flow of service delivery as well as to the therapeutic process.

Fathers

Elke Andrees and Brian Hunt report on the experience of co-running a series of meetings for men whose partners were either expecting a baby or who had babies and young children. Profiles of the men participating in the groups, their domestic situations, and their attitudes towards their wives or partners are described. The aim was to offer the men a therapeutic space in which to reflect on experiences of becoming and being a father, and perhaps having a depressed partner, and to allow the men an opportunity to express some of their emotional responses.

Substance abuse

Figures available on the number of pregnant women who accessed substance abuse pregnancy services in 1996 are presented by Judith Edwards and Sandra Rees. Results of a Needs Assessment Report on parents with substance abuse problems in the Infant-Parent Program in 1997 raise issues such as the effect of drug use on parents' ability to look after their children, support of parents, and the consequences for children of being raised in a family where parents have drug use issues. The time around the birth of a child is identified as the best time for intervention services to have a positive impact on parents' behaviour.

Effect on workers

The focus of the chapter, 'Catastrophe and containment,' by Ruth Safier, is on the impact of work with young families and children on the mind and wellbeing of the worker. Based on the premise that the therapeutic relationship is the important element in bringing about change, and that it is specifically the therapist's capacity to be open to emotional experience that mediates this, this chapter addresses issues of the effect on workers of being in close contact with catastrophic situations and coping behaviour.

Judith Edwards explores how anxiety is a fact in early intervention work because the work demands that workers remain open to the primitive non verbal area of human experience. The necessary conditions to deal with anxiety in early intervention work are outlined, highlighting the need for a supportive workplace culture.

The reports were launched on 26 February 1999 at a meeting of the National Council for the Prevention of Child Abuse in Hobart by the Hon. Warren Truss, Minister for Community Services.

The first study looks at the relationship between parents and their adolescent children, and the second at men and the role of fatherhood.

The aim of the Adolescents in Families Project, by consultants Margarita Frederico, Cathy Davis and James Barber, was to explore elements of parenting of adolescents with the purpose of informing the development of new and existing policies and programs which address the needs of parents and their adolescent children. It was prompted by recognition that although there are many studies dealing with the problems of parenting adolescents, there has been less focus upon how parents support their adolescent child to develop resilience and competence in their transition from childhood to adulthood. In addition, it was thought important to hear what Australian adolescents and their parents say are those components of the parenting relationship which facilitate this transition.

The report commences with a review of literature on the adolescent stage of the life cycle, the impact of the transition to adolescence on family relationship, the development of resilience, competence and coping in adolescence, and parenting adolescents. The report then describes a secondary data analysis of three existing data sets, each of which had surveyed parents and young people in relation to issues concerning adolescents, and the findings of this analysis. The findings of a national telephone survey of a random sample of 750 parents and adolescents and focus groups which were held with parents and adolescents in both rural and urban areas are then presented and discussed along with relevant information obtained from key participants. The report concludes with a discussion of the findings and consideration of implications for policy. A principle underlying the selection of the research process was to ensure that young people and their parents could provide direct input into the research questions.

The study provided the opportunity to ask parents and adolescents their views on the Australian experience of parenting adolescents and to hear from them what they find supportive in the relationship. As the child moves through adolescence their relationship with their parents needs to change, and parents and young people at times may need assistance to negotiate this change.

The report recognises that the period of adolescence can be a time of stress for families, yet the majority of families find a way to negotiate this stage and provide support to their family members. In understanding what is perceived as positive in the relationship, the study seeks to provide knowledge to inform policies and programs.

Key findings

The overwhelming majority of Australian adolescents are happy and well adjusted, and generally speaking their parents are quite involved in the adolescents' lives. Contrary to popular stereotypes conflict is not endemic in homes containing adolescents.

The future

The Government has committed $12 million over four years for child abuse prevention with an emphasis on parenting education initiatives. A further $2 million per year has been allocated through the family relationships skills training program to educate families in positive parenting and family functioning skills.

This report provides evidence of the importance of parenting education to promote a positive relationship between adolescents and their parents. It highlights the role of parents in the development of reliance and competence in their adolescent child and provides information to inform policies and programs to promote and support parent child relationships.

Supporting parents in their task of parenting adolescents, thorough integrated family policies and programs will assist in the development of resilience and competence in Australia's young people and hence strengthen our community.

Implications for policy

A number of conclusions and recommendations are made in the report. It encourages the development of policies and programs which recognise the diversity and complex interrelationship of factors which impact upon parents, adolescents and the parenting relationship. Recognition of this complexity demands an integrated approach to policies and programs which can provide support to families in undertaking the important role of raising adolescents and provides ready access to resources when parents or young people face difficulties in carrying out this role.

The project provides a significant and timely opportunity to review, investigate and provide up-to-date information and analyses on men's role as parents. Major objectives of the project were as follows.

This project constructs a view of contemporary fatherhood from multiple perspectives through: a telephone survey of a random sample of 1000 fathers; a detailed overview of key programs and services for fathers; a review of fatherhood by professionals and service providers; an overview of current research knowledge and thinking about men as parents; and analysis of how contemporary fatherhood is constructed and perceived by children.

The report provides a basis for recommendations for specific strategies to address the needs of fathers and facilitate the development of more effective parenting.

Key findings

Fathers have a significant impact on child development outcomes for both boys and girls, especially for self-esteem, emotional wellbeing, capacity to love and be loved, and ability to participate in society. Being a father is challenging yet relatively unsupported in contemporary Australia. This means that policy frameworks and programs are insufficient. While there is increased pressure and expectations for men to contribute more to families, increased working hours prevent this.

Implications for policy

A number of conclusions and recommendations are made in the report.

Families

Professionals

Program providers

The manual contains an outline of the 1997 and 1998 Purple Ribbon Month campaigns on the Central Coast of New South Wales. It includes detailed information on: starting the campaign; forming a committee; obtaining resources; publicity and promotion; types of events; and a variety of attachments relating to the Central Coast campaign.

The Purple Ribbon Month project was predominantly funded by Wyong Shire Council and coordinated by the Community Services Section.

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