Association of Childrens Welfare Agencies Conference 2006 Improving Care Through Accreditation- The Role of the NSW Children’s Guardian

Introduction Listening to what’s important to children and young people in care- how kids experience the NSW OOHC system Listening to what’s important to children and young people in care- how kids experience the NSW OOHC system Discussions with agencies participating in the OOHC accreditation system Discussions with agencies participating in the OOHC accreditation system Data extracted from the Children’s Guardian information holdings after three years of operating the accreditation and case file audit systems Data extracted from the Children’s Guardian information holdings after three years of operating the accreditation and case file audit systems

Listening to children and young people about what’s important in care The importance of family & social connections – Paul’s story

Listening to children and young people about what’s important in care The importance of having a say in decisions that affect you – Marie’s story

Listening to children and young people about what’s important in care Three key themes identified during discussions with young people and agencies Three key themes identified during discussions with young people and agencies – Connectedness – Participation – Life records Other areas identified through monitoring of OOHC agencies: Other areas identified through monitoring of OOHC agencies: – Residential Care – Health Standards – Educational Support – ATSI Programs These identified as priorities for the Children’s Guardian over the next two years These identified as priorities for the Children’s Guardian over the next two years

What’s important in care NSW Children and Young Persons (Care and Protection) Act 1998 founded on principles of participation and connectedness. NSW Children and Young Persons (Care and Protection) Act 1998 founded on principles of participation and connectedness. Since July 2003, agencies can provide OOHC services only if they: Since July 2003, agencies can provide OOHC services only if they: – Place children and young people in care situations that promote the importance of their families, communities and other significant attachments. – Actively promote the participation of children and young people in decisions that affect them.

Snapshot of the NSW OOHC System – 30 June ,041 children and young people in all forms of OOHC – an 8.3% increase over 3 years. 10,041 children and young people in all forms of OOHC – an 8.3% increase over 3 years. 6 in every 1000 NSW children and young people are in OOHC. 6 in every 1000 NSW children and young people are in OOHC in every 1000 Indigenous children and young people are in OOHC – that’s 26.8% of the OOHC population in every 1000 Indigenous children and young people are in OOHC – that’s 26.8% of the OOHC population. 67.6% of children and young people in OOHC are aged 5-14, 53.3% are under 10, and 20% under % of children and young people in OOHC are aged 5-14, 53.3% are under 10, and 20% under 5. Source: NSW Department of Community Services Annual Statistical Report 2004/05 (May 2006)

What’s happening to children and young people in care? OOHC placement arrangements: OOHC placement arrangements: – Relative and Aboriginal kinship care – 5,031 (50.1%) – Foster Care – 3,692 (36.8%) – Residential care – 300 (3%) – Other (eg: supported accommodation, independent living) – 1,018 (11.1%) This preference for family based care has existed in NSW since the 1800’s. This preference for family based care has existed in NSW since the 1800’s. Care arrangements shared between government and non-government agencies. Care arrangements shared between government and non-government agencies. Source: NSW Department of Community Services Annual Statistical Report 2004/05 (May 2006)

Overview – the role of the NSW Children’s Guardian Main functions: Main functions: – Promotes the best interests of all children and young people in OOHC. – Accredits and monitors government and non- government OOHC agencies. – Accredits and monitors non-government adoption service providers – Authorises the employment of children under 15 in specific industries.

Overview – The Children’s Guardian A strong and unique regulatory regime Independent statutory office under Children and Young Persons (Care and Protection) Act Independent statutory office under Children and Young Persons (Care and Protection) Act OOHC services regulated through a quality assurance process (accreditation), rather than assessment of legal compliance with minimum requirements (licensing). OOHC services regulated through a quality assurance process (accreditation), rather than assessment of legal compliance with minimum requirements (licensing). Regulator of OOHC services is separate of the funder, supported by a strong legislative base. Regulator of OOHC services is separate of the funder, supported by a strong legislative base. Regulates the market. Regulates the market.

How does the Children’s Guardian improve practice and outcomes for those in OOHC? Accreditation is “a structured means of achieving positive organisational change” (Council on Accreditation). Accreditation is “a structured means of achieving positive organisational change” (Council on Accreditation). OOHC accreditation improves outcomes for children and young people because it: OOHC accreditation improves outcomes for children and young people because it: – provides a framework for the independent assessment of the quality of care; – ensures continuous quality improvement at both an agency and system-wide level. Identifies trends and issues where additional attention and research is required. Identifies trends and issues where additional attention and research is required. Raises concerns about individual cases with OOHC agencies and other relevant bodies. Raises concerns about individual cases with OOHC agencies and other relevant bodies. “What is accreditation?”

How does the Children’s Guardian improve practice and outcomes for those in OOHC? Sets standards for OOHC providers. Sets standards for OOHC providers. Provides a “foundation system” for agencies to meet standards: Provides a “foundation system” for agencies to meet standards: – an Accreditation Program – demonstrate compliance with mandatory requirements and core, critical and significant standards. (51) – a Quality Improvement Program (QIP) to help agencies reach accreditation (by 2013). Places conditions on OOHC agencies. Places conditions on OOHC agencies. Monitors performance of OOHC agencies, through QIP and Case File Audits. Monitors performance of OOHC agencies, through QIP and Case File Audits. “The tools”

How does the Children’s Guardian improve practice and outcomes for those in OOHC? AUTHORISING ENVIRONMENT laws, regulations, court decisions OOHC Standards resource allocation OPERATING CAPABILITY accreditation & QIP requirements resources: people, skills, PUBLIC VALUE outcomes – eg participation, connectedness, life records services appropriate to population needs trust & confidence in the system

How are we travelling after 3 years? The “foundation” OOHC accreditation system as at 30 June OOHC agencies: 62 OOHC agencies: – 18 accredited (14 for 5 years; 3 for 3 years; 1 for 1 year). – 12 currently seeking accreditation (8 by 30 November 2006 and 4 by 30 June 2007). – 32 participating in QIP. Accreditation not a barrier to new services being established - 5 new agencies accredited. Accreditation not a barrier to new services being established - 5 new agencies accredited. In , the number of designated agencies decreased but the number of accredited agencies doubled. In , the number of designated agencies decreased but the number of accredited agencies doubled. Rate of accreditation has accelerated since Accreditation Program introduced - this is expected to continue. Rate of accreditation has accelerated since Accreditation Program introduced - this is expected to continue.

How are we travelling after 3 years? The “foundation” OOHC accreditation system as at 30 June 2006 Agency Status %20%40%60%80%100% 30 June 2004 (72 agencies) 30 June 2005 (71 agencies) 30 June 2006 (62 agencies) % of participating agencies Agencies yet to decide which stream Agencies in Quality Improvement Program Agencies seeking accreditation Accredited agencies

Monitoring the care of children and young people – Case File Audits Monitors practice against legislation and OOHC standards – evidence of care Monitors practice against legislation and OOHC standards – evidence of care Case File Audits commenced in July 2004/05. Case File Audits commenced in July 2004/ /06 audits covered 748 government and non- government agency case files – over 1,000 case files to be audited in 2006/ /06 audits covered 748 government and non- government agency case files – over 1,000 case files to be audited in 2006/07. Progressively increasing the number and scope of case files audited – extended to interim orders in 2006/07. Progressively increasing the number and scope of case files audited – extended to interim orders in 2006/07. Compliance set at 80% (up from 65% in 2004/05) Compliance set at 80% (up from 65% in 2004/05) Case files also provide children and young people with “life records”, linking them to their past and helping to support identity and significant connections. Case files also provide children and young people with “life records”, linking them to their past and helping to support identity and significant connections.

Delivering outcomes for children and young people in OOHC In 2005/06, significant improvement in case files providing evidence of children and young people (7 years and older) invited to participate in placement reviews: In 2005/06, significant improvement in case files providing evidence of children and young people (7 years and older) invited to participate in placement reviews: – Large agencies up from 50% to 71%; – Medium agencies up from 70% to 75%; – Small agencies up from 66% to 76%. In 2005/06, increase in: In 2005/06, increase in: – carers participating in case conferences and signing planning and review documentation; – recording of reasons why children and young people did not participate in case reviews; – recording and discussing the views of those who did not attend the case conference. Participation

Delivering outcomes for children and young people in OOHC In 2005/06, 85% of agencies compliant in recording following “connectedness” indicators: In 2005/06, 85% of agencies compliant in recording following “connectedness” indicators: – history and development; – family contact details; – contact arrangements with the mother; and – reviewing contact arrangements with the mother and siblings. In 2005/06 there was an increase in explaining the placement of ATSI children and young people in accordance with the ATSI Placement Principles. In 2005/06 there was an increase in explaining the placement of ATSI children and young people in accordance with the ATSI Placement Principles. Connectedness ATSI programs

Delivering outcomes for children and young people in OOHC In 2005/06: In 2005/06: – 100% of accredited agencies reached Case File Audit compliance benchmark for currency of reviews and file content/structure; – court orders on files up 20% to 83%. In 2005/06, there was a increase in: In 2005/06, there was a increase in: – the number of files containing current case reviews where the Minister had sole or shared parental responsibility; – case files outlining the responsibilities of each person and agency; – planning in preparation for leaving care. Case files – life records

How are we travelling? Areas for further improvement Percentage of agencies who have met one or more of the mandatory requirements or core standards 75% 59% 75% 53% 0% 20% 40% 60% 80% 100% Agencies seeking accreditationAgencies in QIP MandatoryCore

How are we travelling? Areas for further improvement Mandatory requirements met: Mandatory requirements met: – 28% of mandatory requirements met by those seeking accreditation. – 10% of mandatory requirements met by those in QIP. Applicable core standards met: Applicable core standards met: – 32% of applicable core standards met by those seeking accreditation. – 8% of applicable core standards met by those in QIP. – 21% of relevant agencies have met core standards relating to foster carers. – 9% of relevant agencies have met core standard 2A (residential care)

How are we travelling? Areas for further improvement Applicable critical standards met: Applicable critical standards met: – 59% of applicable critical standards met by those seeking accreditation. – 18% of applicable critical standards met by those in QIP. Applicable significant standards met: Applicable significant standards met: – 75% of required number of significant standards (5 of 11) met by agencies seeking accreditation for 5 years. – 19% of required significant standards met by those in QIP.

Observations on compliance – priority areas for improvement Mandatory requirements and core standards These have the lowest compliance rate, yet are the ones that focus on how children and young people experience the OOHC system. These have the lowest compliance rate, yet are the ones that focus on how children and young people experience the OOHC system. Case file audit compliance rates Mean Case File audit compliance rate for accredited agencies was 69% - only one received a compliance rating of over 80%. Mean Case File audit compliance rate for accredited agencies was 69% - only one received a compliance rating of over 80%. Mean Case File audit compliance rate for transitionally accredited agencies was 58% Mean Case File audit compliance rate for transitionally accredited agencies was 58% Residential care Compliance with core residential care standards is lower than compliance with core standards for foster carers, identifying residential care as an area that requires greater attention. Compliance with core residential care standards is lower than compliance with core standards for foster carers, identifying residential care as an area that requires greater attention.

Observations on compliance – priority areas for improvement Participation Children and young people need to participate more in decision making (notwithstanding improvements). Children and young people need to participate more in decision making (notwithstanding improvements). Only 6% of transitionally accredited agencies reach the case file audit benchmark for the area of participation. Only 6% of transitionally accredited agencies reach the case file audit benchmark for the area of participation.Connectedness Parents / carers need to be more involved in case reviews (decline in 2005/06). Parents / carers need to be more involved in case reviews (decline in 2005/06). Case files – life records Case files should provide children and young people with a history of their life in OOHC. Case files should provide children and young people with a history of their life in OOHC. Where DoCS and an OOHC agency share case management responsibilities, the responsibilities of each agency need to be more clearly defined. Where DoCS and an OOHC agency share case management responsibilities, the responsibilities of each agency need to be more clearly defined.

Observations on compliance – priority areas for improvement ATSI Programs No transitionally accredited agencies have met mandatory requirements for ATSI Programs, 27% of the OOHC population. No transitionally accredited agencies have met mandatory requirements for ATSI Programs, 27% of the OOHC population. Health Standards No transitionally accredited agencies have met mandatory requirements for Psychotropic Medication Policies/Procedures. No transitionally accredited agencies have met mandatory requirements for Psychotropic Medication Policies/Procedures. Behaviour intervention and support practices need to be more formalised. Behaviour intervention and support practices need to be more formalised. Immunisation status of children and young people, particularly those aged over 8 need further attention. Immunisation status of children and young people, particularly those aged over 8 need further attention.Education The educational progress of children and young people needs to be better monitored. The educational progress of children and young people needs to be better monitored.

Summary The Accreditation, Quality Improvement and Case File Audit Programs: The Accreditation, Quality Improvement and Case File Audit Programs: – provide evidence of considerable improvement in the quality of court ordered out-of-home care. – identify seven key areas for the Children’s Guardian to focus over the next two years. Case File Audit results suggest accredited agencies need to focus on maintaining standards after achieving accreditation. Case File Audit results suggest accredited agencies need to focus on maintaining standards after achieving accreditation. QIP participants need to accelerate the rate at which they are improving. QIP participants need to accelerate the rate at which they are improving.