1 Your Life Your Wellbeing A Community Care evaluation: practice influence and issues Andrew Anderson The Benevolent Society AES Conference 31 st August 2011

The Benevolent Society Provides support to more than 40,000 children and adults each year – almost 19,000 of these are through our community care programs Community Options, CACP, EACH, Carer and carer respite programs, disability support, ComPacks (NSW) More than 650 staff and 800 volunteers 145 programs across 63 locations in NSW and Queensland Revenue in 2011 was $78m Evaluation is a strategic priority at The Benevolent Society.

The ‘Your Life Your Wellbeing’ project A pilot evaluation was carried out between July 2009 and July 2010 which looked at the following outcomes for clients (and carers) –Overall quality of life –Social connectedness/loneliness –Mental health and self-assessed physical health –Autonomy and control Objectives of the pilot to test measurement tools, & review process (influencing practice was not an explicit objective) Involved staff directly in the selection and implementation of tools “Baseline” data collected from 73 clients over a 3 month period by case-managers & care-workers

Some striking results from the pilot Clients have lower levels of well-being than the Australian population particularly for health & community engagement Clients (particularly those in the HACC COPs programs) reported high levels of psychological distress Levels of isolation were higher among men, those classified as financially disadvantaged, and those living with family and others Aspects of wellbeing were interconnected

Practice influence A workshop held with staff where results presented Staff helped to interpret results and were asked to think about how they might influence their practice Barriers to practice influence –pilot results not generalisable to the wider Benevolent Society Community Care population However……. –raised awareness of the importance of evaluation –much greater levels of compliance around entry of demographic and service data –raised awareness of high levels of isolation and psychological distress, and interconnectedness of elements of wellbeing.

“From the results of the pilot we are not assuming that those clients who have informal supports/carers are happy within their relationships. This has [led] case managers to explore deeper the nature and dynamics within these relationships. Another impact has been…a stronger focus around social inclusion and what this means to a client, as from the results it was clear that many clients are in isolation”. (Manager – Community Care program) “[The finding from the pilot that] ‘people who lived with others (others meaning family or within a boarding home etc) are more likely to feel isolated / lonely than those who live alone’ … highlighted to us case managers, that we need to question these particular clients about their community, their social [outlets] etc….We recognised that it is easy to assume that clients who live with family or generally live with people in the community (boarding homes etc) would feel connected, would naturally have social outlets and probably wouldn't feel lonely as there are people around. With this finding from the pilot, it has taught us to ask deeper questions to this particular client group”. (Case Manager – Community Options program)

Your Life Your Wellbeing now Began Feb 2011 and will run til Aug programs across 4 different geographical areas now participating in longitudinal methodology (three six-month phases). Outcome instruments administered to most new clients by dedicated staff in each area (Project Leaders). Influencing practice is now an explicit objective –on an individual level - client ‘scores’ from the outcome instruments are calculated by the Social Policy and Research Team, fed back to Project Leaders who disseminate to case managers –on a collective level – results analysed to identify key practice issues

Practice influence from Your Life Your Wellbeing Feedback from some of the Case Managers involved in the project “One case manager reflected that one her clients had negative scores for the [tool measuring social isolation] but very high scores for the [tool measuring subjective wellbeing]. When she further investigated this …[the client] reflected on the fact that he has always "felt like a loner, but he is very content with the fact that this is who he is" (and obviously was very satisfied with the way his life is)” “Some Case Managers commented on the fact that some clients can downplay their situation and can appear very "happy - go - lucky", but when they are asked...direct questions in the surveys, they can open up….” “ One client was in danger of eviction (he was behind 5 weeks in rent) but didn't disclose this to the case manager because he consistently downplayed his situation and thought "everything would work out" once he was confronted with some of the questions in the tools, it opened up "a can of worms" and enabled the client to think seriously about his situation. After the interview, the appropriate interventions were able to be put in place to ensure there were contingency plans should he get evicted”.

Practice influence from Your Life Your Wellbeing “I think for our service it will also allow us to get a better idea of carer's wellbeing and needs. Now we…have an understanding of how they are managing” We do regular 'care reviews/reflections' on our clients each week …, so we will be incorporating these findings into the reflections … and talking with the team about ideas/suggestions for client work dependant on the findings etc.

Barriers and enablers to practice change Enablers: Internal evaluation allows greater buy in and ownership Internal staff acting as champions and advocates (e.g. project leaders) Belief in, and commitment to, the evaluation from all staff Frequent and effective communication & timely feedback of results (formative methodology) Effective decision making structures Barriers: Lack of a Senior Manager Research to Practice manager role Time needed to generate scores and feed back to case-managers Skills needed to interpret scores Staff turnover Rigid funding contracts

Policy influence Policy implications arising from the pilot Addressing social isolation should become an integral component of community care services and programs; program goals and funding should be adjusted to reflect this More training about mental health for community care workforce; and vice versa, about aged care among mental health services Improved access to mental health services and coordination between mental health services and community care services Opportunity to influence govt re directions of aged care Government has nominated 2012 as the year of aged care reform Contributes to our knowledge about what really makes a difference to older people’s lives Findings included in our submission to Productivity Commission inquiry into future of aged care 11